Renal hypertension: symptoms and treatment. Symptoms and treatment of renal hypertension Causes of renal hypertension

• What are the features of the disease?

Renal hypertension is a disease in which blood pressure increases due to kidney disease. Renal pathology is characterized by stenosis. With stenosis, the main and internal renal arteries and their branches narrow.

In 10% of patients with high blood pressure, renal arterial hypertension is diagnosed. It is characteristic of nephrosclerosis, pyelonephritis, glomerulonephritis, and other kidney diseases. It most often affects men aged 30 to 50 years.

Renal hypertension is secondary arterial hypertension that occurs as a manifestation of other diseases. The causes of the disease are explained by disruption of the kidneys and their participation in hematopoiesis. With such a health disorder, it is necessary to treat the underlying disease; with successful therapy, the pressure returns to normal.

The cause of renal arterial hypertension is damage to the kidney tissue, while the renal arteries narrow. Due to impaired kidney function, the volume of circulating blood increases and water is retained in the body. This causes an increase in blood pressure. There is an increased sodium content in the body due to a failure in its excretion.

Special sensitive formations in the kidneys that perceive irritations and transmit them to the nervous system, receptors that respond to various changes in the movement of blood through the vessels (hemodynamics), are irritated. The hormone renin is released, it activates substances that can increase the peripheral resistance of blood vessels. This causes abundant release of hormones from the adrenal cortex, and sodium and water retention occurs. The tone of the renal vessels increases, their sclerosis occurs: soft deposits accumulate in the form of gruel, from which plaques are formed that limit the lumen and affect the patency of blood to the heart. There is a circulatory disorder. The kidney receptors are irritated again. Renal hypertension may be accompanied by hypertrophy (excessive enlargement) of the left cardiac ventricle. The disease mainly affects older people; it can occur in young men, because they, compared to women, have more body weight, and therefore a larger vascular bed in which blood circulates.

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What is the danger of kidney hypertension and how can it be determined?

Kidney hypertension is dangerous due to complications. They may be:

• hemorrhage in the retina with decreased vision up to blindness;
• heart or kidney failure;
• serious damage to the arteries;
• changes in blood properties;
• vascular atherosclerosis;
• lipid metabolism disorder;
• cerebrovascular disorders.

Such disorders often become causes of decreased ability to work, disability, and death.

Clinical signs of the disease that may appear in patients:

• systolic or diastolic murmurs heard in the area of ​​the renal arteries;
• heartbeat;
• headache;
• violation of nitrogen excretory function;
• a small amount of protein in the urine;
• decreased specific gravity of urine;
• asymmetry of blood pressure in the extremities.

Renal hypertension, the symptoms of which are stable hypertensive syndrome with predominantly elevated diastolic pressure, can be malignant in 30% of cases. Arterial hypertension may be the main symptom of nephropathy. The combination of hypertension with severe nephrotic syndrome is typical for the development of subacute glomerulonephritis. Malignant hypertension affects patients suffering from periarteritis nodosa, and symptoms of impaired renal function are combined with clinical signs of other diseases. In most cases, renal pathology is expressed by vasculitis of intrarenal arteries of medium caliber, and renal ischemia and infarction develop.

With hypertension of renal origin, patients complain of fatigue and irritability. Damage to the retina of the eyeball (retinopathy) with foci of hemorrhage, swelling of the optic disc, and impaired vascular permeability (plasmorrhagia) are observed. To make an accurate diagnosis, instrumental and laboratory diagnostics, studies of the heart, lungs, kidneys, urinary tract, aorta, renal arteries, and adrenal glands are used. Patients are tested for the presence of adrenaline, norepinephrine, sodium, and potassium in the blood and urine. An important role belongs to radioisotropic and x-ray methods. If damage to the renal arteries is suspected, angiography is performed, which establishes the nature of the pathology that caused arterial stenosis.

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How to treat renal hypertension?

Kidney disease is a common cause of high blood pressure. Treatment of hypertension of renal origin is carried out by cardiologists and nephrologists. Preservation of kidney function is the main goal of therapy. Adequate control of blood pressure is carried out, therapeutic measures are aimed at slowing the development of chronic renal failure and increasing life expectancy. If nephrogenic hypertension is detected or this diagnosis is suspected, patients are sent to the hospital to clarify the diagnosis and treatment. In an outpatient clinic, preoperative preparation is carried out according to the doctor’s indications.

Treatment of renal hypertension combines conservative and surgical methods, antihypertensive and pathogenetic therapy of the underlying disease. The most widely used conservative approach is drugs that affect the pathogenetic mechanisms of the development of arterial hypertension, reducing the risk of disease progression, do not reduce renal blood supply, do not inhibit renal function, do not disrupt metabolism, and develop minimal side effects.

