Symptomatic arterial hypertension

Causes

Symptomatic hypertension is increased blood pressure resulting from damage to organs or body systems involved in regulating blood pressure.

In this case, intravascular blockage by atherosclerotic plaques or vasoconstriction occurs due to an increased amount of enzymes that regulate the diameter of the artery. This type of disease refers to secondary hypertension.

When hypertension is detected in this form, vital human organs are affected: the brain, kidneys, heart, blood vessels, liver.

Increased intravascular pressure is a consequence of pathological processes occurring in these organs; in rare cases, hypertension can be a source of pathology in target organs.

Based on statistics, secondary hypertension in this form manifests itself in 5-15% of cases recorded by doctors. At the same time, the complaints of people with primary and symptomatic hypertension were almost identical.

Based on the etiology of the disease, there are about 70 diagnoses that provoke an increase in intravascular pressure. This factor is nothing more than a symptom, so you should consult a doctor and not self-medicate. Let's consider the most common phenomena in which people develop hypertension:

1. Most often, secondary intravascular hypertension occurs in the renal form, due to diseases of the urinary organs, kidneys, and renal vessels. These abnormalities can be congenital or acquired.

Congenital ones include: abnormal development of organs, renal polycystic disease, hypoplasia, mobile kidney, hydronephrosis, dystopia.

Acquired diseases include: systemic vasculitis, diffuse glomerulonephritis, urolithiasis, oncological diseases of the renal, urinary and vascular systems, atherosclerosis, pyelonephritis, thrombosis, renal tuberculosis, embolism of the renal arteries.

1. The endocrine form of secondary hypertension occurs against the background of pathological processes of the endocrine glands. Thyrotoxicosis, Cushing's syndrome, Pheochromocytoma and Conn's syndrome are prime examples of this phenomenon.

Thyrotoxicosis is a disease caused by dysfunction of the thyroid gland. At the same time, thyroxine (hormone) enters the body in excess quantities. This disease is characterized by an extraordinary increase in intravascular pressure, in which diastolic values ​​remain within normal limits, and systolic values ​​increase greatly.

Pheochromocytoma also belongs to the endocrine form of hypertension and occurs as a result of a tumor of the adrenal glands. An increase in intravascular pressure is the main symptom of the disease. In this case, the values ​​​​may vary for each person individually: in one patient it stays within certain limits, and in another it causes hypertensive attacks.

Aldosteroma or Conn's syndrome appears due to an increased release of the hormone aldosterone into the blood, which provokes untimely excretion of sodium from the body. This enzyme in excess can have a negative effect on humans.

Itsenko-Cushing syndrome most often provokes secondary hypertension in the endocrine form (almost 80% of cases). The main signs of the disease are discrepancies between the face and limbs. In this case, the patient’s legs and arms remain unchanged, and the face takes on a moon-shaped, puffy shape.

Menopause can also cause arterial hypertension due to decreased sexual activity.

1. The neurogenic form of arterial hypertension is characterized by a malfunction in the functionality of the nervous system. The cause of neurogenic secondary arterial hypertension is traumatic brain injury, ischemic conditions, the occurrence of neoplasms, and encephalitis in the brain area. In this case, many different symptoms occur, so this type of hypertension can easily be confused with heart disease (without special diagnostics).

Treatment of this type of hypertension is aimed at restoring brain functions and organ performance.

1. Hemodynamic symptomatic manifestations of hypertension arise due to damage to the heart arteries and the organ itself: congenital aortic narrowing, atherosclerosis, bradycardia, congenital mitral valve disease, coronary artery disease, heart failure. Very often, doctors identify in this form of the disease a discrepancy in blood pressure readings: it is the systolic values ​​that are subject to an increase.

Also, symptomatic hypertension can result from a combination of several cardiac or cardiorenal diseases.

Doctors often recorded drug-induced symptomatic arterial hypertension that appeared as a result of a person’s use of medications that increase intravascular tonometer values, namely: contraceptives, drugs containing glucocorticoids, indomethacin combined with ephedrine, levothyroxine.

It is also worth noting that symptomatic hypertension is divided into transient, mild, stable and malignant. Such a variety of the course of hypertension diseases depends on the cause of their occurrence, damage to target organs and the neglect of the disease, therefore it is recommended to pay attention to the symptoms inherent in intravascular arterial hypertension, and at the slightest increase in pressure (in a calm state) consult a doctor.

Publications in the media

Arterial hypertension (AH, systemic hypertension) is a condition in which systolic blood pressure exceeds 140 mm Hg. and/or diastolic blood pressure exceeds 90 mmHg. (as a result of at least three measurements made at different times against the background of a calm environment; the patient should not take drugs that either increase or decrease blood pressure) • If the causes of hypertension can be identified, then it is considered secondary (symptomatic) • In the absence obvious cause of hypertension, it is called primary, essential, idiopathic, and in our country - hypertension • Isolated systolic hypertension is diagnosed when systolic blood pressure increases more than 140 mm Hg. and diastolic blood pressure less than 90 mm Hg • Hypertension is considered malignant when diastolic blood pressure is more than 120 mm Hg.

Statistics • 20–30% of the adult population suffers from hypertension. The prevalence increases with age and reaches 50–65% in people over 65 years of age, and in the elderly, isolated systolic hypertension is more common, which occurs in less than 5% of the population under the age of 50 years. Before the age of 50, hypertension is more common in men, and after 50 years - in women. Among all forms of hypertension, mild and moderate account for about 70–80%, in other cases severe hypertension is observed • Secondary hypertension accounts for 5–10% of all cases of hypertension, the remaining cases are essential hypertension (hypertension). However, according to specialized clinics, using complex and expensive research methods, secondary hypertension can be detected in 30–35% of patients.

Etiology and pathogenesis • The etiology of hypertension is currently far from completely clear; genetic abnormalities have been identified (see Genetic aspects below). Etiology of secondary hypertension - see Symptomatic arterial hypertension • The main factors determining the level of blood pressure are cardiac output and peripheral vascular resistance. An increase in cardiac output and/or peripheral vascular resistance leads to an increase in blood pressure and vice versa • In the development of hypertension, both internal humoral and neurogenic (renin-angiotensin system, sympathetic nervous system, baro- and chemoreceptors) and external factors (excessive consumption of table salt, alcohol, smoking, obesity) •• Prevalence of vasopressor factors - renin, angiotensin II, vasopressin, endothelin •• Vasodepressor factors - natriuretic peptides, kallikrein-kinin system, adrenomedullin, nitric oxide, Pg (PgI2, prostacyclin).

Genetic aspects. There are many known genetic abnormalities that contribute to the development of hypertension: mutations: angiotensin gene, aldosterone synthetase, b-subunit of amiloride-sensitive sodium channels of the renal epithelium, as well as a lot of loci of the so-called predisposition to the development of hypertension.

Risk factors • Complicated family history •• Lipid metabolism disorders in the patient and his parents •• Diabetes in the patient and his parents •• Kidney disease in parents (polycystic disease) • Obesity • Alcohol abuse • Excessive consumption of table salt • Stress • Physical inactivity • Smoking • Patient's personality type.

At-risk groups. Due to the involvement of various organs and systems in the pathological process, their influence on the course of the disease, groups of patients with high and very high risk are distinguished • The high-risk group includes patients with three or more risk factors, patients with target organ damage or patients with diabetes • The very high-risk group includes patients with concomitant diseases and risk factors.

Classification. Currently, two classifications are common in Russia - WHO and the International Society of Hypertension (1999) and WHO (1978).

