Arterial secondary hypertension treatment. How does secondary arterial hypertension manifest? Classification of secondary arterial hypertension

And hypertension in a general sense is a symptomatic manifestation of third-party diseases or a syndrome. It is accompanied by a persistent or temporary, regular or single increase in systolic and diastolic parameters (upper and lower). Often this concept is confused with the disease of the same name - hypertension.

The pathological process can be primary, actually caused by vascular problems, or secondary - it develops against the background of other diseases and acts as their persistent symptomatic complex.

The last named state has its own ICD-10 code: I15. The postfix indicates the etiological characteristics of the disease. That is, its origin.

Symptomatic or secondary arterial hypertension has a number of specific features.

Among those:

• Sharp, sudden onset. If the primary increase in blood pressure proceeds progressively, slowly, in another case, the start is abrupt. You can roughly determine the moment.
• General grave condition of the patient. The numbers are high, but there is no crisis as such. Therefore, the clinical picture does not peak when emergencies arise.
• Predominantly secondary hypertension develops in patients under 40 years of age.
• The classical methods of therapy do not give any effect, which indicates a symptomatic component. It is necessary to influence the cause, not the effect.

Certain forms of the pathological process have a lot of specific features.

Arterial hypertension can be typed on a key basis. This is the origin. Simply put, the localization of the main focus.

The following forms are called:

• Renovascular... It is caused by diseases of the excretory system. First of all, the kidneys and a violation of the production of a special prehormone renin. There are additional negative factors, such as the accumulation of excess fluid.
• Endocrine type. As the name implies, symptomatic arterial hypertension develops against the background of insufficient or excessive production of specific substances in the human body, with rare exceptions, there are no problems in diagnosis.
• Cardiac or cardiac type. Sometimes it is expanded, including vascular problems, which is fundamentally wrong, because in this moment lies the difference between the primary and secondary forms of the condition. We are talking about a violation of the heart. These are defects, developmental anomalies, congenital and acquired, cardiomyopathies, heart attacks and other pathological conditions.
• Neurogenic variety. It is relatively common. We are talking about disruption of the central nervous system against the background of tumors, infections. The course is difficult.

There are other, situational types of secondary arterial hypertension, for example, after taking alcohol or drugs.

Renal type

As the name implies, they talk about disorders of the excretory system as the basis of the disease.

By itself, this type of symptomatic increase in blood pressure is not uniform. Careful division makes it possible to name two more subtypes.

Renovascular hypertension

Most common. It is caused by a decrease in the quality of blood flow. The amount of fluid connective tissue flowing to the kidney drops. The filtration intensity is insufficient.

The body seeks to compensate for the violation. An excess of prehormone renin is produced. Together with angiotensin, aldosterone, it acts as a pressure level regulator.

Excessive amounts of this substance lead to vasospasm. The lumen of the arteries narrows, making it harder for blood to move. Tonometer readings grow significantly.

Among the reasons for the violation are:

• Atherosclerosis. The most common option. It consists in a low permeability of blood vessels due to blockage by cholesterol plaques.
• Thrombosis. The process is similar, only the occlusion is observed not by lipid structures, but by blood clots.
• Inflammation of the renal parenchyma and pelvis. We can talk about both classical pyelonephritis and autoimmune processes. Diagnostics of such conditions is not difficult.

Compression of the renal arteries by tumors, masses, vasculitis (inflammation of the walls of blood vessels and their subsequent scarring, and even overgrowth) is slightly less common.

Clinical signs are characteristic:

• Strong headache. In the back of the head. It accompanies all forms of hypertension, therefore, it is impossible to say exactly what was the cause without a thorough, thoughtful diagnosis. The intensity of the syndrome is extremely high. The patient takes a forced lying position in order to somehow alleviate the condition.
• Nausea, vomiting. Negative sign. Indicates the growing ischemic phenomena in the cerebral structures.
• Weakness, drowsiness. General asthenia. They accompany the patient constantly, again directly testify in favor of a violation of the normal trophism of the brain.
• Small difference between upper and lower pressure - 10-20 mm Hg. Art.

Usually, this is where the neurological symptoms end, with the exception of rare exceptions.

Renal manifestations are almost always present, such as pain syndrome, abnormal urination, and others.

Typical signs of renovascular hypertension: early onset in women (up to 30 years) and later in men (after 50), absence of a crisis course, approximate evenness of the patient's condition throughout the entire process, resistance to treatment, predominant increase in the lower (diastolic pressure).

Both forms of secondary arterial hypertension can acquire a malignant course. A kind of ongoing crisis.

Standard therapies are meaningless and require intensive treatment of the underlying cause.

Renoparenchymal form

It is much less common.

The fundamental difference from the previous one is the lack of connection with the amount of blood flowing to the kidney. The increase in renin concentration is due to the inflammatory process.

Only a specialist can distinguish one from the other, and then not immediately, but according to the results of laboratory assessment of urine, ultrasound diagnostics, scintigraphy, possibly MRI.

The clinical picture is identical: there is a persistent increase in blood pressure against the background of renal symptoms: edema, lower back pain, disorders of the urination process.

Both varieties are dangerous to health and life. Urgent treatment is required to avoid complications. These include stroke (in 80% of cases), heart attack. Against the background of a pronounced violation, extensive varieties of deviation are likely.

