ARTERIAL HYPERTENSION (grech, hyper-+ lat. tensio tension, tension; lat. arterialis) — increase in blood pressure in arteries — an important symptom patol, the states and diseases which are followed by either increase in resistance to an arterial blood-groove, or increase in cordial emission, or a combination of these factors. Long or considerable G. and. in itself creates patol, the state which is shown an overload and a hypertrophy of heart, tension of adaptable mechanisms of regional blood circulation and pathoanatomical changes in bodies (see. Idiopathic hypertensia ). In the USSR the terms «arterial hypertension» (it is accepted in literature in English and fr. languages) and «an arterial hypertension» (it is accepted in it. to literature) were used most often as synonyms. From 70th 20 century the term «hypertensia» recommend to designate build-up of pressure, and the term «hypertension» — increase in a muscle tone (see. Hypertensia , Hypertension ). In a wedge, practice by the term «arterial hypertension» usually designate system build-up of pressure in arteries of a big circle of blood circulation; in other cases the area of the raised ABP as, e.g., for arterial is specified hypertensia of a small circle of blood circulation (see).
On the nature of increase in the ABP distinguish three forms G. and.: 1) systolic G. and. (increase in the systolic ABP at normal or reduced diastolic), observed at increase in a stroke output of blood or cordial emission; 2) systolodiastolic G. and. (increase in the systolic and diastolic ABP), usually testimonial of increase in both stroke output of blood, and resistance to a blood-groove; 3) diastolic G. and. (increase only in the diastolic ABP), caused by increase in the general peripheric resistance to a blood-groove at decrease in propulsive function of a left ventricle of heart.
Allocate five options of a current of G. and.
1. Tranzitorny G. and. — the rare, short-term and usually slight increases of the ABP which are normalized without treatment.
2. Labile G. and. (moderate and unstable, however quite frequent increase in the ABP), at a cut of the ABP it is normalized under the influence of treatment of i including in some cases use of antihypertensives.
3. Stable G. and. — steady and often substantial increase of pressure, decrease to-rogo perhaps only during the performing active hypotensive therapy.
4. Malignant G. and., characterized by firm very high ABP, especially diastolic (it is higher than 120 mm of mercury.), bystry progressing, considerable tolerance to treatment, early developing of a heavy retinopathy with development of the centers of dystrophy, hemorrhages and necroses in a retina of eyes and bystry accession of a renal failure.
5. Of ampere-second krizovy current (paroxysmal hypertensia), and paroxysmal increases in the ABP can arise against the background of any his reference values (lowered, normal and raised). Definition of weight of a current of G. and. on separate a wedge, to signs (a condition of an eyeground, degree of a hypertrophy of a myocardium of a left ventricle, a functional condition of kidneys, etc.) it is not always possible; at long-term labile hypertensia with a high-quality current the most part of these signs can be more expressed, than at recently arisen high and stable G. and.
For the first time the ABP it was measured on the level of raising of blood in the tube connected to an artery of an animal in 1733 by Hels. Scientific research of G. and. began after 1836 when K. Ludvig offered a way of registration of the ABP by means of a mercury manometer on the smoked tape of a kimograf.
Even before creation of methods of measurement of the ABP at the person in clinic indirect signs were studied and. — intense pulse, emphasis of the II cardiac sound on an aorta, and also hypertrophy of a left ventricle (R. Brayt, 1836) and thickening of a muscular coat of vessels [G. Johnson, 1868].
In 1881 P. A. Mahomed one of the first measured the ABP in clinic and showed his increase at Brayt's disease. Later Yushar (H. Huchard, 1889) paid attention that increase in the ABP comes to light not only in the presence of degenerative changes in kidneys, but quite often precedes them.
With creation of reliable methods of measurement of the ABP at the person [S. Riva-Rocci, 1890; H. A. Korotkov, 1908] the assumption of the most important role of kidneys in G.'s emergence and. it was confirmed by many researchers. Some of them, e.g. Folgard and Headlights (P. Volgard, Th. Fahr, 1914), considered that G. and. it is always connected with diseases of kidneys.
However also other views of G.'s essence expressed and., edges quite often was the only symptom of disease state. For the first time in 1911. Franc (E. Frank) suggested to call similar forms G. and., «an essential hypertension». Since 1927, when Goering's researches (H. E. Hering) was revealed participation of carotid sine in regulation of the ABP, the role of disturbances of nervous control in G.'s origin began to be studied actively and.
The greatest expression neurogenic concept of the nature of G. and. received in G. F. Lang and A. L. Myasnikov's works * which considered a basis of developing of a long «essential hypertension» neurosis and dysfunction of the nervous structures regulating the ABP level. This most accepted point of view was confirmed with numerous researches not only domestic, but also foreign scientists. Along with it a number of researchers continued to study a role of kidneys in maintenance of the system ABP and value patol, changes of kidneys and renal arteries in G.'s genesis and. In 1934 Mr. Goldblatt (N. Goldblatt) with sotr. caused in an experiment increase in the ABP by narrowing of renal arteries of an animal. In 1940 E. Page observed similar effect, concluding a kidney in a cellophane sack that led to its prelum. These researchers connected G.'s emergence by ampere-second increase in the conditions of ischemia of tissues of kidneys of activity of enzyme of a renin. A wedge, analogy of these pilot models G. is considered and. at atherosclerosis, thrombosis and other types of narrowing of a renal artery (G. and. like Goldblatt), and also at an external prelum of kidneys hems, a hematoma, etc. in the outcome of a paranephritis, an injury, etc. (G. and. like Peydzha). Further angiotonic activity of some other hormones was found: catecholamines, Aldosteronum. On the basis of experiments with G.'s development and. during removal of both kidneys Grollmen (A. Grollman, 1949) introduced the idea of a role in G.'s genesis and. deficit of a renal depressor factor. Assume that such factor are the kinina and prostaglandins developed by kidneys. The pathogenetic role in G.'s development is studied and. some other the substances of the humoral nature having in an experiment pressor or depressor properties (serotonin, acetylcholine, a histamine, etc.).
Mass researches among the population allow to reveal only a frequency of G. and., without opening its reasons. According to different data, apprx. 80% of cases of hypertensia it is the share of an idiopathic hypertensia. On a share of hypertensia of other nature which designate as secondary or symptomatic, it is necessary, according to foreign authors, 10 — 15% of cases (systolodiastolic hypertensia), and according to scientific research institute of cardiology of A. L. Myasnikov of the USSR Academy of Medical Sciences — 22 — 23% of cases from which first place on frequency is won by nephrogenic G. and. (apprx. 20% of all cases), the second — endocrine — 3,2%, according to R. Wolff. And., caused by other reasons, meets much less often, and data on its prevalence are insufficiently authentic. The actual frequency of symptomatic hypertensia among the population is probably less, and their statistical structure, perhaps, other since patients with G. and. usually direct to stationary inspection and treatment in connection with the expressed and permanent increase in the ABP that is most characteristic of nephrogenic hypertensia.
