Hypertension - this concept pathophysiological and clinical nature that combines state associated prolonged elevation of pressure in the arteries of the BPC (the systemic circulation).Most characteristic of blood pressure is considered to be the rise in diastolic blood pressure, but basically there is an increase in systolic blood pressure higher than normal.
Generally, the term "hypertension" refers to the pressure of blood vessels and heart cavities.And the criteria for "normal" and "high" pressure to some extent considered provisional.The establishment of these indicators is based on the specific results of the diagnostic survey a large number of the population and the ratio of blood pressure with the risk of kidney, brain and heart complications and premature death.Thus, in adults, hypertension is considered persistent rise in blood pressure above one hundred and forty to ninety.If systolic pressure is less than the mm Hg.Art.from 130 to 139-ti-ti and diastolic - from 80 t
higher pressures on etiological grounds classified into such forms of hypertension as Essential (primary) and symptomatic (secondary).About 90% of cases occur in essential form, which is characterized by increased blood pressure of unknown etiology.Also, this is a form of mild, moderate, severe or quite severe, with an easy to hypertension account for nearly 80%.Furthermore, all of these forms may take the form of primary benign and malignant hypertension.And the latter is characterized by acute development of damage to the vessel walls with manifestations of severe retinopathy and poor kidney function as a result of sharp ups and persistent blood pressure, regardless of its performance.Thus the diastolic pressure is usually higher than one hundred and thirty-one hundred and forty mm Hg.Art.Basically malignant course of the pathological process is observed from the beginning of the formation of the disease.Less so the course is characterized by persistent benign hypertension, which has not been treated.
Depending on pathogenesis distinguish pressurization of blood ejection, which is associated with increased and MOS ONU;hypertension as a result of increased resistance arteriolar tone and hypervolemic shape as a result of polycythemia.
Basically today the cause of this disease (essential form), which accounts for about 95%, is not established yet.
Classic etiopathogenesis of this pathology includes several theories on the origin of hypertension.Among them are neurogenic theory, where the main role in the development of the pathological process is given the central nervous system.As a result of prolonged trauma and negative emotions surge higher nature nerve endings form a characteristic disease regulation.This causes dysfunction of pressure regulators in the brain and in the center of the hypothalamus due to increased sympathetic vasoconstrictive impulses along nerve fibers, and improve the tone in the vessels.And for all of these actions, you must have a hereditary predisposition.
According to the volume-salt theory as primary renal excretory function is disrupted due to a delay in the body of sodium and water, there is an increase ISO and CGO.A local mechanisms of self-regulation of blood flow in response to high blood pressure, called myogenic arteriolar narrowing, which contributes to the normalization of the ISO, thereby increasing the pressure.In addition, excessive intake of salt is a characteristic factor of hypertension.
also at the origin of essential hypertension is hyperactivation of sympathetic-adrenal system, which causes an increase in heart with increased ISO and peripheral vazokonstrikatsii.The possible etiologic factors of the disease include high stress, genetic disorder of higher nervous activity of regulators of blood pressure and age restructuring of neuroendocrine origin involution sex glands, as well as increased activity of the adrenal glands.In addition, enhanced adrenergic stimulation has a significant role in causing high blood pressure.
But the causes of symptomatic hypertension are renal lesions as a result of glomerulonephritis;renal artery stenosis;coarctation of the aorta;foehromotsitomy;hyperaldosteronism;increased thyroid function;consumption of more than sixty milliliters per day of ethyl alcohol;Admission drugs such as antidepressants, oral contraceptives, cocaine and others.
As a rule, before the advent of various complications, hypertension often occurs without any symptoms, but only its manifestation is the increase in blood pressure.At the same time, patients hardly complain, or they are non-specific, however, periodically observed headache at the back or the forehead can sometimes feel dizzy and make noise in the ears.
Hypertension is a disease which is characterized by certain specifics.In this case, a long time, patients can not even guess at the presence of the disease do not experience any symptoms and live a habitual way of life for them, even though they sometimes marked dizziness and general weakness.However, most people attributed this to fatigue, but at this moment it is necessary to pay attention to the appearance of the first signs of this disease and it is desirable to measure blood pressure.
Usually, the first complaint of patients appear after organ damage, since they are the most sensitive to the upsurge of blood pressure.In this case, the first stages of circulatory disorders in the blood vessels of the brain in patients develop whirling head with characteristic pain and noise.Also, such a patient is disturbed memory, and it can not run.In the future, there is a feeling of numbness of limbs, general weakness, flickering flies and double vision, patients begin to speak with difficulty.All symptoms is generally characteristic of the later stages of the development of hypertension, and in the early stages of the disease is marked transient nature of the disease process.Moreover, in the last stages of developing complications such as hemorrhage or cerebral infarction.
Symptoms of heart disease characterized by an increase in LV due to a compensatory reaction aimed at stabilizing the high voltage of the wall as a result of increased afterload, heart failure and coronary artery disease.The process of enlargement or hypertrophy of the left ventricle due to the growth of its mass due to thickening of the cardiomyocytes.In the beginning, there is a thickening of the walls of the left ventricle, and further marked expansion even cardiac chambers.This change of heart is characterized by a poor prognosis, as the causes of heart failure, sudden death, coronary heart disease and the development of ventricular dysfunction.
During the progression of disorders of the left ventricle patients start shortness of breath when performing physical activities, developing cardiac asthma and pulmonary edema as a result of hypertensive crisis, and congestive heart failure.So often these symptoms lead to ventricular fibrillation and myocardial infarction, as a result of atherosclerosis can occur rupture or dissection after its expansion.
in renal lesions protein appears in the urine, as well as watch and microhematuria cylindruria.Infrequently with hypertension develop renal failure.
