Treatment of kidneys with hypertension. Renal hypertension symptoms. Group of mixed renal hypertension

Stably high blood pressure against the background of various kidney diseases is a dangerous condition for both health and life, and requires immediate medical attention. Early diagnosis of renal hypertension and determination of the optimal timely course of treatment will help to avoid many negative consequences.

Renal hypertension (renal pressure, renal hypertension) belongs to the group of symptomatic (secondary) hypertension. This type of arterial hypertension develops as a result of certain kidney diseases. It is important to correctly diagnose the disease and take all necessary medical measures in time to prevent complications.

Disease prevalence

Renal hypertension is diagnosed in about 5-10 cases out of every 100 in patients who have evidence of stable hypertension.

Characteristic features

Like another type of disease, this pathology is accompanied by a significant increase in blood pressure (starting from 140/90 mm Hg. Art.)

Additional signs:

Stable high diastolic pressure.
No age restrictions.
High risk of acquiring malignant hypertension.
Difficulties in treatment.

Renal hypertension. Principles of disease classification

For practical use in medicine, a convenient classification of the disease has been developed.

Reference. Since hypertension is a very diverse pathology, it is customary to use disease classifications that take into account one or a group of existing criteria. Diagnosing a specific type of disease is a top priority. Without such actions, it is generally not possible to choose a competent correct tactics of therapy and designate preventive measures. Therefore, doctors determine the type of hypertension according to the causes that caused the disease, according to the course, specific blood pressure indicators, possible damage to the target organ, the presence of hypertensive crises, as well as the diagnosis of primary or essential hypertension, which is allocated to a separate group.

It is impossible to determine the type of disease on your own! Contacting a specialist and undergoing complex comprehensive examinations are mandatory for all patients.

Treatment with home methods in case of any manifestation of an increase in blood pressure (episodic, and even more so regular) is unacceptable!

Renal hypertension. Principles of disease classification

Group of renoparenchymal hypertension

The disease is formed as a complication of certain types of functional renal disorders. We are talking about unilateral or bilateral diffuse damage to the tissues of this important organ.

List of renal lesions that can cause renal hypertension:

Inflammation of some areas of the kidney tissue.
Polycystic kidney disease, as well as other congenital forms of their anomalies.
Diabetic glomerulosclerosis as a severe form of microangiopathy.
A dangerous inflammatory process with localization in the glomerular renal apparatus.
Infectious lesion (tuberculous nature).
Some diffuse pathologies proceeding according to the type of glomerulonephritis.

The cause of the parenchymal type of hypertension in some cases are also:

inflammatory processes in the ureters or in the urethra;
stones (in the kidneys and urinary tract);
autoimmune damage to the renal glomeruli;
mechanical obstacles (due to the presence of neoplasms, cysts and adhesions in patients).

Group of renovascular hypertension

Pathology is formed due to certain lesions in one or two renal arteries. The disease is considered rare. Statistics confirms only one case of renovascular hypertension out of a hundred manifestations of arterial hypertension.

Provoking factors

You should be wary of:

atherosclerotic lesions with localization in the renal vessels (the most common manifestations in this group of pathologies);
fibromuscular hyperplasia of the renal arteries;
anomalies in the renal arteries;
mechanical compression

Group of mixed renal hypertension

As the immediate cause of the development of this type of disease, doctors often diagnose:

nephroptosis;
tumors;
cysts;
congenital anomalies in the kidneys themselves or vessels in this organ.

Pathology manifests itself as a negative synergistic effect from a combination of damage to the tissues and vessels of the kidneys.

Group of mixed renal hypertension

Conditions for the development of renal pressure

Studying the process of development of various types of renal hypertension, scientists have identified three main factors of influence, these are:

insufficient excretion of sodium ions by the kidneys, leading to water retention;
the process of suppression of the depressor system of the kidneys;
activation of the hormonal system that regulates blood pressure and blood volume in the vessels.

The pathogenesis of renal hypertension

Problems arise when there is a significant decrease in renal blood flow and reduced glomerular filtration efficiency. This is possible due to the fact that diffuse changes in the parenchyma occur or the blood vessels of the kidneys are affected.

How do the kidneys react to the process of reducing blood flow in them?

There is an increase in the level of reabsorption (reabsorption process) of sodium, which then causes the same process in relation to the liquid.
But pathological processes are not limited to sodium and water retention. Extracellular fluid begins to increase in volume and compensatory hypervolemia (a condition in which blood volume increases due to plasma).
A further development scheme includes an increase in the amount of sodium in the walls of blood vessels, which, as a result, swell, while showing increased sensitivity to angiotensin and aldosterone (hormones, regulators of water-salt metabolism).

Why does blood pressure increase in some kidney pathologies?

We should also mention the activation of the hormonal system, which becomes an important link in the development of renal hypertension.

The kidneys secrete a special enzyme called renin. This enzyme promotes the transformation of angiotensinogen into angiotensin I, from which, in turn, angiotensin II is formed, which constricts blood vessels and increases blood pressure. .

Development of renal hypertension

Effects

The algorithm for increasing blood pressure described above is accompanied by a gradual decrease in the compensatory capabilities of the kidneys, which were previously aimed at lowering blood pressure if necessary. For this, the release of prostaglandins (hormone-like substances) and KKS (kallikrein-kinin system) was activated.

Based on the foregoing, an important conclusion can be drawn - renal hypertension develops according to the principle of a vicious circle. At the same time, a number of pathogenic factors lead to renal hypertension with a persistent increase in blood pressure.

Renal hypertension. Symptoms

When diagnosing renal hypertension, one should take into account the specifics of such concomitant diseases as:

pyelonephritis;
glomerulonephritis;
diabetes.

Also pay attention to a number of such frequent complaints of patients, such as:

pain and discomfort in the lower back;
problems with urination, increased volume of urine;
periodic and short-term increase in body temperature;
persistent feeling of thirst;
feeling of constant weakness, loss of strength;
swelling of the face;
gross hematuria (visible admixture of blood in the urine);
fast fatiguability.