Classification of hypertension by WHO and International Society of Hypertension (1999) • Optimal •• Systolic blood pressure: <120 mm Hg •• Diastolic blood pressure <80 mm Hg • Normal •• Systolic blood pressure <130 mm Hg •• Diastolic blood pressure < 85 mm Hg • High normal: •• Systolic blood pressure 130–139 mm Hg •• Diastolic blood pressure 85–89 mm Hg • Grade I (mild) •• Systolic blood pressure 140–159 mm Hg •• Diastolic blood pressure 90–99 mm Hg • subgroup: borderline •• Systolic blood pressure 140–149 mm Hg •• Diastolic blood pressure 90–94 mm Hg • Grade II (moderate) •• Systolic blood pressure 160–179 mm Hg .st •• Diastolic blood pressure 100–109 mm Hg • III degree (severe) •• Systolic blood pressure >180 mm Hg •• Diastolic blood pressure >110 mm Hg • Isolated systolic •• Systolic blood pressure >140 mm Hg .st •• Diastolic blood pressure <90 mm Hg • subgroup: borderline •• Systolic blood pressure 140–149 mm Hg •• Diastolic blood pressure <90 mm Hg • Note. When determining the degree, the highest blood pressure value should be used, for example 140/100 mmHg. — II degree of hypertension.

WHO classification of hypertension (1978) • Stage I - increased blood pressure more than 160/95 mm Hg. without organic changes in the cardiovascular system • stage II - high blood pressure •• with hypertrophy of the left ventricle of the heart •• either with proteinuria and/or a slight increase in the concentration of creatinine in the blood plasma (not more than 176.8 µmol/l) •• or with widespread or localized ( retina) changes in arteries • Stage III - high blood pressure with damage to the heart, brain, retina, kidneys (myocardial infarction, heart failure, cerebrovascular accident, retinal hemorrhage, renal failure).

Blood pressure measurement

• Measurement must be carried out after resting for 5 minutes. 30 minutes before this, it is not recommended to eat, drink coffee, drink alcohol, exercise, or smoke. When measuring, your legs should not be crossed, your feet should be on the floor, your back should rest on the back of the chair. A hand rest is required, and the bladder must be emptied before measurement. Failure to comply with these conditions can lead to an increase in blood pressure: after drinking coffee - by 11/5 mm Hg, alcohol - by 8/8 mm Hg, smoking - by 6/5 mm Hg, with a full urinary bladder - 15/10 mm Hg, in the absence of support for the back - systolic by 6–10 mm Hg, in the absence of support for the arm - by 7/11 mm Hg.

• The shoulder should be at the level of the IV–V intercostal space (a low elbow position increases systolic blood pressure by an average of 6 mm Hg, a high elbow position underestimates blood pressure by 5/5 mm Hg). The shoulder should not be compressed by clothing (measurement through clothing is unacceptable) - systolic pressure may be overestimated by 5–50 mmHg. The lower edge of the cuff should be 2 cm above the elbow (improper application of the cuff can lead to an overestimation of blood pressure by 4/3 mmHg), and it should fit snugly to the upper arm. The air in the cuff should be inflated to 30 mm Hg. above the disappearance of the pulse on the radial artery. The stethoscope should be placed in the cubital fossa. The moment the first sounds appear will correspond to phase I of Korotkoff sounds and shows systolic blood pressure. The rate of decrease in pressure in the cuff is 2 mm/s (slow decompression increases blood pressure by 2/6 mm Hg, fast decompression increases diastolic blood pressure). The moment of disappearance of the last sounds will correspond to the V phase of Korotkoff sounds and corresponds to diastolic blood pressure.

• Measured parameters should be indicated with an accuracy of 2 mmHg. When measuring, it is necessary to listen to the area of ​​the cubital fossa until the pressure in the cuff decreases to zero (you should remember about possible aortic valve insufficiency and other pathological conditions with high pulse pressure, large stroke volume of the heart). During each examination of the patient, blood pressure is measured at least twice on the same arm and the average values ​​are recorded. During the first examination, the pressure is measured on both arms, and subsequently on the arm where it was higher. The difference in blood pressure between the left and right arms should not exceed 5 mmHg. More significant differences should be alarming regarding vascular pathology of the upper extremities.

• When measuring blood pressure with the patient lying down, his arm should be slightly elevated (but not suspended) and be at the level of the middle of the chest.

• Repeated measurements should be carried out under the same conditions. It is necessary to measure blood pressure in a patient in two positions - lying and sitting - in the elderly, with diabetes, in patients taking peripheral vasodilators (to identify possible orthostatic arterial hypotension).

Clinical manifestations are nonspecific and depend on target organ damage.

• Cerebral symptoms •• The main symptom is headache, often on awakening and usually in the occipital region •• Dizziness, blurred vision, transient cerebrovascular accident or stroke, retinal hemorrhages or papilledema, movement disorders and sensory disorders • Intellectual-mnestic disorders.

• Cardiac symptoms •• Palpitations, pain in the heart area, shortness of breath (due to pronounced changes in the heart with hypertension, every second patient has cardiac symptoms) •• Clinical manifestations of coronary artery disease •• Left ventricular dysfunction or heart failure.

• Kidney damage: thirst, polyuria, oliguria, nocturia, microhematuria.

• Peripheral arterial disease: cold extremities, intermittent claudication.

• Hypertension is often asymptomatic.

• It is possible to detect (by palpation) volumetric formations in the kidney area, as well as listen to a systolic murmur over the kidney area.

• Examination - signs of some endocrine diseases accompanied by hypertension: hypothyroidism, thyrotoxicosis, Itsenko-Cushing syndrome, pheochromocytoma, acromegaly.

• Palpation of peripheral arteries, auscultation of vessels, heart, chest, abdomen suggest vascular damage as the cause of hypertension, suspect aortic disease, suggest renovascular hypertension.

Features of collecting anamnesis • Family history of hypertension, diabetes, lipid metabolism disorders, coronary heart disease, stroke, kidney disease • Duration of hypertension and its evolution, previous blood pressure level, results and side effects of previous antihypertensive treatment • Presence and course of coronary artery disease, heart failure, stroke, other diseases in this patient (gout, bronchospastic conditions, dyslipidemia, sexual dysfunction, kidney disease) • Clarification of symptoms of presumably secondary hypertension • Detailed questioning about taking medications that increase blood pressure (GCs, oral contraceptives, NSAIDs, amphetamines, epoetin beta, cyclosporine) • Lifestyle assessment (consumption of table salt, fat, alcohol, smoking, physical activity) • Personal, psychosocial and external factors influencing blood pressure (family, work).

Laboratory and special research methods. It is necessary to exclude symptomatic hypertension, identify risk factors and the degree of target organ involvement.

• OAC (anemia, erythrocytosis, leukocytosis, increased ESR - secondary hypertension).

• OAM - leukocyturia, erythrocyturia, proteinuria, cylindruria (symptomatic hypertension), glucosuria (DM).

• Biochemical tests to determine the concentration of potassium ions, creatinine, glucose, cholesterol (secondary hypertension, risk factors). It should be remembered that a rapid decrease in blood pressure with long-term hypertension of any etiology can lead to an increase in creatinine levels in the blood.

• ECG - left ventricular hypertrophy, rhythm and conduction disturbances, electrolyte disturbances, signs of ischemic heart disease (changes in the terminal part of the ventricular complex, scar changes).

• EchoCG to detect left ventricular hypertrophy, assess myocardial contractility, and identify valvular defects as a cause of hypertension.

• Ultrasound of the kidneys, adrenal glands, renal arteries, peripheral vessels to identify secondary hypertension.

• Fundus examination: hypertensive retinopathy - narrowing and sclerosis of the arteries (symptoms of copper or silver wire), Salus phenomenon.

Diagnostic tactics. The diagnosis of hypertension (essential, primary hypertension) is established only by excluding secondary hypertension. Goals of diagnostic measures for hypertension • Determination of a possible cause • Identification of concomitant diseases • Identification of risk factors for coronary artery disease. Since hypertension itself is one of the risk factors for CHD, the presence of another risk factor further increases the likelihood of developing CHD; in addition, the prescribed treatment can seriously affect risk factors - for example, diuretics and non-selective beta-blockers in the presence of dyslipidemia and insulin resistance can aggravate these disorders • Identification of target organ involvement in the hypertensive process. Their defeat has the most serious impact on the prognosis of the disease and approaches to its treatment.