A progressive method is often used - renal phonation. Treatment is carried out through a vibroacoustic device, microvibrations of sound frequencies, and the application of vibraphones to the body. Sound microvibrations are natural for the human body and have a beneficial effect on the functions of systems and individual organs. This technique can restore kidney function, increase the amount of uric acid secreted by the kidneys, and normalize blood pressure.

During therapy, a diet is prescribed; its features are determined by the nature of the kidney damage. General recommendations include limiting salt and liquid intake. Smoked meats, hot sauce, cheese, strong broth, alcohol, and coffee are excluded from the diet. In some cases, surgical intervention is performed for life-saving reasons. One of the methods for correcting nephrogenic hypertension is nephrectomy (removal of the kidney). With the help of surgery, the majority of patients get rid of nephrogenic hypertension; in 40% of patients, the dosage of antihypertensive drugs used is reduced. Increasing life expectancy, controlling arterial hypertension, and protecting kidney function are important results of surgical intervention.

Timely effective therapy of renal hypertension is the key to rapid and successful remission.

Renal hypertension is secondary arterial hypertension, which is provoked by disturbances in the functioning of the kidneys. This disease is characterized by an increase in blood pressure greater than 140/90 mmHg. If in some forms of arterial hypertension only systolic pressure increases, then in renal hypertension there is a persistent increase in diastolic pressure.

As for the prevalence of the disease, it accounts for 5% of the total number of arterial hypertension diseases.

How the disease develops

For many, the strong connection between the kidneys and increased blood pressure is new. But, in fact, the mechanism is quite simple. If the functioning of the kidneys is impaired, water is not removed from the body in the required amount; it is retained in it along with sodium salts. The latter, in turn, increase the sensitivity of blood vessels to hormonal substances that can increase their tone. When blood circulation in the kidneys is impaired, the release of a special hormone into the blood, renin, also increases. It activates certain processes in the blood, which increase peripheral vascular resistance. Under the influence of renin, the production of additional hormones is stimulated, which further retain water and sodium salts in the body. Thus, we see that a vicious circle is being formed, which can only be broken with medical help.

Forms of the disease

Depending on the reasons that provoked the development of renal hypertension, it is divided into two forms:

• diffuse - caused by kidney damage, for example, chronic pyelonephritis, chronic or acute glomerulonephritis, systemic vasculitis, diabetic nephropathy, polycystic kidney disease;
• renal vascular - develops when the lumen of the renal arteries and their branches narrows.

Symptoms of the disease

As for symptoms, renal hypertension manifests itself in the same way as ordinary arterial hypertension:

• increased blood pressure, in particular its lower level;
• headache;
• swelling, which is caused by fluid retention in the body;
• high fatigue;
• tachycardia.

What is typical for this form of hypertension is that it very rarely leads to hypertensive crises, heart attacks and strokes. But still, in some cases it can be very difficult to treat.

Diagnosis of the disease

If the patient complains of the above-mentioned symptoms, the doctor must prescribe a comprehensive examination. The first thing to do in this case is to take a urine test. It will show the presence of a problem even before the patient begins to suffer from a sustained increase in blood pressure. Here you need to pay attention to the presence of protein in the urine, the level of leukocytes, casts and red blood cells.

The patient should then undergo an ultrasound of the kidneys. The study will show changes in their size and other functional changes. Additional examination methods can also be used: urography, kidney scanning, radioisotope radiography.

Only based on the results of a comprehensive examination can the most accurate diagnosis be made and the most effective treatment prescribed in this case.

Features of the treatment of renal hypertension

The treatment of this disease must be approached with maximum responsibility and high professionalism, because blood pressure and kidney function are closely interrelated. In this case, you need to select medications that can have a beneficial effect on the kidneys without affecting blood pressure, and vice versa, lower blood pressure without having a negative effect on the kidneys.

It is precisely because of this peculiarity of treatment that therapy should in no case be carried out independently, taking a course of diuretics in the hope that they will help get rid of both problems at once. Only a doctor can choose an effective and most important – safe treatment.

In serious cases, surgical treatment may be used. For example, if narrowing of the adrenal artery is diagnosed, then in this case balloon angioplasty is recommended, which involves inserting a special catheter into the vein. After the catheter is removed, only the stent remains. As a result of this treatment, blood pressure decreases.

It is also worth taking care of following a diet, which will help speed up healing and increase the effectiveness of therapy. It is necessary to exclude fatty foods from the diet, and reduce the amount of salt consumed to a minimum.

Folk remedies can also be used in the treatment of renal hypertension. But, the rule about the dangers of self-medication remains relevant, therefore, if you want to use traditional medicine recipes, you should definitely consult a doctor on this matter, who will make a conclusion about the effectiveness and safety of such treatment. If the doctor does not allow you to use folk remedies, it is better to do so. Unauthorized decisions can aggravate the situation and lead to worsening of the disease, more frequent and persistent increases in blood pressure.

