According to data published by WHO since 1998, about a quarter of the entire adult population suffers from ailments associated with high blood pressure. At the age of over 40, the incidence rate is even higher, that is, about 50%. It depends on risk factors and nutritional characteristics of people living in a particular geographical area. However, all cases of pathology are usually divided into two classes: primary and secondary hypertension.
General Information About Hypertension
Primary is essential hypertension. What it is? A disease whose immediate cause is associated with a genetic predisposition activated by a number of risk factors. So, essential hypertension is a pathology, the development of which has already been laid down since birth. Moreover, the probability of its manifestation depends on risk factors, more precisely, on their combination.
For comparison: primary hypertension (essential hypertension) occurs in 90% of all cases. Secondary hypertension is less common: in 10% of cases. It is more often associated with hormonal disorders, in which an increase in pressure is only a symptom. In diseases of the adrenal gland, hypothalamus and pituitary gland, thyroid gland associated with their hyperfunction, it is secondary hypertension that develops, which depends little on the available risk factors.
Genetic background of hypertension
Regulation of blood pressure is a complex humoral process associated with the effect of hormones and enzymes. The development of the latter depends on the function of the organs responsible for it. According to the principle of positive or negative feedback, the amount of mediator or enzyme increases, which activates the process of increasing blood pressure. In the body, this mechanism is aimed at enhancing adaptive reactions in response to stressful effects.
All mechanisms of the stress response to the stimulus are genetically incorporated. With the appearance of defects in structural genes that regulate the functioning of the pressor and depressor vascular systems, prerequisites for the occurrence of the disease arise. However, specific mechanisms of chromosomal changes in genes leading to the appearance of defects have not yet been identified. Although such modifications are inherited. And the following genetic defects and abnormalities are most often detected:
- variations in the structure of the genes responsible for the synthesis of angiotensinogen;
- changes in structural genes encoding the expression of angiotensin II receptors;
- disturbances and anomalies in the structure of the genes of the angiotensin converting enzyme complex;
- changes in the structure of genes responsible for the structure and amount of synthesized renin;
- aldosterone synthase gene variations;
- genetically determined changes in the structural proteins of the beta subunits of the amiloride-sensitive sodium channel in the renal tubules.
With a disease such as essential arterial hypertension, the symptoms of the disease appear only during periods of exacerbation. Initially, the course of the pathology is almost imperceptible. At the same time, the hypothesis was proved and statistically verified that representatives of the Negroid race more often than others suffer from hypertension. The reason for this is a defect in endothelial factors that realize the depressant effect in arterioles and capillaries.
Hypertension Risk Factor Digest
With a disease such as essential hypertension, symptoms, causes and treatment depend on the identified risk factors. If the observed person has a genetic predisposition to hypertension, then the disease itself will not necessarily appear. It depends on specific reasons. The higher their number, the more likely the manifestation of the disease. And the most important factors are the following:
- weight gain (with a BMI of more than 25);
- smoking and systematic consumption of alcohol;
- increased consumption of salt with salted products;
- low physical activity, lack of motor mode;
- the presence of concomitant metabolic syndrome (diabetes, gout, atherosclerosis);
- frequent psycho-emotional stress.
Combination of risk factors
A genetic predisposition for the development of the disease is not enough. Often, even the presence of one of the risk factors does not lead to a clinically significant increase in pressure. However, their combination significantly increases the likelihood of pathology. The same determines the treatment of the disease: essential hypertension is much more difficult to treat in the presence of a large number of risk factors. When there are fewer, treatment is much more successful, and target levels are achieved with fewer drugs.
The most common factors associated with malnutrition and obesity, smoking, alcohol consumption and low physical activity. Moreover, an unmodifiable factor here is only a genetic predisposition. All others can be changed. For this, diet, physical education, refusal of addictions are used. These methods of modifying risk factors comprise the entire spectrum of possible measures used to treat grade I hypertension.
Symptomatic characteristic of hypertension
Regardless of the prevailing opinion of most patients, not so many symptoms manifest essential hypertension. What it is? And all of the above means that initially the disease may not manifest itself clinically. Patients with existing hypertension will not feel an increase in pressure, although its values can increase by 20 or more percent from the initial one. And if systolic pressure rises to 140 or more units, and diastolic pressure - to 90 and above, then the diagnosis is already competent.
Stage Symptoms of Hypertension
In the first degree of hypertension, the symptomatic characteristic is scanty. There may be no clinical signs, although the patient is sometimes disturbed by redness of the cheeks and a sensation of warmth in the face. Sometimes patients complain of fever in the ears, sweating. Of course, it is unreasonable to consult a specialist only on the basis of these clinical signs.
In the second degree, essential hypertension (ICD 10 code I10) is manifested by a slightly larger number of clinical signs. Headaches can be disturbing: they are of a pressing nature and are felt in the back of the head and parietal parts of the head. Patients are concerned about the darkening in the eyes and the "flashing of flies." Often, such signs appear after physical exertion associated with lifting or carrying heavy objects. Moreover, the II degree of the disease is characterized by an increase in SBP within 160-179, and diastolic - 100-109 mmHg.
III degree of the disease essential hypertension: what is it? A persistent increase in pressure above 180 for systolic and above 110 for diastolic. At this stage, the increase in pressure is almost always determined clinically, and it is the same as in the first two degrees. But the treatment here is much more complicated and should include two or more classes of drugs with the use of symptomatic drugs.
Modern treatment principles
With a disease such as essential hypertension, treatment of the cause that directly caused the onset of pathology is an unjustified measure. The disease developed due to a genetic predisposition, that is, due to a factor that cannot be influenced. Therefore, it is important to reduce the significance of other factors, while using the means of symptomatic treatment.
Today there are 7 classes of drugs that treat essential hypertension: what is it from the perspective of evidence-based medicine? This means that therapy should be approached systemically, that is, apply combined treatment. The first classes are ACE blockers and angiotensin receptors. Using one of the drugs of this class, a decrease in pressure is achieved.
But often, even with a maximum daily dose, essential hypertension is poorly controlled. Methods for identifying and treating such conditions, however, are already in place. They are the need for independent control of pressure. If its indicator rises above 140 against the background of treatment, then another class of drugs is required. In the same way, symptomatic treatment is carried out, for example, when a decrease in heart rate, increased diuresis, or the use of calcium channel blockers are required. Consult a physician for all such questions.