Differential diagnosis • Renoparenchymal hypertension - see Arterial hypertension, renoparenchymal • Vasorenal hypertension - see Arterial vasorenal hypertension • Endocrine hypertension constitutes approximately 0.1–1% of all hypertension (up to 12% according to specialized clinics) •• With pheochromocytoma (see Pheochromocytoma ) •• With primary hyperaldosteronism (see Hyperaldosteronism) •• With hypothyroidism - high diastolic blood pressure; other manifestations of the cardiovascular system - decreased heart rate and cardiac output •• In hyperthyroidism - increased heart rate and cardiac output, predominantly isolated systolic hypertension with low (normal) diastolic blood pressure; an increase in diastolic blood pressure in hyperthyroidism is a sign of another disease accompanied by hypertension or a sign of hypertension • Drug hypertension - vasoconstriction due to sympathetic stimulation or direct effects on vascular SMCs, increased blood viscosity, stimulation of the renin-angiotensin system, ion retention may be important in the pathogenesis sodium and water, interaction with central regulatory mechanisms - for more details, see Symptomatic Arterial Hypertension.

TREATMENT

The goal is to reduce cardiovascular morbidity and mortality by normalizing blood pressure, protecting target organs, eliminating risk factors (smoking cessation, compensation for diabetes, reducing the concentration of cholesterol in the blood and excess body weight).

• Recommendations of WHO and IAH (International Society of Arterial Hypertension; 1999) •• In young and middle-aged people, as well as in patients with diabetes, it is necessary to maintain blood pressure at the level of 130/85 mm Hg •• In elderly people, the target blood pressure level is £140 /90 mmHg

• Excessive rapid decrease in blood pressure with significant duration and severity of the disease can lead to hypoperfusion of vital organs - the brain (hypoxia, stroke), heart (exacerbation of angina, myocardial infarction), kidneys (renal failure).

Treatment plan • Control of blood pressure and risk factors • Lifestyle changes • Drug therapy.

Non-drug treatment is indicated for all patients. In 40–60% of patients with the initial stage of hypertension with low blood pressure values, it is normalized without the use of drugs. In case of severe hypertension, non-drug therapy in combination with medication helps to reduce the dose of drugs taken and thereby reduces the risk of their side effects. The mechanisms leading to a decrease in blood pressure are considered to be a decrease in cardiac output, a decrease in peripheral vascular resistance, or a combination of both mechanisms.

• Diet •• Limiting table salt intake to less than 6 g/day (but not less than 1–2 g/day, since in this case compensatory activation of the renin-angiotensin system may occur) •• Limiting carbohydrates and fats, which is very important in the prevention of coronary heart disease , the likelihood of which is increased in hypertension (risk factor). A decrease in excess body weight by 1 kg leads to a decrease in blood pressure by an average of 2 mm Hg •• An increase in the content of potassium and calcium ions in the diet •• Refusal or significant limitation of alcohol intake (especially if it is abused).

• Physical activity - sufficient cyclic activity (walking, light jogging, skiing) in the absence of contraindications from the heart (coronary artery disease), blood vessels of the legs (atherosclerosis obliterans), central nervous system (cerebrovascular accidents) reduces blood pressure, and at low levels it can normalize his. Moderation and gradual dosing of physical activity is recommended. Physical activity with a high level of emotional stress (competition, gymnastics), as well as isometric efforts (weight lifting) are undesirable.

• Other methods - psychological (psychotherapy, autogenic training, relaxation), acupuncture, massage, physiotherapeutic methods (electrosleep, diadynamic currents, hyperbaric oxygenation), water procedures (swimming, shower, including contrast), herbal medicine (chokeberry, tincture of hawthorn, motherwort, mixtures with marsh cudweed, hawthorn, immortelle, sweet clover).

Drug therapy

Basic principles: • It is necessary to begin treatment of mild hypertension with small doses of drugs • Combinations of drugs should be used to increase their effectiveness and reduce side effects • It is preferable to use long-acting drugs (12–24 hours with a single dose).

• b-blockers •• Preference should be given to b-blockers when hypertension is combined with coronary artery disease (angina pectoris and unstable angina, post-infarction cardiosclerosis, heart failure), tachyarrhythmias, extrasystoles •• After abrupt withdrawal of b-blockers, withdrawal syndrome may develop, manifested by tachycardia, arrhythmias, increased blood pressure, exacerbation of angina, development of myocardial infarction, and in some cases even sudden cardiac death. To prevent withdrawal syndrome, a gradual reduction in the dose of the b-blocker is recommended for at least 2 weeks. There is a high-risk group for the development of withdrawal syndrome - these are people with hypertension in combination with angina pectoris, as well as with ventricular arrhythmias •• Drugs ••• Non-selective (blockade of b1- and b2-adrenergic receptors): propranolol 40–240 mg/day at 3 doses, pindolol 5–15 mg 2 times/day, timolol 10–40 mg/day in 2 divided doses ••• Selective (cardioselective) b1-blockers: atenolol 25–100 mg 2 times/day, metoprolol 50–200 mg/day in 2 doses, nadolol 40–240 mg/day, betaxolol 10–20 mg/day.

• Diuretics •• Varieties ••• Thiazides and thiazide-like diuretics (used most often in the treatment of hypertension) are diuretics of moderate potency, suppress the reabsorption of 5–10% of sodium ions (drugs: hydrochlorothiazide 12.5–50 mg/day, cyclopenthiazide 0, 5 mg/day, chlorthalidone 12.5–50 mg/day) ••• Loop diuretics (characterized by the rapid onset of action when administered parenterally) are strong diuretics, suppress the reabsorption of 15–25% of sodium ions (the main drug is indapamide 2.5 mg /day in one dose; furosemide at a dose of 20–320 mg/day is rarely prescribed for continuous use for antihypertensive purposes) ••• Potassium-sparing diuretics are weak diuretics, cause additional excretion of no more than 5% of sodium ions (drugs: spironolactone 25–100 mg / day, triamterene 50–100 mg 4 times / day.) •• Preference for diuretics in the treatment of hypertension is given if there is a tendency to edema and in old age.

• ACE inhibitors •• Preferred for the treatment of hypertension with the following concomitant conditions (diseases): ••• left ventricular hypertrophy (ACE inhibitors are most effective in its regression) ••• hyperglycemia ••• hyperuricemia ••• hyperlipidemia (ACE inhibitors do not aggravate these conditions) ••• history of myocardial infarction ••• heart failure (ACE inhibitors are among the most effective drugs for the treatment of heart failure; they not only weaken its clinical manifestations, but also increase the life expectancy of patients) ••• older age •• Drugs ••• captopril 25–150 mg/day ••• enalapril 2.5–40 mg/day ••• fosinopril 10–60 mg/day ••• lisinopril 2.5–40 mg/day ••• ramipril 2, 5–10 mg/day ••• benazepril 10–20 mg/day.

• Slow calcium channel blockers •• Preferred in the treatment of hypertension in combination with angina (especially vasospastic), dyslipidemia, hyperglycemia, broncho-obstructive diseases, hyperuricemia, supraventricular arrhythmias (verapamil, diltiazem), left ventricular diastolic dysfunction, Raynaud's syndrome •• With bradycardia or predisposition to it, a decrease in myocardial contractility, conduction disturbances, verapamil or diltiazem, which have pronounced negative inotropic, chronotropic and dromotropic effects, should not be prescribed, and, conversely, the use of dihydropyridine derivatives is indicated •• Due to the different sensitivity of patients to slow calcium channel blockers, treatment begins with small doses •• Drugs ••• Diltiazem 120–360 mg/day ••• Isradipine 2.5–15 mg/day ••• Nifedipine (extended dosage form) 30–120 mg/day ••• Nitrendipine 5–40 mg /day ••• Verapamil 120–480 mg/day ••• Amlodipine 2.5–10 mg/day ••• Felodipine 2.5–10 mg/day.

• Angiotensin II receptor blockers •• These drugs are preferable when a dry cough appears during treatment with ACE inhibitors, renal failure (especially in diabetes mellitus) •• Drugs ••• losartan 25–100 mg in 1 or 2 doses ••• valsartan 80 mg 1 time / day ••• eprosartan 600 mg 1 time / day ••• candesartan.

