62. Concept of arterial hypo- and hypertension.

Arterial hypertension – is a stable arterial pressure increasing more than norm. According to WHO, for 20-60 yeared people low limits of norm for systolic and dystolic arterial pressure are 100 and 60 correspondingly, superior – 139 and 89 mm merc col. Boarder (between norm and hypertension, synonym – boarder hypertension – SAP 140-159, DAP – 90-94mm merc col; hypertensive AP – systolic and diastolic – 160 and 95 correspondingly and ore. For people younger than 20 years norm of AP is less on 10-20, for people elder than 60 years – 10-15 mm merc col higher than mentioned ones.

Pressor regulative systems:

1. sympathic-adrenale system;

2. renin-angiotensin system;

3. aldosterone-vasopressine system;

4. glucocorticoids.

Depressor regulative systems:

1. reflexes from baroreceptors of aorta arc and sino-carotide zone;

2. prostaglandines A, E, I;

3. kallikreine-kinine system;

4. atrial sodium-uretic hormone.

Arterial hypertension types:

1. a) Primary – arterial pressure increasing can not be connected with separate disease or pathological process in one or other organs; sometimes this increasing reason is non-clear; synonyms: “essential hypertension”, “hypertonic disease”.

b) Secondary – as a result of pathological processes in different organs and systems; synonym – “symptomatic hypertension”.

2. By heart minute volume (cardiac charge) – haemodynamic types:

1. hyperkinetic – with cardiac charge increasing above norm;

2. eukinetic – with normal cardiac charge;

3. hypokinetic – with decreased cardiac charge.

3. By total peripheral resistance (TPR) changing:

   1. with increased TPR;

   2. with normal TPR;

   3. with decreased TPR.

4. By circulating blood volume:

   1. hypervolemic (volume-dependent) – at primary hyperaldosteronism or Konn’s disease;

   2. normovolemic (volume – independent or volume-free).

5. By type of increased arterial pressure:

   1. systolic – with dominant systolic pressure increasing;

   2. 55eriphera;

   3. 55eriphe-dyastolic or mixed– the mostly widely-spread.

6. By renin content in blood and its effects:

   1. hyperreninic;

   2. normoreninic;

   3. hyporeninic.

7. By clinical course:

   1. benign – with slow development during many years;

   2. malignant – leading to the death during 1-2 years (vascular walls are significantly injured, they have fibrinoid and necrotic changings, renal insufficiency is developed rapidly).

Arterial hypotensions types:

1. Physiological (it is not accompanied by any noceoceptive symptoms).

2. Pathological (it is accompanied by definite symptoms):

1. acute;

2. chronic:

   1. symptomatic (secondary) – as a result of such diseases as:

-cardiac vices;

-myocardites;

• myocardial infarction;

• hard pneumonia;

• hepatitis;

• mechanical jaundice;

• anaemia;

• endocrinopaties;

• exogenic intoxications.

2. neuro-circulatory dystony of hypotensive type (primary).

Pathogenetical classification:

1. Delt with heart contractive function insufficiency.

2. Connected with circulating blood amount decreasing.

3. Appeared due to resistive vessels (arterioles) tone diminishing.