As morbid condition of G. and. can develop owing to influence of exogenous factors (a long or acute psychological overstrain, a brain injury, defeat of depressor vascular zones at a syphilitic aortitis, etc.), and also endogenous disturbances (gormonalnoaktivny tumors cortical or marrow of adrenal glands, a tumor of a hypophysis, etc.).
Main types of G. and. can be grouped as follows.
A. Essential, primary, or idiopathic hypertensia (see).
B. Symptomatic, or secondary, G. and.:
I. Nephrogenic (renal):
1. And. at autoimmune and allergic diseases of kidneys, as preferential inflammatory (a diffusion glomerulonephritis, damages of kidneys at so-called collagenoses, etc.), and dystrophic (an amyloidosis of kidneys, a diabetic glomerulosclerosis), and also at a nephropathy of pregnant women. 2. And. at infectious intersticial diseases of kidneys (hron, pyelonephritis). 3. Renovascular, or renovascular, G. and., developing at disturbance of blood supply of kidneys on one or both renal arteries (inborn narrowing, an atresia, a hypoplasia of renal arteries, angiomas and arteriovenous fistulas, aneurisms; the acquired damages of renal arteries at atherosclerosis, calcification, fibrinferment, an embolism, aneurisms, a fibromuskulyarny hyperplasia of arteries, Takayasu's disease, and also at a prelum of renal arteries or veins hems, hematomas, new growths, etc.). 4. And. at the Urals. diseases of kidneys and urinary tract as inborn (a hypoplasia of kidneys, a polycystosis, an allotopia, doubling, galeto-and a fused kidney), and acquired (a nephrolithiasis, tumors), and also at injuries of kidneys and area of kidneys with formation of hematomas in pararenal cellulose.
II. Renoprival arterial hypertension (during removal of both kidneys).
III. Endokrinopatichesky arterial hypertension:
1. And. at gormonalnoaktivny tumors of a hypophysis (an acromegalia, Itsenko's disease — Cushing), bark of adrenal glands (primary hyper aldosteronism, or Conn's disease, Itsenko's syndrome — Cushing), chromaffin tissue of adrenal glands (pheochromocytoma) or ectopically located gangliyev (paraganglioma), and also at prolonged treatment by corticosteroid hormones in big doses. 2. And. at a diffusion toxic craw. 3. And. at a dyscrinism in the period of a climax.
IV. The angiogenic arterial hypertension (connected with damage of an aorta and large vessels):
1. And. at selective defeat of depressor zones of an aorta and carotid arteries. 2. And. at coarctation of an aorta. 3. And. during the narrowing sleepy, vertebralny and basilar arteries.
V. Neurogenic symptomatic arterial hypertension:
1. So-called tsentrogenny G. and., connected with damage of a brain (encephalitis, tumors, hemorrhages, ischemia, injuries of a skull, etc.). 2. And., connected with defeats of a peripheral nervous system (a polyneuritis, poliomyelitis, poisoning with salts of thallium).
VI. Congestive arterial hypertension (at the heart diseases complicated by heart failure).
VII. Hemodynamic arterial hypertension (at a sclerosis or an arteriolosclerosis of an aorta and large arteries, insufficiency of the aortal valve, a full atrioventricular block, large patol, an arteriovenous anastomosis). VIII. The medicinal arterial hypertension connected using the medicines raising the ABP (ephedrine, pressor amines) or possessing harmful action on kidneys (acetphenetidiene). The given group of types of G. and. for the reasons of their development it is to a certain extent conditional. So, in genesis of hypertensia at coarctation of an aorta matter both hemodynamic factors, and ischemia of kidneys. The hypertensia at a diffusion toxic craw carried in group endocrine on the mechanism is preferential hemodynamic. Hypertensia at defeat sleepy, vertebralny and basilar arteries with the equal right can be carried in group of both angiogenic, and neurogenic (tserebroishemichesky) hypertensia etc. Such group of the reasons of G. and. gives a basis for elaboration of methodical approach to clarification of the specific reason of increase in the ABP in each case.
According to the different nature of emergence of G. and. mechanisms of their development are also diverse. Pathogeny primary, or essential, G. and. it is put and has features in different stages of a disease (see. Idiopathic hypertensia ). From symptomatic forms so-called hemodynamic G.' pathogeny is most studied and. Hypertensia at decrease in elasticity of walls of an aorta and large arteries is connected with impossibility of adequate stretching of an arterial wall the pulse wave passing on a vessel. Hypertensia at insufficiency of the aortal valve is caused by increase in final diastolic volume of blood in a left ventricle owing to regurgitation of a part of blood from an aorta in a left ventricle in the period of a diastole. The same is observed also at the full atrioventricular block which is followed by the expressed bradycardia (in connection with the big duration of a diastole). However in this case, as well as in the presence of arteriovenous shunts of large caliber, the pathogenetic role of the humoral and neuroreflex influences connected partially with compensatory increase in peripheric resistance (is not excluded at considerable lengthening of a diastole), partially — with diffusion ischemia of a brain and renal fabric.
The pathogeny of angiogenic sistolodiastolichesky hypertensia is not identical. So, G. and. at defeat of depressor zones of an aorta and carotid arteries it is connected with death and dysfunction of the baroreceptors located in these areas. At normal function of vascular baroreceptors their excitement within several seconds leads to decrease in the ABP at the expense of the impulsation on depressor and sinus nerves which is slowing down function of sympathetic neurons of a vasomotor center. At the same time pulse urezhatsya, the tone of capacity and resistive vessels decreases, products of a renin and antidiuretic hormone decrease (see. Vasopressin ). Hypertensia at coarctation of an aorta is caused, on the one hand, by sharp increase in resistance to a blood-groove on the site of an aortostenosis (hemodynamic hypertensia), and with another — disturbance of blood supply of kidneys as renal arteries practically in all cases of coarctation of an aorta depart from it below the place of narrowing (nephrogenic G. and.). Narrowing sleepy, vertebral and basilar arteries leads to ischemia of a brain — neurogenic, or tserebroishemichesky, hypertensia, at the same time G.'s reason and. during the narrowing of carotid arteries there can be also a defeat of carotid depressor zones.