• a-blockers •• For long-term treatment of hypertension, selective a1-blockers are mainly used (prazosin 1–20 mg/day, doxazosin 1–16 mg/day, terazosin) •• This group of drugs is widely used in urology in the treatment of benign hyperplasia prostate gland •• Despite many positive effects, drugs in this group are rarely used as monotherapy. Apparently, this is due to disadvantages and side effects, although the danger of most of them is most likely exaggerated. The main indications are combination therapy •• Disadvantages: “first dose phenomenon” (pronounced decrease in blood pressure after the first dose), orthostatic arterial hypotension, long-term selection of the drug dose, development of tolerance (effect evasion), withdrawal syndrome. To prevent the “first dose phenomenon”, it is recommended to take an a-blocker in bed, followed by staying in a lying position for several hours (it is better to take it at night).

• Centrally acting drugs (in recent years they have gradually lost their importance) •• Centrally acting drugs cause a decrease in blood pressure due to inhibition of the deposition of catecholamines in central and peripheral neurons (reserpine), stimulation of central a2-adrenergic receptors (clonidine, guanfacine, methyldopa, moxonidine) and I1 -imidazoline receptors (clonidine and especially the specific agonist moxonidine), which ultimately weakens the sympathetic influence and leads to a decrease in peripheral vascular resistance, a decrease in heart rate and cardiac output •• Drugs in this group are mainly used orally for the treatment of hypertension. Preference should be given to imidazoline receptor agonists as first-line agents for diabetes and hyperlipidemia (they do not aggravate metabolic disorders), COPD (the drugs do not affect bronchial patency), severe hypersympathicotonia, left ventricular hypertrophy (they cause its regression). Methyldopa is most often used in the treatment of hypertension in pregnant women •• Drugs: reserpine and combination drugs containing it (reserpine + dihydralazine + hydrochlorothiazide, reserpine + dihydroergocristine + clopamide), methyldopa up to 2 g / day (when combined with other antihypertensive drugs, no more than 500 mg /day), clonidine at an initial dose of 0.075 3 times / day in 2 divided doses, moxonidine up to 0.4 mg / day in 2 divided doses, guanfacine 1-3 mg / day.

Combination therapy. According to international multicenter studies, the need for combination therapy occurs in 54–70% of patients. Indications for combination therapy are as follows: • Ineffectiveness of monotherapy. Monotherapy with an antihypertensive drug is effective on average in 50% of patients with hypertension (a higher result can be achieved, but then the risk of side effects will increase). To treat the remaining part of the patients, it is necessary to use a combination of two or more antihypertensive drugs • The need for additional protection of target organs, primarily the heart and brain.

Rational combinations of drugs. The most common combination of a diuretic and some other class of drug is used. In some countries, combination therapy with a diuretic is considered a mandatory step in the treatment of hypertension • The most effective combination is a combination of a diuretic and an ACE inhibitor (possibly a fixed combination, for example, capozide, Korenitek) • The combination of a diuretic and an angiotensin II receptor blocker is rational • Approximately the same additive effect has a combination of a diuretic and a beta-blocker (this combination is not the most successful, since both the diuretic and the beta-blocker affect the metabolism of glucose and lipids).

Irrational combinations of antihypertensive drugs can lead to both increased side effects and an increase in the cost of treatment if there is no effect. A striking example of an irrational combination is the combination of beta-blockers and slow calcium channel blockers (verapamil, diltiazem), since both groups of drugs worsen both myocardial contractility and AV conduction (increased side effects), while the combination of beta-blockers with dihydropyridines (for example, nifedipine) is positive.

Treatment of certain types of hypertension

• Resistant (refractory) hypertension - the inability to achieve a reduction in blood pressure to target values ​​(less than 140/90 mm Hg) for more than 1 month in patients with hypertension during combination therapy with two or three antihypertensive drugs in sufficient dosages •• To confirm the diagnosis, it is necessary to test all rational combinations of drugs (primarily including diuretics, the combination “ACE inhibitor + slow calcium channel blocker” is also effective), then prescribe a triple combination in a variety of options, then a combination of four drugs (usually minoxidil is used as one of the components) • • One should remember about possible pseudo-resistance, the cause of which may be symptomatic hypertension, non-compliance with the rules of taking medications, inappropriate dosage, irrational combination of drugs, taking alcohol and drugs that increase blood pressure, weight gain, increased blood volume (for example, in heart failure), deliberate administration the patient misleads the doctor (simulation) •• In each case of resistant hypertension, a thorough examination of the patient is necessary, preferably in a specialized hospital to exclude symptomatic hypertension.

• Hypertension in the elderly •• Treatment should begin with non-drug measures, which in this case quite often reduce blood pressure to the target level. Of great importance is limiting the consumption of table salt and increasing the content of potassium and magnesium salts in the diet •• Drug treatment is based on the pathogenetic features of hypertension at a given age. In addition, it should be remembered that various concomitant diseases often occur in the elderly ••• It is necessary to start treatment with smaller doses (often half the standard) ••• The dose should be increased gradually over several weeks ••• The dose is selected under constant monitoring of blood pressure, and it is better to measure it in a standing position to identify possible orthostatic arterial hypotension ••• It is advisable to use a simple treatment regimen (1 tablet - 1 time / day) ••• You should use medications with caution that can cause orthostatic arterial hypotension (methyldopa, prazosin, labetalol) , and centrally acting drugs (clonidine, methyldopa, reserpine), the use of which in old age is quite often complicated by depression or pseudodementia. When treating with diuretics and/or ACE inhibitors, it is advisable to monitor renal function and blood electrolyte composition.

• Endocrine hypertension - see Symptomatic arterial hypertension.

• “Alcoholic” hypertension - see Symptomatic arterial hypertension.

Complications of hypertension: • MI • acute cerebrovascular accident • heart failure • renal failure • hypertensive encephalopathy • hypertensive retinopathy • hypertensive crisis • dissecting aortic aneurysm.

The prognosis significantly depends on the adequacy of the prescribed therapy and the patient’s compliance with medical recommendations.

Reduction. AH - arterial hypertension.

ICD-10 • I10 Essential (primary) hypertension • I11 Hypertensive heart disease [hypertensive disease with predominant damage to the heart] • I12 Hypertensive [hypertensive] disease with predominant damage to the kidneys • I13 Hypertensive [hypertensive] disease with predominant damage to the heart and kidneys • I15 Secondary hypertension • O10 Pre-existing hypertension complicating pregnancy, childbirth and the puerperium • O11 Pre-existing hypertension with associated proteinuria

Symptoms of secondary arterial hypertension

In addition to increased intravascular pressure with secondary hypertension, the patient also experiences other symptoms. Experts recorded the clinical manifestations of symptomatic hypertension, consisting of 3 factors: increased blood pressure values ​​(expressed as persistence or jumps in indicators), deterioration of the general condition and the presence of symptoms inherent in the pathological process occurring in hemodynamic, neurogenic, endocrine and renal forms.

In some cases, pathological processes occur in a latent form, but provoke the only symptom indicating them - secondary hypertensive disease. Therefore, you should not listen to the opinions of relatives and friends and resort to treatment without a thorough medical diagnosis, or treat hypertension exclusively with folk remedies.

Symptomatic hypertensive disease can be expressed by symptoms that can be present stably within certain limits, or suddenly appear and disappear. Hypertensive patients may notice the following ailments:

• Pain in the area of ​​the back of the head, temples, frontal lobe.
• Difficulty passing urine.
• Dizziness.
• Nausea, which is combined with vomiting.
• Cramps.
• Problems with attention or memory.
• Fatigue and weakness, lethargy.
• The appearance of "floaters" before the eyes.
• Increased frequency of night trips to the toilet.
• Impotence or menstrual irregularities.
• Excessive excretion of urine from the body.
• Increased fatigue.
• Noise in ears.
• Discomfort or pain in the cardiac region.
• Trembling of the body or hands.
• Body hair growth.
• Brittle bones.
• Feverish condition.
• An increase in body temperature not caused by an infectious disease.
• Deviations from the psyche (central nervous system), in the form of apathy or psychological agitation. They arise as a result of the patient undergoing a hypertensive crisis.