In the presence of renal hypertension in the urine of patients often found (during laboratory tests):

bacteriuria;
proteinuria;
microhematuria.

Typical features of the clinical picture of renal hypertension

The clinical picture depends on:

from specific indicators of blood pressure;
functional abilities of the kidneys;
the presence or absence of concomitant diseases and complications affecting the heart, blood vessels, brain, etc.

Renal hypertension is invariably accompanied by a constant increase in the level of blood pressure (with the dominance of an increase in diastolic pressure).

Patients should be seriously wary of the development of malignant hypertensive syndrome, accompanied by spasm of arterioles and an increase in total peripheral vascular resistance.

Renal hypertension and its diagnosis

The diagnosis is based on taking into account the symptoms of concomitant diseases and complications. For the purpose of differential analysis, laboratory research methods are mandatory.

Renal hypertension and its diagnosis

The patient may be given:

OAM (general urinalysis);
urinalysis according to Nechiporenko;
urinalysis according to Zimnitsky;
Ultrasound of the kidneys;
bacterioscopy of urinary sediment;
excretory urography (X-ray method);
scanning of the kidney area;
radioisotope renography (X-ray examination using a radioisotope marker);
kidney biopsy.

The conclusion is drawn up by the doctor based on the results of the patient's questioning (history taking), his external examination and all laboratory and hardware studies.

Treatment of renal hypertension

The course of treatment of renal hypertension must necessarily include a number of medical measures to normalize blood pressure. At the same time, pathogenetic therapy is carried out (the task is to correct the impaired functions of organs) of the underlying pathology.

One of the main conditions for effective assistance to nephrological patients is a salt-free diet.

What does this mean in practice?

The amount of salt in the diet should be kept to a minimum. And for some kidney diseases, a complete rejection of salt is recommended.

Attention! The patient should not consume salt more than the allowed norm of five grams per day. Keep in mind that sodium is also found in most foods, including their flour products, sausages, and canned food, so salting cooked food will have to be abandoned altogether.

Treatment of renal hypertension

In what cases is a tolerant salt regime allowed?

A slight increase in sodium intake is allowed for those patients who are prescribed as a medicine. salturetics (thiazide and loop diuretics).

It is not necessary to severely restrict salt intake in symptomatic patients:

polycystic kidney disease;
salt-wasting pyelonephritis;
some forms of chronic renal failure, in the absence of a barrier to sodium excretion.

Diuretics (diuretics)

Therapeutic effect	Name of the drug
High	Furosemide, Trifas, Uregit, Lasix
Average	Hypothiazide, Cyclomethiazide, Oxodoline, Hygroton
not pronounced	Veroshpiron, Triamteren, Diakarb
Long (up to 4 days)	Eplerenone, Veroshpiron, Chlortalidone
Average duration (up to half a day)	Diacarb, Clopamid, Triamteren, Hypothiazid, Indapamide
Short efficiency (up to 6-8 hours)	Manit, Furosemide, Lasix, Torasemide, Ethacrynic acid
Quick result (in half an hour)	Furosemide, Torasemide, Ethacrynic acid, Triamterene
Average duration (one and a half to two hours after ingestion)	Diacarb, Amiloride
Slow smooth effect (within two days after administration)	Veroshpiron, Eplerenone

Classification of modern diuretic drugs (diuretics) according to the features of the therapeutic effect

Note. To determine the individual salt regimen, the daily release of electrolytes is determined. It is also necessary to fix the volume indicators of blood circulation.

Three basic rules for the treatment of renal hypertension

Studies conducted in the development of a variety of methods to reduce blood pressure in renal hypertension have shown:

A sharp decrease in blood pressure is unacceptable due to the significant risk of impaired renal function. The baseline must not be lowered more than one quarter at a time.
Treatment of hypertensive patients with the presence of pathologies in the kidneys should be aimed primarily at lowering blood pressure to an acceptable level, even against the background of a temporary decrease in kidney function. It is important to eliminate the systemic conditions for hypertension and non-immune factors that worsen the dynamics of renal failure. The second stage of treatment is medical assistance aimed at strengthening renal functions.
Arterial hypertension in a mild form suggests the need for stable antihypertensive therapy, which is aimed at creating positive hemodynamics and creating barriers to the development of renal failure.

Medicines to lower blood pressure in kidney failure

The patient may be prescribed a course of thiazide diuretics, in combination with a number of adrenergic blockers.

Several different antihypertensive drugs are approved for the treatment of nephrogenic arterial hypertension.

Pathology is treated:

angiotensin-converting enzyme inhibitors;
calcium antagonists;
b-blockers;
diuretics;
a-blockers.

Medicines to lower blood pressure in kidney failure

The treatment process must comply with the principles:

continuity;
long duration in time;
dietary restrictions (special diets).

Determining the severity of renal failure is an important factor

Before prescribing specific drugs, it is imperative to determine how severe renal failure is (the level of glomerular filtration is being studied).

Duration of medication

The patient is determined for long-term use of a specific type of antihypertensive drug (for example, dopegyt). This drug affects the brain structures that regulate blood pressure.

Duration of medication

End stage renal failure. Features of therapy

Chronic hemodialysis is required. The procedure is combined with antihypertensive treatment, which is based on the use of special medications.

Important. With the ineffectiveness of conservative treatment and the progression of renal failure, the only way out is transplantation of a donor kidney.

Preventive measures for renal hypertension

In order to prevent renal arterial genesis, it is important to follow simple, but effective, precautions:

systematically measure blood pressure;
at the first signs of hypertension, seek medical help;
limit salt intake;
to ensure that obesity does not develop;
give up all bad habits;
lead a healthy lifestyle;
avoid hypothermia;
pay enough attention to sports and exercise.