Purely diastolic («beheaded») G. and. always happens at increase in peripheric resistance to an arterial blood-groove because of falling of the propulsive function of a left ventricle connected with diseases of the myocardium (a heart attack, myocarditis, etc.), its insufficiency owing to an overstrain or with disturbance of venous return of blood to heart.
In emergence and maintenance of many forms of symptomatic G. and. the humoral system a renin — angiotensin — Aldosteronum is of great importance.
Enzyme renin (see) it is developed by granular cells of the juxtaglomerular device of kidneys. It has no vasoconstrictive effect in experiments on the worrying bodies, but its intravenous administration causes increase in the ABP in animals. At interaction of a renin with alfa2-globulinovy fraction of a blood plasma — the angiotensinogen produced by a liver forms the angiotensin I (which is also not exerting impacts on a tone of a vascular wall) which under the influence of special enzyme (konvertingenzy) quickly turns into the angiotensin II possessing powerful angiotonic action both in experiments on the worrying bodies and at intravenous administration by an animal. There are data that angiotensin II possesses the central vasculomotor action. Numerous experimental and the wedge, data demonstrate existence of a feedforward between contents in a blood plasma of angiotensin II and activity of Aldosteronum. Aldosteronum (see) — an adrenal hormone (mineralokortikoida — exerts impact on distribution of electrolytes (first of all sodium and potassium) in cells and in extracellular liquid, in particular in blood. The strengthened secretion of Aldosteronum leads to increase in a reabsorption of sodium in kidneys and its delay in muscular elements of arterioles that is followed by their swelling and sensitization of receptors of a vascular wall to pressor influences (in particular, to action of noradrenaline). Between the content in blood of Aldosteronum and activity of a renin there is normal inverse relation. At reduction of a renal blood-groove in cells of the juxtaglomerular device of kidneys the plentiful granulation testimonial of the strengthened synthesis of a renin is found. Anatomic localization of these cells near a median cover’ the bringing vessels of a renal ball allows to consider that these cells perform function of volyumoretseptor and participate in regulation of the ABP level, reacting to changes of amount of the blood inflowing to a ball. In fiziol, conditions decrease in the ABP leads to strengthening of synthesis of a renin. Formed as a result of interaction of a renin with angiotensinogen angiotensin (see) leads to increase in the ABP, improvement of perfusion of kidneys and reduction of intensity of synthesis of a renin. Development of a renin decreases also at increase in the ABP of other etiology, napr, connected with hyperproduction of Aldosteronum or noradrenaline. Inverse relation between height of the ABP and intensity of development of a renin at many patol, states is broken; it belongs first of all to nephrogenic (especially to renovascular) hypertensia.
A setpoint value of hyperproduction of a renin at hypertensia at patients hron, a diffusion glomerulonephritis of the hypertensive and mixed form. In kidneys of the patients who died of this disease and also in the drugs received by a biopsy the expressed granulation of cells of the juxtaglomerular device is found. The proliferative and sclerosing process in renal fabric conducting to a zapustevaniye of a part of balls and a prelum of the bringing vessels most often is the cornerstone of the specified forms of nephrite. At a subacute ekstrakapillyarny glomerulonephritis activity of a renin in a blood plasma of patients is considerably increased that is combined with the expressed granulirovannost of cells of the juxtaglomerular device. The pathogenetic role of system a renin — angiotensin in development of hypertensia at acute nephrite is not specified yet.
G.'s development and. at hron, pyelonephritis it is connected by hl. obr. with the progressing sclerosis of interstitial tissue of kidneys and defeat of vessels of kidneys like a hyperplastic or productive endarteritis and a necrotizing arteriolit. It leads to the hypertrophy and a hyperplasia of the juxtaglomerular device and hypersecretion of a renin which is not decreasing at increase in the system ABP. Nephrogenic character and. at hron, unilateral pyelonephritis is confirmed by results of surgical treatment of this disease: in the absence of secondary, connected with long G. and. changes in the kidney which is not affected by inflammatory process, removal of a kidney by the patient leads to permanent normalization of the ABP. Similar data are obtained also at other patol, states which are followed by a prelum of intra renal arteries, and also their inflammatory or dystrophic changes. G. is connected with damage of intra renal arteries and. at a nodular periarteritis, lupoid nephrite, a diabetic glomerulosclerosis, a scleroderma, a hemorrhagic vasculitis. And., developing at the women who had toxicosis of the second half of pregnancy also most often has nephrogenic character and it is in most cases caused hron, a diffusion glomerulonephritis, is more rare pyelonephritis or narrowing of renal arteries. Assume that development of these diseases in the second half of pregnancy is promoted by a prelum of kidneys and ureters the increased uterus, and also the changes of immunity connected with pregnancy.
The most defiantly pathogenetic value of system a renin — angiotensin at renovascular G. and., i.e. connected with narrowing of renal arteries and their branches. Researches of activity of a renin in remote kidneys and in a blood plasma (in particular, the blood flowing from kidneys) patients with renovascular G. and. showed that the leading role in stimulation of secretion of a renin in these cases belongs to reduction of a blood-groove in renal arteries. The angiotensin which is formed as a result of interaction of a renin with angiotensinogen in its active form (angiotensin II) possesses direct pressor action and stimulates synthesis of Aldosteronum which, increasing accumulation of sodium in vascular walls, promotes strengthening of pressor vascular reactions.
Anomalies of development, the acquired narrowing or occlusion of the main renal arteries and their large branches can be the cause of development of renovascular hypertensia. The inborn hypoplasia or an atresia of the main renal arteries causes hypertensia already at early children's age. At adults atherosclerosis which quite often is complicated by thrombosis is the frequent reason of narrowing of renal arteries. Acute occlusion of a renal artery can be a consequence of an embolism or postoperative thrombosis. Sometimes the hyperplasia — the peculiar isolated damage of renal arteries of not clear etiology which is morphologically characterized by an uneven hyperplasia of fibrous and muscular elements leads to narrowing of renal arteries fibro-muskulyarnaya, and sites of a hyperplasia alternate with sites of an atrophy. The disease is found in young women, especially after pregnancy more often.
There are experimental data testimonial of the fact that at the moderate narrowing of a renal artery which is followed by unstable G. and., in medullary tissue of kidneys on the party of narrowing development of anti-hypertensive factors amplifies — kinin (see) and prostaglandins (see), however at high and firm G. and. secretion of these substances decreases. It is supposed that the lack of renal anti-hypertensive factors matters also in a pathogeny of so-called renoprival hypertensia though it is often generally caused by disturbances of balance in the maintenance of ions of sodium and potassium in fabrics and extra intercellular lymphs. Really, renoprival G. and., arising after removal of both kidneys, as a rule, is followed by hypostases, and hypostases disappear and the ABP is normalized if the device «artificial kidney» with the corresponding selection of content of electrolytes in perfused liquid is used to treatment.