Occasionally manifestation of this disease is the loss of vision in the form of reduced light sensitivity and sometimes even blindness.Therefore, one should not underestimate hypertension, as it is characterized by severe consequences, which may cause the patient's death.
One symptom of this disease is considered to be a characteristic headache, occurring at any time of the day or night with a big advantage in the morning after awakening or at night.Headache as bursting and localized gravity mainly at the back with further spread to other areas of the head.When hypertension headache is enhanced by a cough, as well as after the inclinations of the head, which is accompanied by puffiness of eyelids and face a whole.But after a massage, certain muscle movements and upright patients improves blood flow in the veins, which in turn reduces the pain, until its absolute disappearance.
In some cases, headache against a background of high blood pressure may occur as a consequence of intense soft muscles of the head or tendons.The occurrence of this pain can occur after the psycho-emotional or physical stress, and its decision is due to the cessation of conflicts in the family, at work or at rest.Basically, this pain is characterized by stress, resulting in squeezed or contracted head, the patient begins to feel sick, and he strongly dizzy.As a result, long-term pain continuing character, patients become irritable, quick-tempered, they have increased sensitivity to noise and loud sounds of music.
Against hypertension appear specific nature of pain in the heart, which mostly occur at absolute rest or after emotional stress without physical exertion.A typical manifestation of these chest pain is their nekupirovanie using nitroglycerin and long-term follow-up.
symptomatic picture of the disease in some patients, the sum of the signs of the emergence of shortness of breath at the beginning of the pathological process after minor loads, and then in a state of complete rest.All this testifies to the characteristic changes of the heart muscle and heart failure.In the presence of this disease in many patients with swollen lower limbs, due to the delay of sodium and water in the body on the background of hypertension after taking certain medications, or renal impairment.
a result of visual impairment, due to increased blood pressure in patients with marked appearance of flies before his eyes, a mist or veil.This is due to functional disorders of blood circulation in the retina of the eye.And against the backdrop of hemorrhage, retinal detachment, vascular thrombosis developed complications such as diplopia, blurred vision, or loss of its absolute.
stages of hypertension
This pathological process is characterized by consistently high blood pressure systolic and / or diastolic blood pressure.In primary (essential) form of the disease is marked increase in pressure with no obvious reasons for its occurrence.In secondary (symptomatic) - there is the rise of blood pressure with the ability to identify the cause of this increase.
To set the stage of the pathological process used classification, which depends on the target organ damage.Thus, there are three stages of hypertension.
At the first stage, there are no objective symptoms of disorders of the target organs.
The second stage is characterized by objective evidence of changes in target organs without symptoms on their part, or of any violation.It may be left ventricular hypertrophy on the basis of results of research by radiography, electrocardiogram and echocardiogram;retinal artery narrowing generalized or focal character;a slight increase in serum creatinine, or microalbuminuria.
For the third stage is characterized by an objective organ damage with certain symptoms and violations of their functions.
♦ When (transient) stage 1 hypertension celebrated periodical pressure rise associated with spasm of the arterioles.At this point, the vessel wall is not getting enough oxygen, so oxygen starvation occurs and begins their degenerative changes.Later replaced by a spasm of arterioles paralysis where hypoxia is preserved vascular walls.That is why the arterioles may become permeable, and they formed plasmorrhages that extends beyond the walls of blood vessels, which causes perivascular edema.After normalization of blood pressure, and restoration of microcirculation, blood from the walls of the arteries and perivascular spaces gradually removed.But after the increase of physical activity with multiple repetition, there is a compensatory hypertrophy of the left ventricle.Begins hypertension can pause in its development and progression by eliminating the psychological and emotional stress, as well as timely and adequate use of medical treatment.
♦ Stage 2 hypertension is characterized by significant impairment of the arteries to the persistent rise in blood pressure.Typically, this is due to the profound changes in the regulation of the cardiovascular system and its disorders.In this transitional stage in its transition to a stable or second stage of the disease due to the action of neuroendocrine mechanisms.In this case very often elevated pressure and reduced sensitivity pressosensitive which is on the aorta.In addition, permanent vascular spasm, plasmorrhages and the increasing weight of the protein in the vessel walls, leading to arteriolosclerosis or Hyalinosis.This, above all, causes the seal of the vessel walls, resulting in reduced flexibility and their gradual thickening, while contributing to the narrowing of the arterioles.As a result, high levels of blood pressure is constantly on the background of the pathogenesis of increased load on the heart and developing compensatory hypertrophy of the left ventricle.
♦ Stage 3 hypertension is characterized by disruption of bodies as a result of damaged and changed in their arteries.In this case there is a change of secondary character.
In 2003, adopted the modern classification of degrees of risk of hypertension.Therefore, today there are three degrees of the flow of the pathological process with different indices of blood pressure.As a rule, the norm is the systolic blood pressure in mm Hg.Art.from 120 to 129, and the diastolic - from 80 to 84.
Thus, an easy distinction (1) the degree of hypertension, in which blood pressure is recorded in the range of 140/90 to 160/100 mm Hg.Article .;moderate (2) degree - from 160/100 to 180/110 mm Hg.Article .;heavy (3) the degree - above 180/110 mm Hg.Art.
Today severity of hypertension is in direct proportion to the risk factors.Risk - the development of cardiovascular complications on the background of increasing blood pressure.And according to these complications are diagnosed and forecasting of the effects of hypertension.
risk factors that aggravate the disease and its prognosis are: age category (men over fifty years old, and women after sixty years);abuse of nicotine;increased rate of cholesterol;genetic predisposition, as well as obesity, lack of exercise, high-risk ethnic and socioeconomic nature, diabetes.
As a rule, these factors may be modifiable (can be removed) and nekorrigiruemymi.The first group includes diabetes, lack of exercise, high cholesterol levels, smoking.Art.