Considering that the central nervous system experiences a stressful state provoked by the disease, it can greatly disturb a person with attacks of fear, panic, anxiety, and fear of death.
Additional symptoms include increased heart rate, increased sweating and pale skin without factors that can influence these manifestations.

It is also worth noting that the symptoms described above are similar to those of intracranial hypertension. This fact once again proves the need for a medical examination.

“Not a disease, but a symptom”: what is symptomatic arterial hypertension?

Hypertension is one of the most common “diseases of civilization.” Its leading manifestation is an increase in blood pressure. However, there is a group of diseases that are also accompanied by high blood pressure.

With Nina Ananyevna Polyntsova, cardiologist at Clinic Expert Voronezh, we are talking about symptomatic arterial hypertension.

— Nina Ananyevna, what is symptomatic arterial hypertension?

-This is an increase in blood pressure, which is not an independent disease, but a symptom of diseases of other organs. These are the organs involved in regulating blood pressure. Symptomatic hypertension is also called secondary hypertension.

Symptomatic arterial hypertension is an increase

blood pressure, which is not independent

disease, but a symptom of diseases of other organs

— Is symptomatic arterial hypertension reflected in ICD-10?

- Yes. It is designated by code I15.

I15.0 – renovascular increase in blood pressure;

I15.1 – arterial hypertension in other kidney diseases;

I15.2 – secondary hypertension in endocrine pathology;

I15.8 – all other diagnosed types of secondary hypertension.

— How common is symptomatic arterial hypertension?

— According to statistics, it accounts for 5-10% of all cases of increased blood pressure.

— What types of symptomatic arterial hypertension are known?

— There are many symptomatic arterial hypertension. There are about 70 diseases manifested by high blood pressure. Some of them are more common, while others the doctor encounters very rarely in his practice.

According to the domestic classification, symptomatic arterial hypertension is divided into renal (nephrogenic), endocrine, hemodynamic, neurogenic, and iatrogenic.

- Renal (nephrogenic). It is divided into two options: with damage to the kidney tissue and kidney vessels. The first group includes pathologies such as pyelonephritis, glomerulonephritis, polycystic kidney disease, kidney damage due to diabetes mellitus (diabetic nephropathy), urolithiasis and a number of others. Pathologies of the renal vessels include stenosis (narrowing) of the renal artery (particularly due to atherosclerosis), fibrovascular dysplasia, and renal artery vasculitis.

What is the cause of increased blood pressure in renal pathology? With the fact that when this organ is damaged, substances (in particular renin) are produced that cause an increase in blood pressure.

— Endocrine symptomatic arterial hypertension. They, in turn, are divided into several subgroups:

a) adrenal gland. This organ secretes a number of hormones, the increased production of which can also cause an increase in blood pressure. Pathologies include Cushing's syndrome, hyperaldosteronism, pheochromocytoma;

b) pituitary: Cushing's disease;

c) thyroid (related to the thyroid gland). An increase in blood pressure in this case is associated with a disease such as thyrotoxicosis;

d) menopause (due to a lack of female sex hormones). It should also be noted that in the age period during which menopause occurs, hypertension is statistically more common. Therefore, it is not always easy to quickly determine whether we are talking about hypertension or symptomatic arterial hypertension caused by menopause.

What happens to a woman’s body after 40 years? Read about age-related changes in women through the eyes of a gynecologist in our article

— Hemodynamic arterial hypertension. They are associated with damage to certain vessels and the valvular apparatus of the heart. Increased blood pressure is caused by poor circulation.

Among the diseases are coarctation (narrowing) of the aorta at a certain level, heart defects (aortic valve insufficiency, patent ductus arteriosus), complete transverse heart block (one of the types of arrhythmias - heart rhythm disturbances).

More information about arrhythmias can be found here

— Neurogenic arterial hypertension. They are associated with damage to the central nervous system. Occurs with encephalitis, after traumatic brain injury, with severe disturbances in the circulation of cerebrospinal fluid.

— Iatrogenic arterial hypertension. They are caused, in particular, by taking medications. Some examples of such medications: nasal vasoconstrictor drops; inhalers that relieve bronchospasm; glucocorticoids; non-steroidal anti-inflammatory drugs; contraceptives (with long-term use) and others.

— How do symptomatic arterial hypertension manifest itself?

- Signs can be varied. Conventionally, two groups of manifestations can be distinguished:

- increased blood pressure and associated symptoms - such as nonspecific headaches, dizziness, palpitations, etc.;

- symptoms of the underlying disease.

Symptomatic arterial hypertension is observed more often in young people (younger than 20-30 years), or suddenly develops in old age (after 55-60 years).

These hypertensions are characterized by a rapid onset, a crisis course, or an initially persistent increase in blood pressure. Medicines that lower blood pressure are ineffective. According to statistics, among treatment-resistant, aggressive hypertension, 20% are symptomatic arterial hypertension.

There are high numbers of both systolic (upper) and diastolic (lower) pressure. However, there is also isolated systolic hypertension, when the upper pressure is increased, and the lower pressure is either normal or even less than normal. For example, such isolated low diastolic pressure occurs with aortic valve insufficiency: the more severe the insufficiency, the lower the diastolic pressure (in this case, there is an increase in the so-called pulse pressure - the difference between systolic and diastolic).

— How can symptomatic arterial hypertension be detected?

— Diagnostics is based on data obtained during a detailed interview and examination of the patient, and the results of laboratory and instrumental research methods.

Usually, tests such as a general clinical blood test, urine test, some parameters of a biochemical blood test (in particular, glucose, creatinine, cholesterol, potassium), ECG, EchoCG (ultrasound of the heart), and ultrasound of the kidneys are always prescribed.

Depending on the specific manifestations of the underlying disease, appropriate additional examinations are prescribed. For example, renal arterial hypertension can be suspected by a history of kidney pathology, changes in blood tests, and urine tests. According to the doctor's decision, instrumental diagnostics are also used: ultrasound, CT, MRI of the kidneys, intravenous urography, kidney biopsy.

If, against the background of high blood pressure, the patient complains of severe muscle weakness, a tingling sensation, goosebumps, thirst, and the release of large amounts of urine, hyperaldosteronism can be suspected. With it, in addition to the potassium level, it is necessary to study the content of sodium, renin and aldosterone. Ultrasound, CT, and MRI are also performed to detect pathological changes in the adrenal gland.

If the patient has lost weight, is bothered by trembling in his hands, has a sparkle in his eyes, and has bulging eyes, then thyrotoxicosis can be suspected. In this case, an ultrasound examination of the thyroid gland is performed to determine the level of a number of hormones - in particular TSH (pituitary hormone), triiodothyronine (T3) and thyroxine (T4) (thyroid hormones).

Suspicion of hemodynamic arterial hypertension may arise when a systolic murmur is detected during listening (auscultation) of the precordial region. With coarctation of the aorta, the upper part of the human body is well developed, while the lower part is worse, this difference is visible to the eye. With aortic valve insufficiency, high pulse pressure is observed. Cardiac ultrasound and ECG are of great help in establishing and clarifying the diagnosis.

The range of necessary studies in each specific case is determined by the doctor.

— How is symptomatic arterial hypertension treated?

— All patients receive medications that lower blood pressure. Today there are several groups of such drugs. Their choice depends on the underlying disease against which arterial hypertension developed. In addition, treatment of the underlying disease itself is carried out, including, if indicated, surgical treatment (for example, removal of a tumor of the adrenal cortex). If the cause is eliminated, blood pressure may return to normal.

Patients with symptomatic arterial hypertension must be treated by a cardiologist, and in addition to him, a doctor who treats the underlying disease

— Who treats symptomatic arterial hypertension?

— Treatment of symptomatic hypertension is the responsibility of different specialists. Such patients must be treated by a cardiologist, and in addition to him, a doctor who treats the underlying disease. This could be a urologist, nephrologist, endocrinologist, or surgeons of various profiles.

