Essential arterial hypertension is a chronic type of pathology. Morphological changes against 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 pressure indicators. The diagnosis is made on the basis of the exclusion of all other forms of the disease. Essential hypertension is fixed from the moment of depressive renal function decline. First of all, morphological changes spread to the heart and blood vessels.
Norm Option
In a healthy state, pressure is formed against a background of contraction in the left ventricle. In this case, the blood flow is ejected into the aorta, and then goes into the 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 arterioles (the smallest channels) is also of importance. Hypertension is an increase in the arterial vessels of a large circle of hydrostatic pressure. Normally, indicators can fluctuate in accordance with the state of the person. So, during sleep, they decrease, and with psychoemotional or physical activity increase. However, as a rule, the pressure returns to normal - from 100/60 to 140/90. If the indicators are higher than those stated, then hypertension is noted. The reasons why essential arterial hypertension occurs are different.
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 with pathology, certain characteristic relationships are found. For example, essential hypertension occurs only in those groups where the level of salt intake exceeds 5.8 g / day. Experts say that in fact, such excessive intake can become a significant risk factor. The elderly, people with renal failure, and obesity are especially prone to the development of hypertension. There is also a genetic factor.
Diabetes
First of all, when diagnosing, the medical history matters. Essential hypertension is often associated with diabetes. In the pancreas, there are cells of islets of Langerhans. The hormone insulin is produced in them. It controls the concentration of glucose, contributes to its transition into structural elements. Along with this, insulin also has some vasodilating effect. Normally, the hormone can stimulate sympathetic activity. In this case, blood pressure does not change. But in severe cases, for example, against the background of diabetes mellitus, sympathetic stimulating activity may prevail over the vasodilating effect.
Genetic factor
Experts consider it one of the main in the development of pathology. However, genes responsible for the occurrence of hypertension were not detected. Today, researchers are working on the study of factors affecting the renin-angiotensin system. She is involved in the synthesis of a biologically active compound - renin - which increases pressure. This system is located in the kidneys. Essential hypertension in approximately 30% of cases is caused by genetic factors. For example, the incidence is higher among African Americans than among Europeans or Asians. In addition, those with one or both parents suffering from hypertension are more prone to developing pathology. In rare cases, essential hypertension is the result of a genetic disease on the part of the adrenal glands.
Vascular pathology
Many patients with hypertension have high resistance (decreased elasticity) of arterioles. These vessels pass into the capillaries. With loss of elasticity, pressure begins to rise. The reason for this violation from the side of arterioles is not completely clear. However, it was found that a decrease in vascular elasticity is characteristic of individuals with hypertension due to genetic factors, aging, excessive salt intake, and inactivity. A certain role in the development of pathology belongs to inflammatory processes. In this regard, the identification of a C-reactive protein compound in the blood can act as a prognostic factor.
Obesity
This is another significant factor for the occurrence of essential hypertension. With overweight, the likelihood of pathology is 5 times higher. For example, in the United States, about two-thirds of all cases of hypertension are associated with obesity. In more than 85% of patients, the mass index exceeds 25.
Sodium
This compound is also essential in the development of hypertension. In approximately one third of all cases, hypertension is associated with excessive sodium intake. The development of the disease is based on the ability of the compound to retain water. With an excessive content in the bloodstream, the 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 levels of renin. For example, reduced compound levels are common in African Americans. In this regard, diuretics are considered more effective in therapy.
Other factors
It is established that the development of hypertension is significantly affected by snoring. A fairly common and significant provoking factor is age. Over the years, an increase in the number of collagen fibers is found in the vascular walls. Because of this, their thickening and loss of elasticity, decrease in clearance occurs.
Clinical picture
How is essential hypertension manifested ? Symptoms of pathology are often absent. For a long time, only increased pressure acts as the only specific manifestation. There are boundary values in accordance with which a diagnosis is made. So, for the "upper" (systolic) pressure it 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.
- Heart palpitations.
- Double vision.
- Tinnitus.
The intensity of the manifestation 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. As the "targets" are the heart, kidneys, brain.
Pathology stages
In a mild course, the condition is characterized by a periodic increase in pressure (diastolic - more than 95). In this case, stabilization is possible without the use of medications. The average severity of the pathology is characterized by a steady increase in pressure (diastolic - in the range of 105-114). At this stage, expansion of venules, narrowing of arterioles, hemorrhage of the fundus without any other diseases can be detected. The severe stage is characterized by a steady increase in pressure (diastolic - more than 115). Stabilization of the state does not occur even after a 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 the internal organs are also detected.
Accompanying illnesses
Hypertension may be accompanied by:
- Diabetic nephropathy.
- Angina pectoris.
- Heart attack.
- Revascularization of the coronary arteries.
- Transient disorders in cerebral circulation.
- Hemorrhagic and ischemic strokes.
- Swelling in the optic nerve.
- Hemorrhage or exudate.
- Severe retinopathy.
- Exfoliating aneurysm.
- Renal and congestive heart failure.
Diagnostics
It is based on an assessment of pressure indicators. To clarify the diagnosis, at least three independent measurements are necessary. In this case, a mercury tonometer and the Korotkov method are used. Diagnosis of secondary forms of pathology and determining the degree of damage to organs is performed using additional studies. In particular, the patient is prescribed specific and general tests of urine and blood, ultrasound of the internal organs and heart, various tests, ECG and so on.
Daily monitoring
When using this research method, an automatic blood pressure monitor is put on the patient, which records the level of blood pressure during the day. The interval between measurements is usually 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. Such 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 of stabilization. The choice will depend on the nature of the course of the pathology. So, essential and renovascular arterial hypertension have differences in the intensity of manifestations. First of all, therapeutic measures should be aimed at stabilizing the pressure. Along with this, it is necessary to adjust all risk factors. The patient needs to give up smoking and other bad habits, review the diet, normalize weight. For those patients who have been diagnosed with essential arterial hypertension, treatment should also be aimed at eliminating concomitant pathologies: diabetes mellitus and others. Particular attention should be paid to physical activity, wakefulness and sleep patterns. In the menu, the amount of salt and animal fats should be reduced. At the same time, the diet should contain plant foods, dairy products, cereals, fruits and vegetables. Together with these products, microelements and other useful compounds and vitamins will enter the body.
Drug exposure
It should be noted here that essential hypertension is quite easy to eliminate. Today, seven classes of drugs are recommended in Russia. Renovascular hypertension (secondary) is poorly eliminated. In this case, therapy is aimed primarily at combating the underlying pathology. Among the drugs prescribed for the disease, the following are distinguished:
- Diuretics (diuretic medicines). They help remove excess fluid from the body. These include funds "Furosemide", "Hypothiazide" and others.
- Beta and adrenergic blockers. The latter are used only for concomitant pathologies. Beta-blockers include Nadolol, Acebutolol.
- Calcium antagonists. Along with this, the additional magnesium intake in the diet can also be considered as a calcium antagonist.
- ACE inhibitors.
- Imidosaline receptor agonists.
- Antagonists of angiotensin receptors (means "Losartan").
The selection of medicines is carried out by a doctor.