Both in that and in the other case, the treatment is inpatient. With the use of large combined doses of antihypertensive, surgical intervention if necessary).

Antibiotics, diuretics, hormonal drugs (Prednisolone, Dexamateson) are used. Hospitalization lasts until the complete correction of the condition.

Endocrine form

It develops against the background of a violation of the concentration and balance of specific substances in the body. Usually we are talking about three important components: cortisol, aldosterone, angiotensin II. Apart from the renin already mentioned above. To a lesser extent, adrenaline is involved.

What are the reasons for the increase in pressure? The factor is identical: this is a reflex narrowing of the lumen of arteries feeding organs and tissues, impaired blood flow and activation of a compensatory mechanism, which is based on an increase in heart rate and blood pressure.

The reasons are typical. Determined by endocrine pathologies:

• Itsenko-Cushing's disease. Increased production of cortisol. It causes a characteristic clinic, it is difficult to confuse patients.
• Acromegaly. An increase in the concentration of growth hormone, a hormone of the anterior pituitary gland.
• Diabetes. There is insufficient tissue sensitivity to insulin or a reduced production of it.
• Pheochromocytoma. A special adrenal tumor that produces norepinephrine. It is the most common culprit for persistent increases in blood pressure in patients.
• Hypo- or hyperthyroidism. Changes in the concentration of thyroid hormones.

Symptoms have both common features and specific symptoms. As for the first, these are the already mentioned headaches, nausea, vertigo with disorientation in space, darkening in the eyes, deviations in the work of the organs of vision.

We are talking about typical and nonspecific signs that accompany all forms of hypertension, without exception, up to a certain point.

Actually endocrine manifestations speak about the etiology of the process more clearly: obesity (in almost all patients) or underweight against a background of increased or normal nutrition (the hallmark of hypothyroidism).

Body hair growth, excessive or insufficient, growth of mammary glands in men (gynecomastia), thirst, increased and abundant urination, impaired fertility (decreased fertility or complete infertility), growth of ears, nose, palms (against the background of acromegaly).

Over time, the symptoms of the neurological plan decrease, the patient gets used to the disorder. The body adapts. A blurred clinical picture can be confusing for a novice specialist.

The danger is not only and not so much an increase in blood pressure. Although this is not an axiom: strokes, heart attacks and other disorders are possible.

The main diagnosis carries the threatening consequences. Itsenko-Cushing's disease is considered the most severe option presented. The second place is shared by diabetes and pheochromocytoma.

Surgical therapy (if necessary, remove the tumor) and conservative (replacement, using synthetic hormone analogues).

Heart shape

Easy to diagnose. It is caused by the already named defects of cardiac structures, inflammatory conditions (myocarditis, vasculitis), injuries, suffered from heart attacks.

Symptoms are neurological: headaches, nausea, vomiting, vertigo, inability to navigate in space, fatigue, weakness, insufficient concentration of attention, absent-mindedness, emotional lability as an optional psychic sign.

Other points are represented by cardiac manifestations. Rhythm disorders by type, much less often other options. Also shortness of breath, decreased exercise tolerance (endurance decreases).

Symptomatic hypertension rarely develops with severe heart failure or severe cardiac pathologies.

The opposite phenomenon is found: a decrease in the level of blood pressure, which indicates a violation of the contractile function of the myocardium and other related deviations in the work of the entire cardiovascular system and not only.

Etiotropic therapy (aimed at eliminating the root cause). Depends on the diagnosis. There are a lot of options. To normalize the contractility of the myocardium, glycosides are used, the correction of the blood pressure itself is carried out with the help of ACE inhibitors, beta-blockers, calcium antagonists, centrally acting agents (for example, Moxonidine), diuterics.

Eliminated by means of a special group of medicines (Amiodarone or Quinidine, others are not recommended, because they increase the risks of dangerous consequences).

Surgical treatment according to indications. If there are aneurysms, defects leading to the decompensation of the state. The issue is decided on an individual basis.

As part of urgent therapy, Anaprilin, Metoprolol (to stop attacks of sinus tachycardia), Captopril in the amount of a quarter of a tablet are prescribed to gradually lower blood pressure.

Neurogenic form

Partially overlaps with the endocrine, but not always. A classic example of an adjacent symptomatic arterial hypertension is a tumor or mass in the chiasmatic-sellar region.

For example, adenoma, germinoma, glioma of the posterior pituitary gland, craniopharyngioma, Rathke's pocket cyst and others.

A dual process develops: on the one hand, the neoplasm itself compresses the cerebral structures, provokes an increase in intracranial pressure, and hence the unstable production of hormones, on the other hand, key centers are involved that produce specific substances to stimulate the activity of the entire endocrine system.

Secondary arterial hypertension is not always caused by tumors; variants with infections of cerebral tissues (encephalitis, meningitis), trauma are possible.

The presence of vascular protrusions (aneurysms) and arteriovenous malformations affects.

Symptoms are pronounced, well noticeable and extremely varied. Typical manifestations of hypertension are identical: from headache to nausea, vomiting, weakness. The difference is in the nature of the pain syndrome.

If the mass becomes large and begins to compress brain tissue, the intensity is higher.

Third-party manifestations have several planes: mental disorders (lethargy, depressive mood, emotional lability, mental impairment, memory lapses or problems with remembering), neurogenic component (in addition to those already mentioned, there are focal signs, depending on the location of the lesion, for example, when the occipital lobe is involved, visual dysfunctions occur, etc. .).

