The course of internal diseases, pathology of the endocrine and nervous system is very often complicated by symptomatic hypertension. From primary hypertension, the symptomatic( secondary) is characterized by a number of characteristic features at the beginning of the development of the disease, the general course, the appointment of therapeutic treatment regimens. Among all detected and documented cases of persistent BP increase in patients, secondary hypertension accounts for about 10 percent of patients.
What is it?
Arterial hypertension is a regular anomalous increase in pressure up to high, not characteristic for a certain person figures. Secondary hypertension belongs to background or defining signs of the underlying, sometimes not immediately established, disease. In the course of the disease, several special indicators and parameters are distinguished, which allows presumably to separate the secondary form of pathology from essential hypertension. The most frequently observed differences are usually:
- Age - abnormal blood pressure is observed in people older than 20 and younger than 60 years.
- Sudden development of hypertension, with overestimated indications on the tonometer being fixed for a long time.
- Rapid increase in signs of disease.
- Detection of chronic changes in organs and systems.
- The disease almost does not lend itself to improving the standard regimens of prescribed drugs.
- Diastolic pressure digestion is recorded, indicating renal pathologies.
Classification of
The gradual or abrupt formation of secondary hypertension is provoked by many diseases. In general, the aetiology of the origin of the disease is classified into four large groups.
- Neurogenic causes - diseases and traumatic pathologies of the nervous system - tumors, stroke, bruises, inflammatory processes, polyneuropathies. Symptomatic arterial hypertension in cases of localization of tumors and cysts of the brain in the visual boom is called Penfield syndrome.
- Nephrogenous. In many cases, pyelonephritis, glomerulonephritis, lupus, hydronephrosis, and polyneurrosis are established. Also, this group includes changes in the vessels of the kidneys - aneurysms, atherosclerosis, dysplasia, tumor-like neoplasms. Lead to the development of hypertension may be anomalies in the structure of the organ, as well as the removal of the kidney.
- Endocrine - abnormalities of the adrenal cortex, disruption of the thyroid and pituitary - pheochromocytoma, hypothyroidism, acromegaly, Itenko - Cushing 's disease. To this group it is customary to refer to the decreased production of hormones in the climacteric period.
- Hemodynamic - correlate with a congenital or acquired abnormal disorder in large vessels and tissues of the heart.
The presented classification of hypertension-related circumstances is incomplete, there are a number of other diseases with less impact on the appearance of the disease. Provoke a steady rise in blood pressure can and drug therapy - the use of contraceptives, drugs with components of heavy metal salts, indomethacin, glucocorticosteroids.
Causes of symptomatic arterial hypertension
The central causes of secondary hypertension are various pathologies of internal organs. Therefore, the mechanism that causes the development of violations, each patient will differ.
In renal anomalies, the primary triggering mechanism is considered ischemic processes in the tissues of the organ. In this state, the activity of depressant, that is, suppressing the growth of pressure, renal agents is reduced. Endocrine changes lead to an increase in the level of certain hormones, which leads to a rise in blood pressure.
When lesions of the structures of the nervous system, ischemic sites are formed in the centers responsible for the regulation of blood vessels.
Hemodynamic secondary hypertension is represented by combined changes occurring in large blood vessels of the blood supply system and cardiac muscle, the most common are:
- Dysfunction of depressive zones, reduced elasticity of the vessel walls.
- Excessive filling of arteries located above the abnormal area of constriction.
- Reduction in the normal diameter of blood vessels caused by increased blood volume. Narrowing of the blood channels also occurs due to the high viscosity of the blood.
- Increase in the rate and amount of blood flow to the aorta as its inflow to the heart increases.
Symptoms of
Clinical recorded manifestations of secondary hypertension consist of symptoms of leading chronic illness, changes in state of health and periodic pressure spikes.
Sometimes in the history of patients with symptomatic arterial hypertension, high BP values may be the only signs of the development of primary pathology.