Preventive measures for renal hypertension

conclusions

Arterial hypertension is considered an insidious disease that can cause various complications. In combination with damage to the renal tissue or blood vessels, it becomes deadly. Careful adherence to preventive measures and consultation with medical specialists will help reduce the risk of pathology. Everything possible should be done to prevent the occurrence of renal hypertension, and not to deal with its consequences.

Pathologies of the cardiovascular system rank first among the causes of increased mortality among the working population. The diagnosis of "hypertension" is established by a cardiological doctor and requires lifelong drug therapy, adherence to a specific diet and motor regimen.

There are different types of arterial hypertension, one of the most dangerous types is renal hypertension. The level of blood pressure (BP) is formed on the basis of the interaction of the heart muscle, vascular resistance and kidney function. It is about the renal etiology of hypertension that will be discussed in this article, we will analyze the causes of its occurrence, methods of diagnosis and treatment.

Renal hypertension - what is it?

Modern medical classification distinguishes between primary and secondary arterial hypertension. Hypertension of renal etiology is secondary and is associated with primary lesions of the renal blood flow and the functioning of the juxtaglomerular apparatus. Statistics claim that in more than five percent of people with increased intravascular pressure, the pathology is associated precisely with a violation of the kidneys.

The physiology of the human body is arranged in such a way that it is the kidneys that are able to increase pressure by reducing the excretion of water and salt molecules through the urinary tract. An increase in the volume of circulating blood due to the liquid component allows you to restore blood pressure in case of its pathological decrease and vice versa.

Renal hypertension is a type of arterial hypertension that develops with kidney disease.

Causes, symptoms and specifics of renal hypertension

When certain diseases occur, physiological mechanisms are violated, and a persistent increase in blood pressure occurs.

Pathologies that can cause secondary renal hypertension include the following:

chronic or acute inflammatory processes in the renal filter system;
polycystic kidney disease;
tuberculous contamination of the renal tissue;
hydronephrosis;
amyloidosis;
disruption of the renal tissue caused by compression of the parenchyma by the uterus enlarged by the fetus in women;
congenital or acquired narrowing of the renal arteries;
systemic connective tissue pathologies.

The specificity of renal hypertension is associated with the mechanism of its occurrence, due to water retention in the body, not only the afterload on the myocardium increases, but also the preload, which is manifested by an increase in not only systolic, but also diastolic pressure. In parallel, the presence of pain in the lumbar region is usually observed, which is associated with the primary disease that caused the development of hypertension.

Renal arterial hypertension has characteristic features

Allocate both specific and nonspecific clinical manifestations of this disease. The general ones include:

decrease in working capacity;
the appearance of a constant headache;
increase in heart rate;
the appearance of excessive swelling of the lower extremities and face;
bluish coloration of peripheral tissues, redness of the sclera;
increased irritability.

More specific symptoms of renal hypertension include:

increase in systolic and diastolic blood pressure indicators;
the appearance of pain in the lumbar region;
decrease in the daily amount of urine;
temperature rise;
visual impairment;
noise during auscultation in the area of the projection of the branch of the renal arteries;
the presence of different blood pressure indicators on the right and left limbs.

What is the danger of the disease?

An increase in intravascular pressure is dangerous with a significant increase in the risk of developing damage to the so-called target organs. These include the vessels of the brain, heart muscle, lungs, and even retinal arteries. In the absence of proper treatment for hypertension, pulmonary edema, cerebral hemorrhagic stroke, myocardial infarction, or retinal hemorrhage may occur. Renal hypertension has a greater risk of such complications, since it is more permanent, and if it is present, not only the systolic index increases, but also the diastolic one.

Due to various pathologies in the kidneys, there is a decrease in the normal flow of blood to this organ.

Malignant renal hypertension

The modern classification of renal hypertension distinguishes between benign and malignant forms of the disease. The malignant course of pathology is considered the most aggressive and dangerous, since when it occurs, blood pressure indicators exceed 220 to 130 mm Hg. Art. In parallel, there is damage to the vessels of the retina of the third or fourth degree and necrosis of the arterioles of the renal parenchyma.

The second pathology is detected by taking material for a biopsy. Usually, the diagnosis is made without such a traumatic procedure, it is sufficient to identify the indicated BP numbers and the presence of target organ damage. Another dangerous feature of this form of pathology is the rapid progression. In some clinical cases, there is a persistent increase in pressure from normal to critical within one to two days.

Previously, such patients lived no more than one year, but with the advent of effective drugs that affect blood pressure, the five-year survival rate has already exceeded eighty percent. Most deaths are associated with the development of severe ischemia of the heart muscle.

benign renal hypertension

A benign form of increased blood pressure, caused by a violation of the kidneys, is characterized by the presence of increased indicators in tonometry. The difference from malignant is the absence of sharp jumps that can lead to damage to target organs. This form of the disease is difficult to treat with antihypertensive drugs.

With a benign form, the manifestations are less pronounced, the dynamics of the disease is gradual

The classic symptoms of benign renal hypertension are:

dizziness;
noise in ears;
bouts of anxiety;
dyspnea;
weakness.

Diagnosis and treatment of kidneys in hypertension

Only a specialist in therapeutic profile can determine the presence of a disease. After the appearance of the above symptoms, you should immediately consult a doctor for a full diagnosis. Due to long-term neglect of their health and a frivolous attitude to the state of their body, people often bring their illnesses to the stage when standard conservative therapy is already ineffective.

In order to prevent such phenomena, you should regularly undergo preventive examinations with your family doctor.

To identify the diagnosis of "renal hypertension", the doctor uses the following diagnostic methods:

questioning about complaints;
objective examination, during which blood pressure indicators, palpation and percussion are determined;
the presence of a burdened family history is found out.

Be sure the doctor prescribes an ultrasound examination of the kidneys, this method gives an idea of the size, configuration, anomalies in the structure of the organ itself

To confirm the diagnosis and conduct differential diagnosis, the following methods are used:

general clinical analysis of blood and urine;
ultrasound diagnostics of the kidneys and pelvic organs with the determination of blood flow in the specified area according to the method using the Doppler effect;
urographic study;
scintigraphy;
magnetic resonance or computed tomography;
at the final stage, a kidney biopsy is shown to establish an accurate diagnosis.