Therapy is mainly surgical when it comes to tumors. When symptoms appear, there are not many options.

Compression takes place, the expansive spread of the mass effect will only grow. Removal of the neoplasm is required.

In the case of prolactinomas (pituitary adenomas producing the hormone of the same name), it is possible to use drugs. Often, such neoplasias regress against the background of conservative intervention.

Inflammatory processes are eliminated with large doses of antibiotics. The blood-brain barrier determines the inconsistency of the effectiveness of tactics for the treatment of encephalitis or meningitis.

Other varieties

They are episodic, that is, they directly depend on the actions of the patient himself or influencing environmental factors.

• Toxic type. When exposed to salts of heavy metals, mercury vapors, toxic components.
• Alimentary factor. Improper diet with a lot of animal fat, salt.
• Dosage form. When taking antidepressants, neuroleptics, anti-inflammatory non-steroidal origin, as well as hormonal medications.
• The stressful variety.
• Post-traumatic type. It also includes the condition after the surgery.

These moments provoke a symptomatic increase in blood pressure. These are not persistent forms, they are relatively easy to remove even with improvised means.

Attention:

But some of the causes described are potentially fatal to the patient (drug and toxic).

Also known are paradoxical reactions to stimulating substances: from nicotine and caffeine to cocaine, amphetamine and drugs in general.

Treatment is directed at relieving symptoms. In the case of a toxic form, the elimination of poisons from the body is required.

Finally

Symptomatic hypertension is an increase in blood pressure due to the development of non-vascular disease.

These are renal pathologies, abnormalities of the nervous system, hormonal imbalances, and other options.

Diagnostics is not a problem, symptomatic complexes are typical. Therapy in most cases leads to a complete cure, if pronounced changes in the organs have not begun.

Very often, the diagnosis of hypertension is misdiagnosed and, accordingly, patients receive the wrong treatment. As a result, their condition deteriorates significantly, and various complications develop.

This, in particular, often happens in case of errors in diagnostics and incorrect identification of the causes of high pressure. In about 15 cases out of 100, a symptomatic form of arterial hypertension occurs, that is, an increase in blood pressure due to other primary pathologies developing in the human body.

Secondary arterial hypertension is diagnosed when an increase in pressure is caused by a malfunction of the organs involved in its regulation. This condition is characterized by a severe course, can progress rapidly and significantly worsen the patient's condition. This type of hypertension is most often diagnosed in middle-aged people - it is then that diseases of the internal organs begin to appear and chronic pathologies worsen.

There are many causes of secondary hypertension, therefore, the symptoms of the disease in each patient can be significantly different. But there are general features of the development of secondary hypertension:

1. A sharp and stable increase in blood pressure.
2. The rapid progression of the disease.
3. The presence of other diseases.
4. Poor response to standard treatments.
5. Sympathoadrenal crises develop.

Identifying the cause of secondary hypertension is necessary in order to cope with the manifestations of the disease and slow down its course.

If you start uncontrollably taking drugs that reduce blood pressure, then resistance can develop to them, which will lead to a more severe course of the disease, as well as contribute to the progression of the underlying pathology.

Causes and mechanism of development of hypertensive syndrome

Currently, about 70 different diseases have been identified that can cause secondary hypertension. Therefore, during the diagnosis, all possible factors that can cause symptomatic hypertension are checked, which is often delayed, and as a result leads to a severe course of the disease and disorders of the endocrine system and metabolism.

Hypertensive syndrome is most often caused by:

Each of the diseases that cause symptomatic arterial hypertension develop in completely different ways. Therefore, it is impossible to single out any one mechanism for the development of hypertensive syndrome.

General symptoms, forms of development

Secondary hypertension has the same symptoms as primary hypertension. But there is also a difference - with symptomatic hypertension, symptoms of the underlying disease that cause pressure problems appear more.

The main features can be distinguished:

Secondary hypertension is often accompanied by pain in the heart, swelling of the extremities, weight gain, and other symptoms. The rest of the signs depend on the primary disease and the severity of its course.

According to the form of development, 4 states are distinguished:

1. Transient - the pressure rises at times and to low levels. There are slight dysfunctions of internal organs without damage.
2. Labile - hypertension has a persistent course. Slight damage to internal organs is possible.
3. Stable - persistent hypertension with high rates. There are lesions of the cardiovascular system.
4. Malignant - has a high risk of complications and an unfavorable prognosis, since it does not respond to drug therapy.

The rest of the symptoms are determined during the diagnosis using laboratory tests and instrumental examinations. Only after complete diagnosis is it possible to determine the severity of hypertension.

Classification of secondary hypertension

Based on the cause of the disease, that is, the organ, the defeat of which caused an increase in blood pressure, several basic forms are distinguished.

Neurogenic

Neurogenic hypertension develops when the brain or spinal cord is affected. The most common causes: trauma, tumors, ischemia, cerebral edema and other types of damage. In such conditions, not only blood pressure increases, but also intracranial pressure.

As a result, the following symptoms develop:

Diagnostics requires an encephalogram, angiography of blood vessels, MRI and computed tomography of the brain. Only the elimination of the causes will normalize the patient's condition.