You can make an appointment with a cardiologist and other specialists here

ATTENTION: the service is not available in all cities

Interviewed by Enver Aliyev

The editors recommend:

Speculation about hypertension

The Ultimate Guide to High Blood Pressure: Frequently Asked Questions

When is daily blood pressure monitoring prescribed?

For reference:

Polyntsova Nina Ananyevna

Graduate of the Faculty of General Medicine of the Voronezh State Medical Institute in 1979.

In 1980, she completed an internship in surgery, and in 1986, a clinical residency in therapy.

In 1990, she underwent professional retraining in cardiology.

Doctor of the highest category.

Currently, he is a cardiologist at Clinic Expert Voronezh. Receives at the address: Pushkinskaya St., 11.

Peculiarities

Based on the manifestations of hypertension, many people confuse secondary hypertension with primary hypertension. Incorrect treatment leads to unexpected consequences: hypertensive crisis, coronary heart disease, stroke, myocardial infarction, which significantly complicates the course of the disease and leads to premature death.

Symptomatic hypertension differs from primary hypertension in the following ways:

• When using antihypertensive drugs, blood pressure does not always return to normal, or takes a long time to return to normal.
• Frequent panic attacks occur.
• Pressure surges occur suddenly, stay at the same levels or return to normal for a short time.
• The disease progresses rapidly.
• It is observed in a person under 20 years of age or who has lived over 60 years.

If you have the symptoms described above and signs of secondary hypertension, you should immediately go to the doctor. It is important to remember: the earlier the diagnosis is made, the easier it is to eliminate the cause of intravascular pressure and prevent complications from occurring.

Materials

Arterial hypertension

What is blood pressure?

Blood pressure (BP) refers to the force with which blood presses against the walls of the arteries.
Arteries are blood vessels that carry blood from the heart to all organs. The level of blood pressure is determined by the work of the heart and the diameter of the blood vessels. The optimal blood pressure level is 120/80 mm Hg. Art. A blood pressure level below 130/85 mm Hg is considered normal. Art. High normal pressure is considered to be a pressure of 130-139/85-89 mmHg. Art.

Blood pressure is described by two numbers. The top number indicates the maximum pressure in the arteries during each contraction of the heart, that is, when the heart “works” and throws blood into the vascular bed - this is systolic blood pressure (SBP). The bottom number shows the lowest pressure in the arteries in the interval between heartbeats, i.e. when the heart “rests” and fills with blood before the next contraction is diastolic blood pressure (DBP).

Blood pressure may change throughout the day. Blood pressure is lower when you sleep or lie down, but it rises when you stand up. Physical activity, pain, anxiety or stress can cause a temporary rise in blood pressure, which is completely normal and has nothing to do with arterial hypertension.

What is arterial hypertension?

Hypertension means persistently elevated blood pressure. It is impossible to diagnose high blood pressure using one measurement. To make a diagnosis of hypertension, it is necessary that blood pressure is constantly above normal and that the doctor repeatedly (at least three times) during different visits notes elevated blood pressure numbers.

Arterial hypertension (AH) is a condition in which SBP is 140 mm. rt. Art. or more and/or DBP 90 mm. rt. Art. or more, and these values ​​are obtained as a result of at least three measurements made at different times in a quiet environment without previous use of drugs that change blood pressure.

Increased blood pressure may be a consequence of another disease and then it will be called symptomatic arterial hypertension.

In hypertension, an increase in blood pressure is a symptom of the disease, not its consequence, and is caused by a violation of blood pressure regulation. This type of hypertension is the most common. It accounts for up to 95% of all types of arterial hypertension. The causes of essential hypertension are diverse, that is, many factors influence its occurrence.

Why is high blood pressure harmful to health?

With hypertension, clinical symptoms may be absent, and you may not be aware of high blood pressure for a long time. This is dangerous, because in the blood vessels, and then in the vital organs that they nourish - the heart, brain, kidneys, eyes - serious irreversible damage to their structure and function occurs. Therefore, it is necessary to regularly check your blood pressure at a doctor’s appointment or measure it yourself at home using special devices.

Even a slight increase in blood pressure, despite feeling well, is a reason to take it seriously, since hypertension leads to hypertensive crises, during which the risk of developing a cerebral stroke, myocardial infarction, cardiac asthma and pulmonary edema increases many times over.

High blood pressure promotes earlier and more active deposition of cholesterol (CH) in the form of plaques in the vessel wall, which accelerates the development of atherosclerosis in the arteries of the heart, brain, organs of vision, and kidneys. An atherosclerotic plaque narrows the lumen of the vessel and impedes blood flow, as a result of which the delivery of oxygen and nutrients to the organs decreases or even partially stops. This aggravates the course of hypertension and leads to the development of coronary heart disease (angina pectoris, myocardial infarction). With hypertension, the walls of the myocardium of the heart thicken (hypertrophy) and the risk of heart failure increases. In the future, in the absence of adequate treatment for hypertension, the walls of the heart may become thinner, their blood supply may be disrupted, shortness of breath, fatigue, and swelling in the legs may appear, i.e. heart failure may develop. Often hypertension leads to impaired renal function or aggravates the course of existing kidney diseases. In the elderly, elevated blood pressure contributes to memory impairment.

High blood pressure, despite the absence of any symptoms, has an adverse effect on target organs.

Types of symptomatic arterial hypertension

Renovascular hypertension

Renovascular (renal) hypertension occurs when the renal artery narrows, when an insufficient amount of blood enters the kidneys and the kidneys synthesize substances that increase blood pressure. Narrowing of the renal artery occurs with atherosclerosis of the abdominal part of the aorta, if the lumen of the renal artery is blocked, atherosclerosis of the renal artery itself with the formation of plaques narrowing its lumen, blockage of the artery by a thrombus, compression of the artery by a tumor or hematoma, trauma, inflammation of the wall of the renal artery. Congenital renal artery dysplasia is possible, when one or two arteries are narrowed from birth.

Renal arterial hypertension

Kidney diseases such as pyelonephritis, glomerulonephritis, and renal amyloidosis also lead to renal hypertension. The course of such arterial hypertension largely depends on the underlying disease, the speed and degree of blockage of the renal artery. Patients with renovascular arterial hypertension often feel well even with very high blood pressure numbers and do not lose their ability to work.

Renal hypertension usually responds poorly to antihypertensive drugs. During examination, patients may complain of lower back pain, after which an increase in blood pressure occurs. Sometimes a murmur is heard over the renal artery when listening to the abdomen. The x-ray may show different sizes of the kidneys. With excretory and isotope renography, the excretory function of one of the kidneys is reduced. Reliable evidence of the existence of renovascular hypertension in a patient is obtained from aortography and renal angiography (examination of the aorta and renal arteries using contrast agents). Treatment of renal arterial hypertension consists of treating the underlying disease.

Endocrine arterial hypertension

Endocrine arterial hypertension develops in diseases of the endocrine system: pheochromocytoma, primary hyperaldesteronism, Itsenko-Cushing syndrome, hyperparathyroidism (increased production of parathyroid hormones), hyperthyroidism.

Hemodynamic arterial hypertension.

Hemodynamic (mechanical) arterial hypertension occurs with coarctation of the aorta, aortic valve insufficiency, unclosed ductus arteriosus, and in the late stages of heart failure. Most often, hemodynamic arterial hypertension occurs with coarctation of the aorta, a congenital narrowing of the aorta. At the same time, in the vessels extending from the aorta above the site of narrowing, blood pressure is sharply increased, and in the vessels extending below the site of narrowing it is reduced.

A large difference between blood pressure in the upper and lower extremities is important for diagnosis. The diagnosis is finally established by contrast examination of the aorta. Treatment for high degrees of aortic stenosis is surgical.

Neurogenic arterial hypertension

Neurogenic arterial hypertension occurs in diseases of the nervous system. Brain tumors, strokes, injuries and increased intracranial pressure lead to increased blood pressure.

