Hypertension, GB (Arterial hypertension ) — a disease whose main symptom is persistent high blood pressure, from 140/90 mm Hg or higher, the so-called hypertension. Hypertension is one of the most common diseases. It usually develops after 40 years. Often, however, the onset of the disease is observed at a young age, starting from 20-25 years. Hypertension is more likely to occur in women, and several years before the cessation of menstruation. But in men, the disease has a more severe course; in particular, they have a great tendency to contract atherosclerosis of coronary vessels of the heart – angina pectoris and myocardial infarction. With significant physical and mental stress, blood pressure can rise for quite a short time (minutes) in completely healthy people. A more or less prolonged increase in arterial blood pressure also occurs in a number of diseases, in inflammatory processes of the kidneys (nephritis) , in diseases of the endocrine glands (adrenal glands, adnexa of the brain, mouth of the base disease, etc.) But in these cases, it is only one of many symptoms and is a consequence of the anatomical changes in the corresponding organs. Characteristic of these diseases. In contrast, in hypertension, high blood pressure is not the result of anatomical changes in any organ, but is the main, primary manifestation of the disease process.
Hypertonic disease is based on increased tension (increased tone) of the walls of all small arteries (arterioles) of the body. An increased tone of the walls of the arterioles entails their narrowing and, consequently, a decrease in their lumen, which complicates the movement of blood from one section of the vascular system (artery) to another (veins). In this case, the blood pressure on the walls of the arteries increases and, thus, hypertension occurs.
Etiology.
It is believed that the cause of primary hypertension is that from the vasomotor center located in the medulla oblongata, along the nerve pathways (vagus and sympathetic nerves), impulses go to the walls of the arterioles, causing either an increase in their tone and, therefore, their narrowing, or on the contrary, a decrease in tone and expansion of arterioles. If the vasomotor center is in a state of irritation, then mainly impulses go to the arteries, increasing their tone and leading to narrowing of the lumen of the arteries. The influence of the central nervous system on the regulation of blood pressure explains the relationship of this regulation with the mental sphere, which is of great importance in the development of hypertension.
Arterial hypertension (hypertension) is characterized by an increase in systolic and diastolic pressure. It is divided into essential and symptomatic hypertension.
- Essential hypertension – primary hypertension
- Symptomatic – Secondary Hypertension
Exogenous risk factors :
- Nervous stress and mental trauma (life situations associated with prolonged or often repeated anxiety, fear, insecurity , etc.);
- Irrational, excess nutrition, especially meat, fatty foods;
- Abuse of salt, alcohol, smoking;
- Sedentary lifestyle;
Endogenous risk factors :
- All these factors have a decisive role with the obligatory presence of a hereditary predisposition (the gene for depositing norepinephrine); Auxiliary factors:
- Atherosclerosis;
- Obesity;
- Kidney disease ( Chronic pyelonephritis, Glomerulonephritis , Nephritis, Chronic renal failure, etc.);
- Endocrine diseases and metabolic disorders ( thyrotoxicosis, hypothyroidism-myxedema, Itsenko- Cushing’s disease , menopause , etc. );
- Hemodynamic factor – the amount of blood that is released in 1 min, blood outflow, blood viscosity.
- Hepatorenal disorders
- Violations of the sympathetic-adrenaline system,
The starting link of hypertension is an increase in the activity of the sympathetic-adrenaline system under the influence of increasing pressor and lowering depressor factors .
Pressor factors: adrenaline, norepinephrine, renin, aldosterone, endotenin . Depressor factors: prostaglandins , vazokinin , vasopressor factor . Increased activity of the sympathetic-adrenal system and violation hepato-renal system eventually leads to spasm venules , increased heart rate, increased minute volume of blood vessels constrict, occurs razvitieishemii kidney destruction adrenal glands, increased blood pressure. WHO classification. Normal pressure — 120/80 High-normal pressure — 130-139 / 85-90 Boundary pressure — 140/90
Hypertension of 1 degree — 140-145 / 90-95 Hypertension of 2 degrees, moderate — 169-179 / 100-109 Hypertension of 3 degrees, severe — 180 and more / 110 and more.
