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Arterial hypertension: symptoms and diagnosis
Last reviewed: 23.04.2024
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Symptoms of arterial hypertension in clinical manifestations are not significantly different from essential arterial hypertension and are characterized by a wide variety of symptoms. With glomerulonephritis, the severity of arterial hypertension usually depends on the morphological and clinical variant of the disease and does not depend on the state of renal functions; however, severe arterial hypertension, sometimes transformed into malignant, can be observed with IgA-GH and membrane-proliferative glomerulonephritis, even with minor histological changes in the kidneys. In contrast, arterial hypertension with rapidly progressing glomerulonephritis with semilunium can only be expressed moderately, despite significant histological changes in the kidneys. The reason for these features is still unknown. Severe arterial hypertension is often observed after cortical necrosis, with hemolytic-uremic syndrome, scleroderma kidney and often (but not always) with reflux-nephropathy.
In cases of diffuse kidney diseases, the dependence of arterial hypertension on the degree of renal activity is often noted, based on both clinical markers of activity (hematuria, proteinuria) and its morphological features (cell infiltration of glomeruli and stroma, proliferation of mesangial, epithelial and endothelial cells, vasculitis, fixation of immunoglobulins, etc.).
In diseases of the kidneys, as in the case of essential arterial hypertension, the dependence of its frequency on disturbances in the metabolism of purines and / or lipids is noted. In patients with hyperuricemia or hyperlipidemia, arterial hypertension in chronic glomerulonephritis is detected reliably more often in comparison with patients without metabolic disturbances. Hyperuricemia is considered as an independent factor in increasing blood pressure in kidney diseases.
Evaluation of the severity of hypertensive syndrome and the risk of damage to target organs in diffuse kidney disease should be based on 24-hour blood pressure monitoring. Disorders of the circadian rhythm of blood pressure: insufficient level of decrease in night blood pressure, "nocturnal" arterial hypertension, persistent diastolic arterial hypertension - can develop in the early stages of kidney disease even in conditions of determining normal values of arterial pressure with random measurements and with preserved kidney function. Violation of the circadian rhythm of blood pressure at its normal values and the more stable its increase early lead to the defeat of target organs (heart, brain, vessels and kidneys).
In conditions of terminal renal insufficiency, the symptoms of hypertension are complicated by uremic metabolic and hormonal impairments, which contribute both during the arterial hypertension and in the defeat of target organs.
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