Prevention of renal hypertension

If we talk about preventive measures, they should be aimed at maintaining the health of the cardiovascular system and kidneys, because these organs are strongly connected to each other, a disease of one can cause a disease of the second.

Accordingly, we divide prevention into several important components, the first of which is proper nutrition. By reducing the amount of salty and fatty foods in your diet, the patient helps lower blood pressure and maintain kidney health. It is also worth taking care of the correct daily routine, moderate physical activity, which can strengthen blood vessels, helping to maintain normal blood pressure levels.

It is imperative to give up bad habits that have a detrimental effect on the health of the kidneys, cardiovascular system, and any other organ of the human body.

Arterial hypertension is the most common cardiovascular disease. According to statistics, 10% of patients are diagnosed with renal hypertension, which occurs due to diseases of the organ responsible for filtering blood and removing fluid. This condition is not easy to diagnose, is severe in 25% of cases and leads to serious consequences. Therefore, it is necessary to consider in more detail the specifics of the disease, the features of its recognition and therapy.

What is renal hypertension?

This is an increase in pressure due to disruption of the kidneys and, accordingly, disruption of the function of regulating blood circulation. This type of hypertension is also called secondary, since the increase in pressure in this case is a symptom of another disease, and not an independent process, which is typical for the diagnosis of hypertension. Most often, elderly people and young men suffer from this disease due to their greater body weight and, accordingly, a larger volume of the vascular bed. If kidney function resumes, blood pressure returns to normal.

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Types of disease

The renal form of hypertension is divided into 3 groups:

• Renoparenchymal diseases involving the membrane, which regulates fluid flow. The consequence of damage to the parenchyma is edema, protein in the blood and urine due to reverse blood outflow. This category includes diabetes, kidney stones, pyelonephritis, glomerulonephritis, systemic diseases (such as lupus erythematosus, scleroderma), congenital structural defects, and renal tuberculosis.
• - characterized by a narrowing of the lumen of one or more vessels by 75%. It is less common, but leads to a more severe course. The causes of such disorders: atherosclerosis (especially in older people), compression of blood vessels (hematoma, cyst), anomaly of their development. Antihypertensive medications are ineffective in treating this group of diseases.
• Mixed - arterial hypertension syndrome is caused by damage to both the parenchyma and blood vessels. Similar changes can occur in kidney diseases: nephroptosis, tumors, cysts.

Causes and pathogenesis

Hypertension and kidneys - there is a mutual connection between them: due to increased pressure, kidney function is impaired, and, on the other hand, the pathology of this organ leads to arterial hypertension. Renal hypertension is caused by 3 mechanisms:

• An increase in blood flow leads to impaired filtration, accumulation of water and sodium ions. Because of this, a hormone is actively produced that promotes sodium absorption, causing vascular hypertonicity due to swelling of their walls. That is, the pressure rises due to an increase in the amount of fluid outside the cell and swelling of the artery wall.
• Due to improper functioning of the kidneys, a number of biologically active substances are released: renin is released in a larger volume due to vasoconstriction, and, interacting with protein, forms angiotensin-II. It itself increases the tone of blood vessels, and also increases the production of aldosterone, which enhances the absorption of sodium and thereby aggravates the swelling of the arteries.
• The depressor function of the organ suffers - the supply of hormones that lower blood pressure by removing sodium from the vascular muscles is depleted over time and consistently high blood pressure becomes the norm.

The reasons for increased pressure associated with the kidneys correlate with the types of pathology described, which are presented in the table:

Symptoms and specifics of the course

As with hypertension, patients experience difficulty breathing, weakness, dizziness, headache, tachycardia, and a sharp increase in blood pressure. However, kidney damage in hypertension causes the appearance of edema, pain in the lumbar region, and an increase in the frequency and volume of urination. If the disease is benign, the symptoms slowly increase, the rise in blood pressure is stable, anxiety and irritability, and discomfort in the heart area are possible. characterized by rapid development, visual disturbances, nausea and vomiting, minimal difference between upper and lower pressure, severe headache. Subsequently, complications such as heart and kidney failure, lipid metabolism disorder, blindness, and cerebrovascular accident may be added to the clinical picture.

Establishing a diagnosis

Such patients are examined by a therapist and then prescribed treatment. First of all, changes in pressure are detected when performing certain physical exercises and changing body position. Then blood and urine tests are taken to determine the presence of protein. Sometimes, in search of the enzyme, blood is taken directly from the veins of the kidneys. Through a stethoscope, a systolic murmur is heard in the umbilical region. Thanks to ultrasound and MRI, it is possible to study the structure of the kidney and search for formations. Also in diagnosis, excretory urography is used to examine the urinary tract. Angiography and fundus examination can reveal changes in blood vessels, and radioisotope rheography shows the degree of dysfunction. If the doctor suspects oncology, a biopsy with further cytological examination is used.

