Arterial hypertension is a condition in which blood pressure is persistently elevated to 140/90 mm Hg.Art.This pathology is found in 40% of the adult population and occurs frequently not only in the elderly, but also in adolescents, young adults and pregnant women.It has become a true "21st century epidemic", with doctors in many countries urging everyone to measure their blood pressure regularly starting at the age of 25.
According to statistics, only 20-30% of patients with arterial hypertension are adequately treated, and only 7% of men and 18% of women have their blood pressure regularly monitored.In its initial stages, arterial hypertension is asymptomatic or is discovered incidentally during examinations or visits for treatment of other conditions.This results in pathological progression and significant deterioration in health status.Many patients with arterial hypertension do not seek medical help or simply ignore their doctor's advice and do not receive ongoing treatment to correct their blood pressure to normal levels (no more than 130/80 mm Hg) and are therefore at risk of serious complications: stroke, myocardial infarction, heart failure, etc.
Development mechanism and classification
Increased blood pressure is due to narrowing of the lumen of the aorta and arterioles (smaller branches of arteries), which is caused by complex hormonal and neurological processes.When blood vessel walls narrow, the heart's workload increases, and patients develop primary (i.e. primary) hypertension.This pathology occurs in 90% of patients.The remaining 10% of hypertension is symptomatic (i.e., secondary) and is caused by another disease, usually cardiovascular disease.
Essential hypertension (or high blood pressure) does not occur due to damage to any organ.Subsequently, it leads to target organ damage.
Secondary hypertension is caused by dysfunction of the systems and organs involved in blood pressure regulation, i.e., elevated blood pressure is a symptom of an underlying disease.They are divided into:
- Kidney (parenchyma and renal vessels):Caused by congenital or acquired hydronephrosis, acute or chronic glomerulonephritis, polycystic kidney disease, radiation nephropathy, diabetic glomerulonephropathy, etc.;
- Hemodynamics (mechanical and cardiovascular):Develop aortic valve insufficiency, complete atrioventricular block, aortic atherosclerosis, aortic canal patency, aortic coarctation, Paget's disease, arteriovenous fistula, etc.;
- endocrine:Have pheochromocytoma (adrenal hormone-active tumor), paraganglioma, Cohen syndrome, acromegaly, Itsenko-Cushing syndrome or disease, etc.;
- Neurogenic:concomitant diseases and local lesions of the spinal cord and brain, hypercapnia (increased carbon dioxide content in the blood) and acidosis (a shift in the acid-base balance toward an acidic state);
- other:Poisoning in late pregnancy, thallium and lead poisoning, carcinoid syndrome (blood poisoning due to excess hormone), porphyria (hereditary disorder of pigment metabolism), overdose of glucocorticoids, ephedrine, catecholamines, taking hormonal contraceptives, eating foods containing tyramine while taking MAO inhibitors.
Depending on the nature of the disease course, arterial hypertension can be:
- Transient:Increases in blood pressure are occasionally observed, lasting from hours to days, and return to normal without the use of medications;
- Unstable:Increased blood pressure due to any predisposing factor (physical or psycho-emotional stress) requiring medication to stabilize the condition;
- Stablize:The patient's blood pressure continues to be elevated and requires serious, ongoing treatment to normalize it;
- crisis:Patients experience cyclic hypertensive crises;
- Vicious:Blood pressure rises to high levels, pathology progresses rapidly, and may lead to severe complications and death in patients.
Arterial hypertension is classified according to severity as follows:
- Degree I: blood pressure rises to 140-159_90-99 mmHg.Art.;
- Degree II: blood pressure rises to 160-170/100-109 mmHg.Art.;
- Grade III: blood pressure rises to 180/110 mmHg.Art.and higher.
In isolated systolic hypertension, an increase in systolic blood pressure above 140 mmHg is typical.Art.This type of hypertension is more common in people over the age of 50-60, and its treatment also has its own unique characteristics.
Signs of arterial hypertension
People with high blood pressure may experience headaches and dizziness.
For years, patients may not be aware of the presence of arterial hypertension.Some people may experience symptoms of weakness, dizziness, and psychological and emotional discomfort in the early stages of hypertension.As stable or unstable hypertension develops, patients begin to complain of:
- general weakness;
- Flies flicker before your eyes;
- nausea;
- Dizziness;
- throbbing headache;
- numbness and paresthesia in the limbs;
- Shortness of breath;
- difficulty speaking;
- heartache;
- swelling of the limbs and face;
- Visual impairment, etc.
When the patient is examined, lesions will be found:
- Kidney: uremia, polyuria, proteinuria, renal failure;
- Brain: Hypertensive encephalopathy, cerebrovascular accident;
- Heart: Heart wall thickening, left ventricular hypertrophy;
- Blood vessels: lumen narrowing of arteries and arterioles, atherosclerosis, aneurysms, aortic dissection;
- Fundus: hemorrhage, retinopathy, blindness.
Diagnosis and treatment
Patients with signs of arterial hypertension may undergo the following types of tests:
- blood pressure measurement;
- General urine and blood tests;
- Biochemical blood tests to determine levels of total cholesterol, lipoprotein cholesterol, creatinine, potassium, glucose, and triglycerides;
- electrocardiogram;
- EchoCG;
- fundus examination;
- Renal and abdominal ultrasonography.
If necessary, the patient may be recommended for additional testing.After analyzing the data obtained, the doctor selects a medication regimen and gives detailed recommendations for changing the patient's lifestyle.