Patients who complain of frequent high blood pressure may be diagnosed with secondary arterial hypertension. . This disease is usually experienced by older men and women. However, doctors have recently begun to notice that its signs appear in younger people.
Secondary or symptomatic arterial hypertension is observed with damage to internal organs and systems. An increase in blood pressure often occurs against the background of chronic diseases, which from time to time make themselves felt. Primary hypertension is difficult to diagnose. This cannot be said about the secondary form of the disease. The factors causing it quickly become apparent.
The International Classification of Diseases contains information on symptomatic hypertension. Her ICD 10 code is I15.
Symptoms
The hypertensive form of the disease of the cardiovascular system is easily recognized by an increase in blood pressure. This symptom is observed in all types of pathology. Secondary hypertension, a detailed description of which can be found in ICD 10, is recognized by the following features:
- dizziness;
- Black flies before the eyes;
- Headache;
- Noise in ears;
- Rapid pulse;
- Swelling of the extremities, especially after waking up;
- Feelings of anxiety and irritability;
- Weakness;
- Nausea.
Symptoms vary
With secondary arterial hypertension, not all symptoms appear. Sometimes the clinical picture of the disease is limited only to an increase in blood pressure. The most pronounced symptoms are observed in patients who suffer from a disease of a neurogenic type. In this case, they additionally develop tachycardia, sweating and convulsions appear.
If hypertension is caused by problems in the functioning of the kidneys, then it will be difficult for the patient to avoid visual impairment and headaches.
At the very beginning of development, the pathological process may not make itself felt at all. A person will feel only a slight malaise, which many justify with banal fatigue. Although in fact it indicates the emergence of a dangerous disease, the treatment of which is desirable to begin immediately.
If a person has chronic diseases, he must be familiar with the symptoms characteristic of symptomatic hypertension. Thanks to this, he will be able to protect himself from possible complications, which lead to frequent cases of high blood pressure.
It is very important to distinguish between primary and secondary forms of arterial hypertension. In the latter case, the following features will be noticed:
- It is not possible to reduce pressure with traditional drugs;
- An increase in blood pressure occurs suddenly;
- High pressure is sustainable;
- The disorder occurs in young people over the age of 20 or older men and women over 60;
- Sympatho-adrenal crises occur.
It will be possible to accurately diagnose a patient with complaints of a deterioration in his general state of health during his examination in the doctor's office.
An important feature of secondary hypertension is the inability to lower blood pressure with antihypertensive drugs.
The reasons
Causes of secondary hypertension physicians conventionally divided into several groups. All of them depend on the disease of which organ led to an increase in blood pressure values.
| Type of hypertension | The reasons |
| renal | Violation of the circulation of one or two kidneys; Fluid retention in the body; Narrowing of the arteries. |
| Endocrine | Diseases of the adrenal glands; · Diseases of the thyroid gland occurring against the background of hypothyroidism or hyperthyroidism; Acromegaly. |
| neurogenic | · Stroke; · Trauma; Increased intracranial pressure; · A brain tumor; Encephalitis. |
| Cardiovascular | Congenital or acquired heart defects; · Heart failure; · Damage to the aorta. |
| Medicinal | Reception of antidepressants; Abuse of oral contraceptives, which contain estrogens; Long-term use of glucocorticoids. |
Quite often, arterial hypertension of the secondary form develops in people who regularly drink alcoholic beverages. Therefore, among the causes of the development of the pathological process can also be attributed to chronic alcoholism.
Alcoholics are at risk
Classification
There are various types into which secondary hypertension is divided. They may differ from each other in symptoms and methods of treatment.
Renal hypertension
Secondary hypertension of this type is the most common. It occurs in 80% of cases. This disorder develops against the background of acquired or congenital damage to the structure of the kidneys or arteries that feed them.
The severity of hypertension depends on how quickly the blockage of the renal artery occurs and how exactly the disease itself, which has become its root cause, proceeds. Usually, at the earliest stage of the development of renal pathology in patients, the pressure does not increase. Hypertension manifests itself only after a significant damage to the tissues of the excretory organ occurs.
It is especially necessary to be afraid of secondary arterial hypertension in patients who have been diagnosed with pyelonephritis. With inflammatory processes in the renal pelvis, the risk of problems with blood pressure is the highest.
This outcome leads to another disease, which is called glomerulonephritis. It is also infectious. Often this pathology acts as a complication in patients suffering from tonsillitis.
Renal hypertension is common in young patients. If you do not start its treatment, then it will be very difficult to avoid the development of renal failure. It is worth noting that with an infectious disease, the risk of a malignant course of hypertension is 12%.
If a person has problems with the endocrine glands, then he may develop endocrine hypertension. This condition is often diagnosed in patients who have thyrotoxicosis. So called thyroid disease, which manifests itself in the form of increased secretion of the hormone thyroxine into the blood. With such violations, an increase in systolic pressure occurs. At the same time, diastolic blood pressure remains normal.
