Secondary arterial hypertension – causes, symptoms and treatment

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Secondary arterial hypertension is a pathological condition caused by a malfunction of the internal organs that are involved in the regulation of blood pressure. Distinguish from essential hypertension in that it is possible to establish the causes.

This type of disease in most cases has a malignant and progressive course, practically does not lend itself to medical correction of antihypertensive drugs. All the time, a high and persistent blood “pressure” is revealed.

Scientists distinguish more than 70 different pathologies that can lead to the development of symptomatic disease. A differential diagnosis is required. But finding the exact etiology requires a lot of time, which leads to severe damage to the target organs.

Secondary hypertension accounts for up to 25% of cases of all ailments. For a favorable prognosis, it is necessary to establish the pathophysiology of the abnormal process in a short time, to eliminate it with the help of adequate treatment.

>In accordance with the International Classification of Diseases (ICD-10 code), arterial hypertension is a group of pathological conditions due to which chronically high blood pressure values ​​are diagnosed. The list of these ailments is quite extensive.

Secondary hypertension may be caused by taking certain medications. These include contraceptives for oral administration, non-steroidal anti-inflammatory drugs, pills for the treatment of cardiovascular diseases.

If the increase in blood pressure is due to the primary pathology of the brain, then a diagnosis of central hypertension is made. Usually it develops due to brain injuries, a violation of central regulation. Other causes: cerebral hemorrhage, heart attack, encephalopathy.

The mechanisms of development of renal hypertension lie in impaired renal function:

  • The renal arteries are affected. This reason is most common. The kidneys play a dominant role in the regulation of diabetes and DD. If they receive a small amount of blood, they produce components that increase systemic blood pressure to provide renal blood flow. The causes of blood circulation disorders are different: atherosclerotic changes, thrombosis, tumor neoplasms.
  • Polycystic kidney disease is a genetically determined pathology that provokes gross transformations in the form of a large number of cysts, which leads to impaired organ function up to a severe form of renal failure.
  • A prolonged course of inflammatory processes in the kidneys. For example, a chronic form of pyelonephritis. Such a disease is rare, but not excluded.

Endocrine hypertension develops as a result of an endocrine disorder. The pathogenesis is as follows:

  1. Itsenko-Cushing’s disease. The etiology is based on the destruction of the adrenal cortex, which leads to increased production of glucocorticosteroids. As a result, a person increases the load inside the blood vessels, there are characteristic signs of the disease.
  2. Pheochromocytoma is a pathology that affects the adrenal medulla. In medical practice is relatively rare. Usually leads to hypertension of a malignant and progressive course. Due to compression of the tumor, the release of adrenaline and norepinephrine into the blood is observed, which leads to a chronically high diabetes and DD or a crisis course.
  3. Cohn’s disease – a tumor located in the adrenal glands, provokes an increase in the concentration of aldosterone. Hypokalemia, an increase in blood pressure develops. Feature: drugs of hypotensive effect practically do not work.
  4. Violation of the thyroid gland.

Cardiovascular hypertension is caused by many diseases. These include congenital narrowing of the aorta, open ductus arteriosus, aortic valve insufficiency, late stages of chronic insufficiency.

Very often, secondary degrees of arterial hypertension appear against the background of a malfunction in the kidneys. This state is characterized by a stable high blood pressure, which is caused by a violation of blood circulation in the organs.

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Clinical manifestations of secondary hypertension

The symptoms of primary and secondary arterial hypertension are different, respectively, there are different approaches to treatment. In the first case, the disease has all the signs of hypertension, but the etiology remains unclear. In the second case, there are symptoms of hypertension + manifestations that are characteristic of a specific disorder in the body.

The clinic in the second case will be mixed. In each individual picture, signs and symptoms will vary significantly. Some have a short-term increase in blood pressure up to critical values, others have a persistent slight increase, etc.

Doctors say that the disease changes the emotional background and the person’s character is not for the better. Therefore, if a loved one has become irritable, quick-tempered, his mood changes dramatically, then the body signals a disease.

Symptoms of increased arterial “pressure”:

  • Intense headaches.
  • Visual impairment (visual impairment, spots and flies in front of the eyes).
  • Dizziness, tinnitus.
  • Nausea, sometimes vomiting.
  • General malaise (weakness and lethargy).
  • Rapid heartbeat, pulse.
  • Swelling of the lower extremities and face (especially in the morning).
  • Feeling of anxiety, emotional lability.

Clinical manifestations against the background of the neurogenic form of hypertension are most pronounced. The patient complains of severe tachycardia, persistent headaches, excessive sweating, convulsive state (rarely).

With endocrine hypertension, specific completeness is manifested. That is, a person’s face and body are completely fattening, while the upper and lower limbs remain the same. It is usually diagnosed in women with menopause.

Due to renal hypertension, severe headaches occur, vision deteriorates significantly, heaviness appears in the head, and a feeling of one’s own heartbeat.

Signs that distinguish the primary form of the disease from the secondary:

  1. The sudden onset of the disease.
  2. Young age up to 20 years or after 60 years of age.
  3. A persistent increase in diabetes and DD.
  4. The rapid progression of pathology.
  5. Low efficiency or complete lack of effect of drug treatment.
  6. Symptomatic-adrenal seizures.

