Pathophysiology
Any long-term rise in blood pressure above the upper limit of normal vibrations (hypertension) may be the cause of diseases and pathological conditions of the heart and blood vessels. It is known that the probability of developing coronary heart disease, latent or overt cardiac and renal failure, and cerebrovascular events in adults with diastolic blood pressure (BP) greater than 90 mm Hg. two times higher than in diastolic blood pressure below 80 mm Hg. Hypertension is a pathological condition of the body's adult due to prolonged elevation of systolic blood pressure above 140 mm Hg. and diastolic blood pressure above 90 mm Hg. If diastolic blood pressure below 90 mm Hg., and systolic blood pressure above 160 mm Hg., then such hypertension is defined as isolated systolic hypertension. For a long time, the increase in total peripheral vascular resistance (SVR), considered the leading pathogenesis of primary hypertension (essential hypertension, hypertension) in the vast majority of patients. In this context, the rise in diastolic blood pressure that is in direct connection with the round, recognized more adverse than the increase in systolic blood pressure. Therefore, the severity of hypertension was evaluated, focusing on the level of diastolic blood pressure. In recent decades was a significant positive correlation of high systolic blood pressure with the risk of complications of hypertension and related diseases. Isolated systolic hypertension in patients 65 years and most often leads to dangerous complications and diseases, where there is currently no effective method for its correction. Therefore, the severity of hypertension is determined in accordance with the findings of both systolic and diastolic blood pressure. When hypertension in the stage pre-disease pharmacotherapy is not used in an effort to eliminate rational hypertension increased physical activity, diet, therapy and recreation. Most clinicians and researchers agree that the pharmacological correction of hypertension should start with a steady rise in diastolic blood pressure above 95 mm Hg. The reason for the long and steady rise in blood pressure above the upper limit of the range of normal fluctuations in 95% of patients aged 18 to 65 usually is not quite clear. These patients are considered suffering from hypertension, i.e. primary or essential (lat. Essentia - essence) arterial hypertension (AH). In essential hypertension long and pathological rise in blood pressure is a primary care pathogenesis, its very essence, and not a consequence of any other disease. Secondary hypertension is a consequence of disease and n ontological states quite clear etiology and pathogenesis. Among all: cases of hypertension following fixed frequency types of secondary hypertension (Cheriyan, J, 2010):
♦ AH as a result of renal parenchymal disease - 3-4%;
♦ renal vascular hypertension - 0.5-1%;
♦ hypertension associated with hyperactivity of the adrenal glands (pheochromocytoma, primary aldosteronism, and Cushing's syndrome) - 0.1-0.3%;
♦ secondary hypertension due to other reasons - 0.1-0.3%.
♦ severe and very severe hypertension is often secondary to kidney disease.
In 33% of these patients reveal a renal vasculature (renovascular) hypertension. In 5% of women are constantly taking contraceptives containing estrogen, after 5 years from the beginning of their use becomes higher diastolic blood pressure of 90 mm Hg. The pathogenesis of this secondary hypertension is unclear. It is believed that estrogens accelerate the implementation of the genetic susceptibility to primary hypertension and renal dysfunction exacerbated hidden that cause secondary hypertension. If hypertension develops in prepubertal children, her cause disease with abnormal renal parenchymal or renovascular it is. In post-pubertal children hypertension in most cases the primary, but the frequency of secondary hypertension in this period of ontogenesis is still higher than that of adults.
Risk Factors
According to Cheriyan, J. (2010), there are a number of conditions that affect the appearance and development of high blood pressure. About sixty percent of adults have certain risk factors hypertension, and half of them are present more than one factor, whereby a total risk of the disease is greatly increased.
Heredity
Arterial hypertension in first-degree relatives (father, mother, grandparents, brothers or sisters) is significantly increased likelihood of developing the disease. The risk increases even more if the high blood pressure had two or more relatives.
Gender
Men are more likely to develop hypertension, particularly in the age of 35-50 years. However, after menopause, the risk is greatly increased and women.
Age
High blood pressure most often occurs in people older than 35 years, and the older people, those tend to be higher numbers of his blood pressure.
Stress and mental strain
Stress hormone adrenaline causes the heart to beat faster, pumping more blood volume per unit of time, whereby the pressure increases. If stress continues for a long time, constant load wears out vessels and increased blood pressure becomes chronic.
Alcohol consumption
This is one of the main causes of high blood pressure. Daily consumption of alcoholic beverages increases the pressure by 5-6 mm. Hg per year.
Atherosclerosis
Excess cholesterol leads to loss of elasticity of the arteries, and atherosclerotic plaque narrowing the lumen of blood vessels, which complicates the work of the heart. All this leads to an increase in blood pressure. However, hypertension and, in turn, boosts the development of atherosclerosis, since these diseases are risk factors for each other.
Smoking
The components of tobacco smoke, getting into the blood to cause vasospasm. Not only nicotine and other substances contained in tobacco contribute to mechanical damage to artery walls, which predispose to the formation of the atherosclerotic plaque site.
