Internal illnesses. Hypertension (etiology, pathogenesis, classification, clinical picture) (most important)

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Internal illnesses. Hypertension (etiology, pathogenesis, classification, clinical picture) (most important)

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4. HYPERTENSION (ETIOLOGY, PATHOGENESIS, CLASSIFICATION, CLINIC)

A chronically occurring disease, the main manifestation of which is the syndrome of arterial hypertension, not associated with the presence of pathological processes in which an increase in blood pressure is due to known causes.

Etiology. Neuropsychic overstrain, dysfunction of the sex glands.

Pathogenesis. There is a violation of the biosynthesis of sympathetic amines, as a result of which the tone of the sympathetic-adrenal system increases. Against this background, the activation of the pressor mechanisms of the renin-angiotensin-aldosterone system and the inhibition of depressor factors: prostaglandins A, E, and the kinin system occur.

Classification. In clinical conditions, the disease is divided according to the severity of arterial hypertension, the degree of risk of developing damage in target organs, and the stage of development of hypertension.

Clinic. With stage I hypertension, periodic headaches, tinnitus, and sleep disturbance appear. Mental performance decreases, dizziness, nosebleeds are noted. Possible cardialgia.

In the left thoracic branches, the presence of high-amplitude and symmetrical T waves is possible, the minute volume of the heart remains normal, increasing only during exercise. Hypertension crises develop as an exception.

With stage II hypertension, frequent headaches, dizziness, shortness of breath during exercise, and sometimes angina attacks appear. Nocturia and the development of hypertensive crises are possible.

The left border of the heart shifts to the left, at the apex the first sound is weakened, an accent of the second tone is heard above the aorta, sometimes a pendulum-like rhythm.

With stage III hypertension, two options are possible:

1) development of vascular accidents in target organs;

2) a significant decrease in minute and stroke volumes of the heart with a high level of peripheral resistance.

In the malignant form of hypertension, extremely high blood pressure figures are noted (diastolic blood pressure exceeds 120 mmHg). Renal failure progresses, vision decreases, weight loss, symptoms from the central nervous system, changes in the rheological properties of the blood appear.

hypertensive crises. Sudden sharp increase in blood pressure. Crises are of two types.

Type I crisis (hyperkinetic) is short-term. It manifests itself as a sharp headache, dizziness, decreased vision, nausea, and less often vomiting. Characterized by agitation, palpitations and trembling throughout the body, pollakiuria; towards the end of the crisis, polyuria or profuse loose stools are observed. Systolic blood pressure increases and pulse pressure increases.

Type II crisis (eu- and hypokinetic) is severe. It develops gradually, lasting from several hours to 4-5 days or more. Caused by circulatory hypoxia of the brain, characteristic of later stages of hypertension. It manifests itself as heaviness in the head, sharp headaches, sometimes paresthesia, focal disturbances of cerebral circulation, and aphasia. There may be anginal pain in the heart area, vomiting, and attacks of cardiac asthma. Diastolic pressure increases significantly. Blood pressure must be reduced gradually over several hours.

Author: Myshkina A.K.

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