Endocrine hypertension develops in the following diseases:
- Pheochromocytoma. Hypertension is considered as the main symptom of adrenal tumors. In pheochromocytoma, elevated blood pressure is either stable or paroxysmal;
- Conn's syndrome. Symptomatic pathology in this case is characterized by increased production of the hormone aldosterone. Because of it, sodium is retained in the body. As a result, the amount of trace element in the blood becomes excessive;
- Syndrome Itsenko-Cushing. About 80% of patients with this disease suffer from hypertension. It is recognized by specific changes in the body. For example, a person’s body may become denser or the face may take on a puffy shape. At the same time, the limbs remain in a normal state;
- Climax. A female disease that is caused by the extinction of sexual function. In this state, jumps in blood pressure often occur.
Endocrine hypertension, like other types of disease, responds well to treatment if it was started in a timely manner.
Disorders in the endocrine system can also cause high blood pressure.
Neurogenic hypertension
The disease is caused by a violation in the work of the central nervous system. High blood pressure is not the only symptom that indicates neurogenic hyperplasia. It is also recognized by the following features:
- sweating;
- Dizziness;
- Skin rashes;
- convulsions;
- Tachycardia;
- Pain in the head.
Therapeutic therapy that is offered for neurogenic hypertension is based on the elimination of brain lesions.
Hemodynamic hypertension
Secondary or symptomatic arterial hypertension of the hemodynamic type develop against the background of damage to large arteries and the heart. These include:
- Atherosclerosis;
- narrowing of the aorta;
- Mitral valve defect;
- Heart failure;
- systolic hypertension.
As a rule, none of these diseases is the only cause of secondary hypertension. It develops against the background of 2 pathological processes, for example, chronic pyelonephritis and stenosis of the renal arteries.
The development of secondary arterial hypertension may well be provoked by improper medication. A certain group of medications has this painful condition in the list of its side effects and complications.
With drug hypertension, jumps in blood pressure can be paroxysmal or protracted. As a rule, such reactions occur as a result of the use of such drugs for medicinal purposes:
- oral contraceptives;
- Non-steroidal anti-inflammatory drugs;
- "Cyclosporine".
If the patient continues to take drugs that worsen his condition, then he may develop extensive brain pathologies.
Hypertension may be a side effect of medication
Diagnostics
Diagnosis of symptomatic arterial hypertension consists of several standard procedures. This violation is recognized by systolic-diastolic or systolic murmurs that are heard in the epigastric region.
This sign usually indicates the presence of stenosis of the arteries of the kidneys.
To measure current blood pressure, the doctor will ask the patient to take a standing position, and then lying down. Measurements are taken at rest and at the end of physical activity. Due to the difference between the pressure values, the specialist will be able to determine a number of secondary syndromes that occur with this form of hypertension.
It will be necessary to study the state of the artery in secondary arterial hypertension, which suffers from renal pathologies. It is mandatory to conduct an ultrasound of the excretory organs, supplemented by scintigraphy, dopplerography and angiography with preliminary contrasting.
If the doctor suspects the development of nephrogenic hypertension, he will conduct a complete examination of the patient using instrumental and laboratory diagnostic methods. The patient will undergo general urine and blood tests, as well as bakposev for the presence of a bacterial type infection in the body.
Due to the fact that there may be several reasons that provoked the appearance of secondary hypertension, diagnosis is supplemented by CT and MRI methods. If a tumor is present in the body, then a biopsy is mandatory.
Any patient suspected of having a secondary form of hypertension is referred to an ophthalmologist for evaluation. This is due to the fact that the disease can lead to damage to the retina of the eye. Therefore, it is very difficult to do without consulting a narrow-profile specialist.
Treatment
Treatment of the symptomatic form of arterial hypertension is not standard. The doctor will not be able to offer the patient medicines that help reduce blood pressure values. They won't give much results. In this case, it is required to act specifically on the root cause that explains the persistent increase in blood pressure.
Therapy for secondary hypertension can be of two types. With an uncomplicated course of the disease, it is recommended to limit the medication course. If its effectiveness is insufficient, one has to turn to more radical methods of treatment.
Medications
Treatment with drugs does not always give a positive result. Therefore, it is recommended to combine it with surgical therapy. In combination, these methods help to reduce the number of attacks of hypertension, normalize blood pressure and prolong remission.
Doctors advise to supplement intensive therapy with complex antihypertensive treatment. It requires taking a number of medications of different pharmacological groups:
- Antihypertensive drugs - "Moxonidine";
- ACE inhibitors - Enalapril, Fosinopril, Captopril;
- Calcium channel antagonists - Kordafen, Verapamil;
- Diuretics - "Indapamide", "Furosemide";
- Beta-blockers - "Pindolol", "Timolol".
Medicines work best in combination with each other. Therefore, taking only one drug is impractical.
Hypertension is usually treated with several drugs with different effects.
Surgery
Surgical intervention is performed if, during the diagnosis, the patient was diagnosed with benign or malignant tumors that cause high blood pressure.
A variety of surgical procedures is determined for each patient individually. It all depends on the primary disease, the age of the patient, the nature of the pathological process and its severity.
Prevention
Preventive measures that help reduce the likelihood of developing secondary hypertension are common to all patients. To improve your general well-being and avoid frequent jumps in blood pressure, the following rules help:
- It is necessary to regularly walk in the fresh air;
- Avoid stressful situations;
- It is advisable to normalize weight if a person has a tendency to be overweight;
- It is necessary to give up bad habits;
- It is recommended to limit the daily portion of salt.