Nephrogenic

This hypertension develops when the kidneys are affected due to trauma, tumors, systemic diseases, glomerulonephritis, and other inflammatory processes. Secondary nephrogenic hypertension is divided into two forms: parenchymal and renovascular. In rare cases, a mixed form is isolated.

Parenchymal hypertension develops only when a significant part of the kidneys are affected, chronic renal failure develops, or the disease becomes malignant. Renovascular hypertension is diagnosed when high blood pressure is caused by diseases of the renal arteries. The main reason is atherosclerotic vascular disease.

Secondary renal hypertension is accompanied by a persistent course, which increases even more with the use of salty foods. Patients feel strong thirst, fatigue, weakness, and in the evening they observe severe swelling.

Endocrine

Endocrine disorders lead to the fact that the internal glands begin to produce excessive amounts of hormones, leading to hypertension. The most common causes of endocrine hypertension are: hypo- and hyperthyroidism, adrenal tumors, pituitary adenoma, Itsenko-Cushing's and Cohn's syndromes.

In addition to the usual symptoms, the following signs join: muscle weakness, panic attacks, sudden weight gain, heart rate rises, and the load on the heart increases. The main signs - headaches, dizziness, weakness - are pronounced.

Hemodynamic

Hemodynamic or cardiovascular hypertension occurs when large vessels and the heart are affected. In this case, the cause of hypertension is a violation of systemic blood flow, an increase in cardiac output and an increase in vascular resistance.

Main reasons:

1. Coarctation of the aorta.
2. Takayasu's disease.
3. Aortic insufficiency.
4. AV block.
5. Sclerosis of the heart arteries.

Symptoms of hemodynamic hypertension from the cardiovascular system appear in different ways, depending on the diagnosis. But besides the general symptoms, there are: pain and heaviness in the heart, disturbances in heart rate and pulse, but hypertensive crises are not typical for this form.

Medicinal

Symptomatic drug hypertension often occurs with prolonged or inappropriate use of certain medications.

What medications can cause an increase in blood pressure:

1. Glucocorticosteroids.
2. Oral contraceptives.
3. Adrenomimetics.
4. Tricyclic antidepressants.
5. Non-steroidal anti-inflammatory drugs.

The hypertensive effect of most drugs is based on the retention of sodium, potassium and water in the body or on an increase in blood viscosity. This form of hypertension is often diagnosed when a patient has a medical condition that requires long-term medication.

Principles of therapy

Therapy for the symptomatic form of hypertension does not have a specific scheme. Each patient, depending on the diagnosis, is selected drugs that help to cope with the underlying disease. Treatment of hypertensive syndrome is impossible until the disease that provoked high blood pressure is eliminated.

Most often, conservative treatment is carried out, some patients have to take medications all their lives in order to support the work of internal organs and keep pressure within normal limits.

What drugs can be prescribed:

Medicines are selected very carefully, taking into account the characteristics of the patient's condition. In those cases when drug treatment is impossible - for tumors, heart defects, extensive kidney damage - they resort to surgical intervention.

Patients are recommended to have adequate sleep, regular rest, proper nutrition and elimination of physical and psycho-emotional stress. It is imperative to give up bad habits, control weight and undergo regular examinations.

Secondary hypertension or hypertensive syndrome has a more severe course than primary hypertension, since the patient's well-being is significantly complicated by the manifestations of the underlying disease.

But at the same time, it is much easier to establish the causes of the symptomatic form of hypertension, provided that the attending physician prescribes a complete examination. If you control the course of the underlying disease and take preventive measures, you can prevent the development of complications and the transition of hypertension to a malignant form.

Secondary hypertension (secondary high blood pressure) is an increase in blood pressure (BP) associated with the presence of a disease. Secondary hypertension differs from the usual type of high blood pressure (essential hypertension), which is often referred to as hypertension.

Hypertension, also known as primary hypertension, has no specific cause and is believed to be related to genetic factors, poor diet, lack of exercise, and obesity. Secondary hypertension is associated with diseases of the kidneys, arteries, heart, or endocrine system. Secondary hypertension also develops during pregnancy.

Proper treatment of secondary hypertension will help control the underlying disease and high blood pressure. This reduces the risk of developing serious complications - including cardiovascular disease, kidney failure, and stroke.

Symptoms

Like primary hypertension (essential hypertension), secondary hypertension usually has no specific signs or symptoms, even though BP is dangerously high. Some people with secondary hypertension experience headaches, but it can be difficult to understand whether the cause is high blood pressure or something else.

If you have high blood pressure, then one of the signs indicates the presence of secondary hypertension:

• High blood pressure that is difficult to treat (resistant hypertension)
• Very high blood pressure - systolic blood pressure above 180 millimeters of mercury (mmHg) or diastolic blood pressure above 110 mmHg
• Medicines that were previously effective in lowering blood pressure no longer work;
• A sudden sharp increase in blood pressure before the age of 30 or after 55 years;
• The absence of hypertension in your relatives.

If you have a medical condition that can lead to secondary hypertension, measure your blood pressure more often.

The reasons

A number of conditions cause the development of secondary hypertension. These include:

Risk factors

The most important risk factor for developing secondary hypertension is the presence of a disease that can trigger an increase in blood pressure.