Patients pay attention to the following recurrent changes in the condition:
- Unexpected pain in different parts of the head.
- Vertigo.
- Fatigue and weakening.
- Possible nausea and vomiting.
- Pain and discomfort in the heart region
- Periodic temperature fluctuations.
- Psychoemotional disorders are arousal or vice versa, an apathetic state that develops after a crisis.
Part of the patients in the survey revealed signs of panic attacks - a sense of anxiety, fear of death, blanching of the skin, excessive sweating, uncaused tachycardia.
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National guidelines for diagnosis and treatment
Arterial hypertension is considered one of the most common ailments among the adult population. The disease, which lasts for several years, leads to the development of ischemia and heart attacks, various forms of strokes, complications in case of an illness contribute to the loss of efficiency, a person often gets a disability.
There is a trend towards an increase in the number of patients with AD among young people. In connection with the high risk for the possibility of a fatal outcome and a general deterioration in the quality of life, the All-Russian Society of Cardiologists developed National Recommendations.
The document specifies the main stages of diagnosis, recommended treatment plans and subsequent monitoring of patients with hypertension.
The attending physician of a patient with recordable high BP values conducts all therapy, including the appointment of instrumental examinations and the selection of groups of pharmaceutical preparations, based on this document.
Look at the doctor's story about the causes of symptomatic arterial hypertension, diagnosis, the correct approach to treatment and possible negative consequences for the brain structures in case of delaying a visit to the doctor:
Differential diagnosis
The diagnosis begins with a survey, a detailed survey and a competent examination of the patient. During the conversation, the doctor needs to identify previously occurring diseases, including injuries, infections, childhood illnesses. Arterial pressure is measured repeatedly in hospital and at home, the patient must constantly record it and record the indicators.
The national guidelines specify the basic rules for taking pressure readings, under what conditions its figures can be questionable. To identify pathologies, the following tests and studies are prescribed:
- Urinalysis is mandatory. According to its indicators, the number of red blood cells, leukocytes, and protein is determined. Their excess testifies to kidney problems.
- Blood test - pay attention to anemia, lipid, creatine, urea, total protein, hypokalemia, hormone levels.
- Assign ultrasound of vessels and tissues of the kidneys, heart.
- Angiography of vessels.
- ECG.
- Computerized tomography.
Instrumental examinations are assigned based on the symptoms of the disease and the revealed abnormalities in the analyzes. In some cases it is recommended to prescribe radiographs of kidney vessels, intravenous urography, angiography from additional methods.
At the stage of analysis, instrumental diagnostics and data collection, it is necessary to differentiate the primary cause, further treatment will depend on this. If necessary, the patient is placed in the hospital for complex diagnostics.
Treatment of
Therapy of established symptomatic hypertension according to the national recommendation consists in highly effective treatment of the underlying cause, elimination of symptoms and in the appointment of different groups of antihypertensive medications, depending on the level of BP registered.
When choosing drugs, it is necessary to take into account contraindications for the main pathologies and possible side reactions, since some medications designed to reduce blood pressure are not compatible with the determining illness.
Increased pressure is effectively reduced when the principles of familiar life change. Rejection of harmful addictions, rationally composed nutrition scheme, moderate physical energy, reduction in body weight - all this positively affects the persistent decrease in the parameters of the tonometer.
When a brain tumor is detected, progressive atherosclerotic plaques, adrenal cysts, surgical intervention is indicated.
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Features of treatment of individual groups of patients
- AG in elderly people, taking a long time, requires a gradual decrease in pressure, as a sharp fall leads to acute heart failure. Hypotensive drugs are prescribed from small doses and gradually increase the dosage, selecting the one at which the BP values come back to normal. For the treatment of elderly patients, two or three groups of antihypertensive medications, diuretics, calcium antagonists are usually used. Usually prescribe Indopamide, Nitrendipine, Enalapril, a well-chosen combination of drugs reduces the risk of developing senile dementia.