If necessary, as a preventive measure, the doctor will prescribe a number of drugs to the patient that will help maintain his health.
If high blood pressure occurs against the background of diseases of the heart, blood vessels, kidneys, endocrine disorders, pathologies of nervous regulation, then such hypertension is called secondary. More than 50 diseases are known in which systemic pressure rises. Such conditions are characterized by a severe course and a weak effect of traditional antihypertensive therapy, early development of complications. Treatment requires addressing the underlying cause of hypertension.
Secondary hypertension accounts for about 10% of all detected increases in blood pressure. The most common causes of this pathology include:
- diseases of the nervous system - concussion, neuropathy, tumor, meningoencephalitis, stroke;
- kidney damage - anomalies in the structure, narrowing or compression of blood vessels, pyelo- or glomerulonephritis, nephrosclerosis, polycystosis; high pressure provokes the deposition of amyloid in the tissues, inflammation of the vessels, including those of autoimmune origin, prolapse of the kidneys or their removal;
- violation of the hormonal background during menopause, pathology of the thyroid and parathyroid glands, pituitary or adrenal glands;
- hemodynamic changes with, or insufficiency of the aortic valves, narrowing of the arteries that feed the brain;
- taking medications - corticosteroids, birth control pills, thyroxine, indomethacin, antidepressants.
Classification
Secondary hypertension may be transient. In this case, the pressure rises slightly and sporadically. There are no changes in the fundus, there is no increase in the myocardium of the left ventricle. In the labile form, these manifestations are mild, and the pressure is moderately high, decreasing only after taking medication.
The selection of clinical forms of arterial hypertension is most conveniently carried out according to the etiological factor, since diagnosis and treatment are performed in accordance with the cause of the disease.
Left ventricular hypertrophy is the cause of secondary hypertension Arterial hemodynamic
Occurs when the lumen of the aorta narrows. One such obstruction to blood flow is coarctation. This is a congenital developmental anomaly in which there is a segmental narrow area.
The examination reveals the following deviations:
- weak pulsation of the femoral arteries,
- increased apical impulse,
- systolic murmur at the base of the heart, apex and vessels of the neck.
Pulmonary hypertension
Increased pressure in the pulmonary vascular system can be a manifestation of an autoimmune process, heart disease, chronic bronchial diseases, vascular thrombosis. HIV-infected people who take drugs, centrally acting appetite suppressants, and contraceptives are at high risk.
Manifestations of pulmonary hypertension in the early stages are increased fatigue, shortness of breath, rapid heartbeat with little exertion, and then at rest. With an increase in hypoxia, fainting, arrhythmia, cough with asthma attacks, the appearance of blood in the sputum, pain in the right hypochondrium and swelling of the legs are noted. The heavy ones are followed.
renal
In inflammatory processes in the renal tissue, nephropathy due to gout or diabetes, polycystic hypertension is a late complication. Kidney pathology can be suspected when high blood pressure numbers are detected at a young age, and there are no heart and brain disorders.
A distinctive feature of such diseases is the rapid progression of kidney failure, the appearance of swelling of the face and legs, and impaired urination.
Damage to the renal arteries (renovascular hypertension) begins suddenly, the condition of patients deteriorates sharply, while drugs to reduce pressure have little effect. A quarter of patients have signs of a malignant course. The main reason - .
Pheochromocytoma
The tumor of the adrenal glands has the ability to produce hormones of the cortical layer - adrenaline, norepinephrine and dopamine. Increased pressure is accompanied by intense headaches, hand tremors, increased sweating, frequent and strong heartbeat, crises with panic attacks. Body temperature is elevated, can reach 38 - 39 degrees.
Primary aldosteronism
Occurs with adenoma of the adrenal cortex. There is sodium and fluid retention with simultaneous loss of potassium. Traditional medicines do not lower blood pressure, there is muscle weakness, convulsive syndrome, intense thirst, and the prevalence of nocturnal urination. Hypertensive crises can end with attacks of cardiac asthma, swelling of the lung tissue, a decrease in cardiac contractility, and a stroke.
Itsenko-Cushing syndrome
Caused by increased production of glucocorticoids by the adrenal glands. Increased blood pressure has a consistently high level, there are no crises, and patients do not respond to antihypertensive drugs.
The diagnosis is helped by a typical appearance - a moon-shaped face, obesity, hirsutism, purple stretch marks on the skin of the abdomen and thighs.
Medical
Drugs that provoke high blood pressure have a vasoconstrictive effect, retain fluid in the body, and increase blood density. The main such groups are:
- adreno- and sympathomimetics - Ephedrine, Pseudoephedrine (used in drops and tablets for the common cold);
- non-steroidal anti-inflammatory - inhibit the formation of prostaglandins that expand the lumen of the arteries;
- analogues of female sex hormones, including contraceptives - stimulate the renin-angiotensin system, retain fluid in the body;
- antidepressants, especially tricyclic ones, stimulate the activity of the sympathetic department of the nervous system, narrow the arteries;
- glucocorticoids retain sodium and increase sensitivity to vasoconstrictors.
neurogenic
It happens with the inflammatory process, brain tumors, craniocerebral injuries, ischemic attacks. In addition to hypertension, there is a severe headache, periodic bouts of dizziness and fainting, convulsions, unsteadiness when walking, impaired coordination of movements, vision, and speech.