At primary aldosteronism (at the expense of hypersecretion of Aldosteronum a gormonalnoaktivny tumor of adrenal glands) activity of a renin in a blood plasma low, is often equal to zero that confirms data on existence of inverse relation between the content in blood of Aldosteronum and activity of a renin. It is not excluded that this dependence is mediated by the ABP level since at the secondary hyper aldosteronism which is not followed by increase in the ABP, activity of a renin in a blood plasma normal, and at a secondary hyper aldosteronism at patients with renovascular hypertensia — it is even raised. And. in cases of primary hyper aldosteronism has extrarenal character and it is connected with influence of Aldosteronum on mineral metabolism in a vascular wall.
And. at gormonalnoaktivny tumors of chromaffin tissue of adrenal glands — a pheochromocytoma, a pheochromoblastoma and a paraganglioma it is caused by a constant or periodically arising hypersecretion of mediators of a sympathetic nervous system, first of all noradrenaline. Noradrenaline, influencing an alpha adrenoreaktivnye of system of a vascular wall, causes tonic contraction of their smooth muscles that is followed by G.'s development and.
And. at a disease and Itsenko's syndrome — Cushing is connected with hyperfunction of the bark of adrenal glands which is followed by the strengthened synthesis of cortisol owing to what the maintenance of both glucocorticoids, and mineralokortikoid (Aldosteronum) increases.
And. at a diffusion toxic craw it is observed at rather early stages of a disease, before development of a thyrocardiac cardiomyopathy. It is connected with increase in propulsive function of heart and increase in cordial emission under the influence of the increased content in blood of thyroxine. Thus, hypertensia at patients with a diffusion toxic craw has hyperkinetic character. It is not excluded that a nek-ry role in G.'s development and. at these patients plays and patol, a condition of c. N of page (neurosis).
Pathogeny of other forms G. and. is in a stage of studying. Assume, e.g., that G. and. at ischemia of a brain has compensatory character and it is directed to improvement of blood supply of a brain, however specific mechanisms of development of this form G. and. are studied insufficiently. The B development of hypertensia at injuries, tumors and other serious organic illness of a brain undoubted value has the organic damage and functional changes of hypothalamic structures which are followed by disturbance of the central nervous control of the ABP level and in some cases the humoral shifts caused by disorders of functions of a hypophysis.
The role in G.'s pathogeny is a little studied and. such pressor humoral factors as tyramine, oksitriptamin, serotonin and number of depressor substances (histamine, acetylcholine, adenosine). It is known that the carcinoid of intestines which is followed by the increased development serotonin (see), quite often proceeds with G. and. Still also the pathogenetic role in G.'s development is not studied and. some major environmental factors, napr, excess reception with food of sodium chloride (so-called salt arterial hypertension).
Experimental arterial hypertension
for the purpose of the most profound studying of causes of infringement of regulation of the ABP use various models of arterial hypertension on animals. Experimental G. and. receive on monkeys, dogs, rats, rabbits and other animals, modeling disturbances of functions of c. N of the page, hemadens, kidneys and other systems participating in regulation of action of the heart, a tone of vessels, fabric metabolism. These models are not similar to G. and. the person, but they are a convenient method of a research of processes of formation and stabilization of the increased ABP level. The data obtained on models played an important role in formation of modern views on an etiology and a pathogeny of an idiopathic hypertensia and symptomatic forms G. and. also formed a basis for creation of effective measures of prevention and treatment of these diseases.
So-called neurogenic models G. are closest to an idiopathic hypertensia of the person and. These models form scientific base for justification of the most recognized neurogenic theory of an origin of the idiopathic hypertensia formulated by G. F. Lang and A. L. Myasnikov (1950, 1954) on a basis a wedge, observations and experimental works of school of I. P. Pavlov.
Neurogenic forms G. and. receive by creation at animal negative emotions (fear, rage, obstacles to achievement of the goal, impossibility to avoid danger etc.), an overstrain of century of N of (development of the difficult, demanding a thin differentiation reflexes, reorganization it is information saturated situational stereotypes at collision in time of defensive, food and sexual vozbuzhdeniye, and also by change biol, rhythms, flocking instincts etc.).
Example of neurogenic model is experimental G. and., to-ruyu receive on monkeys (baboons, hamadryads), making at them collisions of defensive, sexual and food vozbuzhdeniye, perversions of the daily mode of lighting in combination with an allergic sensitization. At the same time, according to X. M. Markova (1967), pressure, usual for this species of monkeys, 120 — 140/70 — 85 mm of mercury. after 2 months 110 — 130 mm of mercury increase to 190 — 200/.
So-called tsentrogenny G.' modeling and. in an experiment it is based on primary disturbance of blood circulation and a lymph flow in a brain. Such models are created by means of bandaging of brain vessels, a prelum of brain fabric, a multiple embolism limf, vessels, concussions, causing an aseptic inflammation in the field of premotorny bark etc.
The most typical for this group is G. and., arising at ischemia of a brain., Stable increase in the ABP can be received on rabbits, tying up the main arteries of a brain (e.g., at unilateral bandaging of branches of the general carotid artery above a carotid sine). At this ABP, according to V. V. Suchkov (1969), within 30 — 40 days raises from 125 to 180 mm of mercury. also remains high within 5 months,
for understanding of the reasons stabilizing the ABP on a high level researches on models of nephrogenic forms G. have Great value and., which reproduce generally by two methods: narrowing of renal arteries (metal brackets, rings, spirals, a silk ligature) and compression of kidneys from the outside (a wrapping cellophane, rubber, tightening by a 8-shaped ligature, removal of a kidney under skin of a back etc.).
Nephrogenic G. and., the blood supplies of kidneys received by reduction, are stable only during the narrowing of arteries of both kidneys or at an arteriostenosis of one kidney in combination with removal of the second kidney. Depending on depth of ischemic damages renal G. and. arise in various terms (from several days to several months) and differ in the expressed increase in the ABP, especially diastolic, and a tendency to stabilization of hypertensia. At a malignant current of renal G. and. The ABP raises to 200/150 mm of mercury. and more, hl. obr. due to increase in peripheric resistance.
Renoprival G.'s model and. in an experiment on rats with one remote kidney Grollmen with sotr for the first time created. in 1943 „The assumption that this form G. and. it is connected with deficit of the depressor substances produced by a kidney, finds confirmation that replanting by a nefrektomirovanny animal of normal kidneys or administration of renal extracts by it reduces or prevents renoprival G.'s emergence and.