Drugs for the treatment of renal hypertension

For the treatment of renal hypertension, both surgical and medical methods are used. Therapy with drugs is more gentle and conservative. The development of the pharmaceutical industry has made it possible to obtain a large number of effective drugs.

These include angiotensin-converting enzyme inhibitors, they are able to inhibit the work of the juxtaglomerular apparatus and normalize the level of blood pressure, these include:

"Captopril";
"Enalapril";
Fosinopril.

Surgery

Surgical intervention is considered a more radical method of correcting the condition of such patients. It is effective in renal artery stenosis, in which case balloon angioplasty is performed, which restores normal renal blood flow and stabilizes blood pressure. Surgical methods are also used in the development of tumors, cysts and other bodies that compress the vessels of the kidney or its parenchyma.

Prevention of hypertension in kidney disease

To date, there are no specific methods for the prevention of renal hypertension. Non-specific methods include:

maintaining a healthy lifestyle;
sports;
following a diet with a low salt content of up to 5 grams;
getting rid of excess body weight;
treatment of major diseases that can cause damage to the vessels and parenchyma of the kidneys.

In this topic, we will take a closer look at what renal hypertension is, the symptoms, treatment, and diagnostic measures. This disease is a painful condition characterized by high blood pressure. The disease is gaining momentum every year, and every 5 people who have applied for qualified medical help are diagnosed with this disease.

Renal hypertension makes itself felt when there are functional disorders of the kidneys. This organ is responsible for filtering arterial blood, for removing excess fluid from the body, as well as sodium and harmful substances that enter the blood.

When the kidneys do not work properly, blood flow to them decreases, fluid and sodium accumulate, which leads to their retention and the formation of puffiness. Sodium particles, having accumulated in the blood, act as provocateurs of swollen vessel walls. This causes their acute sensitivity. With impaired kidney function, renin is released, which is converted to angiotensin, and then aldosterone. These substances increase vascular tone and reduce existing gaps, which contributes to an increase in pressure. Along with this process, the production of substances responsible for the condition of the arteries decreases, as a result, the renal receptors begin to be irritated with greater force.

How are hypertension and kidneys related?

Hypertension and kidneys. There is a clear relationship between these concepts, namely: arterial hypertension leads to kidney dysfunction, and if you look from the other side, various kidney diseases act as provocateurs of changes in blood pressure.

Causes of the disease:

Various painful conditions of the kidneys (pyelonephritis, polycystic and others).
Diabetes.
Hypoplasia.
Cystic formations in the kidneys.

Symptoms of the disease.

General symptoms:

causeless, sharp increase in pressure;
the disease manifests itself before the age of 30;
swelling of the limbs;
pain in the lumbar region;
the absence of a family line of hypertensive patients with a chronic course of the disease and heart disease.

Symptoms in a benign course of the disease:

slow development of the disease;
increased pressure is kept stable, without sudden jumps;
dull pain in the head;
weakness;
persistent shortness of breath and dizziness;
anxiety for no reason.

Symptoms of the malignant course of the disease:

the rapid development of the disease;
diastolic pressure readings are more than 120 mm Hg. Art., the difference between the indicators of the tonometer is quite insignificant;
there is a visual impairment;
complaints of severe, headaches, especially in the back of the head;
nausea, vomiting reflex;
dizziness.

Renal arterial hypertension is characterized by pressure indicators of 140/90 mm Hg. Art., but higher values may be detected. The disease develops at a fairly young age. As a rule, the diastolic pressure reading increases. The conservative method of treatment is practically not effective. The disease is malignant. These are the main symptoms of the disease in question.

Diagnostic measures and treatment of the disease

To correctly diagnose, you should consult with a therapist. After a full study and study of the obtained tests, he will prescribe the appropriate treatment. Only with a comprehensive examination of the patient can the disease be correctly diagnosed.

How to treat the disease.
Only the attending physician, after a complete examination of the patient, can prescribe a course of treatment for renal hypertension. In each individual case, the patient's individual intolerance to the drugs and the sensitivity of the microflora are taken into account.

An integrated approach includes:

Direct treatment of kidney diseases.
A course of therapy aimed at reducing pressure.

It is important to know that in the acute course of the disease, provoked as a result of the pathology of the renal arteries, it is necessary to resort to surgical treatment. Balloon angioplasty may be used if a narrowing of the renal artery has occurred. The method consists in the fact that a catheter is inserted into the artery, containing a balloon on the edge. In a certain place, it swells, which leads to the expansion of the artery. After this procedure, the catheter is removed, but the stent remains. This method improves blood flow and lowers blood pressure.

When carrying out drug treatment, the use of table salt is limited to 3-4 g per day. A course of treatment is prescribed, which includes small doses at the initial stage. Therapy is carried out with the appointment of one drug, then others are added. In the presence of renal hypertensive syndrome, which has been present for more than 2 years, therapeutic measures should be carried out without interruption.

Treatment of renal hypertension is designed for a long period of time, which can be up to 6 months. With this disease, treatment may include periodic cleaning of the blood, using hemodialysis for this purpose.

It is important to remember that it is strictly forbidden to self-medicate with renal hypertension, as well as to use in practice the advice of people who do not have the appropriate medical education.

Failure to comply with this rule can harm health and greatly worsen the condition.

Kidney phonation is a micromassage performed at the cellular level. This method allows you to carry out the procedure both at home and on an outpatient basis. It is carried out using a special medical device.

The phonation of the kidneys compensates for the lack of biological microvibration of tissues in the problem area of the body. It is carried out by devices that have vibraphones. It is they that are superimposed through a napkin on the patient's body, and then the apparatus and the body interact through microvibrations. For the procedure, the Vitafon device is often used.

How to treat renal hypertension at home

Given the degree of the disease, the attending physician may recommend using alternative methods of treatment. At the same time, it is imperative to follow the principles of proper nutrition.