Therapeutic measures

Drug treatment of pathology

Treatment of renal hypertension is carried out by cardiologists together with nephrologists. Therapy begins with diet No. 7. Sometimes with a transient increase in pressure, this is enough. In case of poor tolerance to the diet or insignificant improvement in the condition, medications called loop diuretics are added. These include "Furosemide", "Torasemide".

In renal failure, the degree of dysfunction is calculated based on glomerular filtration, which is subsequently taken into account during the selection of medications. Drugs used to normalize blood pressure are thiazide diuretics and adrenergic blockers. Some antihypertensive medications improve kidney function. These include Dopegit and Prazosin.

Renal hypertension occurs in people with kidney disease when their blood pressure is high for a long time. With long-term treatment and observation by a doctor, it is possible to normalize blood pressure by restoring kidney function.

General characteristics of the pathology

Among hypertensive patients, in 10% of patients, pressure surges are caused precisely by impaired renal function. At risk are people with diseases of the genitourinary system, most of them are men over 30 years old. When measuring indicators above normal, both upper (systolic) and lower (diastolic) pressure are found.

The kidneys filter the blood, regulate the volume of fluid in the body, remove excess sodium ions and cell waste products. Due to the push of blood from the heart there is a powerful flow to the periphery, and when the heart muscle relaxes, the blood returns back. At this moment, filtration occurs through the renal glomeruli. Nephrogenic hypertension begins at the time of deterioration of blood flow in the kidneys and glomerular dysfunction.

The body delays the excretion of sodium salts and fluids, tissue swelling appears, the walls of blood vessels thicken, and due to an excess of secreted enzymes, sclerotic plaques appear in the arteries, narrowing the lumen of blood vessels. The return of blood to the heart weakens, vascular tone deteriorates, as a result of which blood pressure rises and remains at a high level. Long-term fixation at elevated levels (more than 140/90 mm Hg) leads to disruption of the cardiovascular system and to more serious complications.

Causes of the disease

The root cause of the development of kidney pathology, which contributes to an increase in blood pressure to the nephrogenic type of hypertension, is:

• abnormal structure of the kidneys: organs that have not grown to normal volume, double structure;
• inflammation in tissues – previously diagnosed pyelonephritis and other kidney diseases.

Experts divide the causes of renal renal pressure (vascular disease) into those acquired during life and congenital. The second type includes:

• pathological narrowing of the renal arteries;
• narrowing of the aortic lumen or complete obstruction (when the tissues of the vessel walls grow excessively).

Acquired causes of progressive renal hypertension:

• nephropathy arising after developing diabetes;
• atrophy of kidney tissue as a result of age-related changes;
• urolithiasis;
• the appearance of compaction of the fibrous capsule of the organ.

The development of renal failure contributes to the rapid appearance of renal hypertension. In this case, neglect of well-being and lack of drug treatment leads to death. At the first symptoms, you should consult a doctor for a referral for examination and a nephrologist.

In addition to the above, the following diseases can cause increased renal pressure:

• systemic lupus erythematosus;
• diabetic destruction of the body;
• scleroderma;
• liver diseases;
• classic hypertension.

Symptoms of renal hypertension

The pathology is characterized by the following symptoms:

• increased renal and cardiac pressure, occasionally only renal pressure increases;
• increased fatigue for no apparent reason;
• lesions of the retina with hemorrhages and swelling of the optic nerve, the appearance of black “spots”, defocus;
• swelling of the limbs, pain in the lumbar region;
• abnormal sharp increases in pressure.

During the examination of the patient, murmurs are detected in the arteries of the kidneys in the area above the navel and on the lumbar side. Additionally, asymmetric data appears when measuring pressure on different limbs, changes in the chemical composition of urine - protein content, a decrease in its density.

There are differences in the clinical picture malignant and benign renal hypertension:

• In the case of a malignant form, the disease develops instantly: lower pressure can soar to 119 mm Hg. Art. and almost level with the top. The optic nerve is affected, headaches begin in the occipital area.
• In benign hypertension, the disease develops slowly. There is a uniform increase in pressure that does not decrease after taking medications. Patients suffer from pain in the frontal region, feel weakness, and shortness of breath. The heart speeds up, the patient feels pulsation and pain in the left sternum.

Diagnosis

It is not possible to identify renal hypertension on your own; to find out the causes of the pathology, you need to consult a therapist. He must select a large number of causes with similar symptoms that provoke an increase in renal pressure.