Target organs . Stage 1 – the absence of signs of damage to the target organs. Stage 2 – detection of one of the target organs (left ventricular hypertrophy, retinal narrowing, atherosclerotic plaques). Stage 3 – encephalopathy, strokes, fundus hemorrhage, optic nerve edema, fundus change according to the Kes method .
Types of hemodynamics . 1. Hyperkinetic type – in young people, increased sympathetic-adrenaline system. Increased systolic pressure, tachycardia, irritability, insomnia , anxiety 2. The eukinetic type is the defeat of one of the target organs. Left ventricular hypertrophy. There are hypertensive crises, angina attacks . 3. Hypokinetic type – signs of atherosclerosis, displacement of the borders of the heart, blurred fundus, strokes , heart attacks, pulmonary edema. With secondary hypertension ( sodium-dependent form) – edema, increased systolic and diastolic pressure, dynamism , lethargy, muscle weakness, muscle pain.
There are 2 types of hypertension: the first form is benign, slow-flowing. 2nd form – malignant. With the first form, symptoms increase over 20-30 years. Phases of remission, exacerbation. Amenable to therapy. With the 2nd form, both systolic and diastolic blood pressure rises sharply, and is not amenable to medical treatment. More common in young, with renal hypertension, symptomatic hypertension. Malignant hypertension is associated with kidney disease. A sharp deterioration in vision, an increase in creatinine , azotemia.
Types of hypertensive crises (according to Kutakovsky ).
1. Neurovegetative – the patient is agitated, restless, hand tremor, wet skin, tachycardia, at the end of the crisis – excessive urination. The mechanism of the hyperadrenergic system. 2. Edematous option – the patient is inhibited, drowsy, diuresis is reduced, swelling of the face, hands, muscle weakness, increased systolic and diastolic pressure. It often develops in women after abuse of salt, liquid. 3. Convulsive option – less common, loss of consciousness, tonic and clonic convulsions are characteristic. The mechanism is hypertensive encephalopathy, cerebral edema. Complication – hemorrhage in the brain or subarachnoid space. Clinical symptoms. Painful symptoms develop gradually, only in rare cases does it begin acutely, progressing rapidly. Hypertension in its development goes through a number of stages. 1st stage. Neurogenic, functional stage. At this stage, the disease can go away without any particular complaints, and can be manifested by fatigue, irritability, periodic headaches, palpitations, sometimes pains in the heart and a feeling of heaviness in the back of the head. Blood pressure reaches 150/90, 160/95, 170 / 100mm Hg, which is easily reduced to normal. At this stage, a rise in blood pressure is easily provoked by psycho- emotional and physical stress. 2nd stage. Sclerotic stage. In the future, the disease progresses. Complaints intensify, headaches become more intense, occur at night, early in the morning, not very intense, in the occipital region. Dizziness, a feeling of numbness in the fingers and toes, flushing of blood to the head, flickering of “flies” in front of the eyes, poor sleep, rapid fatigue are noted. An increase in blood pressure becomes persistent for a long time. In all small arteries, to a greater or lesser extent, phenomena of sclerosis and loss of elasticity, mainly of the muscle layer, are detected. This stage usually lasts several years. Patients are active, mobile. However, malnutrition of organs and tissues due to sclerosis of small arteries leads ultimately to deep disorders of their functions. 3rd stage. The final stage. At this stage, heart or kidney failure, cerebrovascular accident is detected. At this stage of the disease, its clinical manifestations and outcome are largely determined by the form of hypertension. Persistent hypertensive crises are characteristic. In heart form, heart failure develops (shortness of breath, cardiac asthma, edema, enlarged liver). In the brain form, the disease mainly manifests itself as headaches, dizziness, noise in the head, and visual disturbances. With hypertensive crises, headaches of the type of Liquor pain appear , which intensifies with the slightest movement, nausea, vomiting, and hearing impairment appear. At this stage, elevations in blood pressure can lead to impaired cerebral circulation. There is a risk of cerebral hemorrhage ( stroke ). The renal form of hypertension leads to renal failure, which is manifested by symptoms of uremia.