Essential arterial hypertension is a pathology of chronic type. Morphological changes in the background of the disease are different, it all depends on the nature of its occurrence. Next, consider what constitutes essential hypertension of all degrees of severity.
General information
The main clinical sign of pathology is a persistent increase in blood pressure. The diagnosis is based on the exclusion of all other forms of the disease. Essential hypertension is fixed from the moment of decrease in depressor renal function. First of all, morphological changes extend to the heart and blood vessels.
Normal option
In a he althy state, pressure is formed against the background of contraction in the left ventricle. In this case, the blood flow is ejected into the aorta, and then goes to small arteries. The pressure level is set in accordance with the blood volume in the vessels, the degree of tension of the arterial walls. The tone of the arterioles (the smallest channels) is also important. Hypertension is an increase in the arterial vessels of a large circle of hydrostaticpressure. Normally, indicators can fluctuate in accordance with the state of the person. So, during sleep, they decrease, and during psycho-emotional or physical stress they increase. However, as a rule, the pressure returns to normal - from 100/60 to 140/90. If the indicators are higher than those given, then hypertension is stated. The causes of essential hypertension are varied.
Risk factors
Essential hypertension is considered the most common type of hypertension, but it is not always possible to identify the provoking factor. However, in patients suffering from pathology, certain characteristic relationships are found. For example, essential hypertension occurs only in those groups where the level of s alt intake exceeds 5.8 g/day. Experts note that in fact, such excessive intake can become a significant risk factor. Especially predisposed to the development of hypertension are the elderly, people with renal insufficiency, and obesity. There is also a genetic factor.
Diabetes
First of all, when diagnosing, the medical history matters. Essential hypertension often accompanies diabetes mellitus. The pancreas contains cells of the islets of Langerhans. They produce the hormone insulin. It controls the concentration of glucose, promotes its transition into structural elements. At the same time, insulin also has some vasodilating effect. Normally, the hormone is able to stimulate the sympatheticactivity. In this case, blood pressure does not change. But in severe cases, such as diabetes, the sympathetic stimulatory activity may override the vasodilating effect.
Genetic factor
Specialists consider it one of the main in the development of pathology. However, the genes responsible for the appearance of hypertension have not been found. Today, researchers are working to study the factors that affect the renin-angiotensive system. It is involved in the synthesis of a biologically active compound - renin - which contributes to an increase in pressure. This system is located in the kidneys. Essential hypertension in about 30% of cases is caused by genetic factors. For example, the incidence is higher in African Americans than in Europeans or Asians. In addition, those who have one or both parents suffer from hypertension are more prone to the development of pathology. In rare cases, essential hypertension is the result of a genetic disorder in the adrenal glands.
Pathologies of vessels
Many hypertensive patients have high resistance (reduced elasticity) of the arterioles. These vessels become capillaries. When elasticity is lost, pressure begins to rise. The reason for this violation of the arterioles is not completely clear. However, it has been established that a decrease in vascular elasticity is characteristic of persons with hypertension due to genetic factors, aging, excessive s alt intake, and physical inactivity. certain role inThe development of pathology also belongs to inflammatory processes. In this regard, the detection of a C-reactive protein compound in the blood can act as a prognostic factor.
Obesity
This is another significant factor in the occurrence of essential hypertension. With excess body weight, the likelihood of pathology is 5 times higher. For example, in the US, about two-thirds of all cases of hypertension are associated with obesity. More than 85% of patients have a mass index greater than 25.
Sodium
This compound is also essential in the development of hypertension. Approximately one third of all cases of hypertension is associated with excessive intake of sodium in the body. The development of the disease is based on the ability of the compound to retain water. With an excess of fluid in the bloodstream, pressure rises.
Renin
The effect of this biologically active compound is associated with an increase in vascular tone. This causes an increase in pressure. Hypertension can be accompanied by both low and high renin levels. For example, reduced levels of the compound are typical for African Americans. In this regard, diuretics are considered more effective in therapy.
Other factors
It has been established that snoring has a significant effect on the development of hypertension. Age is considered to be a fairly common and significant provoking factor. Over the years, an increase in the number of collagen fibers is found in the vascular walls. Because of thisthere is their thickening and loss of elasticity, a decrease in the lumen.