Diagnosis of an atypical increase in diastolic pressure begins with constant monitoring of blood pressure levels over an extended period of time. If within a month the patient showed signs of hypertension, and the blood pressure was consistently elevated (not lower than 140/90), then the pathology is present. The presence of noticeable failures in the functioning of the kidneys determines secondary hypertension; to prevent irreversible consequences, the doctor immediately prescribes comprehensive treatment.

To accurately determine the pathology, patients undergo the following studies:

• general blood analysis;
• urine test: with pathology, proteins appear in the urine;
• angiography of renal vessels;
• Ultrasound of affected kidneys and large vessels;
• urography to assess the condition of the urinary tract;
• biopsy;
• MRI and tomography of renal vessels;
• dynamic scintigraphy.

Treatment of kidney pressure

Treatment involves setting two tasks:

• restoration of the functioning of the kidneys and urinary system;
• therapy that eliminates the causes of renal hypertension.

It can be difficult to lower high blood pressure at home, so the doctor prescribes a combination of medications. Depending on the severity of the disease, the doctor prescribes medications from the following groups:

• , stopping the reabsorption of salts and liquids and accelerating their excretion in the urine;
• substances that reduce calcium absorption to reduce heart muscle tension;
• ACE inhibitors, which block enzymes in the body that cause hypertension;
• beta blockers.

In complex treatment, a hardware phonation procedure is used. The patient is given attachments of a vibroacoustics device, which helps speed up the removal of uric acid from the body, stabilize kidney function and restore blood pressure.

In severe stages of the disease, when folk remedies are not effective, and side symptoms from pills can irreparably harm the body, the doctor decides on surgical intervention. The operation is performed when polycystic disease, oncological tumors and congenital anomalies of the kidney structure are detected.

If a narrowing of the lumen of the adrenal artery is detected, the patient is prescribed balloon angioplasty. Occasionally, with severe damage to the kidney vessels, the surgeon decides to perform a nephrectomy - removal of the kidney. This happens when the disease is in an advanced state, when there is a risk to life.

Doctors confirm that renal hypertension can be cured by supplementing drug therapy with folk remedies:

• bearberry infusion lowers diastolic pressure;
• eating dill seeds cleanses the blood vessels of the kidneys;
• a collection of birch, wild pear, cattail and centaury leaves reduces inflammation.

Each recipe must first be agreed with a specialist.

Comprehensive treatment of renal hypertension under the supervision of a physician should be supplemented by a strict diet with a high content, minimizing the amount of salt consumed, avoiding and increasing physical activity. This will help reduce kidney pressure and avoid irreversible complications for people with severe forms of the disease.

Forecast

Lack of treatment and delays in going to the doctor provoke the pathology to become chronic, which can cause irreparable harm to internal organs and even lead to death.

Renal hypertension can cause the following diseases:

• renal and heart failure;
• cerebrovascular accidents;
• eye hemorrhages;
• blurred vision;
• irreversible deformations of large vessels;
• metabolic disorders.

Impaired blood flow, constantly elevated blood pressure and damage to blood vessels lead to dysfunction of internal organs and all vital systems. However, with timely treatment and detection of pathology in the early stages, a complete cure for the disease and restoration of the affected organs and blood vessels are possible.

Video about renal hypertension

The frequency of development, causes, symptoms and treatment of pathology is described in this TV show:

Preventive measures

To protect against impaired functioning of the kidneys and cardiovascular system, you need:

• monitor your blood pressure level if you feel unwell;
• If you measure your blood pressure and notice an increase over several days, consult a doctor immediately;
• exclude from the diet foods harmful to kidney receptors: spicy, fried, smoked, fatty;
• reduce salt intake to 3 g per day or less;
• leave bad habits;
• maintain the correct daily and sleep schedule, get enough sleep (especially if you have diseases of the cardiovascular system);
• engage in moderate physical activity and sports to strengthen the body, muscle tone and immunity, while it is important not to overdo it and monitor your well-being during training;

In folk medicine, there are proven recipes for protection against the symptoms of renal hypertension. Necessary:

• take a teaspoon of fish oil every day and add fatty fish to your diet;
• add garlic and onions during cooking, and also eat them raw as a vitamin and immunostimulating supplement;
• make a health drink from kefir with herbs or garlic (you can replace the ingredients or add seaweed), take 1 glass a day before meals;
• drink fresh vegetable juices, juice from celery, carrots and beets is especially useful;
• in therapeutic doses, add hawthorn infusion to tea or drink undiluted.

Going to the doctor immediately after the onset of symptoms often helps to identify other serious kidney pathologies and begin treatment for them. It is important to realize that many people have problems with blood pressure due to poor lifestyle and diet. The combination of lifestyle correction with competent drug treatment guarantees a complete cure for renal hypertension.

