For hypertension, don't just recognize the surface 140, 90, the internal pathology is more important
High blood pressure and low blood pressure, what is blood pressure? In fact, just like the water pressure of running tap water, if there is no pressure, there will be no motivation to move forward, including blood pressure and water pressure. Therefore, 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, compliance of the arterial wall, and peripheral arterial resistance. Changes in any one of these factors will cause fluctuations in blood pressure, that is, 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; not taking long-term regular medication, not insisting on measuring blood pressure, and not paying attention to non-drug therapy. It is one of the risk factors for coronary heart disease, stroke, chronic renal failure and vision loss. Therefore, it is very helpful for us to understand the process of hypertension
Essential hypertension is divided into benign hypertension and malignant hypertension
A period of dysfunction
This stage is the earliest stage of hypertension. Blood pressure fluctuates and increases, but it may be asymptomatic, or dizziness and headache. After rest or treatment, blood pressure can return to normal.
reason
Intermittent spasmodic contraction of small arteries throughout the body without substantial arterial vascular disease. After the vasospasm, the lumen becomes thinner and the resistance increases, which causes the blood pressure to rise. When the spasm is relieved, the blood pressure can return to normal. Also because it is a non-persistent spasm, it is easy to relieve the spasm after rest or treatment.
The stage of arterial disease
Blood pressure during this period is not fluctuating, manifested as a significant increase in blood pressure, requiring the use of antihypertensive drugs to lower blood pressure.
The long-term spasm of small arteries and the stimulation of vascular endothelial cells by elevated blood pressure lead to the development of arterioles, small arteries and large arteries. After sclerosis, the elasticity of the blood vessels is weakened, the blood vessel wall is thickened, the lumen is narrowed, and the arterial spasm is transformed into a substantial lesion.
Visceral disease stage
Heart disease
The electrocardiogram showed left ventricular hypertrophy and myocardial strain. In severe cases, heart failure occurs, mainly manifested as asthma, which is related to the amount of activity, called exertional dyspnea. When this symptom occurs, the prognosis is poor.
Because of the long-term rise in blood pressure, the heart pumps blood at a high intensity. The so-called exercise can build muscle, and the same is true of the heart. The left ventricle will become hypertrophic, and the heart will passively increase the weight of up to 400g or more (normal men are about 260g, women are about 250g).
Is left ventricular hypertrophy good or bad?
It is not good. 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 is reduced, and the amount of blood pumped is reduced. The more hypertrophy, the smaller the amount of blood pumped each time, and the compensatory increase in heart rate to compensate, the heart rate will become faster, and it is easy to cause heart failure. As shown in the figure below, the left ventricular hypertrophy heart chamber is significantly smaller.
- Kidney disease
Because there are two kidneys, there is a certain reserve, so early lesions are not prone to symptoms. In the advanced stage, the greater the degree of lesions, after renal decompensation, there will be edema, proteinuria and nephrotic syndrome (high proteinuria, high edema, hyperlipidemia and hypoproteinemia), and severe uremia.
The glomerulus can be thought of as a capillary bulb. In high blood pressure, these afferent arterioles are hardened, the wall is thickened, and the lumen is narrowed, resulting in fibrosis, sclerosis or hyalinization of glomerular ischemia, resulting in the corresponding renal tubule atrophy due to ischemia. Some relatively mildly diseased glomeruli have compensatory hypertrophy and compensatory dilatation of renal tubules. Results: Kidneys shrunk, hardened in texture, and uneven on the surface of the kidneys, as shown in the figure below.
- Brain disease
Symptoms of hypertensive encephalopathy, such as headache, dizziness, vertigo, vomiting, visual disturbance, etc.;
Hypertensive crisis symptoms, such as severe headache, disturbance of consciousness, convulsions, etc.
Due to the sclerosis of the small cerebral arteries, the ischemia of the local area is caused, the permeability of capillaries is increased, and some substances in the blood vessels will leak out, resulting in cerebral edema. Depending on the degree of lesions, different degrees of symptoms of hypertensive encephalopathy will occur.
If the ischemic site is not relieved in time, the ischemic tissue will necrosis, that is, infarction, which is one of the main causes of lacunar cerebral infarction.
The above are symptoms of ischemia, the following are bleeding
Cerebral hemorrhage is the most serious complication of hypertension, and hypertension is also the most common cause of cerebral hemorrhage.
There are mainly 2 reasons:
Due to the sclerosis of the small arteries of the cerebral blood vessels, the blood vessels become brittle and have poor compliance. When the blood pressure suddenly rises, it will cause ruptured hemorrhage;
Also due to the decreased elasticity of the blood vessel wall, 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 malignant hypertension at the onset. The latter is more common in adolescents and is characterized by:
Blood pressure rises significantly, often exceeding 230/130mmHg, and the lesions develop rapidly, and hypertensive encephalopathy may occur, or renal failure and retinal hemorrhage may occur earlier.
summary
Returning to the early pathological changes of hypertension, the importance of small vasospasm can be seen. 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 are 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 long-term state, persistent vasoconstriction is the main state, which can cause spasm of fine and small arteries throughout the body, increase peripheral vascular resistance, and increase blood pressure.