Watch a video about hypertension and its treatment:
Diagnosis of secondary symptomatic hypertension
You can suspect a secondary increase in blood pressure by the following signs:
- the patient is less than 20 years old or more than 65;
- acute onset with high numbers;
- the course is malignant;
- complications are rapidly growing (stroke, heart attack, pulmonary edema, detachment of the retina);
- development of crises with high activity of the sympathetic system;
- the presence of diseases that provoke hypertension;
- low response to .
Diagnostic methods differ for different types of secondary hypertension. The most informative are:
- with coarctation of the aorta and pulmonary hypertension, chest x-ray, ultrasound and;
- with kidney - urine examination (protein, erythrocytes, cylinders, leukocytes, low density), ultrasound of the kidneys (inflammation, cysts, heterogeneity of the parenchyma, dilated pelvis), nitrogenous compounds are increased in the blood; to determine the filtration capacity, a renogram, urogram, angiography, MRI of the kidneys or CT, biopsy are used;
- with increased catecholamines in the urine, ultrasound or MRI of the adrenal glands, radioisotope diagnostics can determine the activity of hormone synthesis, metastasis;
- with aldosteronism, aldosterone and blood sodium are increased, low potassium, chloride ions, radioisotope scanning helps visualize the tumor, the degree of increase in the cortical layer of the adrenal glands;
- with Itsenko-Cushing's disease - high blood 17-hydroxyketosteroids, hydrocortisone; in case of difficulties in making a diagnosis, ultrasound, CT or MRI of the adrenal glands or their scanning after the administration of radioisotope preparations are prescribed;
- neurogenic hypertension is diagnosed on the basis of CT and MRI of the brain, ultrasound of the vessels of the head, and angiography.
Treatment of the disease
Since in the vast majority of cases, medications do not have a significant effect on the course of secondary arterial hypertension, surgical treatment is prescribed. His choice is determined by the type of pathology and the existing complications. It is most advisable to carry out the operation before the development of stable negative changes in the lungs, heart, brain and kidneys.
With coarctation of the aorta, it is surgically reconstructed by excising the narrowed area and suturing or prosthetics, as well as creating bypasses for blood flow. The operation is assigned only in the early stages.
If the cause of high pressure is, then anticoagulants, oxygen inhalations are indicated, with heart defects, their prompt elimination is necessary.
Treatment of nephritis is carried out using anti-inflammatory drugs, diuretics. Vasorenal hypertension requires the following types of surgical interventions:
- arterial plasty,
- stent placement,
- reconstruction of the renal artery,
- creating a connection (anastomosis) bypassing the narrowing.
Tumors of the adrenal glands, pituitary gland, or brain must be removed. Neurogenic hypertension is treated with drugs that reduce the manifestations of hypoxia and ischemia of the brain tissue.
Prevention of the development of the disease
Primary preventive measures for symptomatic hypertension are reduced to the prevention of malformations of the heart and blood vessels, the exclusion of stressful and toxic effects on the body, the avoidance of excessive solar exposure, the rejection of bad habits, the normalization of nutrition and lifestyle. The use of drugs is carried out only after the appointment or agreement with the cardiologist.
In order to stop the progression of diseases, a timely visit to the doctor is required, the passage of a full range of examinations to detect the cause of high pressure. Taking medications, as well as surgical treatment in the early stages, avoids such severe, sometimes fatal complications of hypertension as cardiac asthma, pulmonary edema, heart attack, stroke, and kidney failure.
Secondary hypertension occurs against the background of diseases of the vessels, kidneys, lungs, endocrine organs, nervous system. This group of diseases is distinguished by a severe course and low efficiency of traditional antihypertensive therapy.
Diagnostic tests are required to identify the cause of symptomatic hypertension, and CT, MRI, and radioisotope scanning in complex cases may be prescribed. Treatment is carried out by influencing the underlying pathology, most often surgical interventions are indicated.
Read also
If pulmonary hypertension is diagnosed, treatment should begin as soon as possible to alleviate the patient's condition. Drugs for secondary or high hypertension are prescribed in a complex manner. If the methods did not help, the prognosis is unfavorable.
Arterial hypertension is characterized by an increase in pressure (above 140 to 90). Today it is the most common chronic disease.
Distinguish between primary and secondary arterial hypertension. In the first case, the cause cannot be determined. Secondary arterial hypertension (symptomatic) is always associated with pathologies of the organs involved in the processes of pressure regulation.
It develops for any reason, revealing which, it is possible to bring blood pressure back to normal and.
Sometimes constant high blood pressure causes the development of secondary nephropathy, characterized by impaired renal function. The pathological condition is due to damage to the vessels, glomerular apparatus, parenchyma.
Secondary nephropathy in arterial hypertension often leads to wrinkling (reduction in size) of the kidneys. In advanced cases, they stop working, then a life-threatening condition develops.