To lower renal pressure, you can use the following recipes:

To prepare a collection that helps relieve the inflammatory process, you will need: 2 tbsp. l. birch leaves, 5 tbsp. l. flax seeds, 1 tbsp. l. strawberry leaves and 1 tbsp. l. blackberry leaves. All ingredients should be mixed and ground with a coffee grinder until a powder is formed. For a decoction, take a few tablespoons of the finished mass, pour 500 g of boiling water. Let it brew for 7 hours. It is recommended to take the infusion for 3 weeks 5 times a day. After the first course, it is worth taking a break and only then resume taking the folk drug.
To quickly reduce renal pressure, you should prepare an infusion of bearberry. For this plant in the amount of 3 tbsp. l. you need to pour 2 cups of boiling water. Insist 30 minutes. Drink an infusion of 200 ml 3-4 times a day.
To prepare the tincture, you need 3 tbsp. l. carrot seeds and 1 liter of boiling water. Grind the seeds in advance with a blender and place in a thermos. Pour boiling water over and leave for 10 hours. After that, it is recommended to strain the composition and consume 1 glass before meals 5 times a day. The course of treatment is designed for 14 days.

Preventive actions

Constantly monitor your pressure, it should not be too high or too low.
If symptoms are present, contact a specialist immediately.
Never use for treatment drugs that are not recommended by the attending physician.
If you are overweight, try to limit the intake of high-calorie foods.
Reduce the amount of salt you eat.
Quit smoking completely.
Include onion and garlic in your diet regularly.
It is recommended to take fish oil.

Finally, it is worth noting that if hypertension is not treated, then death is possible. Be healthy!

Renal hypertension is accompanied by a prolonged increase in blood pressure, which is due to a violation of the kidneys. This type of disease is secondary and is diagnosed in every tenth patient with high blood pressure.

A characteristic sign of pathology is a prolonged increase in the symptom, which in medicine is called renal pressure. This condition usually occurs in people at a young age. Treatment of renal hypertension and its effectiveness will depend on the correctness of the diagnosis.

The described ailment not only causes suffering to patients and worsens the quality of life, but is also dangerous with the possibility of serious pathological phenomena, such as:

Decreased vision, up to blindness;

Development of cardiac and renal pathologies;

Severe damage to the arteries;

Pathological changes in the composition of the blood;

The occurrence of atherosclerosis of the vessels;

Problems with lipid metabolism;

Disorders of cerebral blood supply.

The disease negatively affects a person's performance, leads to disability, which often ends fatally.

Renal hypertension, the treatment of which depends on the symptoms, manifests itself as a stable hypertensive syndrome. Often the process turns into oncology. The disease can be expressed as the main symptom of nephropathy. Clinical manifestations of the underlying disease can be expressed in conjunction with symptoms of other diseases.

With the development of hypertension of renal etiology, patients complain of weakness, often get tired.

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Hypertension is diagnosed if a person's blood pressure values are above 140/90 for several weeks. However, urinalysis can detect problems at an early stage of development. When additional diseases of the excretory system are detected, the renal form of the disease is diagnosed, which is considered secondary.

Laboratory blood and urine tests represent one of the most important diagnostic steps. Ultrasound examination helps to determine the presence of physiological changes in the kidneys and other disorders.

Patients also undergo scanning, urography and radiography.

MSCT: stenosis of the right renal artery (arrow) in a patient with vasorenal hypertension

With the help of combined methods, it is possible to determine the type of disease, after which it is worth starting treatment tactics.

Therapy of the disease is aimed at resolving two main tasks: resuming the functionality of the kidneys, restoring blood supply and reducing blood pressure.

For this purpose, drugs are used to treat renal hypertension, as well as special hardware and surgical techniques.

Therapeutic tactics are aimed at curing the main disease. The conservative method involves the appointment of pharmaceuticals that affect the mechanism of the appearance of arterial hypertension. One of the main principles is therapy with a minimum number of side effects.

A sample list of pills for the treatment of renal hypertension consists of diuretics, beta-blockers, as well as many other drugs prescribed by the attending physician.

One of the innovative and effective therapeutic methods is phonation. It involves the installation of special devices on the human body that help restore the functionality of the kidneys, increase the production of uric acid, and restore blood pressure.

Phonation of the kidneys with the apparatus "Vitafon" at home

Surgical therapy for a disease such as renal hypertension is due to individual characteristics (for example, doubling of an organ or the formation of cysts on it).

Treatment of hypertension in renal artery stenosis involves the use of balloon angioplasty. The meaning of the technique is that a catheter is inserted into the artery, which is equipped with a balloon. This device swells and enlarges the artery. When the catheter is removed from the vessels, a special stent remains. As a result, the blood supply will be significantly improved, the vascular walls will be strengthened - and the pressure will decrease.

For information on how stenting is performed for renal artery stenosis, see this video:

Treatment of renal hypertension with folk remedies should be performed only if this has been previously agreed with the doctor. Herbal preparations, characterized by a pronounced diuretic effect, abound. But not all of them are considered harmless to the heart.

Incorrectly selected medicines contribute to the aggravation of the course of the pathology and can lead to serious complications.

One of the most important aspects is the diet, which increases the effectiveness of treatment and speeds up recovery. The list of allowed foods will depend on how badly the kidneys are affected.

Patients should minimize the consumption of liquids and table salt, exclude junk food, smoked meats, pickles from the menu. You should also minimize the consumption of alcohol and coffee.

About the treatment of renal hypertension, see this video:

If the therapeutic tactics are chosen unreasonably or by the patient himself without the knowledge of the doctor, this can lead to the appearance of severe and even fatal consequences. Elevated blood pressure levels in kidney disease act as a trigger for further health problems, namely:

Development of pathologies of the cardiovascular system;

kidney failure;

Changes in the composition of the blood;

Problems with cerebral blood supply;

Irreversible processes of vision function;

Disorders of lipid metabolism;

Arterial lesions.

