Hypertension

Hypertension (hypertension) is a disease characterized by increased blood pressure (for middle-aged people maximum - more than 140 mm RT. Art., minimum - 90 mm RT. Art.).
Etiology. The occurrence of hypertension is associated with prolonged nervous stress, anxieties, mental injuries. Ill hypertension more people doing mental work and those whose job requires a lot of nervous tension. In the basis of hypertension is a violation of the functional state of the Central nervous system and other systems (endocrine and other)influencing the regulation of vascular tone. This leads to changes in vascular tone, spasm of small arteries and increase blood pressure. Long spastic condition of the arterioles contributes to the development of their sclerosis, which makes it more resistant hypertension and leads to malnutrition tissue and organs.
The clinical picture of hypertension depends on the stage and form of the disease. There are three stages of hypertension: I - primary, or transient, characterized by unstable, short-term rise in blood pressure, which in favorable conditions to normal quickly; II - stable during which increased blood pressure becomes more permanent, and III - sclerotic, when prolonged hypertension complicated by the development of pronounced changes both in vessels (arteriolosclerosis)and implement their bodies. By predominant affection of vessels of the heart, brain or kidneys there are three forms of hypertension - heart, brain and kidney. There is also a rapidly progressive, or malignant, a variant of the flow of hypertension. At the beginning of the disease the patient's health may be satisfactory, but often, especially in connection with disturbances and fatigue, headaches, heaviness in the head, dizziness, a sense of tidal to the head, insomnia, palpitations. With the transition of hypertension in the second stage, these symptoms are worse and become more permanent; in stage III join the symptoms of severe heart failure, brain and kidneys depending on the form of hypertension.
In the study of patients with hypertension in addition to high blood pressure, are hard, intense pulse, hypertrophy of the left ventricle (left border of the heart toward the left, the apical jerk is reinforced); the degree of hypertrophy depends on the severity and duration of disease. Auscultation over the aorta heard the focus of the second tone. In severe hypertension significantly reduced vision; in the study of the fundus find changes vessels and retina (the so-called angiospastic pigmentosa).
At any stage of hypertension may occur periodically sudden sharp increase in blood pressure - a hypertensive crisis. It is characterized by sharp headaches caused by spasm of the blood vessels of the brain, often accompanied by nausea, vomiting, loss of consciousness, visual disturbances. Sometimes pain in the chest due to spasm of the coronary arteries (see angina); may develop acute heart failure due to sudden overload of the left ventricle (see Cardiac asthma). The sudden increase in blood pressure during crises when a significant change of the brain can cause bleeding in the brain (see the Stroke), but a prolonged spasm of the coronary arteries when the crisis may end in myocardial infarction (see). However, complications such as bleeding in the brain, stenocardia, myocardial infarction, can appear out of the crisis, so as hypertension contributes to the development of atherosclerosis of vessels of heart and brain. In addition, the long overload heart with severe hypertension results in its hypertrophy with consistently developing heart failure. Last may manifest attacks cardiac asthma or a chronic blood circulation disorders in small and large circle. When kidney form of hypertension develops sclerotic changes in the kidneys (see Nephrosclerosis), which are accompanied by violations of the kidneys and can lead to uremia (see).
The diagnosis is very difficult, as well as similar clinical picture is observed with arterial hypertension syndrome of different origin-related kidney disease, tumors of the adrenal gland, near endocrine diseases, cerebral lesions (tumors, trauma, congenital narrowing (coarctation) of the aorta, the expressed atherosclerosis of the aorta and so on (so-called symptomatic hypertension). Safe to exclude all these diseases as a cause of hypertension, and the diagnosis of hypertension is often possible only as a result of complex research conducted by qualified doctors in the well-equipped hospital. Such a study is necessary to send the following patients with arterial hypertension: 1) with resistant hypertension developed at a young age, especially during pregnancy (nephropathy pregnant women) and in cases when the arterial pressure at the hands higher than in the feet (coarctation of the aorta); 2) with the change of urine (low specific weight, protein, erythrocytes, a large number of leukocytes, cylinders), attesting to the kidney; 3) severe crises, accompanied by chills and heartbeat; 4) with bouts of severe muscle weakness (syndrome horse); 5) in cases where arterial hypertension is hard not to yield to the activity gipotenziveh funds (see below) or is malignant, rapidly progressive course.
Forecast for hypertension depends on the stage and form of the disease. In the early stages it is favourable. Prognosis worsens in severe and rapid disease progression, with the development of sclerotic changes in the vessels. Poor prognosis in stage III disease, severe damage of the vessels and organs, especially the kidney form of hypertension.


Fig. 1. Hemorrhage and cysts in the brain tissue. Fig. 2. Hypertrophy of the left ventricle. Fig. 3. Fine-grained surface primary wrinkled kidneys.