Complications

Secondary hypertension worsens the course of the underlying disease, which causes an increase in blood pressure. If you do not receive treatment, secondary hypertension can lead to the following conditions:

Preparing to see a doctor

An increase in blood pressure is easy to detect with a routine physical examination. In this case, the doctor may order an additional examination, or refer you to a doctor who specializes in treating the underlying disease you suspect. For example, if your doctor thinks your high blood pressure is related to kidney disease, they will refer you to a nephrologist.

Your time with your doctor is limited, so a list of questions prepared in advance will help you save time. List your questions from most important to least important. When evaluating secondary hypertension, ask the following questions:

• What is the cause of high blood pressure in my case?
• What examination is recommended for me to undergo? How to prepare for it?
• Is the increase in blood pressure in my case temporary or permanent?
• What methods of treatment are used in this case, and which of them do you recommend to me?
• What side effects can I expect with treatment?
• I have other medical conditions. How do they influence each other?
• Should I limit my diet or exercise?
• How to make lifestyle changes to lower your blood pressure?
• Is there an analogue of the drug that you prescribed to me?
• How often do I have to come to your appointment to have my blood pressure checked?
• Do I need to measure my blood pressure at home? If so, how often?
• Which type of blood pressure monitor is best? How to use it correctly?

In addition to the questions that you planned to ask the doctor, do not hesitate to ask any questions during the conversation if you do not understand something.

Your doctor will likely ask you a series of questions. It is better to prepare in advance for the answers to save time. Your doctor will ask:

• Do any of your relatives have high blood pressure?
• If so, do you know the cause? Does your relative have diabetes or kidney disease?
• Do you have any unusual symptoms?
• How much salt do you consume?
• Has your body weight changed recently?
• Did your blood pressure rise during pregnancy?

Diagnostic methods

To diagnose secondary hypertension, your doctor will first measure your blood pressure using an inflatable cuff, as in a routine examination. With a single detection of an increase in blood pressure, it is impossible to diagnose secondary hypertension: for this, an increase in blood pressure is recorded at least six times during repeated visits to the doctor. To determine the exact cause of the increase in blood pressure, the doctor will prescribe an additional examination.

• Blood test. To diagnose the underlying disease, your doctor will prescribe a blood test for potassium, sodium, total cholesterol, triglycerides, and other chemicals in your blood.
• Analysis of urine. Your doctor will order a urinalysis to check for other conditions that cause high blood pressure.
• Ultrasound of the kidneys. Because many kidney diseases are associated with secondary hypertension, your doctor may order an ultrasound scan of the kidneys. In this non-invasive examination, the ultrasound specialist will move an instrument called a transducer across the skin. A transducer, which sends sound waves, measures how sound waves bounce off your kidneys, and sends images created by the sound waves to a computer monitor.
• Electrocardiogram (ECG). If your doctor thinks your secondary hypertension may be due to heart problems, you will be given an electrocardiogram. In this non-invasive test, sensors (electrodes) that record the electrical activity of your heart are attached to your chest and sometimes to your extremities. The ECG measures the timing and duration of each electrical phase of the heart's contraction.

Treatment methods

Often, drug therapy or surgery is needed for the main treatment. With effective treatment of the underlying disease, secondary hypertension will decrease or even disappear. Is enough change lifestyle - Eat healthy food, increase physical activity and maintain a normal body weight - to maintain normal blood pressure values. You may need to keep taking your blood pressure medication, and your underlying medical condition affects the choice of medication. Patients with secondary hypertension are prescribed:

• Thiazide diuretics. Diuretics (diuretics_are drugs that act on the kidneys to help your body get rid of sodium and water and reduce blood volume. These drugs have many analogues and are generally less expensive than other drugs for treating high blood pressure. If you are not taking diuretics and have high blood pressure, talk to your doctor about prescribing another drug or changing the drug you are taking for a diuretic Possible side effects of these drugs include increased urination and a higher risk of sexual dysfunction.
• Beta blockers. These drugs reduce the stress on the heart and dilate the blood vessels, causing the heart to contract more slowly and with less effort. Beta blockers alone are not effective enough for treating hypertension in African Americans and the elderly, but when combined with thiazide diuretics, their effectiveness is significantly increased. Potential side effects include fatigue, trouble sleeping, slowing heart rate, and cold hands and feet. In addition, beta blockers are generally not prescribed for people with bronchial asthma, as they can lead to muscle spasms in the lungs.
• Angiotensin converting enzyme (ACE) inhibitors. These medicines help widen blood vessels by blocking the production of a natural chemical that constricts blood vessels. ACE inhibitors are especially effective in treating high blood pressure in people with coronary artery disease, heart failure, or kidney failure. Like beta-blockers, ACE inhibitors alone are not effective in African Americans, but when combined with thiazide diuretics, their effectiveness is increased. Possible side effects include dizziness and coughing, and these drugs are not recommended during pregnancy.
• Angiotensin II receptor blockers. These medications help dilate blood vessels by blocking the action - but not production - of a naturally occurring chemical that constricts blood vessels. As ACE inhibitors, angiotensin II receptor blockers are effective in people with coronary artery disease, heart failure, and renal failure. These drugs have fewer potential side effects than ACE inhibitors, but they are also not prescribed during pregnancy.
• Calcium channel blockers. These medicines help relax the muscles in your blood vessels. Some of them slow down the heart rate. Calcium channel blockers themselves are more effective in African Americans and the elderly than ACE inhibitors or beta blockers. Possible side effects include water retention, dizziness, and constipation. It is necessary to warn about the certain risk of grapefruit lovers. Grapefruit juice interacts with some calcium channel blockers to increase blood levels of the drug, thereby increasing the risk of side effects. Ask your doctor or pharmacist if grapefruit juice is affecting the medicine you are taking; in some cases, it can be difficult to find the right treatment. You may need to take more than one drug in conjunction with lifestyle changes to lower your blood pressure. In addition, you may need to see your doctor at least once a month until your blood pressure stabilizes.