Clinical picture
How does essential hypertension manifest itself? Symptoms of pathology are often absent. For a long time, only increased pressure acts as the only specific manifestation. There are borderline values, according to which the diagnosis is established. So, for the "upper" (systolic) pressure, this is 140-159 mm Hg. Art., for diastolic - 90-94. In some cases, essential primary hypertension is accompanied by:
- Headache in the back of the head.
- Rapid heartbeat.
- Double vision.
- Tinnitus.
The intensity of these symptoms increases with a sharp increase in pressure (hypertensive crisis). Over time, changes begin in the vessels and in the internal organs of an irreversible nature. The "targets" are the heart, kidneys, brain.
Stages of pathology
With a mild course, the condition is characterized by a periodic rise in pressure (diastolic - more than 95). In this case, the stabilization of the condition is possible without the use of medications. The average severity of the pathology is characterized by a steady increase in pressure (diastolic - within 105-114). At this stage, expansion of venules, narrowing of arterioles, hemorrhages of the fundus without other diseases can be detected. The severe stage is characterized by a steady increase in pressure (diastolic - more than 115). Stabilizationstate does not occur even after the crisis. At this stage, changes in the fundus are more pronounced. The condition is also accompanied by the development of arteriolo- and arteriosclerosis, left ventricular hypertrophy, cardiosclerosis. Pathological changes in internal organs are also found.
Comorbidities
Hypertension may be accompanied by:
- Diabetic Nephropathy.
- Angina.
- Heart attack.
- Revascularization of the coronary arteries.
- Transient disturbances in cerebral circulation.
- Hemorrhagic and ischemic strokes.
- Swelling in the optic nerve.
- Hemorrhage or exudate.
- Severe retinopathy.
- Dissecting aneurysm.
- Renal and congestive heart failure.
Diagnosis
It is based on an assessment of pressure indicators. To clarify the diagnosis, at least three independent measurements are required. In this case, a mercury tonometer and the Korotkov method are used. Diagnosis of secondary forms of pathology and determination of the degree of organ damage is performed using additional studies. In particular, the patient is prescribed specific and general urine and blood tests, ultrasound of internal organs and the heart, various tests, ECG, and more.
Daily monitoring
When using this method of research, an automatic tonometer is put on the patient, fixing the level of blood pressure during the day. Interval between measurements, astypically 30-60 minutes during the day and 60-120 minutes at night. As a result, several dozen results are obtained. Based on the data, you can determine the average pressure per day, night, day. In addition to direct indicators, you can get information that indirectly indicates the presence of hypertension. This information is provided by measuring the rate of increase and decrease in pressure at different times of the day.
Essential hypertension treatment
There are various methods to stabilize the state. The choice will depend on the nature of the pathology. Thus, essential and renovascular hypertension have differences in the intensity of manifestations. First of all, therapeutic measures should be aimed at stabilizing pressure. At the same time, all risk factors must be adjusted. The patient needs to give up smoking and other bad habits, review the diet, and normalize weight. For those patients who have been diagnosed with essential arterial hypertension, treatment should also be aimed at eliminating comorbidities: diabetes mellitus and others. Particular attention should be paid to physical activity, wakefulness and sleep patterns. In the menu, the amount of s alt and animal fats should be reduced. At the same time, plant foods, dairy products, grains, fruits and vegetables should be present in the diet. Together with these products, microelements and other useful compounds, vitamins will enter the body.
Medication effects
Here followsIt should be noted that essential hypertension is quite easy to eliminate. Today in Russia, seven classes of drugs are recommended. Renovascular hypertension (secondary) is difficult to eliminate. In this case, therapy is aimed primarily at combating the underlying pathology. Among the drugs prescribed for the disease, the following are distinguished:
- Diuretics (diuretics). They help remove excess fluid from the body. These include the means "Furosemide", "Hypothiazid" and others.
- Beta and adrenoblockers. The latter are used only for concomitant pathologies. Beta-blockers include Nadolol, Acebutolol.
- Calcium antagonists. Along with this, additional intake of magnesium as part of the diet can also be considered the intake of a calcium antagonist.
- ACE inhibitors.
- Imidozaline receptor agonists.
- Angiotensin receptor antagonists (Losartan).
The selection of medicines is carried out by a doctor.