Pathology of the cardiovascular system, developing as a result of dysfunction of higher centers of vascular regulation, neurohumoral and renal mechanisms and leading to arterial hypertension, functional and organic changes in the heart, central nervous system and kidneys. Subjective manifestations of high blood pressure include headaches, tinnitus, palpitations, shortness of breath, pain in the heart, blurred vision, etc. Examination for hypertension includes monitoring of blood pressure, ECG, echocardiography, ultrasound of the arteries of the kidneys and neck, urine analysis and biochemical parameters blood. Once the diagnosis is confirmed, drug therapy is selected taking into account all risk factors.

General information

The leading manifestation of hypertension is persistently high blood pressure, i.e. blood pressure that does not return to normal levels after a situational rise as a result of psycho-emotional or physical stress, but decreases only after taking antihypertensive drugs. According to WHO recommendations, normal blood pressure is not exceeding 140/90 mmHg. Art. Exceeding the systolic reading over 140-160 mmHg. Art. and diastolic - over 90-95 mm Hg. Art., recorded at rest with double measurements during two medical examinations, is considered hypertension.

The prevalence of hypertension among women and men is approximately the same 10-20%; the disease most often develops after the age of 40, although hypertension is often found even in adolescents. Hypertension contributes to a more rapid development and severe course of atherosclerosis and the occurrence of life-threatening complications. Along with atherosclerosis, hypertension is one of the most common causes of premature mortality in the young working population.

There are primary (essential) arterial hypertension (or hypertension) and secondary (symptomatic) arterial hypertension. Symptomatic hypertension accounts for 5 to 10% of hypertension cases. Secondary hypertension is a manifestation of the underlying disease: kidney diseases (glomerulonephritis, pyelonephritis, tuberculosis, hydronephrosis, tumors, renal artery stenosis), thyroid gland (thyrotoxicosis), adrenal glands (pheochromocytoma, Itsenko-Cushing syndrome, primary hyperaldosteronism), coarctation or atherosclerosis of the aorta, etc. .

Primary arterial hypertension develops as an independent chronic disease and accounts for up to 90% of cases of arterial hypertension. In hypertension, high blood pressure is a consequence of an imbalance in the body's regulatory system.

Mechanism of development of hypertension

The pathogenesis of hypertension is based on an increase in cardiac output and peripheral vascular resistance. In response to the influence of a stress factor, disturbances in the regulation of peripheral vascular tone by higher centers of the brain (hypothalamus and medulla oblongata) occur. A spasm of arterioles occurs on the periphery, including renal arterioles, which causes the formation of dyskinetic and dyscirculatory syndromes. The secretion of neurohormones of the renin-angiotensin-aldosterone system increases. Aldosterone, which is involved in mineral metabolism, causes retention of water and sodium in the vascular bed, which further increases the volume of blood circulating in the vessels and increases blood pressure.

With arterial hypertension, blood viscosity increases, which causes a decrease in the speed of blood flow and metabolic processes in tissues. The inert walls of the vessels thicken, their lumen narrows, which fixes a high level of total peripheral vascular resistance and makes arterial hypertension irreversible. Subsequently, as a result of increased permeability and plasma saturation of the vascular walls, the development of elastofibrosis and arteriolosclerosis occurs, which ultimately leads to secondary changes in organ tissues: myocardial sclerosis, hypertensive encephalopathy, primary nephroangiosclerosis.

The degree of damage to various organs in hypertension may be different, so there are several clinical and anatomical variants of hypertension with predominant damage to the vessels of the kidneys, heart and brain.

Classification of hypertension

Hypertension is classified according to a number of criteria: the reasons for the rise in blood pressure, damage to target organs, the level of blood pressure, the course, etc. Based on the etiological principle, they distinguish between: essential (primary) and secondary (symptomatic) arterial hypertension. According to the nature of the course, hypertension can have a benign (slowly progressive) or malignant (rapidly progressive) course.

The level and stability of blood pressure is of greatest practical importance. Depending on the level there are:

• Optimal blood pressure -< 120/80 мм рт. ст.
• Normal blood pressure is 120-129/84 mm Hg. Art.
• Borderline normal blood pressure - 130-139/85-89 mm Hg. Art.
• Arterial hypertension of the first degree - 140-159/90-99 mm Hg. Art.
• Arterial hypertension of the II degree - 160-179/100-109 mm Hg. Art.
• Stage III arterial hypertension - more than 180/110 mm Hg. Art.

According to the level of diastolic blood pressure, the following types of hypertension are distinguished:

• Mild course - diastolic blood pressure< 100 мм рт. ст.
• Moderate course - diastolic blood pressure from 100 to 115 mm Hg. Art.
• Severe - diastolic blood pressure > 115 mm Hg. Art.