Lifestyle and home treatment

Treatment of secondary hypertension is challenging, but the same lifestyle changes that are used to treat primary hypertension can help. The following measures should be taken:

• Eat healthy foods. Try a DASH diet rich in fruits, vegetables, whole grains, and low-fat dairy. Consume more potassium to prevent and control high blood pressure. Potassium is found in vegetables and fruits such as potatoes, spinach, bananas, and apricots. Eat less fatty foods and saturated fats.
• Reduce the salt in your diet. A lower salt intake of 1,500 milligrams (mg) per day is recommended for people aged 51 and older, as well as African Americans of all ages and those with hypertension, diabetes, and kidney disease. Healthy people can consume no more than 2,300 mg of salt per day.
• Maintain a healthy body weight. If you are overweight, losing even 4.5 kilograms of weight will lower your blood pressure.
• Increase your physical activity. Regular exercise can help lower blood pressure and keep body weight in check. Exercise for at least 30 minutes a day.
• Limit your alcohol intake. Even if you are healthy, drinking alcohol raises your blood pressure. If you choose to drink an alcoholic beverage, do so in moderation - 15 ml of alcohol per day as pure alcohol for women and all people over 65, and 30 ml of alcohol per day for men.
• Do not smoke. Tobacco damages blood vessel walls and accelerates the development of atherosclerosis. If you smoke, talk to your doctor about how to quit this bad habit.
• Manage stress. Avoid stress as much as possible. Practice healthy psychological adjustment techniques such as muscle relaxation and deep breathing. Healthy prolonged sleep also helps in combating stress.

Refractory arterial hypertension is diagnosed when the patient takes three or more antihypertensive drugs (one of them is mandatory a diuretic), in a dosage that is close to the maximum dose.

As a result, it is still not possible to normalize and stabilize blood pressure indicators at the required level.

Based on medical practice, we can say that more than 40% of patients are resistant to antihypertensive treatment, despite the fact that the doctor rigidly titrates and combines medications of different groups.

Resistant arterial hypertension is subdivided into two forms of the disease. The first form is true-resistant arterial hypertension, and the second form is pseudo-resistant arterial hypertension.

It is necessary to consider the reasons for the development of such forms of the disease, to find out why antihypertensive drugs do not help to correct the situation, and what treatment does the doctor recommend?

Many scientific publications are devoted to the main recommendations regarding the rules for measuring arterial parameters. Nevertheless, many medical specialists are constantly in a hurry somewhere, and quite often ignore the rules, as a result of which this leads to numerous errors in blood pressure indicators, but the patient should know.

Doctors can use a cuff that is too small, measure blood pressure without resting the patient, quickly release air from the cuff, record indicators exclusively on one hand, which is fundamentally wrong.

The pseudo-resistant form of hypertension is rare in patients, and in situations where the classical measurement of blood pressure does not correspond to the true values \u200b\u200bof the indicators. As a rule, most often this phenomenon can be observed in elderly patients who have a history of atherosclerotic changes in the blood vessels.

Pseudo-resistant hypertension may be suspected by a physician if:

• No target organ lesions were identified.
• Blood pressure in the brachial artery is much higher than in the lower limbs.
• Symptoms of hypotension while taking antihypertensive drugs, while there is no pronounced decrease in blood pressure.
• Isolated systolic hypertension.

As all of the above shows, the main reason for diagnosing such a pathology can be called a doctor's mistake. The second includes low patient adherence to the prescribed therapy.

Such a circumstance may be based on the fact that the doctor did not quite specifically explain the rules of treatment, the main recommendations for therapy, and so on. In this regard, the patient did not fully realize what complications may arise against the background of arterial hypertension, as a result of which he ignores many of the doctor's prescriptions.

There are also such reasons for pseudo-resistant arterial hypertension:

1. Wrong regimen of taking medications, wrong frequency of use and dosage. For example, the doctor prescribed to take the medicine too often, up to 5 times a day, one tablet.
2. Insufficient lifestyle correction. In this situation, the therapy recommended by the doctor is quite adequate, however, the patient ignores optimal physical activity, has not changed his diet, and consumes a lot of salt and alcoholic beverages.

In any case, if such a diagnosis is made, the doctor recommends an extensive examination of the patient in order to find the main causes and eliminate them as quickly as possible.

In medical practice, there are a number of reasons that lead to this condition of a person. In turn, each reason is further subdivided into a group of factors that negatively affect blood pressure indicators.

As mentioned above, the main reason for this diagnosis is incorrect measurement of blood pressure. In medicine, there is such a term as "white coat syndrome", which doctors do not always take into account.

The fact is that it often happens that the doctor for the patient acts as a kind of psychological factor, as a result of which the patient begins to worry, as a result, when measuring blood pressure, the indicators will be higher than in reality.