Pathology prevention measures are no less important than the treatment of hypertension in renal failure, and are aimed at maintaining the full functioning of the kidneys and the cardiovascular system, since there is a close relationship in the functionality of these organs.
In order to prevent the occurrence of hypertension, it is necessary:

Control blood pressure, when the first signs of the disease appear, consult a doctor;

Minimize the intake of food that has a negative effect on the kidney receptors;

Minimize salt intake;

Completely give up bad habits;

Make the daily routine correct;

Do sport;

Overweight people should strive to lose weight through physical activity.

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Read more about whether you can play sports with high blood pressure.

In addition to all of the above, there is also prevention using folk methods, which involves protection from an illness of any form:

Every day, use a small spoonful of fish oil;

Add onion and garlic to food;

Drink freshly squeezed juices;

Buy hawthorn tincture and take it according to the instructions.

Being one of the clinical manifestations of a whole list of diseases, nephrogenic hypertension helps to diagnose serious diseases. You should not drink medicines to treat renal hypertension on your own. Only timely and effective treatment gives a person every chance for a successful recovery.

Disease prevalence

Renal hypertension is diagnosed in about 5-10 cases out of every 100 in patients who have evidence of stable hypertension.

Like another type of disease, this pathology is accompanied by a significant increase in blood pressure (starting from 140/90 mm Hg. Art.)

Additional signs:

Stable high diastolic pressure.
No age restrictions.
High risk of acquiring malignant hypertension.
Difficulties in treatment.

For practical use in medicine, a convenient classification of the disease has been developed.

Reference. Since hypertension is a very diverse pathology, it is customary to use disease classifications that take into account one or a group of existing criteria. Diagnosing a specific type of disease is a top priority. Without such actions, it is generally not possible to choose a competent correct tactics of therapy and designate preventive measures. Therefore, doctors determine the type of hypertension according to the causes that caused the disease, according to the course, specific blood pressure indicators, possible damage to the target organ, the presence of hypertensive crises, as well as the diagnosis of primary or essential hypertension, which is allocated to a separate group.

It is impossible to determine the type of disease on your own! Contacting a specialist and undergoing complex comprehensive examinations are mandatory for all patients.

Treatment with home methods in case of any manifestation of an increase in blood pressure (episodic, and even more so regular) is unacceptable!

Renal hypertension. Principles of disease classification

Group of renoparenchymal hypertension

The disease is formed as a complication of certain types of functional renal disorders. We are talking about unilateral or bilateral diffuse damage to the tissues of this important organ.

List of renal lesions that can cause renal hypertension:

Inflammation of some areas of the kidney tissue.
Polycystic kidney disease, as well as other congenital forms of their anomalies.
Diabetic glomerulosclerosis as a severe form of microangiopathy.
A dangerous inflammatory process with localization in the glomerular renal apparatus.
Infectious lesion (tuberculous nature).
Some diffuse pathologies proceeding according to the type of glomerulonephritis.

The cause of the parenchymal type of hypertension in some cases are also:

inflammatory processes in the ureters or in the urethra;
stones (in the kidneys and urinary tract);
autoimmune damage to the renal glomeruli;
mechanical obstacles (due to the presence of neoplasms, cysts and adhesions in patients).

Provoking factors

You should be wary of:

atherosclerotic lesions with localization in the renal vessels (the most common manifestations in this group of pathologies);
fibromuscular hyperplasia of the renal arteries;
anomalies in the renal arteries;
mechanical compression

As the immediate cause of the development of this type of disease, doctors often diagnose:

nephroptosis;
tumors;
cysts;
congenital anomalies in the kidneys themselves or vessels in this organ.

Pathology manifests itself as a negative synergistic effect from a combination of damage to the tissues and vessels of the kidneys.

Group of mixed renal hypertension

Conditions for the development of renal pressure

Studying the process of development of various types of renal hypertension, scientists have identified three main factors of influence, these are:

insufficient excretion of sodium ions by the kidneys, leading to water retention;
the process of suppression of the depressor system of the kidneys;
activation of the hormonal system that regulates blood pressure and blood volume in the vessels.

The pathogenesis of renal hypertension

How do the kidneys react to the process of reducing blood flow in them?

There is an increase in the level of reabsorption (reabsorption process) of sodium, which then causes the same process in relation to the liquid.
But pathological processes are not limited to sodium and water retention. Extracellular fluid begins to increase in volume and compensatory hypervolemia (a condition in which blood volume increases due to plasma).
A further development scheme includes an increase in the amount of sodium in the walls of blood vessels, which, as a result, swell, while showing increased sensitivity to angiotensin and aldosterone (hormones, regulators of water-salt metabolism).

We should also mention the activation of the hormonal system, which becomes an important link in the development of renal hypertension.

The mechanism of increasing blood pressure

Development of renal hypertension

Effects

Renal hypertension. Symptoms

When diagnosing renal hypertension, one should take into account the specifics of such concomitant diseases as:

pyelonephritis;
glomerulonephritis;
diabetes.

Also pay attention to a number of such frequent complaints of patients, such as:

pain and discomfort in the lower back;
problems with urination, increased volume of urine;
periodic and short-term increase in body temperature;
persistent feeling of thirst;
feeling of constant weakness, loss of strength;
swelling of the face;
gross hematuria (visible admixture of blood in the urine);
fast fatiguability.

In the presence of renal hypertension in the urine of patients often found (during laboratory tests):

bacteriuria;
proteinuria;
microhematuria.

Typical features of the clinical picture of renal hypertension

The clinical picture depends on:

from specific indicators of blood pressure;
functional abilities of the kidneys;
the presence or absence of concomitant diseases and complications affecting the heart, blood vessels, brain, etc.

Renal hypertension is invariably accompanied by a constant increase in the level of blood pressure (with the dominance of an increase in diastolic pressure).

Patients should be seriously wary of the development of malignant hypertensive syndrome, accompanied by spasm of arterioles and an increase in total peripheral vascular resistance.