Benign, slowly progressive hypertension, depending on target organ damage and the development of associated (concomitant) conditions, goes through three stages:

Stage I(mild and moderate hypertension) - blood pressure is unstable, fluctuating during the day from 140/90 to 160-179/95-114 mm Hg. Art., hypertensive crises occur rarely and are not severe. There are no signs of organic damage to the central nervous system and internal organs.

Stage II(severe hypertension) - blood pressure in the range of 180-209/115-124 mm Hg. Art., hypertensive crises are typical. Objectively (with physical and laboratory examination, echocardiography, electrocardiography, radiography), narrowing of the retinal arteries, microalbuminuria, increased creatinine in the blood plasma, left ventricular hypertrophy, and transient cerebral ischemia are recorded.

Stage III(very severe hypertension) - blood pressure from 200-300/125-129 mm Hg. Art. and higher, severe hypertensive crises often develop. The damaging effect of hypertension causes the phenomena of hypertensive encephalopathy, left ventricular failure, the development of thrombosis of cerebral vessels, hemorrhages and edema of the optic nerve, dissecting vascular aneurysm, nephroangiosclerosis, renal failure, etc.

Risk factors for developing hypertension

The leading role in the development of hypertension is played by disruption of the regulatory activity of the higher parts of the central nervous system, which control the functioning of internal organs, including the cardiovascular system. Therefore, the development of hypertension can be caused by frequently repeated nervous overstrain, prolonged and severe anxiety, and frequent nervous shocks. The occurrence of hypertension is facilitated by excessive stress associated with intellectual activity, night work, and exposure to vibration and noise.

A risk factor in the development of hypertension is increased salt intake, which causes arterial spasm and fluid retention. It has been proven that consuming >5 g of salt per day significantly increases the risk of developing hypertension, especially if there is a hereditary predisposition.

Heredity, aggravated by hypertension, plays a significant role in its development in close relatives (parents, sisters, brothers). The likelihood of developing hypertension increases significantly if two or more close relatives have hypertension.

Arterial hypertension in combination with diseases of the adrenal glands, thyroid gland, kidneys, diabetes mellitus, atherosclerosis, obesity, and chronic infections (tonsillitis) contribute to the development of hypertension and mutually support each other.

In women, the risk of developing hypertension increases during menopause due to hormonal imbalance and exacerbation of emotional and nervous reactions. 60% of women develop hypertension during menopause.

Age factors and gender determine an increased risk of developing hypertension in men. At the age of 20-30 years, hypertension develops in 9.4% of men, after 40 years - in 35%, and after 60-65 years - in 50%. In the age group under 40 years, hypertension is more common in men; in older age groups, the ratio changes in favor of women. This is due to a higher rate of male premature mortality in middle age from complications of hypertension, as well as menopausal changes in the female body. Currently, hypertension is increasingly being detected in people at a young and mature age.

Alcoholism and smoking, poor diet, excess weight, physical inactivity, and poor ecology are extremely conducive to the development of hypertension.

Symptoms of hypertension

The course of hypertension is varied and depends on the level of increase in blood pressure and the involvement of target organs. In the early stages, hypertension is characterized by neurotic disorders: dizziness, transient headaches (usually in the back of the head) and heaviness in the head, tinnitus, pulsation in the head, sleep disturbance, fatigue, lethargy, a feeling of weakness, palpitations, nausea.

Later, shortness of breath occurs when walking quickly, running, exercising, or climbing stairs. Blood pressure is persistently above 140-160/90-95 mmHg. (or 19-21/12 hPa). Sweating, redness of the face, chill-like tremor, numbness of the toes and hands are noted, and dull, prolonged pain in the heart area is typical. With fluid retention, swelling of the hands (“ring symptom” - it is difficult to remove the ring from the finger), swelling of the face, puffiness of the eyelids, and stiffness are observed.

In patients with hypertension, there is a veil, flickering of flies and lightning before the eyes, which is associated with vasospasm in the retina; There is a progressive decrease in vision; retinal hemorrhages can cause complete loss of vision.

Complications of hypertension

With a long-term or malignant course of hypertension, chronic damage to the blood vessels of target organs develops: the brain, kidneys, heart, eyes. Instability of blood circulation in these organs against the background of persistently elevated blood pressure can cause the development of angina pectoris, myocardial infarction, hemorrhagic or ischemic stroke, cardiac asthma, pulmonary edema, dissecting aortic aneurysm, retinal detachment, uremia. The development of acute emergency conditions against the background of hypertension requires a decrease in blood pressure in the first minutes and hours, as it can lead to the death of the patient.

The course of hypertension is often complicated by hypertensive crises - periodic short-term increases in blood pressure. The development of crises may be preceded by emotional or physical overstrain, stress, changes in meteorological conditions, etc. In a hypertensive crisis, there is a sudden rise in blood pressure, which can last several hours or days and is accompanied by dizziness, severe headaches, a feeling of heat, palpitations, vomiting, cardialgia , visual impairment.