In some cases, the increase in blood pressure is the only symptom of symptomatic hypertension. Additionally, only signs of the underlying disease are manifested.

Differential diagnosis of symptomatic hypertension

Diagnosing secondary hypertension is a complex process. It is required to differentiate the increase in blood pressure from many other diseases. An unspecified diagnosis can cost a human life. Diagnostic measures are comprehensive.

First of all, take into account the clinical manifestations of which the patient complains. If there is a suspicion of a secondary form of the disease, then a comprehensive examination is carried out, during which diseases that contribute to the growth of arterial parameters are gradually excluded.

Common studies include: analysis of urine and blood, ultrasound of blood vessels, determination of heart pathologies, ultrasound of the kidneys. Each form of hypertension is diagnosed according to a special principle.

With the nephrogenic form, the patient has a sediment in the urine. If a fever, pain in the joints joins, then they talk about periarteritis – the disease affects many systems, including the kidneys. If only fever and an increase in diabetes and DD are present, then infectious processes in the urinary system are suspected.

If there is a suspicion of endocrine disruption, the hormonal background is examined – catecholamines in urine and blood are determined, the amount of thyroid hormones.

With kidney diseases, the diastolic value often increases. Hemodynamic hypertension is characterized by an isolated increase in systolic numbers. With endocrine genesis, in most cases systolic-diastolic hypertension is detected.

Features of the treatment of secondary hypertension

Conservative therapy is selected individually taking into account the characteristics of the patient’s condition and the specifics of the concomitant disease. When pathologies of the kidneys are detected, they often resort to surgical intervention.

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Often, the operative path is the only solution if pheochromocytoma, cancer, corticosteroma is diagnosed. If a tumor is found in the pituitary gland, then the therapy is carried out using laser radiation or a radioactive method.

Be sure to prescribe pills that are aimed at eliminating the underlying ailment. The treatment regimen is supplemented by several antihypertensive drugs to normalize blood pressure. One drug does not help lower blood pressure, only combinations.

Depending on the cause, the treatment may be as follows:

  • For pathology of the adrenal glands, the surgical treatment is recommended.
  • If there are inflammatory processes in the kidneys, antibiotics and anti-inflammatory drugs are prescribed.
  • For problems with the thyroid hormone treatment. Only under the supervision of a doctor.
  • If pathogenesis is due to heart disease or a strong narrowing of the aorta, then cardiac surgery is required. Be sure to prescribe medications for heart failure.
  • With the dosage form, appointments are adjusted, drugs are replaced by similar means without such a side effect.
  • Against the background of hypertension of central etiology, it is necessary to compensate for the primary disease if possible. For example, with a brain tumor – an operation, with a stroke – conservative therapy.

To reduce arterial values, antihypertensive drugs from different groups are prescribed on the tonometer. These are inhibitors of angiotensin-converting enzyme, beta-blockers, diuretics, calcium antagonists, etc. The treatment regimen is always individual. Additionally, tablets are prescribed in accordance with the existing violation. For blood thinning – Aspecard.

The key to successful treatment is competent and timely differential diagnosis, which avoids complications in the future.

Several types of the disease are distinguished: renovascular (congenital narrowing of the vessels of the renal artery) and renal arterial hypertension.

Prevention of secondary hypertension

There are many preventive measures for symptomatic disease. However, the main recommendation for hypertensive patients is the timely treatment of any disease. If you feel unwell, there are disturbing symptoms, you should immediately contact a medical institution.

Day mode optimization. This allows you to give the body the necessary rest, to restore strength after daily activity. It is recommended to sleep 8 hours a day, with hard work take breaks.

Physical activity helps all organs and systems to function normally. With hypertension, they approach it carefully. Some sports can trigger a sharp jump in blood pressure to critical numbers.

The most important preventive measures:

  1. Avoid stress.
  2. Hiking
  3. Normalization of metabolism.
  4. Weight loss (if overweight or obese).
  5. Rejection of bad habits.
  6. Reduced salt intake.

Symptomatic hypertension is a difficult pathology, it requires special attention of medical specialists, a thorough diagnosis and an effective method of therapy. The problem is relevant, since the disease is practically not amenable to conservative correction.

The lack of treatment leads to a number of serious complications – heart failure, cerebral hemorrhage, edema of the internal organs. Subsequently, they can lead to disability and death. With a malignant form of hypertension, the prognosis is poor.

All about hypertension, the specialist will explain in the video in this article as clearly and informatively as possible.

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Tatyana Jakowenko

Editor-in-chief of the Detonic online magazine, cardiologist Yakovenko-Plahotnaya Tatyana. Author of more than 950 scientific articles, including in foreign medical journals. He has been working as a cardiologist in a clinical hospital for over 12 years. He owns modern methods of diagnosis and treatment of cardiovascular diseases and implements them in his professional activities. For example, it uses methods of resuscitation of the heart, decoding of ECG, functional tests, cyclic ergometry and knows echocardiography very well.

For 10 years, she has been an active participant in numerous medical symposia and workshops for doctors - families, therapists and cardiologists. He has many publications on a healthy lifestyle, diagnosis and treatment of heart and vascular diseases.

He regularly monitors new publications of European and American cardiology journals, writes scientific articles, prepares reports at scientific conferences and participates in European cardiology congresses.