27.10.2021

Diagnosis and treatment of hypertension

The most common complaint of headache occurs only with a sharp increase in blood pressure in cases of hypertensive encephalopathy and in malignant arterial hypertension. Increased blood pressure may be accompanied by dizziness, nosebleeds and weakness. However, these complaints are quite often encountered at a normal level of blood pressure.

Symptoms of high blood pressure are not specific.

Symptoms of arterial hypertension-induced vascular lesions include blurred vision, intermittent weakness and dizziness due to transient ischemia of the central nervous system, hematuria and nocturia. Angina may occur due to accelerated development of atherosclerosis, severe chest pain during aortic dissection, shortness of breath and other signs of acute and chronic heart failure. Myocardial infarction and stroke are also possible.

Complaints related to the underlying disease in cases of symptomatic arterial hypertension include severe muscle weakness, polydipsia and polyuria in primary hyper aldosteronism, arthralgia, weight loss and fever with periarteritis nodosa.

Arterial hypertension, as defined by the WHO Expert Committee, is a constantly increased systolic and / or diastolic pressure.

Essential hypertension (primary hypertension or hypertension)  is high blood pressure in the absence of a probable cause of its increase.

Secondary hypertension  (symptomatic) is hypertension, the cause of which can be identified.

According to the latest recommendations of the WHO and the International Hypertension Community (1999), several levels of arterial hypertension are identified.

According to this classification, arterial hypertension is an increase in systolic blood pressure up to 140 mm Hg. Art. and higher or diastolic arterial pressure up to 90 mm Hg. Art. and above, if such an increase is stable, i.e. confirmed during repeated measurements of blood pressure (at least 2-3 times on different days for 4 weeks).

Categories
Systolic blood pressure, mm Hg.
Diastolic blood pressure, mm Hg.
Optimal
<120
80
Normal
<130
85
High normal
130-139
85-89
Hypertension:
1 degree  (mild arterial hypertension)
140-159
90-99
subgroup: borderline
140-149
90-94
II degree  (moderate arterial hypertension)
160-179
100-109
III degree  (severe arterial hypertension)
> 180
> 110
Isolated systolic hypertension
> 140
<90
subgroup: borderline
140-149
<90

Classification of arterial hypertension for an etiological approach (WHO, 1996 p.):

I.  Primary  (essential, idiopathic) hypertension.
Ii. Secondary hypertension :
Renal hypertension:
  1. Renoparenchymatous hypertension.
  2. Renovascular hypertension.
  3. Hypertension after kidney transplantation (post-transplant hypertension).
Endocrine hypertension:
  • Pheochromocytoma.
  • Primary mineralocorticoidism:
    • primary hyper aldosteronism;
    • deoxycorticosterone-producing tumor;
  • adrenogenital syndrome (congenital adrenal hyperplasia).
  • Glucocorticoidism: Cushing syndrome.
  • primary hyperrenism.
  • Acromegaly.
  • Hyperpathiroididism.
  • Endothelin-producing tumor.
  • Hypo-and hyperthyroidism.
  • Menopausal hypertension.
  • Diabetic kidney damage.
Pregnancy Hypertension:
  1. Pre-eclampsia / eclampsia.
  2. Pre-eclampsia on the background of existing chronic hypertension.
  3. Transient hypertension.
Cardiovascular hypertension:
  1. Coarctation of the aorta.
  2. Systolic cardiovascular hypertension:
    • hyperkinetic syndrome;
    • aortic insufficiency;
    • aortic sclerosis;
    • severe bradycardia (with atrioventricular blockade III degree);
    • arteriovenous shunts, uninflated arterial (Batalov) duct.
Hypertension associated with drugs and other substances (drug hypertension):
  1. Oral contraceptives.
  2. Carbenoxolone (pseudoaldosteronism).
  3. Therapy with glucocorticosteroids in large doses (pseudo-tuberous syndrome).
  4. Erythropoietin.
  5. Ciclosporin.
  6. Alcohol
Neurogenic hypertension:
  • Hypertension caused by neurological damage.
  • Brain concussion.
  • Sleep apnea syndrome.

The main tasks of the clinical, laboratory and instrumental examination of a patient with arterial hypertension at the EUROLAB medical clinic are:

  1. detection of secondary (symptomatic) arterial hypertension, which is potentially treatable;
  2. clarification of the nature and severity of individual manifestations and complications of the disease that are important when prescribing treatment;
  3. identification of risk factors for diseases associated with atherosclerosis.
Complaints

Most patients have no complaints and an increase in blood pressure is detected only when it is measured.

Complaints may be related to:

  1. high blood pressure;
  2. vascular lesion due to arterial hypertension;
  3. the main disease in cases of symptomatic hypertension.

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