- AG and diabetes mellitus. People with high sugar levels in blood tests should learn that reducing pressure can be achieved only by treating the underlying disease. For this category of patients it is important to follow a diet, reduce weight. Some groups of antihypertensive drugs can negatively affect the metabolism of carbohydrates, so the selection of the drug is under the supervision of the doctor. Patients with diabetes for the treatment of high blood pressure are usually prescribed Physiotenses and one of the safest diuretics. Depending on the revealed disorders in the kidney, hypotensive drugs can be administered immediately from several groups.
- AG and cerebrovascular diseases. For patients with similar pathologies, the purpose of all groups of pressure-lowering drugs is indicated, except for those that can lead to severe hypotension. In the emergence of acute cerebral stroke, antihypertensive therapy is prescribed after stabilization of the patient's condition.
- AH and ischemic heart disease. When a history of ischemic heart disease is identified, lifelong use of the corrective pressure of therapy can reduce the repeated risk of coronary insufficiency. Do not use drugs that lead to a sharp decrease in blood pressure.
- AG in combination with CHF.Practically in all patients with chronic insufficiency in the work of the heart, an increase in blood pressure is revealed. Hypotensive drugs are combined with a diuretic, proven effectiveness with this form of Enalapril disease.
- AG in case of kidney damage. Adequate reduction in blood pressure in patients with renal pathologies allows to minimize the risk of developing CRF.It is necessary during the therapy to achieve constant control over blood pressure and a decrease in the level of protein and erythrocytes in the urine. In addition to antihypertensive drugs, antiplatelet agents, statins, diuretics are prescribed.
- AG and pregnancy. High blood pressure during pregnancy complicates childbirth, up to a lethal outcome. In the first trimester of pregnancy, the main drugs are not prescribed in connection with the possibility of developing pathologies in the fetus. Medillop is considered the only antihypertensive drug safe in pregnancy in the first months. In the 2nd and 3rd trimester appoint Dopegit. In the last months of childbearing, in addition to these drugs, Nifedipine can be used.
High blood pressure is the reason for the hospitalization of a woman.
- AG in combination with asthma and chronic lung disease. Many drugs used to improve respiratory function can increase blood pressure. Ipratropium bromide, glucocorticosteroids in inhalations are considered safe. Of antihypertensive drugs are chosen Nebivolol, Bisoprolol, Betaxolol, diuretics.
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The course of the disease and the prognosis of
Symptomatic hypertension is divided into four forms of presumed development, depending on their type suggest a possible outcome of the disease.
- The transient form is characterized by an easily adjustable increase in blood pressure. There are no changes in the fundus and left ventricular hypertrophy on the ECG.
- Labile arterial hypertension - AD normalizes after a course of antihypertensive drugs. Changes in the left ventricle and vessels of the retina are insignificant.
- A stable form is established in patients with persistent indices of blood pressure, pronounced hypertrophy of the ventricular size of the heart and vascular anomalies of the retina.
- Malignant form is the most serious type of disease. BP indices exceed the indications of a tonometer above 200 mm Hg. The diastolic pressure rarely falls below 120 mm Hg. Art. This form is characterized by a sharp beginning. Instant elevation of pressure to high figures and a high risk of complications - strokes, heart attacks.
Arterial hypertension with timely detection of pathology and constant treatment in most affected people is well amenable to drug correction.
To a malignant hypertension with fast deterioration of state of health the kidney diseases more often result.
Prevention
The main preventive measure to prevent the development of hypertension is the timely detection and competent treatment of major diseases. The likelihood of developing secondary hypertension is minimized if the following recommendations are observed:
- Reduce total intake of salt and fat.
- Monitor body weight.
- Follow life-long principles of physical energy.
- Eliminate the negative impact of bad habits - smoking and abuse of alcohol-containing beverages.
Thus, only the person himself can improve himself. A careful attitude to your body will help in time to recognize hypertension and help in diagnosis.