As for the low adherence to therapy, several factors can be attributed to it. First, the patient does not fully understand that not only the numbers on the tonometer are important, but also his general well-being; low cultural level of the patient; over-prescription of various medications that have a number of side effects.

In a number of situations, it was found that the reason may also be the financial factor, when the patient independently replaces drugs with similar and cheap options, not quite realizing that they have a slightly different effect. The following reasons for the development of refractory hypertension are distinguished:

• Inadequate therapy - wrong dosage, frequency of administration of funds. When the patient complains of poor health, the doctor does not attempt to change the treatment regimen, adjust the dosage and frequency of administration.
• Lack of lifestyle correction - excess body weight, smoking cigarettes, abuse of alcoholic beverages, table salt, sweet, smoked and fried foods.
• Volume overload, which can be caused by severe renal failure, the use of antihypertensive drugs, high water intake, salt intake, and inappropriate treatment with diuretic drugs.

True-resistant hypertension is based on other causes of development. These include undetected secondary arterial hypertension, severe hypertension, or.

Due to the reasons identified, a medical specialist can revise the patient's clinical picture in order to prescribe adequate treatment that will lower blood pressure indicators and normalize the patient's well-being.

It often happens that the doctor, having not fully studied the patient's anamnesis, already recommends immediate medication.

Over time, the situation does not get better, blood pressure remains at the same high level, the patient feels worse every day, as a result, he diagnoses pseudo-resistant arterial hypertension.

Modern antihypertensive drug treatment should provide for the optimal choice, that is, the doctor recommends a single remedy (monotherapy), or draws up a certain treatment regimen that includes several different drugs.

As practice shows, monotherapy is rarely prescribed, since complex therapy most often helps to achieve a persistent lowering effect. The benefits of this therapy are as follows:

1. Medicines are used with different principles of action, which simultaneously allows you to control several pathogenetic pressure links.
2. Since the treatment always includes two or more drugs, they can be prescribed in a relatively low dosage, which minimizes the development of negative phenomena.
3. If fixed combinations are prescribed, that is, one tablet contains two potent substances at once, this makes it possible to improve the patient's body's susceptibility to the prescribed treatment.

In any case, in order to draw up a competent treatment regimen, the doctor must take into account the patient's condition, the severity of the course of the disease, concomitant pathologies, indications and contraindications for the use of the drug, as well as a list of side effects.

Reasonable drug combinations:

• Beta blockers plus diuretics.
• Angiotensin converting enzyme inhibitors plus diuretics. Sometimes it is advisable to replace inhibitors with angiotensin-2 receptor antagonists.
• Calcium channel blockers in combination with beta blockers.
• Diuretic drugs in symbiosis with calcium blockers.
• Alpha blockers plus beta blockers.

Sometimes the doctor uses other combinations with centrally acting drugs, if he believes that this will be more justified in the given clinical picture. In some cases, a more complex scheme can be made, which includes five or more drugs in a row.

As a rule, preference is given to drugs with prolonged action, which allow them to maintain their effect for 24 hours. It is sufficient to take such tablets once a day, which significantly improves the patient's adherence to the recommended treatment.

In medical practice, there are often situations when the patient does not inform the doctor that they are taking other medications. At the same time, the patient does not even think about the fact that his medications can reduce the effectiveness of antihypertensive drugs.

Therefore, it is very important to inform the doctor about all medications taken so that he optimizes the treatment regimen, taking into account the principle of the effect of all pills.

For example, steroids can interfere with the effectiveness of drugs to lower blood pressure. Clinical studies have shown that steroids are the cause of resistant hypertension in 20%. The elderly age of patients is a risk factor.

Some of the drugs contain sympathetic amines. And in order to lower blood pressure indicators, such drugs must be abandoned.

If it is not possible to refuse steroids, then diuretic drugs are included in the therapy without fail. While taking them, potassium control is recommended, because hypokalemia may develop.

There are also such groups of drugs that affect pressure in combination with antihypertensive drugs:

1. Sex hormones. Some contraceptives can intensify and inhibit the course of arterial hypertension if high dosages of sex hormones are used. The risk factor in this situation is overweight, smoking, renal failure, diabetes mellitus.
2. Medicines that have a direct effect on the sympathetic nervous system. In this case, alpha-blockers, beta-blockers, which help to level the side effects of this interaction, are mandatory added to the treatment regimen.
3. Non-steroidal anti-inflammatory drugs.
4. Antidepressants of the tricyclic group.

It often happens that from the patient's point of view, a harmless drug can be a catalyst for the induction of arterial hypertension, as a result of which internal organs are affected - the liver, kidneys, brain, retina.

In conclusion, it should be said that the causes of resistant hypertension can be a combination of several exogenous factors and secondary forms of hypertension. Therefore, it is necessary to establish the specific reasons for this condition, then eliminate the factors, and then prescribe multicomponent therapy for arterial hypertension, and about this in the video in this article.

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 increases. Such conditions are characterized by a severe course and weak effect from traditional antihypertensive therapy, early development of complications. Treatment requires action on the 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 - structural anomalies, vasoconstriction or compression, pyelo- or glomerulonephritis, nephrosclerosis, polycystic; high blood pressure provoke amyloid deposition in tissues, vascular inflammation, including autoimmune origin, prolapse of the kidneys or their removal;
• violation of hormonal levels in menopause, pathology of the thyroid and parathyroid glands, pituitary gland 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, thyroxin, indomethacin, antidepressants.