The diagnosis is based on taking into account the symptoms of concomitant diseases and complications. For the purpose of differential analysis, laboratory research methods are mandatory.

Renal hypertension and its diagnosis

The patient may be given:

OAM (general urinalysis);
urinalysis according to Nechiporenko;
urinalysis according to Zimnitsky;
Ultrasound of the kidneys;
bacterioscopy of urinary sediment;
excretory urography (X-ray method);
scanning of the kidney area;
radioisotope renography (X-ray examination using a radioisotope marker);
kidney biopsy.

The conclusion is drawn up by the doctor based on the results of the patient's questioning (history taking), his external examination and all laboratory and hardware studies.

One of the main conditions for effective assistance to nephrological patients is a salt-free diet.

The amount of salt in the diet should be kept to a minimum. And for some kidney diseases, a complete rejection of salt is recommended.

Attention! The patient should not consume salt more than the allowed norm of five grams per day. Keep in mind that sodium is also found in most foods, including their flour products, sausages, and canned food, so salting cooked food will have to be abandoned altogether.

Treatment of renal hypertension

In what cases is a tolerant salt regime allowed?

A slight increase in sodium intake is allowed for those patients who are prescribed as a medicine. salturetics (thiazide and loop diuretics).

It is not necessary to severely restrict salt intake in symptomatic patients:

polycystic kidney disease;
salt-wasting pyelonephritis;
some forms of chronic renal failure, in the absence of a barrier to sodium excretion.

Diuretics (diuretics)

Therapeutic effect	Name of the drug
High	Furosemide, Trifas, Uregit, Lasix
Average	Hypothiazide, Cyclomethiazide, Oxodoline, Hygroton
not pronounced	Veroshpiron, Triamteren, Diakarb
Long (up to 4 days)	Eplerenone, Veroshpiron, Chlortalidone
Average duration (up to half a day)	Diacarb, Clopamid, Triamteren, Hypothiazid, Indapamide
Short efficiency (up to 6-8 hours)	Manit, Furosemide, Lasix, Torasemide, Ethacrynic acid
Quick result (in half an hour)	Furosemide, Torasemide, Ethacrynic acid, Triamterene
Average duration (one and a half to two hours after ingestion)	Diacarb, Amiloride
Slow smooth effect (within two days after administration)	Veroshpiron, Eplerenone

Classification of modern diuretic drugs (diuretics) according to the features of the therapeutic effect

Note. To determine the individual salt regimen, the daily release of electrolytes is determined. It is also necessary to fix the volume indicators of blood circulation.

Studies conducted in the development of a variety of methods to reduce blood pressure in renal hypertension have shown:

A sharp decrease in blood pressure is unacceptable due to the significant risk of impaired renal function. The baseline must not be lowered more than one quarter at a time.
Treatment of hypertensive patients with the presence of pathologies in the kidneys should be aimed primarily at lowering blood pressure to an acceptable level, even against the background of a temporary decrease in kidney function. It is important to eliminate the systemic conditions for hypertension and non-immune factors that worsen the dynamics of renal failure. The second stage of treatment is medical assistance aimed at strengthening renal functions.
Arterial hypertension in a mild form suggests the need for stable antihypertensive therapy, which is aimed at creating positive hemodynamics and creating barriers to the development of renal failure.

The patient may be prescribed a course of thiazide diuretics, in combination with a number of adrenergic blockers.

Several different antihypertensive drugs are approved for the treatment of nephrogenic arterial hypertension.

Pathology is treated:

angiotensin-converting enzyme inhibitors;
calcium antagonists;
b-blockers;
diuretics;
a-blockers.

Medicines to lower blood pressure in kidney failure

The treatment process must comply with the principles:

continuity;
long duration in time;
dietary restrictions (special diets).

Before prescribing specific drugs, it is imperative to determine how severe renal failure is (the level of glomerular filtration is being studied).

The patient is determined for long-term use of a specific type of antihypertensive drug (for example, dopegyt). This drug affects the brain structures that regulate blood pressure.

Duration of medication

End stage renal failure. Features of therapy

Chronic hemodialysis is required. The procedure is combined with antihypertensive treatment, which is based on the use of special medications.

Important. With the ineffectiveness of conservative treatment and the progression of renal failure, the only way out is transplantation of a donor kidney.

In order to prevent renal arterial genesis, it is important to follow simple, but effective, precautions:

systematically measure blood pressure;
at the first signs of hypertension, seek medical help;
limit salt intake;
to ensure that obesity does not develop;
give up all bad habits;
lead a healthy lifestyle;
avoid hypothermia;
pay enough attention to sports and exercise.

Preventive measures for renal hypertension

conclusions

What pills can be taken with hypertension?

When is antihypertensive therapy administered?
Drugs affecting the reninangiotensin system
Calcium channel blockers
Beta blockers
Diuretics
Centrally acting drugs

In recent years, hypertension has occupied a leading position among diseases of the heart and blood vessels. Previously, elderly patients suffered from an increase in blood pressure, but at present, pathology is detected in young people. The long course of the disease leads to dystrophic disorders in the tissues of the heart, kidneys, brain and organs of vision. The most dangerous complications of hypertension are myocardial infarction and cerebral stroke, which can lead to severe disability and death. The modern pharmacological industry produces a wide variety of drugs that help normalize the general condition of patients and improve the quality of life.

When is antihypertensive therapy given?

Pills for hypertension should be prescribed by a specialist after a comprehensive diagnosis, taking into account blood pressure numbers, the presence of concomitant diseases, contraindications, and the age of patients. The combination of these components during therapy is of great importance for achieving positive results and maintaining health at the proper level. When the pressure rises to 140/90 mm Hg. Art. and above, we can talk about the development of hypertension.

Risk factors for disease progression include:

diabetes;
hypercholesterolemia;
obesity;
hypodynamia;
chronic stress;
decreased glucose tolerance;
bad habits;
hereditary predisposition.