In need of studying of influence of the high ABP on a current of others patol, processes (e.g., atherosclerosis) G. often use and., the abdominal part of an aorta arising during the narrowing over an otkhozhdeniye of renal arteries. This so-called, koarktatsionny hypertensia has not only the hemodynamic nature, but is connected also with reduction of blood supply of kidneys and ischemia of the bodies and fabrics which are in area of reduced pressure.
From hormonal G.' models and. the greatest distribution was gained by model of DOKA-hypertensia, to-ruyu receive administration of 11-cortexone-acetate or in a .vida of daily subcutaneous injections (1 — 10 mg for 30 — 70 days), or by implantation of large numbers (apprx. 40 — 50 mg) oil solution of DOCK under leather of animals. Introduction of DOCK at additional loading (drink of 1 — 4% of solutions of sodium chloride) is the most effective. At the same time speak about Doc-salt G. and. DOKA-hypertensia is followed by the expressed allergic inflammatory defeats of vessels of heart, kidneys, intestines and other bodies; most quickly it develops at young animals. A kind of DOKA-hypertensia is suprarenal G. and., edges arises during the underrunning of an adrenal gland of an animal the silk thread moistened in turpentine. It is close on origins and morfol, to changes to these types of experimental G. and. and the so-called adrenalo-regeneration hypertensia for the first time got by Skelton (F. R., Skelton, 1959).
For clarification of a role of disturbances of depressor influences from baroreceptors of vessels in G.'s pathogeny and. reflexogenic G.'s model is applied and., or «hypertensions of a disinhibition». Reflexogenic G. and. receive denervation of carotid sine and aortic arches, imposing around carotid sine of the plastic or metal cases interfering stretching of bifurcations of carotid arteries. The purpose of all interventions is reduction of depressor influences from barorecrptor zones. Reflexogenic G. and. it is characterized by slow increase in the ABP, a cut during 2 — 3 weeks reaches a maximum and exceeds initial level for 40 — 60% at rabbits and 60 — 70% at dogs and keeps on a high level from 1 year to 2 years (H. N. Gorev, 1959). The ABP at reflexogenic G. and. it is subject to big fluctuations, the hypertrophy of a myocardium is less expressed, there are no phenomena of a nephrosclerosis, the cardiac rhythm and minute emission are increased; at such animals during sleep or at adrenergic blockade of the ABP it is normalized.
In 1962 Mr. Okamoto and Aoki (To. Okamoto, To. Aoki) distinguished animals with the increased systolic pressure from rats of the Wistar line (145 — 175 mm of mercury.) also received a pure line of spontaneously hypertensive rats (SHR) by crossing of hypertensive individuals.
To the 30th week after the birth systolic pressure at rats of this line reaches 170 — 180 mm of mercury. In 37% of cases of G. and. accepts a malignant current.
This hypertensia is considered a close analog of essential hypertensia at people and is widely used for studying of hereditary and other factors in firm G.' pathogeny and.
As patol, G.'s condition and. can have the defined wedges, manifestations. The hypertrophy and an overstrain of the left departments of heart concern to them that can be shown by complaints of patients to heartbeat, an asthma, pains in heart. At long G. and. changes of vessels of an eyeground are observed (angiopatiya) and changes of the retina (see. Retinopathy ). These changes in some cases are followed short-term or even steady (at a retinopathy) by visual disturbances. Regional circulatory disturbances are more often observed during an idiopathic hypertensia, but are possible also at any symptomatic G. and. In such cases the corresponding complaints of patients (on a headache, dizzinesses, attacks of stenocardia etc.) and objective symptoms which dynamics at G. are noted and. different genesis can have the features. In some cases at symptomatic G. and. in a wedge, a picture signs of a basic disease dominate (see. Giperaldosteronizm , Itsenko — Cushing a disease , Glomerulonephritis , Pheochromocytoma ). As symptom of a disease of G. and. can sharply arise (e.g., at acute nephrite, an injury of area of kidneys, fibrinferment or an embolism of the main renal artery) or, what is more often, develops gradually. Stages of a course of symptomatic hypertensia usually do not allocate.
At G. and. any origin there can be (with various frequency) same complications, as at idiopathic hypertensia (see), including heavy frustration cerebral circulation (see), heart failure with development cardiac asthma (see), fluid lungs (see), etc. Nephrogenic hypertensia often become complicated renal failure (see) whereas at an idiopathic hypertensia it is observed exclusively seldom. At many symptomatic G. and. there can be complications characteristic of the disease which served as the reason of hypertensia (thyrocardiac heart at patients with a diffusion toxic craw, innidiation of a pheochromoblastoma, etc.).
G.'s Identification and. usually comes easy and comes down to measurement of the ABP, a cut, however, at single measurement at persons from tranzitorny and paroxysmal G. and. it can be normal. Stating G.'s presence and., it is necessary to take into account age investigated (age standards — see. Arterial pressure ). Diastolic ABP of 95 mm of mercury. above in all age groups it is regarded as diastolic G. and. Dynamic research ABP allows to establish character of a course of hypertensia. In some cases it is not known when the patient had G. and. Approximately estimate its duration on degree of an angiopatiya of a retina at a research of vessels eyeground (see) and on degree of a hypertrophy of a left ventricle of heart.
Absolutely reliable ways of differentiation of an idiopathic hypertensia and symptomatic G. and. does not exist, and in hard differential and diagnostic cases the diagnosis of an idiopathic hypertensia is the diagnosis of an exception. For G.'s diagnosis and. on etiol, to the principle in scientific research institute of cardiology of A. L. Myasnikov of the USSR Academy of Medical Sciences the special scheme of a step-by-step research of patients providing transition (if necessary) from rather simple methods of a research to more difficult is developed. It gives the chance not only to put etiol, and the pathogenetic diagnosis, but also to avoid the complications which are found, e.g., during the carrying out an aortografiya at patients hron, a diffusion glomerulonephritis or at a biopsy of the only kidney.