Classification
Secondary arterial hypertension accompanies more than 50 diseases. There is a classification of hypertension (depending on the cause of development). Conventionally, 5 secondary forms of arterial hypertension are distinguished:
- neurogenic;
- Hemodynamic;
- Medicinal;
- Endocrine;
- Nephrogenic.
The cause of the neurogenic form of hypertension is vascular diseases, lesions of the peripheral and central nervous system (brain tumors). The hemodynamic form is due to damage to the myocardium, main vessels: heart disease (acquired, congenital), pathology of the aorta, valves. The dosage form of hypertension develops after taking certain drugs: glucocorticoids, antidepressants, contraceptives, etc.
There are several forms that develop for reasons of any endocrine disease. The pituitary form of secondary hypertension is due to increased secretion of growth hormone by the pituitary gland. Adrenal occurs when the adrenal glands secrete hormones that increase blood pressure.
Hyperparathyroid hypertension is caused by increased secretion of parathyroid hormone, which regulates calcium levels. The endocrine form of the disease also develops due to a tumor of the adrenal glands, other organs, when the level of corticosteroids rises. The cause of the increase in blood pressure are tumors:
- Aldosteronoma (high levels of aldosterone);
- Pheochromocytoma (high levels of adrenaline norepinephrine).
Quite often, symptomatic hypertension develops due to kidney damage. There are nephrogenic forms of hypertension: parenchymal and renovascular. In the first case, a persistent increase in pressure accompanies nephropathy, polycystosis, pyelonephritis, glomerulonephritis, kidney tuberculosis.
Such diseases are characterized by a violation of the structure of organ tissues. Renovascular (vasorenal) hypertension appears if blood flow is obstructed (as a rule, with sclerotic vascular lesions).
Symptoms
A characteristic symptom of secondary hypertension is high blood pressure.It is accompanied by the following clinical manifestations:
- Headache;
- Frequent pulse;
- Dizziness;
- Weakness;
- Noise in ears;
- Edema of the face, limbs;
- "Flies" before the eyes;
- Nausea;
- Irritability;
- Anxiety.
Prevention
Prevention of arterial hypertension is a top priority for people with a hereditary tendency, and for those whose blood pressure is kept within the extreme limits of the norm. This will prevent the development of the disease or its complications.
Prevention of arterial hypertension can be primary and secondary. Primary includes methods that will avoid the development of the disease. These include:
If there is obesity, it is important to reduce weight. This should be done gradually, losing no more than 3-4 kg per month.
The preventive measures for hypertension include a balanced diet. Do not allow excess fat in the diet (more than 50-60 g per day). Animal fats should be no more than 1/3 of the specified norm.
Fast carbohydrates should be limited: sugar, sweets, starchy foods. The diet should include a sufficient amount of proteins (low-fat fish, poultry, dairy products, etc.). It is good to eat foods containing a lot of calcium, magnesium, potassium:
- Beet;
- Baked potato;
- Beans;
- Dried apricots;
- Prunes;
- Raisin.
Non-drug therapy is consistent with the primary prevention measures outlined above. It is necessary to regularly monitor the pressure, measuring it at least twice a day. You should follow the recommendations of the doctor and seek medical help in a timely manner if the condition worsens.
Cardiologist
Higher education:
Cardiologist
Kabardino-Balkarian State University named after A.I. HM. Berbekova, Faculty of Medicine (KBGU)
Level of education - Specialist
Additional education:
"Cardiology"
State Educational Institution "Institute for the Improvement of Doctors" of the Ministry of Health and Social Development of Chuvashia
Frighteningly high numbers on the tonometer have long been no longer the lot of the elderly. Hypertension is getting younger not because the vessels wear out early. The cause of high blood pressure is increasingly becoming pathologies of organs that directly affect the level of blood pressure. In this case, its increase is a symptom of other diseases, that is, it is secondary.
Essential and secondary hypertension - what's the difference?
Essential, primary, idiopathic - this is the name of hypertension when blood pressure indicators consistently exceed 140/90 mmHg. The term "essential" means true, that is, etiologically not associated with other diseases. Of the huge "army" of hypertensive patients, it accounts for 90%.
Its main difference from secondary (symptomatic) hypertension is that the level of blood pressure is successfully corrected by antihypertensive drugs. If you keep it within the targets, then it rarely takes a malignant course.
Secondary hypertension is a consequence of a malfunction of organs that directly affect blood pressure:
- kidneys;
- adrenal glands;
- endocrine glands.
This also includes neurogenic and hemodynamic disorders. If in the treatment of primary hypertension the main place is given to antihypertensive drugs, then in the secondary form it is directed to the treatment of the underlying disease.
For the doctor, the defining sign of the secondary nature of hypertension is the lack of response to the use of drugs that reduce pressure. Sometimes the diagnosis does not raise doubts with a specialist already at the first appointment and according to the results of tests, when the primary pathology is expressed not only by an increase in pressure, but also by other diagnostic signs.
Another feature of secondary hypertension is a malignant course. If the numbers of systolic pressure "go off scale" over 200 mm and are difficult to reduce, this is a signal to the doctor for differential diagnosis.
