For high blood pressure, don't just understand the surface 140, 90, the internal pathology is more important
There are high blood pressure and low blood pressure, so what is blood pressure? In fact, just like the water pressure of tap water, if there is no pressure, there will be no motivation to move forward, including blood pressure and water pressure. So when the blood pressure is high, the blood flow in the blood vessels will increase; when the blood pressure is low, the blood flow will slow down.
What we call high blood pressure is arterial blood pressure, which is composed of four factors: cardiac ejection, body blood volume, arterial wall compliance, and peripheral arterial resistance. Changes in any of these factors will cause fluctuations in blood pressure, that is, affect high or low blood pressure.
As one of the chronic diseases, hypertension generally has the phenomenon of "three highs, three lows, and three nos". That is, high prevalence, high risk, and high growth trend; low awareness rate, low treatment rate, and low control rate; no long-term regular medication, no adherence to blood pressure measurement, and no emphasis on non-drug treatment. It is one of the risk factors for coronary heart disease, stroke, chronic renal failure and vision loss. Therefore, it is helpful to understand the process of high blood pressure
Essential hypertension is divided into benign hypertension and malignant hypertension
A period of dysfunction
This stage is the earliest stage of hypertension. The blood pressure fluctuates and rises, but there may be no symptoms, or dizziness and headache. After rest or treatment, the blood pressure can return to normal.
reason
It is intermittent spasm and contraction of small arteries throughout the body, without substantial arterial vascular disease. After vasospasm, the lumen becomes thinner, and the resistance increases, which causes blood pressure to rise. When the spasm is relieved, the blood pressure returns to normal. Also because it is a non-continuous spasm, it is easy to relieve the spasm after rest or treatment.
The period of arterial disease
There is no fluctuation in blood pressure in this period, showing a significant increase in blood pressure, and antihypertensive drugs need to be used to lower blood pressure.
The long-term spasm of small arteries and the stimulation of vascular endothelial cells by elevated blood pressure develop into small arteries, small arteries and large arteries. After hardening, the elasticity of blood vessels is weakened, the wall of blood vessels is thickened, the lumen is narrowed, and arterial spasm is transformed into a substantial lesion.
Visceral disease period
Heart disease
Electrocardiogram showed left ventricular hypertrophy and myocardial strain. Heart failure occurs in severe cases, mainly manifested as asthma, which is related to the amount of activity and is called exertional dyspnea. When this symptom occurs, the prognosis is poor.
Because of the long-term rise in blood pressure, the heart pumps blood hard. The so-called exercise can build muscles, and the same is true for the heart. The left ventricle will become hypertrophic, and the heart will passively increase its weight, which can reach more than 400g (normal men are about 260g, women are about 250g).
Is left ventricular hypertrophy good or bad?
It is not good. The left ventricular hypertrophy increases the left ventricular wall, and the ventricular cavity is narrowed. After the narrowing, the amount of blood returned to the heart becomes smaller, and the amount of blood pumped becomes smaller. The more hypertrophic, the smaller the amount of blood pumped each time, and the heart rate will be increased compensatoryly to compensate, and the heart rate will become faster, which is likely to cause heart failure. As shown in the figure below, the left ventricular hypertrophy is significantly smaller.
- Kidney disease
Because there are two kidneys with a certain reserve, early lesions are less likely to cause symptoms. In the late stage, the more severe the disease is, the more severe the renal decompensation will be, edema, proteinuria and nephrotic syndrome (high proteinuria, high edema, hyperlipidemia and hypoproteinemia) will appear, and uremia will appear in severe cases.
The glomerulus can be thought of as a ball of capillaries. In high blood pressure, these afferent arterioles harden, the wall thickens, and the lumen narrows, causing glomerular ischemia to undergo fibrosis, sclerosis, or hyalinization, causing the corresponding renal tubules to atrophy due to ischemia. Some glomeruli with relatively mild lesions will be compensatory hypertrophy, and the renal tubules will also be dilated compensatoryly. Results: The kidney shrunk, hardened, and the surface of the kidney was uneven, as shown in the figure below.
- Brain lesions
Symptoms of hypertensive encephalopathy, such as headache, dizziness, vertigo, vomiting, visual impairment, etc.;
Symptoms of hypertensive crisis, such as severe headache, disturbance of consciousness, convulsions, etc.
Because of cerebral arteriosclerosis, localized ischemia is caused, capillary permeability is increased, some substances in blood vessels will leak out, and cerebral edema occurs. Depending on the extent of the lesion, different degrees of symptoms of hypertensive encephalopathy will occur.
If the occurrence of the ischemic site is not relieved in time, the ischemic tissue will be necrotic, that is, infarction, which is one of the main causes of lacunar infarction.
The above are symptoms of ischemia, and the following are bleeding
Cerebral hemorrhage is the most serious complication of hypertension. Hypertension is also the most common cause of cerebral hemorrhage. It is usually massive hemorrhage, which often occurs suddenly.
There are two main reasons:
Because the small arteriosclerosis of the cerebral blood vessels makes the blood vessels brittle and poorly compliant, when the blood pressure suddenly rises, it will cause rupture bleeding;
Also because the elasticity of the blood vessel wall decreases, small aneurysms or tiny aneurysms are formed locally when the blood pressure is high. When the blood pressure suddenly rises, these aneurysms rupture and bleed.
It can be exacerbated by benign hypertension, or it is malignant hypertension at the time of onset. The latter is more common in adolescents, and its onset features include:
The blood pressure rises significantly, often exceeding 230/130mmHg, and the lesion develops rapidly, and hypertensive encephalopathy may occur, or renal failure, retinal hemorrhage, etc. may occur earlier.
summary
Going back to the early pathological changes of hypertension, we can see the importance of spasm of small blood vessels. To prevent high blood pressure, in addition to not smoking, eating less salt, avoiding obesity and other risk factors, being open-minded, optimistic, and combining work and rest is also one of the important ways to prevent high blood pressure, which is easy to ignore. Because of mental stress and high tension, in such a state for a long time, the long-lasting blood vessels are mainly in a state of contraction, which can cause spasm of small and small arteries throughout the body, increase peripheral vascular resistance, and increase blood pressure.