The rational direction of diagnostic searches is promoted by careful studying and critical evaluation of the anamnesis. It is necessary to consider instructions on the acute diseases of kidneys and urinary tract postponed in the past which can be the cause latentno of the proceeding diseases of the kidneys which are followed by G. and. Acute glomerulonephritis (see) or acute pyelonephritis (see) quite often terminates in the seeming recovery, meanwhile the disease gets a latent current and is distinguished only at use of special methods of a research. Attacks of renal colic or an otkhozhdeniye of stones in the anamnesis allow to assume nephrolithiasis (see), become complicated hron, pyelonephritis. Paroxysms of muscular weakness are characteristic of primary aldosteronism (see. Giperaldosteronizm ). At women it is important to pay attention to communication of hypertensia with pregnancy, and if similar connection is established, further researches most often find hron, the diffusion glomerulonephritis as an outcome of primary nephropathy of pregnant women, is more rare hron, pyelonephritis and a stenosis of the main renal arteries. Heavy and especially malignant G.'s development and. at persons is younger 30 and 50 years are more senior allows to think of its symptomatic character. Nephrogenic G. and. seldom proceeds paroksizmalno; on the contrary, at the tumors consisting of chromaffin fabric (a pheochromoblastoma, a pheochromocytoma, a paraganglioma), the crises which are followed by sharp raising of the ABP are observed in 50% of cases. At G. and. at women in the period of a climax crises remind those at gormonalnoaktivny tumors of chromaffin fabric, but symptoms of excess emission in blood of catecholamines (heartbeat, increase in the ABP, a shiver, a hyperglycemia, etc.) are usually less expressed. Specifying the anamnesis, it is necessary to find out whether the patient had a cherepnomozgovy injury, encephalitis, a vasculitis of vessels of a brain, etc., whether accepted it is long the pharmaceuticals capable to cause G. and. (ephedrine, pressor amines, corticosteroids, etc.).
The physical research sometimes allows to establish and even to assume the reason of hypertensia. Data of survey can have diagnostic value at, and., connected with a disease or Itsenko's syndrome — Cushing, an acromegalia, a diffusion toxic craw, coarctation of an aorta (at adults), insufficiency of the aortal valve and the combined heart diseases complicated by heart failure. Palpatorny identification of the increased, displaced or movable kidney demands an exception of the nephrogenic nature of G. and. Developing of hypertensive crisis at a deep palpation of area of kidneys is characteristic of a pheochromocytoma. Important diagnostic value has a research of a pulsation of large arteries and measurement of the ABP on both hands and legs. The expressed asymmetry of a pulsation and size ABP can indicate systemic lesion of vessels, and in particular a possibility of renovascular or tserebroishemichesky hypertensia. Weakening of a pulsation of carotid arteries can testify to tserebroishemichesky character of G. and. or about its communication with defeat of depressor zones of carotid arteries. Decrease in a pulsation and the ABP standing at the high ABP and intense pulse on hands (or only on the right hand) — one of the main a wedge, signs coarctations of an aorta (see), in the presence a cut also the strengthened pulsation of intercostal arteries is possible. The high and piston pulse of peripheral arteries meets at aortic incompetence and a patent ductus arteriosus. Assessment of rate of cordial reductions has diagnostic value. Detection of sharp bradycardia helps G.'s recognition and., connected with a full atrioventricular block (see. Heart block ). Tachycardia comes to light at G. and., connected with a thyrotoxicosis, hypothalamic frustration, intoxication sympathomimetics, and also at primary aldosteronism and during hypertensive crises at a pheochromocytoma. In diagnosis of heart diseases and anomalies of development of cardiovascular system auscultation of heart and vessels matters. So, at coarctation of an aorta distalny places of narrowing systolic noise which is carried out on the course of an aorta and large arteries is sometimes listened. Auscultation matters a nek-swarm and in diagnosis of renovascular hypertensia: approximately at 30% of patients it is possible to listen or register the systolic noise slightly above a navel which is usually displaced towards defeat on FKG.
In diagnosis of nephrogenic hypertensia researches of urine have essential value. The expressed changes in urine (an albuminuria, an erythrocyturia, a pyuria, a cylindruria, decrease ud. the weight of urine) speak about very probable nephrogenic nature of hypertensia. At the same time quite often the damages of kidneys serving as G.'s reason and., for many years proceed latentno, being followed by non-constant minimum changes in an urocheras, or such changes in general can not be (e.g., at a polycystosis, a hypoplasia of kidneys). At renovascular G. and. changes in urine manage to be revealed only at a half of patients. At the same time small changes in urine are often observed at the damages of kidneys caused by G. and. any origin, i.e. secondary in relation to hypertensia.
For specification of the diagnosis use the quantitative methods of the analysis of an urocheras allowing to define number of the uniform elements of blood and cylinders allocated with urine in days or for an hour (see. Kakovsky-Addis method ). Coloring of urine by Shterngeymer's method — Malbina and calculation of number of microbes in fresh urine can confirm the assumption of existence of infectious process in kidneys or urinary tract.
Special value has identification at patients with G. and. signs hron, renal failure. For this purpose investigate the content of nitrogenous slags in blood, and also partial functions of kidneys (filtering, a reabsorption, clearance of Diodrastum, concentration ability, etc.). Existence of a renal failure with an azotemia does almost reliable the assumption of nephrogenic hypertensia, T; to. at G. and. other nature and at an idiopathic hypertensia the azotemia develops exclusively seldom. The renal failure can be absent also at the hypertensia connected with damage of one kidney (in view of normal functioning of the second kidney) that does recognition of the nature of G. and. in these cases even more difficult.
Statement of the correct diagnosis is promoted by a separate research of function of each kidney, especially by means of tracer techniques. An isotope renografiya (see. Renografiya radio isotope ) allows to reveal asymmetry of function of kidneys at their unilateral or uneven bilateral defeat that is especially important at pyelonephritis and renovascular hypertensia. Valuable information on size, a form and function of each of kidneys is provided by scanning of kidneys. A usual X-ray analysis of kidneys of a maloinformativn as on roentgenograms the shadow of kidneys not always clearly is visible. Contrast urography (see) allows to receive accurate shadows of a renal pelvis and urinary tract; therefore it often helps the correct recognition of the nature of G. and. at such diseases as hron, pyelonephritis, anomalies of development and a tumor of kidneys, and also diagnosis of renovascular hypertensia, at a cut on the party of defeat observe three urografichesky signs: reduction of a kidney, delay of contrasting of a renal pelvis in early stages of a research and its excessive contrasting at late stages. If the intravenous piyelografiya does not give rather clear picture or its carrying out is contraindicated (e.g., at a renal failure), for diagnosis hron, pyelonephritis or others the Urals. diseases retrograde is shown piyelografiya (see).