Additional signs that may suggest symptomatic hypertension include:
- increased pressure at a young age;
- a sharp onset of severe hypertension (there is no gradual increase in the syndrome);
- increased pressure is accompanied by panic attacks.
There are symptomatic "markers" for each type of secondary hypertension. For renal genesis, an increase in lower pressure is characteristic. Diseases of the endocrine glands give rise to both upper and lower pressure, and circulatory disorders often raise the upper one.
Renal origin of hypertension
Secondary arterial hypertension (VAH) is of two types - renovascular, which occurs when there is a violation of the blood supply to the kidneys. It usually has a severe course and a poor prognosis. The second type is renoparenchymal hypertension caused by chronic diseases of the renal tissue (parenchyma).
Most often, renovascular (vasorenal) hypertension is caused by atherosclerotic changes in the renal vessels. In second place is fibromuscular dysplasia of the arteries. Both significantly impair blood flow in the kidneys. Other reasons:
- vasculitis;
- trauma;
- congenital aneurysms of the renal vessels;
- tumors, cysts, angiomas.
In response to a lack of nutrition, the kidneys begin to produce the enzyme renin. Renin, through a cascade of biochemical reactions, forms the hormone angiotensin, which constricts blood vessels and maintains a stable high pressure.
Atherosclerosis is typical for older men. Almost half of the patients have a bilateral lesion. Fibromuscular dysplasia as a cause of renovascular hypertension is typical for women under 30 years of age.
Hypertension begins with a sharp rise in blood pressure without response to antihypertensive drugs. In addition, patients experience:
- tendency to drop pressure when taking a vertical position;
- stable high blood pressure without hypertensive crises;
- systolic murmur when listening to the renal arteries;
- disruption of the kidneys.
Conservative treatment is carried out if the lesion is unilateral or with a slight increase in pressure. In other cases, a surgical operation is performed with the reconstruction of bypass vessels for blood flow (bypass).
Secondary arterial hypertension occurs in almost half of patients with renal disease:
- pyelonephritis;
- glomerulonephritis;
- polycystic.
Symptomatic hypertension develops in the same way in all diseases:
- an increase in intraglomerular pressure due to narrowing of the efferent arterioles;
- an increase in plasma volume due to a violation of the excretion of fluid from the body;
- increased activity of the renin-angiotensin-aldosterone system (RAAS) in nephropathy;
- an increase in the synthesis of endothelin 1, which has a pronounced vasoconstrictive effect;
- decrease in the depressor function of the organ.
The chronic course of pyelonephritis and glomerulonephritis can only be manifested by increased pressure. With polycystic hypertension, hypertension develops against the background of ischemia of the renal tissue affected by cysts.
Symptomatic renal hypertension is treated with medication using ACE inhibitors, diuretics and sartans (angiotensin II receptor blockers), which also have a nephroprotective effect.
Endocrine symptomatic hypertension
Violation of the endocrine glands leads to hormonal imbalance. The pressure level is affected by:
- Itsenko-Cushing's disease, which affects women more often during hormonal changes (puberty, menstruation, childbirth, menopause, abortion, and so on);
- pheochromocytoma;
- Kohn's disease;
- hyperthyroidism, hyperparathyroidism.
Cushing's syndrome
An increase in pressure in Itsenko-Cushing's disease is due to increased production of adrenocorticotropic hormone as a result of pituitary adenoma or adrenal cortex. Hypertension has a systolic-diastolic form, its course is usually benign, the pressure does not rise to high numbers.
Cushing's syndrome gives the patient a characteristic appearance - obesity of the trunk with thin limbs. In women, increased hair growth begins, in men, sexual function worsens. The rise in pressure is due to:
- increased synthesis of cortisol, which activates the central nervous system;
- an increase in the susceptibility of blood vessels to the vasoconstrictive effect of adrenaline and norepinephrine;
- retention of fluid and salt in the body;
- increased synthesis of angiotensin II.
Treatment consists in removing the neoplasm, which was the root cause of hypertension. If the operation is impossible, conservative treatment is prescribed to reduce the synthesis of cortisol. BP is adjusted with ACE inhibitors.
Pheochromocytoma
Pheochromocytoma is a hormonal neoplasm of the adrenal cortex, consisting of cells that actively produce catecholamines that affect blood pressure. If the tumor is located on the outer side of the adrenal gland, the synthesis of norepinephrine increases. With its internal localization, adrenaline and dopamine are secreted.
Variants of the course of hypertension depend on the location of the neoplasm:
- adrenal tumor provokes hypertensive crises against the background of normal pressure;
- noradrenal pheochromocytoma causes a stable permanent increase in blood pressure.
Increased production of norepinephrine is clinically manifested by an increase in lower pressure. Adrenaline gives a picture of systolic hypertension with tachycardia, sweating and trembling. Sharp rises in pressure with pheochromocytoma cause agitation in the patient, trembling of the hands, severe nausea with vomiting.
