Elevated Blood Pressure : Causes, Symptoms, Diagnosis & Treatment

• Causes Of High Blood Pressure
• Physiological Factors
• Arterial Hypertension
• Cardiovascular Diseases
• Kidney Disease
• Endocrine Disorders
• Preeclampsia Of Pregnant Women
• Complications Of Pharmacotherapy
• Rare Causes
• Diagnostics
• Treatment
• Help Before Diagnosis
• Conservative Therapy
• Surgery

Elevated blood pressure is observed both in essential hypertension and in symptomatic forms of hypertension that are associated with diseases of the kidneys, central nervous system, and endocrine system. In healthy individuals, a short-term increase in pressure occurs in stressful situations, with the “white coat syndrome”. To diagnose the causes, laboratory tests are prescribed - general and biochemical blood tests, lipid and hormonal profiles, and an assessment of GFR. Instrumental methods are used - ECG, echocardiography, ultrasound of the kidneys and endocrine glands. Relief of the symptom includes lifestyle changes, antihypertensive drugs, elimination of the causes of the symptom.

Causes of high blood pressure

Physiological factors

A short-term increase in blood pressure is noted when the sympathoadrenal system is activated. This happens with stress, strong fear. BP increases moderately, not accompanied by a serious deterioration in health. After elimination of the psychotraumatic factor, the condition returns to normal. With fever, the indicators of the tonometer also change, their growth is proportional to the level of body temperature.

A widespread phenomenon is the "white coat syndrome". During the measurement of blood pressure in a medical institution (for example, during a medical examination), its level exceeds the norm. This is due to the excitement and nervousness that the patient experiences at the sight of medical workers. At the same time, self-monitoring of pressure at home does not show deviations from the norm. It is believed that the presence of such a syndrome increases the risk of developing hypertension in the future.

Arterial hypertension

Primary arterial hypertension is the most common pathological cause of elevated blood pressure. Problems with blood pressure mostly begin after 5 years. When measured with a tonometer, indicators above 140/9 mm Hg are obtained. Art. Registration of proportionally increased systolic and diastolic pressure is characteristic. The diagnosis of arterial hypertension is established if the indicated values ​​were obtained from 3 independent measurements.

Cardiovascular diseases

An increase in systolic pressure is a typical manifestation of atherosclerosis. For coarctation of the aorta, the presence of elevated blood pressure in both arms is more specific, when measuring indicators on the legs, normal values ​​\u200b\u200bare obtained. On visual examination, a good development of the muscles of the arms and torso is noticeable with relatively short and weak lower limbs.

The pressure rises with Takayasu's disease (nonspecific aortoarteritis). A pathognomonic sign - increased blood pressure is recorded on the arm and leg of one half of the body, and on the other hand, the level remains normal. Symptoms appear in young patients, usually between 15 and 3 years of age. Hypertension is observed with stenosis of the carotid and vertebrobasilar arteries, aortic valve insufficiency, complete atrioventricular blockade.

kidney disease

The presence of a symptom in kidney damage is associated with an increased release of vasoconstrictor factors into the blood, water and salt retention in the tissues. For renal forms of hypertension, the presence of a sharply increased diastolic pressure (up to 11 mm Hg and above) is characteristic with a relatively small increase in systolic pressure. A similar clinical picture often occurs in young and middle-aged patients. Several groups of diseases contribute to the appearance of increased blood pressure:

• Diseases of the renal parenchyma : chronic glomerulonephritis and pyelonephritis, diabetic glomerulosclerosis, amyloidosis.
• Damage to the vessels of the kidneys : atherosclerotic stenosis of the renal artery, fibromuscular dysplasia.
• Congenital anomalies : polycystic, hypoplastic, horseshoe kidney.

endocrine disorders

Periodic sharp fluctuations in blood pressure occur in women with complicated menopause. The symptom is accompanied by intense redness of the skin, sweating. It is caused by hormonal changes in the body, disorders of the autonomic innervation of vascular tone. Hormones play an important role in the regulation of blood pressure, so the following endocrine diseases provoke its increase:

• thyrotoxicosis. In thyroid pathology, isolated systolic hypertension is recorded, and diastolic blood pressure is normal or even reduced. There is tachycardia, tremor of the fingers, hot and dry skin. The pathognomonic symptom is exophthalmos.
• Pheochromocytoma. A tumor of the adrenal medulla is manifested by an increase in pressure to extremely high numbers - from 180/12 mm Hg. Art. Symptoms, as a rule, are determined in patients aged 20-4 years. With pheochromocytoma, tachycardia, tachypnea, severe headache are disturbing.
• Itsenko-Cushing's disease. There is a persistent, refractory to drug therapy increase in pressure. Systolic and diastolic pressure increases evenly. A combination of elevated blood pressure with obesity of the upper half of the body, purple striae, and increased hairiness is typical.
• Hyperaldosteronism. It is characterized by a stable and steady increase in pressure, which is not stopped by standard drugs, in addition to potassium-sparing diuretics. In addition to increased blood pressure, muscle weakness, functional paresis, paresthesia are detected.