From laboratory methods of a research special value in recognition of the reasons of G. and. has a research of balance of electrolytes and a number of hormones. Quite often found at G. and. the hypopotassemia can depend on many reasons. Sometimes G. and. serves one of signs of primary damage of adrenal glands (primary aldosteronism, Itsenko's syndrome — Cushing), especially if it is combined with a giperkaliuriya, but often it results from the secondary hyper aldosteronism connected with nephrogenic, in particular renovascular, and other forms G. and. At gormonalnoaktivny tumors of chromaffin fabric (a pheochromocytoma, a pheochromoblastoma, a paraganglioma) the content in urine of catecholamines, their predecessors and metabolites considerably increases, and in the period of crisis allocation of noradrenaline, adrenaline and vanililmindalny to - you quite often increase in tens of times. Significant increase in excretion of Aldosteronum and lack of activity of a renin in blood is characteristic of primary aldosteronism, and it is not defined both in an ortostaza, and at changes of the salt mode. Substantial increase of activity of a renin in a blood plasma is most characteristic of renovascular hypertensia.
Difficult tool diagnostic methods are applied usually at the final stage of researches if the diagnosis was not established at earlier stages and only when the expected results can promote performing more perspective therapy, including a possibility of surgical treatment. For final establishment of localization of a pheochromocytoma or an aldosteroma the pnevmorenografiya, especially in combination with a tomography of adrenal glands is shown. Renovascular G. and. is confirmed by carrying out transfemoralny aortografiya (see), edges gives the chance to accurately see a ventral aorta and branches departing from it, in particular renal arteries. In the first phase of a research (vazogramm) it is possible to find localization of narrowing, its degree and extent, pre-and post-stenotic expansion of an artery, in the second phase (nefrogramm) — a difference in intensity of contrasting and the sizes of kidneys. Nefrogramma gives clear idea of a form and position of kidneys, in some cases allows to reveal tumors of kidneys. On time of emergence of a vazogramma and nefrogramma judge asymmetry as kidneys. Angiographic researches are conducted also for specification of the diagnosis of coarctation of an aorta, and also G. and. tserebroishemichesky nature. A puncture transdermal biopsy of kidneys (see. Kidneys ) plays the leading role in diagnosis of such diseases as hron, a diffusion glomerulonephritis, an amyloidosis, a diabetic glomerulosclerosis, some system vasculites; it helps also recognition of renal defeat at a nephropathy of the second half of pregnancy, hron, pyelonephritis if data of other researches are insufficient for the diagnosis.
Need for acute management by sick G. and. arises at acute development of hypertensia (e.g., owing to an embolism of a renal artery) and at hypertensive crises.
For perhaps more bystry decrease in the ABP intravenously (or intramusculary) enter rausedyl (1 — 2 ml of 0,1% of solution), Dibazolum (6 — 8 ml of 0,5% of solution); ganlioblokiruyushchy means (arfonad, petrolhexonium, Dimecolinum, Pentaminum, etc.). For decrease in the ABP at crises at patients with a pheochromocytoma adrenolytic drugs are most effective: Tropaphenum (1 — 2 ml of 1 — 2% of solution in a muscle or 1 ml of 1% of solution slowly in a vein) and phentolamine (redzhitin) — 1 ml
of 0,5% of solution in a muscle or slowly in a vein. Widely applied purpose of bloodlettings, bloodsuckers, mustard plasters and hot (mustard) foot baths ineffectively.
Sick G.' hospitalization and. pursues two main objectives: identification of the reason of hypertensia and development of system of the most effective to lay down. actions. Hospitalization is shown at an aggravation of a current of G. and. (e.g., at increase of crises) and at symptoms of the menacing and developing complications (disturbance of cerebral and coronary circulation, a heart or renal failure). If the wedge, a picture gives the grounds to think of the possible symptomatic nature of hypertensia, patients should be directed in specialized to lay down. the institutions having all arsenal of modern diagnostic methods.
At diagnosis of symptomatic forms G. and. the therapy directed to treatment of a basic disease is carried out. It is most effective when the cause of increase in the ABP manages to be removed in the surgical way. The ABP is with firmness normalized after operation of replacement of the aortal valve at its insufficiency by a prosthesis, at electric cardiac activation at patients with a full atrioventricular block, after surgical correction of a number of anomalies of development of vessels (arteriovenous shunts, coarctations of an aorta). The possibility of surgical treatment of G. is represented especially important and., one kidney (pyelonephritis, an injury, a tumor, anomaly of development) caused by defeat, and also G. and. at gormonalnoaktivny tumors of adrenal glands and during the narrowing of renal arteries, since with listed patol. states connected a most cases of hard proceeding G. and. Timely operation (removal of a kidney, adrenal gland, the tumor ectopically located, revascularizations of kidneys) at similar patients leads to permanent normalization of the ABP. Defining indications to operation, it is necessary to have clear idea of a functional condition of kidneys or the kidney which is not affected by the basic patol. process. If as a result of long hypertensia in kidneys (or a kidney, edges after alleged operation will remain only) the arteriolosclerosis, surgical treatment developed not only does not lead to normalization of the ABP, but can become the reason of development of a renal failure.
Pathogenetic medicamentous therapy is possible only at some forms of symptomatic G. and. At an aldosteronism appointment of antagonists of Aldosteronum is shown (Spironolactonum, veroshpiron); at G. and. in the period of a climax use of sex hormones is effective. A symptomatic treatment generally same, as at an idiopathic hypertensia. At the majority of symptomatic forms G. and. decrease in the ABP can be reached by use of hypothiazid, ganglioblokator, derivative guanetidin, Methyldopa.
Surgical treatment of renovascular arterial hypertension
the First successful reconstructive renal artery operations was executed in 1952 by Thompson and Smitvik (J. Thompson, R. Smithwick). The indication to operation is the firm, not giving in to conservative therapy renovascular G. and. Contraindications to performance of reconstructive operations at occlusal damages of renal arteries are fresh (before half a year) disturbances of cerebral or coronary circulation, onkol. diseases, the expressed decompensation of cardiovascular system and the heavy renal failure which is not giving in to conservative therapy and also widespread damage of both renal arteries when it is technically impossible to execute recovery operation.
The choice of a method of surgical treatment at occlusal damages of renal arteries is carried out with the obligatory accounting of an etiology of occlusal damages of renal arteries (atherosclerosis, fibro-muskulyarnaya a dysplasia, aortoarteriit) and features of the defeat.
At renal artery operation usually use three main accesses: at reconstruction of one renal artery — a torakofrenolyumbotomiya on the X mezhreberye, at simultaneous interventions on both renal arteries — a median laparotomy and in cases of reconstruction of a ventral aorta and renal arteries — a torakofrenolaparotomiya.
In 60 — the 70th during the carrying out reconstructive operations on renal arteries the vast majority of surgeons gave preference to operations with use as plastic materials of alloprotez.
