Hypertension (hypertension) is a disease characterized by an increase in blood pressure (for middle-aged people, the maximum is over 140 mm Hg., The minimum is over 90 mm Hg.).
Etiology. The occurrence of hypertension is associated with prolonged nervous overstrain, anxiety, mental trauma. Hypertension more often occurs in people of mental labor and those whose work involves significant nervous tension. The basis of hypertension is a violation of the functional state of the central nervous system and other systems (endocrine, etc.) that affect the regulation of vascular tone. This leads to a change in vascular tone, spasm of the small arteries and an increase in blood pressure. The prolonged spastic condition of arterioles contributes to the development of their sclerosis, which makes hypertension more resistant and leads to malnutrition of tissues and organs.Go
The clinical picture of hypertension depends on the stage and form of the disease. There are three stages of hypertension: I - initial, or transient, characterized by non-constant, short-term increase in blood pressure, which in normal conditions quickly normalizes; II - stable, during which the increase in blood pressure becomes more constant, and III - sclerotic, when prolonged hypertension is complicated by the development of marked changes in the vessels (arteriosclerosis) and in the organs supplied by them. According to the primary lesion of the heart, brain or kidney vessels, there are three forms of hypertension - cardiac, cerebral, and renal . There is also a rapidly progressive, or malignant, variant of the course of hypertension. At the onset of the disease, the patient’s well-being may remain satisfactory, but often, especially due to anxiety and overwork, headaches, heaviness in the head , dizziness , feeling of flushes to the head, insomnia , palpitations . With the transition of hypertension in stage II, these symptoms intensify and become more permanent; in stage III, symptoms of pronounced damage to the heart, brain and kidneys are added to them, depending on the form of hypertension.
In the study of patients with hypertension in addition to increasing blood pressure, find a hard, intense pulse , hypertrophy of the left ventricle of the heart (the left border of the heart is shifted to the left, the apical impulse is enhanced); the degree of hypertrophy depends on the severity and duration of the disease. During auscultation of the aorta, the accent of the second tone is heard. With severe hypertension, vision is significantly reduced; in the study of the fundus of the eye find changes in blood vessels and retina (the so-called angiospastic retinitis ).
In any stage of hypertension, a sudden sharp increase in blood pressure can occur from time to time - a hypertensive crisis. It is characterized by sharp headaches caused by a spasm of the brain vessels, often accompanied by nausea , vomiting, loss of consciousness, and visual disturbances. Sometimes there is pain behind the sternum due to spasm of the coronary arteries (see. Thoracic toad ); acute heart failure may develop due to a sharp overload of the left ventricle (see Cardiac asthma ). A sudden increase in blood pressure during crises with a significant change in the vessels of the brain can lead to brain hemorrhage (see Stroke ), and a long-lasting spasm of the coronary arteries during a crisis can result in myocardial infarction (see). However, complications such as hemorrhages in the brain, angina pectoris, myocardial infarction , may appear outside the crisis, since hypertension contributes to the development of atherosclerosis of the heart and brain vessels. In addition, prolonged overload of the heart in severe hypertension leads to hypertrophy of the heart with consistently developing heart failure. The latter may be manifested by attacks of cardiac asthma or a chronic impairment of blood circulation occurs in the large and small circle. In renal hypertension develops sclerotic changes in the kidneys (see Nephrosclerosis), which are accompanied by impaired renal function and can lead to uremia (see).Go
The diagnosis is very complicated, since a similar clinical picture is observed in arterial hypertension of other origin, associated with kidney diseases, adrenal tumors, a number of endocrine diseases, brain lesions (tumors, injuries), congenital aortic stenosis (coarctation), marked aortic atherosclerosis, etc. (so-called symptomatic hypertension). It is safe to exclude all these diseases as the cause of arterial hypertension and to diagnose hypertension is often possible only as a result of a complex study conducted by qualified doctors in a well-equipped hospital. The following patients with arterial hypertension should be referred to such a study: 1) with persistent hypertension developed at a young age, especially during pregnancy (pregnant nephropathy) and in cases where blood pressure on the arms is higher than on the legs (aortic coarctation); 2) with changes in urine (low specific gravity, protein, erythrocytes , a large number of white blood cells, cylinders), indicating kidney damage; 3) with severe crises, accompanied by chills and palpitations; 4) with bouts of severe muscle weakness (Conn syndrome); 5) in cases where arterial hypertension persists is not inferior to the action of active antihypertensive drugs (see below) or has a malignant, rapidly progressive course.
The prognosis of hypertension depends on the stage and form of the disease. In the early stage it is favorable. The prognosis worsens with severe and rapid progression of the disease, with the development of sclerotic changes in the vessels. Unfavorable prognosis in stage III of the disease, with severe damage to blood vessels and organs, especially in renal form of hypertension.
Fig. 1. Hemorrhages and cysts in the brain tissue. Fig. 2. Hypertrophy of the left ventricle of the heart. Fig. 3. The fine-grained surface of the primary wrinkled kidney.