During a hypertensive crisis, patients are frightened, excited or inhibited, and drowsy; in severe cases they may lose consciousness. Against the background of a hypertensive crisis and existing organic changes in blood vessels, myocardial infarction, acute cerebrovascular accidents, and acute left ventricular failure can often occur.

Diagnosis of hypertension

Examination of patients with suspected hypertension has the following goals: to confirm a stable increase in blood pressure, exclude secondary arterial hypertension, identify the presence and degree of damage to target organs, assess the stage of arterial hypertension and the degree of risk of complications. When collecting anamnesis, special attention is paid to the patient’s exposure to risk factors for hypertension, complaints, level of increase in blood pressure, the presence of hypertensive crises and concomitant diseases.

Dynamic measurement of blood pressure is informative for determining the presence and degree of hypertension. To obtain reliable blood pressure levels, the following conditions must be met:

• Blood pressure measurement is carried out in a comfortable, quiet environment, after 5-10 minutes of patient adaptation. It is recommended to exclude smoking, exercise, eating, tea and coffee, and the use of nasal and eye drops (sympathomimetics) 1 hour before measurement.
• The patient's position is sitting, standing or lying down, with the arm at the same level as the heart. The cuff is placed on the shoulder, 2.5 cm above the fossa of the elbow.
• At the patient's first visit, blood pressure is measured in both arms, with repeated measurements after a 1-2 minute interval. If blood pressure asymmetry is > 5 mm Hg, subsequent measurements should be carried out on the arm with higher values. In other cases, blood pressure is usually measured on the “non-working” arm.

If blood pressure readings differ from each other during repeated measurements, then the arithmetic mean is taken as the true one (excluding the minimum and maximum blood pressure readings). In case of hypertension, self-monitoring of blood pressure at home is extremely important.

Laboratory tests include clinical blood and urine tests, biochemical determination of the level of potassium, glucose, creatinine, total blood cholesterol, triglycerides, urine analysis according to Zimnitsky and Nechiporenko, Rehberg test.

On electrocardiography in 12 leads in hypertension, left ventricular hypertrophy is determined. ECG data is clarified by echocardiography. Ophthalmoscopy with fundus examination reveals the degree of hypertensive angioretinopathy. An ultrasound scan of the heart determines enlargement of the left chambers of the heart. To determine target organ damage, abdominal ultrasound, EEG, urography, aortography, CT scan of the kidneys and adrenal glands are performed.

Treatment of hypertension

When treating hypertension, it is important not only to lower blood pressure, but also to correct and reduce the risk of complications as much as possible. It is impossible to completely cure hypertension, but it is quite possible to stop its development and reduce the frequency of crises.

Hypertension requires the combined efforts of the patient and the doctor to achieve a common goal. At any stage of hypertension it is necessary:

• Follow a diet with increased consumption of potassium and magnesium, limiting the consumption of table salt;
• Stop or sharply limit alcohol intake and smoking;
• Get rid of excess weight;
• Increase physical activity: it is useful to engage in swimming, physical therapy, and walking;
• Take prescribed medications systematically and for a long time under the control of blood pressure and dynamic supervision of a cardiologist.

For hypertension, antihypertensive drugs are prescribed that depress vasomotor activity and inhibit the synthesis of norepinephrine, diuretics, β-blockers, antiplatelet agents, hypolipidemic and hypoglycemic drugs, and sedatives. The selection of drug therapy is carried out strictly individually, taking into account the entire range of risk factors, blood pressure levels, the presence of concomitant diseases and target organ damage.

The criteria for the effectiveness of treatment of hypertension is the achievement of:

• short-term goals: maximum reduction in blood pressure to a level of good tolerance;
• medium-term goals: preventing the development or progression of changes in target organs;
• long-term goals: prevention of cardiovascular and other complications and prolongation of the patient’s life.

Prognosis for hypertension

The long-term consequences of hypertension are determined by the stage and nature (benign or malignant) of the disease. Severe course, rapid progression of hypertension, stage III hypertension with severe vascular damage significantly increases the frequency of vascular complications and worsens the prognosis.

With hypertension, the risk of myocardial infarction, stroke, heart failure and premature death is extremely high. Hypertension has an unfavorable course in people who become ill at a young age. Early, systematic therapy and blood pressure control can slow the progression of hypertension.

Prevention of hypertension

For primary prevention of hypertension, it is necessary to exclude existing risk factors. Moderate physical activity, a low-salt and low-cholesterol diet, psychological relief, and giving up bad habits are useful. It is important to early identify hypertension through monitoring and self-monitoring of blood pressure, follow-up of patients, adherence to individual antihypertensive therapy and maintenance of optimal blood pressure levels.