However plastic prostheses (from teflon, a Dacron, lavsan, semi-biological and electrowire) promoted developing of thromboses of the reconstructed highway in the next and remote postoperative the periods almost in 1/4 cases. In this regard for reconstruction of renal arteries began to use an autovena and an autoarteriya more widely.
Operation of a chrezaortalny endarteriektomiya from a renal artery by method of a reversing (fig.) was widely adopted. Fundamental difference of this way of operation from others was: production of all manipulations without disturbance of an integrity of a vascular wall of a renal artery; failure from use of any plastic materials. Operation of a chrezaortalny endarteriektomiya is method of the choice at atherosclerosis (see. Atherosclerosis, surgical treatment of occlusal defeats ), and in some cases it is quite successfully applied at an aortoarteriita and fibro-muskulyarnoy a dysplasia (an intimalny fibroplasia) of a renal artery. In the latter case, if the renal artery is affected on rather small site, optimum operation is the resection of this site with imposing of an anastomosis the end in the end. Performance of such operation is helped by existence of a nephroptosis since existing «excess» of an artery allows to resect freely struck part of a vessel and to impose an anastomosis without tension. Lack of need for plastic materials, simplicity and reliability of a method do this operation by operation of the choice at this group of patients. At widespread damage of arteries of one kidney because of fibro-muskulyarnoy dysplasia when in patol, process also branches of a renal artery are involved, it is carried out nephrectomy (see) since radical reconstructive operations are not developed for such defeats.
Surgical treatment of an aortoarteriit of a ventral aorta with involvement in patol, process of renal arteries is one of the most difficult sections of modern angiosurgery. In view of an extreme variety of pathology and existence of the combined damages of an aorta and renal arteries the choice of methods of treatment in each case depends on the nature of pathology and weight of the general condition of the patient.
At patients aortoarteriity carry out hl. obr. operations of bypass shunting of an aorta in the place of narrowing and prosthetics of renal arteries using as plastic material hallo - prostheses (see. Alloplasty ).
In the postoperative period special attention should be paid on adequate compensation of blood loss, to carry out the treatment preventing development of a renal failure, to exercise control of the ABP level and function of kidneys. The immediate and long-term results of operational treatment demonstrate normalization of the ABP at 70 — 85% of patients that speaks about high performance of surgical treatment of renovascular hypertensia.
the Absolute recovery at symptomatic G. and. (i.e. permanent normalization of the ABP) it is possible at timely elimination of the reason of hypertensia, napr, during surgical removal of gormonalnoaktivny tumors of adrenal glands or the affected kidney, at revascularization of a kidney in cases of narrowing of a renal artery etc. Long existence of stable G. and. any origin leads to development in kidneys of an arteriolosclerosis. Thus, the accessory factor of maintenance of the ABP on a high level is created, and elimination of the prime cause of hypertensia does not allow to achieve normalization of the ABP. When it is impossible to achieve an absolute recovery, the forecast depends on a form G. and., its tolerances to medicinal treatment and for features of a current of a basic disease. Patients with tranzitorny and labile hypertensia, as a rule, for many years keep working capacity almost in full, especially if they systematically receive adequate treatment by hypotensive and etiotropic means.
Working capacity and life expectancy of patients decides on high stable hypertensia by health of patients, existence of complications and reaction of the ABP to medicamentous therapy. Quite often similar patients it is also long (for many years) keep working capacity, losing it only during the periods of an exacerbation of a disease or as a result of emergence of complications. Use of hypotensive therapy by the similar patient leads to considerable extension of their life. Hypertensia with a paroxysmal current (e.g., at a pheochromocytoma) in many cases leads to disability only for the period of crisis and several days after its termination. Over time in connection with growth of a tumor crises become more and more frequent, long and heavy, the ABP during the mezhkrizovy period increases, and patients with firmness lose working capacity. Duration of a course of a disease from its first manifestations before full disability fluctuates from several months to several years. In cases of high tolerance to hypotensive therapy at patients from steady and considerable G. and. the forecast worsens, especially if the renal failure joins.
symptomatic G.'s Prevention and. comes down to prevention of the diseases which are its cornerstone and also to timely treatment of such diseases as an acute glomerulonephritis, acute pyelonephritis, etc. which in the absence of necessary therapy can get hron, a current.
Arterial hypertension at children
Increase in the ABP is observed at 4 — 6% of school students. At 50 — 70% from them of G. and. remains for a long time. At 54,4% of children with the raised ABP symptomatic forms G. come to light and., what is probably lower than their true frequency.
Among symptomatic G. and. the leading place belongs to nephrogenic hypertensia at various pathology of kidneys (anomaly of development of kidneys, pyelonephritis, a glomerulonephritis, cystous and occlusal diseases of kidneys, patol, mobility of kidneys, organic lesion of renal veins, etc.). Smaller value has G. and. at collagenic diseases, at defeat of c. N of page (an injury of the head, a tumor and inflammatory diseases of a brain, micro and hydrocephaly, poliomyelitis, etc.), at various patol, conditions of closed glands (adrenal glands, a hypophysis, a thyroid gland), and also at disturbances of a hemodynamics owing to inborn heart diseases and vessels.
Wedge, manifestations of an initial phase of primary G. and. at children essentially do not differ from those at adults. The disease proceeds is good-quality, staging of development is observed; hypertensive crises at children's age are absent. On the contrary, at secondary G. and., especially renal genesis, hypertensive crises can be observed. Stable G. and. at children proceeds with the expressed hypertrophy of a left ventricle of heart, an angiopatiya and an angiosclerosis of vessels of a retina of eyes.
Main diagnostic methods of G. and. at children same, as well as at adults. Also methods of prevention and treatment are generally identical. At primary, and. at children's age the organization of the correct day regimen is important. Streamlining of a daily routine, alternation of study and rest, walk on air for fight against a hypoxia and a hypodynamia, an exception of additional loadings is necessary. Elimination of conflict situations in a family, school etc. is necessary. In initial stages of a disease use of central acting agents is shown (bromides, barbiturates, meprobamate, etc.). The course of an electrophoresis with solution of magnesium sulfate and bromides and treatment by oxygen bathtubs has good effect. Appoint also drugs of Rauwolfia, Dibazolum, diuretics. Use of beta adrenoblockers is perspective (anaprilin, Obsidanum, inderal, Viskenum). Observations show that early use of sedative and hypotensive drugs at G. and. at children is justified.
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I. K. Shkhvatsabaya, V. A. Bogoslovsky, H. A. Ratner, V. V. Suchkov; M. D. Knyazev (hir.), M. Ya. Studenikin (ped.).