The temperature can rise to 39 ° C, tachyarrhythmia is characteristic. Crises begin spontaneously, sometimes at night. They pass on their own in about a quarter of an hour. Treatment is only surgical. A positive result is achieved in almost 90% of cases. If surgical treatment is not possible, the pressure is reduced with the help of drugs - blockers of "slow" calcium channels, centrally acting drugs, adrenoblockers
Kohn's disease
Kohn's disease develops with a tumor of the adrenal cortex. This is a syndrome accompanied by increased secretion of aldosterone, a mineralocorticosteroid hormone that retains water in the body. It contributes to the appearance of volume-dependent arterial hypertension. The upper and lower pressure figures grow evenly, hypertension rarely proceeds severely and gives complications. Additional signs:
- a decrease in the content of potassium in the blood, which leads to convulsions;
- tachycardia, possible extrasystoles.
The choice of treatment - conservative or surgical - depends on the tumor. With an adenoma or carcinoma, an operation is performed. With diffuse growth, drug treatment gives the best result.
Surgery does not always relieve hypertension. This is due to the fact that some patients have concomitant essential hypertension. Drug therapy is based on the use of drugs - aldosterone blockers.
Thyroid disease
Hyperparathyroidism is a malfunction of the parathyroid glands located on the thyroid. They produce parathyroid hormone. Its excess negatively affects the formation of bone tissue, washing out calcium from it. Then its concentration in the blood rises. This process is caused by a tumor of the thyroid gland.
Excessive amounts of parathyroid hormone negatively affect the kidneys, leading to the formation of parathyroid hypertensive factor. 70% of patients with this diagnosis suffer from arterial hypertension.
With hyperthyroidism, the synthesis of hormones that accelerate metabolism increases. At the same time, the work of the heart accelerates, cardiac output increases, which leads to the systolic variant of arterial hypertension - the upper pressure rises, and the lower one may even fall slightly.
If the increase in pressure is associated with the presence of a tumor, surgical treatment is used. It completely eliminates the cause of VAH.
Arterial hypertension associated with circulatory disorders has several causes:
- coarctation of the aorta - congenital abnormal narrowing of the vessel;
- atherosclerosis;
- valve defects.
In all cases, pathologies are accompanied by an increase in pressure. With coarctation, hypertension proceeds smoothly, without being complicated by crises. Upper and lower pressure rise evenly. Treatment is only surgical.
Secondary atherosclerotic hypertension usually presents as isolated systolic hypertension. The reason is the loss of elasticity in the aorta as a result of atherosclerotic deposits and calcification. This variant of VAH is typical for the elderly - after 55-60 years. With aortic valve insufficiency, systolic hypertension also develops.
Neurogenic VAG
Neurogenic symptomatic hypertension develops when parts of the brain that affect blood pressure in one way or another are affected. It can be:
- tumors of any origin;
- injuries (concussions and bruises of the brain);
- inflammation of an infectious and non-infectious nature.
If the tumor develops in the zone of the visual tubercle, hypertension becomes malignant. It is called Penfield syndrome. It is accompanied by unbearable headaches, frequent crises with nausea, vomiting, convulsions and visual impairment up to its loss.
VAH of neurogenic origin may be associated with disorders of cerebral circulation. Elevated intracranial pressure, stroke, or thrombosis with damage to areas of the brain have a direct impact on the process of blood pressure regulation. Hypertension may be paroxysmal or permanent.
Neurogenic VAH is usually accompanied by increased heart rate, headache, increased salivation, and dizziness. Treatment should be comprehensive - aimed at eliminating the underlying disease and reducing pressure. Antihypertensive therapy is selected according to the same principles as for essential hypertension.
Stress or nervous hypertension
This term implies an increase in blood pressure in response to a stressful situation. The mechanism of its development is based on the accumulation of oxidants in neurons. Free lipid oxidation in the cells of the medulla oblongata and cerebral cortex affects the sensitivity of neurotransmitters. As a result, the processes of blood pressure regulation change. And this can lead to its persistent increase.
The stress response triggers a series of biochemical reactions that increase the production of renin and angiotensin. The result is an increase in the level of adrenaline and norepinephrine, and, accordingly, blood pressure.
At the initial stage, stress hypertension is corrected by changes in diet and lifestyle. Diet, avoidance of alcohol, active lifestyle, aromatherapy, breathing exercises usually give a good result. If it is necessary to use medications, they are selected in the same way as in primary hypertension.
Prognosis for secondary hypertension
The course of the disease and prognosis depend on the nature of the primary pathology. If left untreated, it is negative for any type of VAG. Renal hypertension has a malignant course with an unfavorable prognosis.
In any case, a severe course is observed with the development of complications of hypertension affecting the vessels of the brain and heart. This applies equally to primary and secondary hypertension.
A favorable outcome is observed in the hemodynamic form and VAH caused by Itsenko-Cushing's disease.
Which doctor should I contact?
The first doctor who is treated with high blood pressure is a general practitioner or cardiologist. Their task is to conduct a primary diagnosis and, if secondary hypertension is suspected, refer to the appropriate specialist.
Renal hypertension is treated by a nephrologist, hemodynamic - by a cardiologist, neurogenic and nervous - by a neurologist, disorders of the endocrine glands are within the competence of an endocrinologist.
With an increase in blood pressure, each person should be attentive to health, turn to for examination and examination, and, if necessary, start adequate treatment in a timely manner.
