Primary and secondary forms
According to etiology (origin), there are two major groups:
- Primary (essential, idiopathic) — there is no clear cause for the patient's blood pressure elevation. In Russian medical practice, the term “Hypertensive disease” (Gipertricheskaya bolezn) is traditionally used to describe this condition.
- Secondary (symptomatic) — a specific pathology leading to the increase in values (e.g., kidney disease or an endocrine disorder) is identified.
What determines the blood pressure level?
Blood pressure values depend on a combination of three key factors:
- Tone of smooth muscle cells of the vascular wall (it is important to note that in some forms of pathology, it may not be elevated, but even decreased).
- Cardiac output (minute volume of blood).
- Circulating blood volume (CBV).
Depending on the magnitude of cardiac output, three hemodynamic variants are distinguished:
- Hyperkinetic: output is increased, while total peripheral vascular resistance (TPVR) is normal or decreased.
- Hypokinetic: output is decreased, but TPVR is significantly increased.
- Eukinetic: output is normal, TPVR is increased.
A mixed (systolic-diastolic) variant is also encountered.
Classification by the triggering link of pathogenesis
Depending on the initiating mechanism, five main groups of arterial hypertension are distinguished:
- Neurogenic (accounting for about 50% of cases). Divided into centrogenic and reflex types. Often occur in organic brain injuries (trauma, encephalitis, tumors, ischemia), which lead to activation of the sympathetic nervous system and hormone release.
- Endocrine. Associated with adrenal pathology (pheochromocytoma, hyperaldosteronism), thyroid pathology (hyper- and hypothyroidism), or pituitary pathology (Cushing's disease).
- Hypoxic (metabolic). Develop due to oxygen deprivation in organs, most commonly in the brain and kidneys. Include ischemic (e.g., renovascular hypertension), venous-congestive, and hypoxic forms.
- Hemic. Caused by changes in the blood properties themselves — an increase in its volume or viscosity (e.g., in polycythemia or hyperproteinemia).
- Mixed. Simultaneous or sequential involvement of multiple mechanisms (e.g., in allergic reactions).
Degrees of blood pressure elevation
To assess the severity of the condition, a classification based on blood pressure levels is used (values are indicated in mm Hg):
| Category | Systolic BP | Diastolic BP |
|---|---|---|
| Optimal | < 120 | < 80 |
| Normal | < 130 | < 85 |
| High normal | 130–139 | 85–89 |
| Grade 1 (mild) | 140–159 | 90–99 |
| Grade 2 (moderate) | 160–179 | 100–109 |
| Grade 3 (severe) | > 180 | > 110 |
| Isolated systolic | > 140 | < 90 |
Risk factors contributing to the development of the pathology include a burdened family history, renal and vascular pathologies (including coarctation of the aorta and Takayasu arteritis), endocrine disorders, metabolic syndrome, and psychophysiological characteristics (frequent stress, choleric personality type).
Briefly: answers to topical questions
Which specific organs are considered target organs damaged in arterial hypertension?
Target organs damaged in prolonged arterial hypertension include the heart, kidneys, blood vessels, brain, and retina.
- Heart — left ventricular hypertrophy develops.
- Kidneys — albuminuria is observed.
- Blood vessels — thickening of the intima-media complex occurs.
- Brain — thrombosis, hemorrhages, and lacunar infarctions form (hypertensive encephalopathy and strokes develop).
- Retina — microangiopathy occurs with the development of hypertensive retinopathy.
What criteria are used to divide hypertensive disease into stages (Stage I, II, III)?
The provided sources do not specify the exact distribution into Stage I, II, and III of hypertensive disease.
It is indicated that the stage of arterial hypertension is determined by the presence of:
- diabetes mellitus (DM);
- target organ damage (TOD);
- associated clinical conditions (ACC).
The stage reflects the severity of target organ damage. The grade of arterial hypertension is determined by the blood pressure level.
How to memorize the three main factors determining pressure levels? Imagine a plumbing system: Pump (cardiac output), Pipes (vascular tone), and Water (circulating blood volume). Any pharmacological agent that lowers blood pressure (antihypertensive) acts on one of these elements.
Class and exam questions
What is the difference between hypertension and hypertensive disease?
The term “hypertomia” is used to describe excessive muscle tension, including vascular smooth muscle cells. “Hypertension” means an increase in fluid pressure in cavities or vessels. To describe high blood pressure, it is more correct to use the word “hypertension”.
How does a hypertensive reaction differ from the disease?
A reaction is a transient, adaptive pressure surge regulated by physiological mechanisms that normalizes after the stimulus disappears. A disease, however, is persistent, does not resolve on its own, and is accompanied by tissue damage.
How do catecholamines increase blood pressure?
With an excess of adrenaline and noradrenaline (e.g., in pheochromocytoma), alpha- and beta-adrenergic receptors are stimulated. This causes marked constriction of arterioles and venules and increases the force and frequency of heart contractions, leading to an increase in cardiac output.
What else to study on this topic
- The role of the sympathoadrenal system and the hypothalamic-pituitary-adrenal axis in the development of centrogenic hypertension.
- Pathogenesis of renovascular hypertension and the cascade of reactions of the RAS system.
- Mechanisms of blood pressure elevation in endocrinopathies: hyperaldosteronism and ACTH overproduction.
- Cerebroischemic hypertension: impact of medulla oblongata hypoxia on the vasomotor center.
- Hemic arterial hypertensias: impact of blood viscosity and polycythemia on hemodynamics.
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