Excess sodium food
Modern man consumes food much more salt than necessary his body. Excess salt in an organism often leads to a spasm of arteries, fluid retention and, as a consequence, the development of hypertension.
Physical inactivity
People living a sedentary lifestyle have 20-50% higher risk of hypertension than those who are active in sports or physical labor. Untrained heart worse handle the load, and the metabolism is slower. In addition, physical activity helps to cope with stress, lack of exercise while weakens the nervous system and the whole organism.
Obesity
People who are overweight have a higher than the thin, blood pressure. This is not surprising, as obesity is often associated with other listed factors - an abundance of animal fats in the diet (which causes atherosclerosis), salty foods, and low physical activity. It is estimated that each kilogram of extra weight means an increase in pressure of 2 mm. Hg.
Signs and Symptoms
Obvious signs of hypertension are (Williams, H., 2015):
a headache that does not have a clear link with the time of day, can occur at night or early in the morning after waking up. As a rule, it is the feeling of "wrap" of gravity or fullness in the head. Sometimes the pain is enhanced by a strong cough, bent his head straining, may be accompanied by slight swelling of the eyelids, face;
pain in the heart, which occur at rest or under emotional stress;
impaired vision in which there is fog, a veil, "flies" before the eyes;
noise in ears.
In patients with hypertension sometimes happens hypertensive crisis - an emergency condition caused by the excessive rise in blood pressure, which is fraught with serious, sometimes life-threatening changes in organs and systems (brain, heart, kidneys, etc.).
Hypertensive crisis may provoke stress, physical activity, as well as discontinuation of antihypertensive medications. Hypertensive crisis is characterized by a sudden onset. During the attack, a person may experience:
severe headache;
blurred vision (up to a partial loss of visual fields);
nausea, sometimes vomiting;
redness of the skin and mucous membranes of the person;
sometimes squeezing chest pain;
shortness of breath;
sometimes cramps.
Diagnostics
Diagnosis of hypertension is largely facilitated if the patient has information about cases of hypertensive disease in the family. Are the most important information about high blood pressure (hypertension) in several close relatives, especially first-degree relatives (parents, siblings). This means that the patient has a genetic predisposition to hypertension. In this case, he must pay particularly close attention to the state of his health, even if at the moment the diagnosis is not confirmed that, in principle, the data on this family disease as hypertension are strong confirmation of the diagnosis of hypertension (Williams, H., 2015).
Finally, for the diagnosis of hypertension is set phasic arterial hypertension. In most cases, patients with hypertension are two or all three stages of the disease. In the case of essential hypertension high blood pressure occurs in a young, sometimes even adolescence, and the disease progresses gradually. Of course, the staging of hypertension can be traced only in the evaluation of long-term dynamics of the disease. It is impossible, however, to say that the so-called malignant form of hypertension can develop very quickly, in just a few days, but this form is rare.
The main symptom of hypertension is permanently high blood pressure, so the correct diagnosis requires regular measurement of pressure in the patient (Revisions for Diagnosis, Pathology and Management of Hypertension, 2015).
The traditional method of measuring blood pressure using a sphygmomanometer is a fairly simple procedure. The cuff, which is wrapped arm above the elbow, when inflated pinched arterial vessels. Because the cuff is slowly starting to bleed, and when the systolic pressure in the brachial artery slightly exceeds the pressure in the cuff, a portion of the blood breaks through the clamping area. The pressure in the cuff at this point is assumed to be the systolic (upper). The sound of the blood hits the wall of the artery below the clamping space, clearly audible through a stethoscope. Arterial hypertension is diagnosed when blood pressure is 140/90 mm Hg and higher.
Treatment
The goal of treatment of hypertension is to reduce the risk of organ damage (heart, brain, kidneys), because these bodies suffer from high blood pressure in the first place, even if subjectively have no discomfort.
General principles of treatment of hypertension are as follows:
Mild disease using non-drug methods:
limit salt intake to 5g / day,
weight normalization when excess
moderate exercise 3-5 times a week (walking, jogging, swimming, physiotherapy)
smoking cessation,
the use of herbal sedatives at increased emotional excitability (for example, a decoction of valerian).
In the absence of the effect of the above methods, go to take medications.
It should be noted that currently in pharmacies a wide range of different drugs for treatment of hypertension, both new and known for many years. Under different trade names can be produced drugs with the same active ingredient. Layman to understand them is difficult, but, despite the abundance of drugs, they can identify the main groups, depending on the mechanism of action: Diuretics, ACE inhibitors, beta-blockers, calcium antagonists.
References
Cheriyan, J., & McEniery, C. (2010). Hypertension. Oxford: Oxford University Press.
Revisions for Diagnosis, Pathology and Management of Hypertension | almostadoctor. (n.d.). Retrieved July 1, 2015.
Williams, H. (2015, February 11). Hypertension: Pathophysiology and diagnosis. Retrieved July 1, 2015.