Usually, after examination of the patient, primary or secondary arterial hypertension is established.
The exact diagnosis depends on the manifestations of the pathology.
Letters from our readers
Topic: Grandma's blood pressure returned to normal!
From: Christina [email protected])
To: site administration
Kristina
Moscow city
My grandmother's hypertension is hereditary - most likely, the same problems await me with age.
- general examination of blood and urine;
- blood test for glucose, creatinine, cholesterol;
- determination of the amount of potassium and sodium in the blood;
- urine sample according to Zimnitsky, Nechiporenko;
- examination of the condition of the fundus.
When the doctor has received all the data, they are analyzed, examined and a detailed questioning of the patient is carried out. If symptoms characteristic of secondary hypertension are noted, further diagnosis is performed.
Symptoms that define the disease include:
- age up to 20 years, as well as over 60 years;
- rapid development of the disease;
- sudden deterioration in well-being, the presence of high readings on the tonometer;
- etiological disorders;
- sympathoadrenal crises;
- failure of antihypertensive drugs.
If secondary hypertension is established, the presence of malfunctions in the work and structure of organs is assessed. For this, standard studies may not be enough. In such a situation, X-rays, ultrasound are additionally prescribed, CT, MRI can be prescribed. If a disease is detected, which is characterized by an increase in blood pressure, a diagnosis is established, appropriate therapy is carried out.
After finding the cause of a complex pathology, treatment is selected. Therapy is prescribed taking into account the individual characteristics of the patient and the underlying disease, the nature of the medications and the necessary procedures depend on this. Contraindications to them are taken into account.
If an infection is detected, foci of inflammation in the kidneys, polycystic disease is established, anti-inflammatory, antibacterial drugs are required, and the level of water-salt metabolism is restored. In difficult cases, a perineal examination or hemodialysis is performed.
With valvular defects and anomalies of the arteries of the kidneys, in the case of coarctation of the aorta, surgical intervention is practiced. Malignant tumors of the pituitary gland, kidneys, and adrenal glands should be promptly removed.
When hypertension is determined by changes in the functioning of the brain, anticonvulsant medications are additionally used. If there is a tumor, hemorrhage occurs, surgical methods are used.
In addition, antihypertensive therapy is prescribed when medications are selected that reduce the readings on the tonometer. Among them: Enalapril, Amlodipine, Metoprolol, Furosemide, Diakarb, Veroshpiron, Sermion and Pentoxifylline.
The therapist prescribes the treatment after a comprehensive examination and the conclusion of such doctors as an endocrinologist, a surgeon, a neurologist, a cardiologist also participate in the study. At the same time, it is impossible to single out any general scheme, since each patient is individual, taking into account all the features, and procedures and medications are prescribed that have their own contraindications.
In addition to drug therapy and surgery (if necessary), experts also recommend changing. In this case, it will be easier to track the change in readings on. It is advisable to adhere to the principles. It is important to reduce the amount of salty food, quit smoking, lose weight, start.
The purpose of the complex of these measures is to get rid of symptomatic arterial hypertension, reduce pressure indicators and stabilize them. Normal blood pressure is considered to be:
- less than 150/90 mm Hg Art. aged 60 years and over;
- less than 140/90 mm Hg Art. under the age of 60.
Pressure below 140/90 mm Hg. st. is observed when there are risks of ischemia, chronic kidney pathologies, coronary artery disease, diabetes mellitus.
After the start, regular monitoring of the situation is carried out in order to correct it in time if necessary and to avoid possible side effects from the drugs. Success is noted if the pressure steadily decreases 3-6 months after the start of treatment. In this case, it can be continued.
To prevent the occurrence of symptomatic systemic hypertension, a number of recommendations should be considered:
- observe the daily routine;
- sleep duration should be at least 8 hours;
- avoid stress, anxiety;
- actively engage in sports;
- stop smoking, exclude or minimize the amount of alcohol consumed;
- reduce the amount consumed daily (no more than 6 g);
- get rid of excess weight, this should be done gradually, losing no more than 3-4 kg per month.
It is also advisable to review the diet, consume no more than 50-60 g of fat during the day, and animal fat should be within 1/3 of this amount.
It is recommended to reduce or completely eliminate sugar, sweets and flour products, enriching the diet with ingredients with a high protein content (sour-milk products, lean meats, fish, etc.). It is useful to consume food, which contains potassium, magnesium and calcium (beans, dried apricots, baked potatoes, as well as prunes, raisins).
It is especially important to follow these tips for those who have a hereditary tendency to high blood pressure.
These recommendations refer to the primary methods of prevention, with their help, you can completely avoid the appearance of health problems, against which symptomatic arterial hypertension develops. If this happens, secondary prevention is carried out. Its purpose is to prevent the occurrence of complications against the background of high readings on the tonometer. Among her activities:
- Medical. They include taking antihypertensive drugs, they help reduce pressure, avoid complications of pathology.
- Non-drug. They include recommendations for primary prevention. Additionally, pressure control should be performed, it is measured twice during the day, at least.
A timely visit to a doctor in the presence of discomfort will allow you to immediately detect hypertension, find out the cause and eliminate it, avoiding complications.
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