Symptomatic arterial hypertension

Description:

Symptomatic, or secondary, arterial hypertension (SG) is an arterial hypertension, prichinno connected with certain diseases or damages of the bodies (or systems) participating in regulation arterial pressure.

Frequency of symptomatic arterial hypertension makes 5 — 15% of all patients arterial hypertension.

Symptoms of Symptomatic arterial hypertension:

Classification. There is a set of classifications of SG, however allocate four SG main groups.

I. Renal (nephrogenic). II. Endocrine.

Hypertensia, the hearts caused by defeat and large arterial vessels (hemodynamic).
Tsentrogennye (caused by organic lesion of a nervous system). The SG group at the combined defeats is sometimes allocated [Arabidze G. G., 1982].
The combination of several (more often than two) the diseases potentially capable to bring to arterial hypertension, for example is possible: diabetic glomerulosclerosis and chronic pyelonephritis; atherosclerotic stenosis of renal arteries and chronic piyelo-or glomerulonephritis; a kidney tumor at the patient having atherosclerosis of an aorta and brain vessels, etc. Some authors carry to the main groups of S G and is exogenous caused arterial hypertension [Kushakovsky M. S., 1983; Gogin E. E., etc., 1997]. Enter into this group arterial hypertension, developed as a result of poisonings with lead, thallium, cadmium, etc., and also medicines (glucocorticoids, contraceptive means, indometacin in combination with ephedrine, etc.).

However and with the given additions classification is not exhaustive. There is arterial hypertension at a polycythemia, chronic obstructive diseases the easy and other states which did not enter classification.

In the present section four SG main groups are considered.

Clinical manifestations at S G in most cases consist of the symptoms caused by increase arterial pressure and symptoms of a basic disease.

Arterial pressure can be explained with increase headaches, dizziness, flashing of "front sights" before eyes, noise and a ring in ears, various pains in heart and other subjective feelings. The hypertrophies of a left ventricle found at physical inspection, accent of the II tone over an aorta — result stabilnoyarterialny hypertensia. Characteristic changes of vessels of an eyeground come to light. Radiological and elektrokardiografichesk find signs of a hypertrophy of a left ventricle (in more detail see. "Idiopathic hypertensia").
Symptoms of a basic disease:
can be pronounced, in such cases establish character of SG on the basis of the developed clinical symptomatology of the corresponding disease;
can be absent, the disease is shown only by increase arterial pressure; in such situation of the assumption of symptomatic character arterial hypertension arise at:
a) development arterial hypertension at persons of young age is also more senior than 50 — 55 years; b) acute development and bystry stabilization arterial hypertension on high figures; c) asymptomatic current arterial hypertension; d) resistance to hypotensive therapy; e) malignant character of a current arterial hypertension.

On character of a current of SG, as well as an idiopathic hypertensia, divide into high-quality and malignant forms. The syndrome malignant arterial hypertension meets in 13 — 30% of all SG.

Various expressiveness of symptoms and wide range of the diseases which are followed arterial hypertension cause extreme variability of a clinical picture of S G. In this regard stages of diagnostic search will be presented separately for each group of the diseases allocated in classification.

Renal (nephrogenic) hypertensia. Renal arterial hypertension — the most frequent reason of SG (70 — 80%). They are subdivided on arterial hypertension at diseases of a parenchyma of kidneys, the renovascular (renovascular) hypertensia and arterial hypertension connected with urine outflow disturbance. The most part renal arterial hypertension is represented by diseases with renoparenkhimatozny and renovascular pathology.

The clinical picture of the numerous diseases which are followed arterial hypertension of renal genesis can be shown by the following syndromes:

arterial hypertension and pathology of an uric deposit; arterial hypertension and fever; arterial hypertension and noise over renal arteries; arterial hypertension and the palpated tumor of an abdominal cavity; arterial hypertension (monosimptomno).

These syndromes can be revealed at different stages of diagnostic search.

Reasons of Symptomatic arterial hypertension:

Etiological factors for SG are the numerous diseases which are followed by development arterial hypertension as a symptom. More than 70 similar diseases are described.

• Diseases of kidneys, renal arteries and urinary system:

a) acquired: a diffusion glomerulonephritis, chronic pyelonephritis, intersticial nephrite, system vasculites, an amyloidosis, a diabetic glomerulosclerosis, atherosclerosis, thrombosis and an embolism of renal arteries, pyelonephritis against the background of an urolithiasis, obstructive uropathies, tumors, tuberculosis of kidneys, etc.

b) inborn: hypoplasia, allotopia, anomalies of development of renal arteries, hydronephrosis, polycystosis of kidneys, patholologically movable kidney and other anomalies of development and position of kidneys.

Diseases of endocrine system: pheochromocytoma and pheochromoblastoma; aldosteroma (primary aldosteronism, or sindromkonn); kortikosteroma; disease and syndrome of Itsenko^kushinga; acromegalia; diffusion toxic craw.
Heart diseases, aorta and large vessels:
a) the heart diseases acquired (insufficiency of the valve of an aortya other) and inborn (an open arterial channel, etc.); the heart diseases which are followed by a congestive serdechnoynedostatochnost and a total atrioventricular block; b) damages of an aorta inborn (coarctation) and acquired (arteritis of an aorta and its branches, atherosclerosis); stenoziruyushchiyeporazheniya of carotid and vertebral arteries, etc.

• TsNS diseases: brain tumor; encephalitis; injuries; ochagovyeishemichesky defeats, etc.

Renovascular (renovascular) arterial hypertension treat renal SG.

Treatment of Symptomatic arterial hypertension:

Etiological treatment. At identification arterial hypertension, the caused pathology of renal vessels, coarctation of an aorta or hormonal and active adenomas of adrenal glands, raise a question of an operative measure (elimination of the reasons leading to development arterial hypertension). In the first ocheredyeto concerns a pheochromocytoma, aldosteronprodutsiruyushchy adenoma of an iadenokartsinoma of an adrenal gland, a kortikosteroma and, of course, hypernephroid cancer of a kidney.

At adenoma of a hypophysis use methods of active influence with the help rentgeno-and radiotheraphy, treatments by the laser, in some cases make operations.

Medicinal therapy of a basic disease (nodular periarteritis, erythremia, congestive heart failure, infection of uric ways, etc.) gives positive effect and in the relation arterial hypertension.

II. Medicinal hypotensive therapy. In most cases therapy is not limited to means, a napravlennymina treatment of the basic disease which led to development arterial hypertension, and combined with appointment of various groups of hypotensive drugs.

Sick with a rack arterial hypertension at damage of kidneys widely appoint diuretics [a dichlothiazide (hypothiazid), furosemide, Triamterenum, or Triampur compositum] in combination with APF inhibitors.

In the absence of due hypotensive effect in addition appoint r-adrenoblockers and peripheral vazodilatator.

The combination therapy using various groups of medicines is shown at stable, especially diastolic, arterial hypertension of any genesis.

It is especially carefully necessary to consider contraindications to use of medicines and possible side effects.

At advanced age it is not recommended to reduce quickly arterial pressure at long stable arterial hypertension as coronary, cerebral and renal circulation can worsen.

It is possible to apply small doses of caffeine and Cordiaminum to normalization of a tone of brain vessels and improvement of regulation of nervous processes, especially in the morning when arterial pressure low.