Preeclampsia of pregnant women

Preeclampsia, which occurs in the second half of pregnancy, is accompanied by an increase in blood pressure over 140/90. Simultaneously with hypertension, severe edema, headaches, and nausea are noted. If left untreated, blood pressure rises to very high levels, visual disturbances, vomiting join the symptoms. If, against the background of increased blood pressure and nephropathy, convulsions develop, they talk about the transition of the state to the stage of eclampsia.

Complications of pharmacotherapy

Fluctuating blood pressure is one of the most common side effects of drug treatment. The pressure usually changes some time after the start of the medication. Exceptions are drugs with sympathomimetic activity, which provoke a sharp jump in blood pressure immediately after use. A complication in the form of high blood pressure is possible when taking the following groups of drugs:

• Hormones : glucocorticoids, oral contraceptives.
• Drugs affecting the central nervous system : MAO inhibitors, tricyclic antidepressants.
• Non-steroidal anti-inflammatory drugs (with prolonged use).
• Sympathomimetics : ephedrine, tyramine.

Rare Causes

• Pathologies of the central nervous system : tumors and cysts of the brain, subarachnoid hemorrhage, meningitis and meningoencephalitis.
• Diseases of the blood system : erythremia, hypercoagulation.
• Acute stress : burn disease, crisis in sickle cell anemia, withdrawal syndrome in alcoholism.
• Exogenous intoxications : lead, thallium, cadmium.

Diagnostics

At the initial examination, the cardiologist conducts a physical examination, measures the pressure on the arms and legs. To obtain the most reliable results, daily monitoring of blood pressure (ABPM) is prescribed. Diagnostic search is aimed at finding the etiological factors that caused elevated blood pressure. The survey plan usually includes:

• ECG. According to the electrocardiogram, signs of myocardial hypertrophy, violations of repolarization processes are revealed. With a change in blood pressure towards increased, single extrasystoles and other rhythm disturbances may occur, manifestations of congenital or acquired malformations of the heart can be detected.
• ultrasound. Echocardiography evaluates the function of the heart. Often visualize hypertrophy of the myocardium of the left ventricle. To exclude renal hypertension, ultrasound of the kidneys, Dopplerography of the renal arteries is mandatory. According to the indications, sonography of the main endocrine glands is done.
• standard analyses . A general blood test is performed, fasting glucose levels are measured. In a biochemical study, the levels of urea and creatinine are studied, the lipid spectrum is the levels of cholesterol, different fractions of lipoproteins. In the general analysis of urine, the amount of protein and cellular elements is determined.
• Advanced laboratory tests . In the presence of typical symptoms of endocrine pathology, the level of a number of hormones is examined: corticosteroids, aldosterone, catecholamines. To assess kidney function, creatinine clearance is calculated. A glucose tolerance test is recommended to rule out the metabolic syndrome.
• Additional instrumental studies . To determine the cardiothoracic index, the shape and size of the heart, an overview X-ray of the chest is performed. To confirm atherosclerotic vascular disease, angiography is performed. For a more detailed study of the structure of the kidneys, adrenal glands, CT, MRI are prescribed.

Treatment

Help before diagnosis

Normalization of elevated blood pressure begins with non-drug measures. To reduce the load on the heart, in the diet you need to limit the amount of salt and liquid. In case of lipid metabolism disorders, animal fats are excluded. It is necessary to establish a daily routine: allocate sufficient time for sleep, add feasible physical activity. The use of alcohol and smoking is completely excluded.

Conservative therapy

Drug treatment is carried out taking into account the etiology of high blood pressure. In symptomatic conditions caused by stress, it is advisable to prescribe sedatives. To eliminate hypertension in thyrotoxicosis, thyreostatics are effective. Most cases of elevated blood pressure require the use of classic antihypertensive drugs, which in cardiology are divided into 5 groups:

• Diuretics . Mainly recommended for elderly patients with concomitant heart failure, edema. Means are not used during pregnancy, hypercalcemia, gout.
• ACE inhibitors . Indicated for increased pressure in combination with left ventricular dysfunction, diabetes, kidney disease. Not prescribed for pregnant women.
• Angiotensin II receptor blockers . The mechanism of action of ARBs is similar to the previous group of drugs, but they cause a smaller number of undesirable effects. The disadvantage is the high price.
• calcium antagonists . They have a vasodilating effect, so they are often used with a sharp increase in diastolic blood pressure. An additional effect of drugs is antiarrhythmic action.
• Beta blockers . As monotherapy may be recommended for young patients. Also taken with concomitant chronic heart failure, tachyarrhythmias.

Surgery

Surgical treatment is mainly used for secreting tumors of the endocrine system, which are distinguished by therapeutic refractoriness of elevated blood pressure. Shown surgical removal of pheochromocytoma, adenoma of the adrenal cortex, subtotal resection of the thyroid gland. With renal causes of hypertension, reconstructive operations are performed on the renal arteries, in advanced situations - nephrectomy.

Cardiac and vascular surgeons treat some of the cardiovascular causes of high blood pressure. With coarctation of the aorta, the defect is corrected, after which the symptoms disappear. Patients with aortic insufficiency require heart valve replacement. For complete AV block causing hypertension, a permanent pacemaker is implanted.