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Arterial hypertension: what is it?

manometer for hypertension

Arterial hypertension is a condition in which a constant increase in blood pressure of 140/90 mm Hg is determined.Art.This pathology is found in 40% of the adult population and often occurs not only in the elderly, but also in adolescents, young people and pregnant women.It has become a real "epidemic of the 21st century" and doctors in many countries urge everyone to measure their blood pressure regularly, starting at the age of 25.

According to statistics, only 20-30% of patients with arterial hypertension receive adequate therapy, and only 7% of men and 18% of women regularly monitor their blood pressure.In the initial stages, arterial hypertension is asymptomatic or is discovered accidentally during examinations or when visiting a doctor for the treatment of other diseases.This leads to the progression of the pathology and significant deterioration of health.Many patients with arterial hypertension who do not seek medical help or simply ignore the doctor's recommendations and do not receive constant treatment to correct blood pressure to normal levels (not more than 130/80 mm Hg), risk severe complications of this pathology: stroke, myocardial infarction, heart failure, etc.

Mechanisms of development and classification

measurement of blood pressure in hypertension

The increase in blood pressure is due to narrowing of the lumen of the main arteries and arterioles (the smaller branches of the arteries), which is caused by complex hormonal and nervous processes.When the walls of the blood vessels narrow, the work of the heart increases and the patient develops essential (ie, primary) hypertension.This pathology occurs in 90% of patients.In the remaining 10%, hypertension is symptomatic (ie, secondary) and caused by other diseases (usually cardiovascular).

Essential hypertension (or hypertension) does not develop as a result of damage to any organs.This subsequently leads to target organ damage.

Secondary hypertension is provoked by disorders in the functioning of systems and organs that are involved in the regulation of blood pressure, i.e.an increase in blood pressure is a symptom of the underlying disease.They are classified into:

  • renal (parenchymal and renovascular):develop as a result of congenital or acquired hydronephrosis, acute or chronic glomerulo- and pyelonephritis, polycystic kidney disease, radiation kidney disease, diabetic glomerulonephritis, etc.;
  • hemodynamic (mechanical and cardiovascular):develop with aortic valve insufficiency, complete atrioventricular block, aortic atherosclerosis, open aortic canal, coarctation of the aorta, Paget's disease, arteriovenous fistulas, etc.;
  • endocrine:develop with pheochromocytoma (hormonally active tumor of the adrenal glands), paragangliomas, Kohn's syndrome, acromegaly, Itsenko-Cushing's syndrome or disease, etc.;
  • neurogenic:develop with diseases and focal lesions of the spinal cord and brain, hypercapnia (increase in the amount of carbon dioxide in the blood) and acidosis (shift of the acid-base balance to acidity);
  • others:develop with late toxicosis during pregnancy, thallium and lead poisoning, carcinoid syndrome (blood poisoning with an excess of hormones), porphyria (hereditary disorder of pigment metabolism), overdose of glucocorticoids, ephedrine, catecholamines, taking hormonal contraceptives, eating foods with tyramine while taking MAO inhibitors.

According to the nature of the course, arterial hypertension can be:

  • transitive:an increase in blood pressure is observed sporadically, lasts from several hours to several days and normalizes without the use of drugs;
  • labile:increase in blood pressure due to the influence of any provoking factor (physical or psycho-emotional stress), treatment is required to stabilize the condition;
  • stable:the patient has a constant increase in blood pressure and serious and constant therapy is needed to normalize it;
  • crisis:the patient experiences periodic hypertensive crises;
  • malignant:blood pressure rises to high levels, the pathology rapidly progresses and can lead to severe complications and death of the patient.

Arterial hypertension is classified according to severity as follows:

  • I degree: blood pressure rises to 140-159_90-99 mm Hg.Art.;
  • II degree: arterial pressure rises to 160-170/100-109 mm Hg.Art.;
  • III degree: blood pressure rises to 180/110 mm Hg.Art.and higher.

In isolated systolic hypertension, only an increase in systolic pressure above 140 mmHg is characteristic.Art.This form of hypertension is more often observed in people over 50-60 years old and its treatment has its own characteristic features.

Signs of arterial hypertension

headache due to arterial hypertension

Patients with arterial hypertension may experience headaches and dizziness.

For many years, patients may be unaware of the presence of arterial hypertension.Some of them in the initial period of hypertension note episodes of weakness, dizziness and discomfort in their psycho-emotional state.With the development of stable or labile hypertension, the patient begins to complain of:

  • general weakness;
  • flashing of flies before the eyes;
  • nausea;
  • vertigo;
  • throbbing headache;
  • numbness and paresthesia in the limbs;
  • shortness of breath;
  • difficulty speaking;
  • pain in the heart;
  • swelling of the limbs and face;
  • visual impairment, etc.

When examining the patient, lesions are found:

  • kidneys: uremia, polyuria, proteinuria, renal failure;
  • brain: hypertensive encephalopathy, cerebrovascular accident;
  • heart: thickening of the heart walls, left ventricular hypertrophy;
  • vessels: narrowing of the lumen of arteries and arterioles, atherosclerosis, aneurysms, aortic dissection;
  • fundus: hemorrhages, retinopathy, blindness.

Diagnosis and treatment

Patients with signs of arterial hypertension may be prescribed the following types of research:

  • blood pressure measurement;
  • general tests of urine and blood;
  • biochemical blood test to determine the level of total cholesterol, lipoprotein cholesterol, creatinine, potassium, glucose and triglycerides;
  • EKG;
  • Echo-CG;
  • fundus examination;
  • Ultrasound of the kidneys and abdominal cavity.

If necessary, the patient may be recommended to undergo additional tests.After analyzing the obtained data, the doctor selects a regimen of drug therapy and gives detailed recommendations for changing the patient's lifestyle.