Drug-induced arterial hypertension

Drug-induced hypertension occurs when taking certain medications. These may be oral contraceptives, non-steroidal anti-inflammatory drugs, ephedrine, nervous system stimulants.

Risk factors for developing essential hypertension

Essential hypertension is the most common type of hypertension, although its cause is not always identified. However, in people with this type of hypertension, some characteristic relationships, so-called risk factors, have been identified.

Excess salt in food

Currently, scientists have reliably established that there is a close connection between the level of blood pressure and the amount of salt consumed daily by a person. Essential hypertension develops only in groups with high salt intake, more than 5.8 g per day.

In fact, in some cases, excessive salt intake may be an important risk factor. For example, excessive salt intake may increase the risk of hypertension in the elderly, Africans, obese people, genetic predisposition and kidney failure.

Sodium plays an important role in hypertension. About a third of cases of essential hypertension are associated with increased sodium intake. This is due to the fact that sodium is able to retain water in the body. Excess fluid in the bloodstream leads to increased blood pressure.

Heredity

The genetic factor is considered to be the main factor in the development of essential hypertension, although scientists have not yet discovered the genes responsible for the occurrence of this disease. Scientists are currently investigating genetic factors that affect the renin-angiotensin system, the same one that is involved in the synthesis of renin, a biologically active substance that increases blood pressure. It is located in the kidneys.

Approximately 30% of cases of essential hypertension are associated with genetic factors. If there are first-degree relatives (parents, grandparents, siblings), then the development of arterial hypertension is highly likely. The risk increases even more if two or more relatives have high blood pressure. Very rarely, a genetic disease of the adrenal glands can lead to hypertension.

Floor

Men are more predisposed to developing arterial hypertension, especially at the age of 35-55 years. However, after menopause, the risk increases significantly in women. The risk of developing hypertension increases in women during menopause. This is due to a hormonal imbalance in the body during this period and an exacerbation of nervous and emotional reactions. According to research, hypertension develops in 60% of cases in women during menopause. In the remaining 40%, blood pressure is also persistently elevated during menopause, but these changes disappear when the difficult time for women is left behind.

Age

This is also a fairly common risk factor. With age, there is an increase in the number of collagen fibers in the walls of blood vessels. As a result, the wall of the arteries thickens, they lose their elasticity, and the diameter of their lumen decreases.

High blood pressure most often develops in people over 35 years of age, and the older the person, the higher their blood pressure numbers usually are. In men aged 20-29 years, hypertension occurs in 9.4% of cases, and in men aged 40-49 years - already in 35% of cases. When they reach 60-69 years of age, this figure increases to 50%.

It should be taken into account that under the age of 40, men suffer from hypertension much more often than women. After 40 years, the ratio changes in the other direction. Although hypertension is called “the disease of the autumn of a person’s life,” today hypertension has become much younger: more and more often people who are not yet old are suffering from it.

Arterial pathology

In a large number of patients with essential hypertension: there is an increase in resistance (that is, loss of elasticity) of the smallest arteries - arterioles. The arterioles then become capillaries. Loss of elasticity of arterioles leads to increased blood pressure. However, the reason for this change in arterioles is unknown. It has been noted that such changes are typical for individuals with essential hypertension associated with genetic factors, physical inactivity, excessive salt intake and aging.

Renin

Renin is a biologically active substance produced by the juxtaglomerular apparatus of the kidneys. Its effect is associated with an increase in arterial tone, which causes an increase in blood pressure. Essential hypertension can be either high or low renin. For example, African Americans have low renin levels in essential hypertension, so diuretics are more effective in treating hypertension.

Stress and mental strain

Stress is understood as the presence of changes that occur in the body in response to extremely strong irritation. Stress is the body's response to strong environmental factors. Under stress, those parts of the central nervous system that ensure its interaction with the environment are included in the process. But most often, a disorder of the functions of the central nervous system develops as a result of prolonged mental stress, which also occurs in unfavorable conditions. With frequent mental trauma or negative stimuli, the stress hormone adrenaline causes the heart to beat faster, pumping a larger volume of blood per unit of time, as a result of which the pressure increases. If stress continues for a long time, then the constant load wears out the blood vessels, and the increase in blood pressure becomes chronic.

Smoking

The fact that smoking can cause the development of many diseases is so obvious that it does not require detailed consideration. Nicotine primarily affects the heart and blood vessels.

Obesity

A very common risk factor. Overweight people have higher blood pressure than thin people. Obese people are 5 times more likely to develop hypertension compared to those who are of normal weight. More than 85% of patients with arterial hypertension have a body mass index greater than > 25 kg/m2.

Diabetes

It has been established that diabetes mellitus is a reliable and significant risk factor for the development of atherosclerosis, hypertension and coronary heart disease.

Insulin is a hormone produced by the cells of the islets of Langerhans in the pancreas. It regulates blood glucose levels and promotes its passage into cells. In addition, this hormone has some vasodilating properties. Normally, insulin can stimulate sympathetic activity without causing an increase in blood pressure. However, in more severe cases, such as diabetes, stimulatory sympathetic activity may exceed the vasodilatory effect of insulin.

Snore

It has been noted that snoring may also be a risk for essential hypertension.

How to determine the severity of hypertension?

The severity of essential hypertension is determined by the degree of increase in blood pressure, target organ damage, and determination of the risk of cardiovascular complications.

Degrees of arterial hypertension

If the SBP or DBP value falls into different categories, then the higher category is set.

The degree of hypertension is established in cases of newly diagnosed hypertension and in patients not receiving antihypertensive drugs. When determining risk, many factors are taken into account: gender, age, cholesterol levels in the blood, obesity, the presence of diseases with arterial hypertension in relatives, smoking, sedentary lifestyle, target organ damage.

Heart

Since the load on the heart muscle increases during arterial hypertension, compensatory hypertrophy (increase) in the thickness of the heart muscle of the left ventricle occurs. Left ventricular hypertrophy is considered a more important risk factor than diabetes, high blood cholesterol and smoking. In conditions of hypertrophy, the heart needs increased blood supply, and the reserve in arterial hypertension is reduced. Therefore, patients with hypertrophy of the wall of the left ventricle of the heart are more likely to develop myocardial infarction, heart failure, rhythm disturbances, or sudden coronary death.

Brain

Already in the early stages of arterial hypertension, blood supply to the brain may decrease. Headache, dizziness, decreased performance, and noise in the head appear. In the deep parts of the brain, with long-term arterial hypertension, small infarctions (lacunar) occur; due to impaired blood supply, the brain mass may decrease. This is manifested by intellectual decline, memory impairment, and in advanced cases, dementia (dementia). Kidneys There is a gradual sclerosis of the vessels and tissues of the kidneys. Their excretory function is impaired. The amount of urea metabolic products in the blood increases, and protein appears in the urine. Ultimately, chronic renal failure is possible. In arterial hypertension, almost all vessels are also affected. Depending on the presence of these risk factors, there are 1, 2, 3 or 4 degrees:

• Risk grade 1 (low risk) means that the patient has less than a 15% chance of having a cardiovascular event over the next 10 years.

• Risk level 2 (medium risk) assumes that the probability of cardiovascular complications in this patient is 15%-20% over the next 10 years

• Risk grade 3 (high risk) assumes that the likelihood of cardiovascular complications in this patient is 20-30% over the next 10 years

• Risk level 4 (very high risk) implies a probability of cardiovascular complications of more than 30% over the next 10 years.

Main symptoms of hypertension

Arterial hypertension often does not manifest itself in any way, which is why this disease has been called the “silent killer.” This is due to the fact that very often a person does not even suspect that he has high blood pressure, and only learns about it when complications occur, often fatal, such as a stroke or myocardial infarction.

Such asymptomatic manifestations of hypertension can last up to several years or even decades.

In some cases, manifestations of arterial hypertension include headaches, dizziness, shortness of breath and blurred vision.

It should be noted that the presence of symptoms of arterial hypertension is a reliable sign in comparison with its asymptomatic course, since the patient consults a doctor earlier, learns about his disease and begins treatment.

Headache. Therefore, it is not for nothing that doctors recommend checking your blood pressure when you have headaches; this diagnostic method is very simple, but at the same time informative.