Classification

Secondary hypertension can be transient. In this case, the pressure increases slightly and sporadically. There are no changes in the fundus, there is no increase in the left ventricular myocardium. In the labile form, these manifestations are weak, and the pressure is moderately high, it decreases only after taking medications.

Isolation 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 - a cause of secondary hypertension

Arterial hemodynamic

It occurs when the aortic lumen narrows. One of these obstacles 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. In the high-risk area there are HIV-infected people who use drugs, centrally acting appetite suppressants, and contraceptives.

Manifestations of pulmonary hypertension in the early stages are increased fatigue, shortness of breath, frequent heartbeat with little exertion, and then at rest. With an increase in hypoxia, fainting, arrhythmia, cough with attacks of suffocation, the appearance of blood in sputum, pain in the right hypochondrium and swelling of the legs are noted. The heavy ones are accompanied.

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, the absence of heart and brain disorders.

A distinctive feature of such diseases is the rapid progression of renal failure, the appearance of swelling of the face and legs, and impaired urination.

The defeat of the renal arteries (renovascular hypertension) begins suddenly, the condition of the patients deteriorates sharply, while the drugs to lower the pressure practically do not work. A quarter of patients have signs of a malignant course. The main reason - .

Pheochromocytoma

An adrenal tumor has the ability to produce cortical hormones - adrenaline, norepinephrine and dopamine. High blood pressure is accompanied by intense headaches, hand tremors, increased sweating, frequent and strong heartbeats, crises with panic attacks. The body temperature is elevated, it can reach 38 - 39 degrees.

Primary aldosteronism

It occurs with an adenoma of the adrenal cortex. There is a retention of sodium and fluid with a simultaneous loss of potassium. Traditional medicines do not lower blood pressure, muscle weakness, convulsive syndrome, intense thirst, and predominance of nighttime urination are noted. Hypertensive crises can end in attacks of cardiac asthma, pulmonary tissue edema, a drop in cardiac contractility, and a stroke.

Itsenko-Cushing's syndrome

Caused by increased production of glucocorticoids by the adrenal glands. High blood pressure has a consistently high level, there are no crises, patients do not respond to antihypertensive drugs.

The diagnosis is assisted by a typical appearance - a moon-shaped face, obesity, hirsutism, purple stretch marks on the skin of the abdomen and thighs.

Medication

Drugs that provoke high blood pressure have a vasoconstrictor 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, which 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 part of the nervous system, narrow the arteries;
• glucocorticoids retain sodium and increase sensitivity to vasoconstrictor substances.

Neurogenic

It happens in the inflammatory process, brain tumors, traumatic brain injury, ischemic attacks. In addition to hypertension, there is a severe headache, periodic attacks of dizziness and fainting, convulsions, unsteadiness when walking, impaired coordination of movements, vision, speech.

Watch the 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 over 65;
• sharp start with high numbers;
• the course is malignant;
• complications rapidly increase (stroke, heart attack, pulmonary edema, detachment of the retina of the eye);
• the 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 renal - urine analysis (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 sodium in the blood are increased, low potassium, chlorine ions, radioisotope scanning helps to visualize the tumor, the degree of increase in the adrenal cortex;
• with Itsenko-Cushing's disease - high blood 17-hydroxyketosteroids, hydrocortisone; if it is difficult to diagnose, an ultrasound, CT or MRI of the adrenal glands is prescribed or their scanning after the administration of radioisotope drugs;
• 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 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, its surgical reconstruction is carried out by excision of the narrowed area and suturing or prosthetics, as well as the creation of bypass paths for blood flow. The operation is scheduled only in the early stages.

If the cause of high pressure is, then anticoagulants, oxygen inhalations are shown, with heart defects, their prompt elimination is necessary.

Treatment of nephritis is carried out using anti-inflammatory drugs, diuretics. Renovascular hypertension requires the following types of surgical interventions:

• plastic arteries,
• installation of a stent,
• renal artery reconstruction,
• creating a connection (anastomosis) bypassing the constriction.

Tumors of the adrenal gland, 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 disease development

Primary preventive measures for symptomatic hypertension are reduced to preventing heart and vascular malformations, eliminating stress and toxic effects on the body, avoiding excessive sun exposure, giving up bad habits, normalizing nutrition and lifestyle. The use of drugs is carried out only after prescription or agreement with a cardiologist.

In order to stop the progression of diseases, a timely visit to a doctor is required, a full range of examinations are required to detect the cause of high blood pressure. Taking medications, as well as surgical treatment in the early stages, allows you to avoid such severe, sometimes fatal complications of hypertension, such as cardiac asthma, pulmonary edema, heart attack, stroke, renal failure.

Secondary hypertension occurs against the background of diseases of the vessels, kidneys, lungs, endocrine organs, and the nervous system. This group of diseases is distinguished by a severe course and low efficiency of traditional antihypertensive therapy.

To identify the cause of symptomatic hypertension, diagnostic tests are required; CT, MRI and radioisotope scanning can be prescribed in difficult cases. Treatment is carried out by influencing the underlying pathology, most often surgical interventions are indicated.

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