Headache with increased blood pressure is mainly associated with vasoconstriction of the soft tissues of the head. The most characteristic symptom of arterial hypertension is a headache in the back of the head, as well as in the temples with a sensation of beating in them.

In addition, tinnitus may also be felt, which is associated with narrowing of the vessels of the hearing aid.

Double vision and blurred vision, such as pins and needles, are usually associated with vasoconstriction of the optic nerve, as well as the retina. This can sometimes even lead to temporary blindness. Vasoconstriction and impaired blood flow cause dysfunction of the retina with high blood pressure.

Nausea and vomiting during a hypertensive crisis are associated with increased intracranial pressure.

Shortness of breath may indicate ischemic events in the heart when there is a disturbance in blood flow in the coronary arteries.

In some cases, with arterial hypertension, a hypertensive crisis (or, as they say, hypertensive crisis) may occur. This is a condition in which there is a sharp increase in blood pressure, most often in combination with neurological manifestations in the form of severe headache, dizziness, double vision.

In addition, during a crisis, nausea and even vomiting may occur. Pain in the chest may also be observed, which is associated with ischemic phenomena in the coronary arteries (remember that when blood pressure increases, the arteries narrow).

The appearance of such a patient may be characteristic, with redness of the skin, and emotional agitation is often observed.

Methods for diagnosing hypertension

Diagnostic methods that allow you to determine the presence of arterial hypertension in a person are:

Blood pressure is measured using a special device - a tonometer, which is a combination of a sphygmomanometer and a phonendoscope.

Before measuring blood pressure (BP), you should not smoke or drink tea or coffee for 30 minutes, and you must rest for 5 minutes. The room should be quiet and warm.

The hand selected for measuring blood pressure must be relaxed and freed from clothing. This arm should be free of arteriovenous fistulas for dialysis, brachial artery incision scars, and lymphedema that may result from axillary lymph node removal or radiation therapy.

If you have not yet felt the pulse on the radial artery, then do so to make sure that it is not changed. Position your arm so that the brachial artery (in the elbow area) is at the level of the heart (fourth intercostal space at the edge of the sternum).

Position the cuff bladder over the brachial artery. The lower part of the cuff should be located 2.5 cm above the elbow. Attach the cuff so that it fits snugly around your shoulder. The arm must be slightly bent at the elbow joint.

To determine how high to raise the cuff pressure, first assess your systolic blood pressure. While monitoring the radial pulse with one finger, quickly inflate the cuff until the radial pulse disappears.

Note the pressure gauge readings and add another 30 mmHg. This method is used to ensure that too high pressure in the cuff during further inflation does not cause discomfort in the patient. This also avoids the error caused by the appearance of an auscultatory gap - a silent interval between systolic and diastolic blood pressure.

Quickly release all the air from the cuff and wait 15-30 seconds.

Place the stethoscope over the brachial artery. Quickly inflate the cuff to the previously determined level, and then slowly deflate the air at a rate of approximately 2-3 mmHg. in 1 second. Note the level at which you heard the sound of at least two consecutive contractions. This value corresponds to systolic blood pressure.

Continue decreasing the pressure in the cuff until the sound fades and disappears. To make sure that the sounds have really disappeared, continue listening until the pressure drops another 10-20 mmHg.

Then quickly release all the air from the cuff until the pressure drops to zero. The vanishing point, which is just a few millimeters of mercury below the fading point, provides the most accurate estimate of diastolic blood pressure in adults.

For some people, the muting point and the vanishing point are quite far apart. If the difference is more than 10 mmHg. Art., write down both values ​​(for example, 150/80/68 mmHg).

Round systolic and diastolic pressure values ​​within 2 mmHg. Wait 2 minutes. and then repeat.

Calculate the average. If the first two readings from the device differ by more than 5 mmHg, you need to measure your blood pressure again.

Avoid inflating the cuff with slow, repetitive movements, as the resulting venous congestion may cause incorrect readings.

It is worth noting that in a family where there is a patient with arterial hypertension, it is advisable to always have a device for measuring blood pressure; it is necessary that one of the relatives knows how to use it.

The patient himself can also measure his own blood pressure. In addition, there are currently special electronic devices on the market that measure blood pressure, pulse rate, and also allow you to enter blood pressure readings into the device’s memory.

Normal blood pressure limits for an adult are 110-139/70-89 mmHg.

Diagnosis of arterial hypertension also involves interviewing the patient with a doctor. The doctor asks the patient what diseases he previously suffered from or is currently suffering from.

An assessment of risk factors is carried out (smoking, high cholesterol, diabetes mellitus), as well as hereditary history, i.e., whether the patient’s parents, grandparents and other close relatives suffered from arterial hypertension.

A physical examination of the patient includes, first of all, examination of the heart using a phonendoscope. This method allows you to detect the presence of heart murmurs, changes in characteristic tones (increase or, conversely, weakening), as well as the appearance of uncharacteristic sounds. These data, first of all, indicate changes occurring in the heart tissue due to increased blood pressure, as well as the presence of defects.

An electrocardiogram (ECG) is a method that allows you to record changes in the electrical potentials of the heart over time on a special tape. This is an indispensable method for diagnosing, first of all, various heart rhythm disorders. In addition, the ECG allows us to determine the so-called hypertrophy of the left ventricular wall, which is characteristic of arterial hypertension.

Echocardiography (ultrasound examination of the heart) - allows you to determine the presence of defects in the structure of the heart, changes in the thickness of its walls and the condition of the valves.

Arteriography , including aortography, is an x-ray method for studying the condition of arterial walls and their lumen. This method allows you to detect the presence of atheromatous plaques in the wall of the coronary arteries (coronary angiography), the presence of coarctation of the aorta (congenital narrowing of the aorta in a certain area), etc.

Dopplerography is an ultrasound method for diagnosing the state of blood flow in vessels, both in arteries and veins. In case of arterial hypertension, first of all, the doctor is interested in the condition of the carotid arteries and cerebral arteries. Ultrasound is used for this widespread purpose, since it is absolutely safe to use and is not characterized by complications.

Biochemical blood tests are also used in the diagnosis of arterial hypertension. First of all, the level of cholesterol, triglycerides and low- and very low-density lipoproteins is determined, as they are an indicator of susceptibility to atherosclerosis. In addition, blood glucose levels are determined.

Study of the condition of the kidneys , for which methods such as a general urine test, a biochemical blood test (for creatinine and urea levels), as well as ultrasound of the kidneys and its vessels are used. Ultrasound of the thyroid gland and blood test for thyroid hormones. These research methods help to identify the role of the thyroid gland in the occurrence of high blood pressure.

It is possible that the list of studies offered to you will be different. This is natural. Your doctor will prescribe the necessary examination based on the characteristics of your body and the course of your arterial hypertension.

Treatment

Treatment of the secondary form of arterial hypertension is aimed at reducing intravascular parameters. Naturally, this will become possible after eliminating the cause of their appearance - pathological processes in the body.

For this, 2 types of therapy are used:

1. Surgical intervention. This allows you to eliminate neoplasms of the endocrine glands, brain and kidneys, heart defects that provoke hypertension. If necessary, during the operation, artificial implants are implanted into the person, or the affected areas of the organs are removed.
2. Drug therapy is required when hypertension persists after surgery due to incurable hormonal imbalances. In this case, the patient must take medications until death (continuously).

For treatment, medications are used - antagonists that block the production of harmful hormones and stop the development of hypertension: diuretics, sartans, ACE inhibitors, beta blockers and calcium channel blockers, centrally acting drugs, alpha blockers and drugs that block vascular receptors. Consequently, secondary hypertension is characterized by a complex human condition, including pathological diseases of target organs, therefore, in this case, self-medication is unacceptable. It is recommended to undergo an annual examination by a cardiologist, even if hypertensive symptoms are completely absent, because a person may not pay attention to a mild ailment (attribute hypertension to fatigue) or not notice the appearance of hypertension in a latent form, allowing the disease to actively gain momentum and shorten life.