The debut of the disease begins with a periodic increase in blood pressure, usually against the background of a stressful situation. This causes a headache, drowsiness, weakness, sometimes flashing "flies" before the eyes. Often this condition is associated with overwork and do not go to the doctor. After a time, hypertension forms the activation of compensatory reactions in the body, which significantly smooth out the clinical picture. Patients cease to feel the pathological vasospasm, but the disease is constantly progressing.

When episodes of hypertension are detected in the early stages, drug therapy is not prescribed. Improving the condition can be achieved by rational nutrition, physical education, giving up bad habits, normalizing the regime of work and rest. After the occurrence of a persistent increase in blood pressure, it is recommended to drink one drug under the constant supervision of a doctor. With the ineffectiveness of monotherapy, several antihypertensive drugs or tablets with a combined composition are prescribed.

In the kidneys, with a decrease in pressure, the substance prorenin is produced, which, entering the bloodstream, turns into renin, and after interacting with a special protein, it is synthesized into an inactive substance angiotensin 1. Under the influence of resolving factors, it reacts with an angiotensin-converting enzyme (ACE) and acquires active properties - angiotensin 2. This substance has a vasoconstrictive effect, causes an increase in cardiac activity, promotes water retention in the body, excites the centers of the sympathetic nervous system. Depending on the influence of the drug on a certain link of the reninangiotensive system, two groups of drugs are distinguished.

The active substance in the composition of the drug blocks the work of the enzyme of the same name. As a result, pressure and pulse normalize, the excitability of the nervous system decreases, and the excretion of fluid from the body increases.

List of funds:

captopril;
ramipril;
enalapril;
quinopril;
zofenopril.

The appointment of drugs is contraindicated in pregnancy, diabetes mellitus, severe autoimmune pathologies, renal and hepatic insufficiency. Captopril is not used for long-term treatment of the disease, especially in elderly patients with symptoms of atherosclerosis of the cerebral arteries. It is usually used to stop hypertensive crises - a sharp increase in blood pressure. Every third patient notes a dry cough while taking this group of drugs. If a side effect occurs, the product must be replaced.

The active substance in the composition of the drug blocks angiotensin 2 receptors. Sartans are new generation drugs that have been created in the last decade. They gently normalize blood pressure in hypertension, do not cause withdrawal syndrome, and can have a therapeutic effect for several days.

List of funds:

candesartan;
losartan;
valsartan;
telmisartan.

Medicines are contraindicated during breastfeeding, gestation, in childhood, with a significant loss of fluid and an increase in the content of potassium in the blood.

In the cell membrane of muscle fibers there are special channels through which calcium enters and causes their contractility. This leads to vasospasm and increased heart rate. The drugs of this group close the pathways for calcium to move into the cell, thereby causing a decrease in the tone of the vascular wall, a decrease in the pulse, and a decrease in the load on the myocardium.

List of funds:

diltiazem;
verapamil;
nifedipine;
amlodipine;
diltiazem;
nifedipine;
lacidipine.

Medicines are prescribed for hypertension, combined with angina pectoris and cardiac arrhythmias. Decrease in pulse rate is caused by verapamil and diltiazem. In recent years, nifedipine has ceased to be used in medical practice due to its short duration of action and the ability to cause side effects. Drinking tablets of this group is not recommended in old age, childhood and puberty, with liver failure, hypersensitivity to the active substance, acute myocardial infarction. At the beginning of treatment, swelling of the extremities may occur, which usually disappears within a week. If edema persists for a long time, the drug must be replaced.

Beta receptors are located in the tissues of the kidneys, bronchi, and heart, which, when excited, can cause an increase in pressure. The hypotensive effect is achieved by combining the substance in the preparation with these receptors, preventing biologically active substances from affecting their work. For hypertension, selective drugs are recommended that interact exclusively with myocardial receptors.

List of funds:

bisaprolol;
atenolol;
metoprolol;
carvedilol;
nebivolol;
celiprolol.

The drugs are prescribed for resistant forms of hypertension, concomitant angina pectoris, cardiac arrhythmias, myocardial infarction. Non-selective drugs such as carvedilol, nebivalol, celiprolol are not prescribed for diabetes mellitus, signs of bronchial asthma.

Diuretic drugs affect filtration in the renal glomeruli, helping to remove sodium from the body, which pulls fluid along with it. Thus, the effect of the drug is associated with the loss of water, which reduces the filling of the bloodstream and normalizes high blood pressure in hypertension.

List of funds:

spironolactone;
indapamide;
hydrochlorothiazide (hypothiazide);
triampure;
furosemide.

If potassium-sparing diuretics such as spironoloctone and triampur are used, replacement therapy is not required. Furosemide is recommended for the relief of acute attacks, as it has a pronounced, but short-lived effect. Means are contraindicated in anuria, lactose intolerance, electrolyte imbalance, severe diabetes mellitus.

Medicines of this group prevent overexcitation of the nervous system and normalize the work of the vasomotor center, which helps to reduce high blood pressure.

List of funds:

methyldopa;
moxonidine;
rilmenidine.

Tablets are prescribed to patients with emotional instability, as well as to patients under stress and increased excitability. Additionally, it is recommended to drink tranquilizers, sleeping pills and sedatives.

If you experience the first symptoms of hypertension, you should seek the advice of a specialist. After a comprehensive examination, the doctor will tell you which drugs should be used to normalize general well-being. He will competently select a combination of medicines and their dosage, prescribe the time for taking the pills and control their effectiveness. Only such an approach can stop the further progression of the pathology and exclude the occurrence of serious consequences. To maintain health, self-medication is strictly contraindicated.

Drugs to lower blood pressure

Target organs are those organs that are most affected by increased pressure, even if you do not feel this increased pressure. We already spoke about one such organ when we discussed hypertrophy of the left ventricular myocardium - this is the heart.

Another such organ is the brain, where, with high blood pressure, processes such as microscopic strokes can occur, which, if there are enough of them, can lead to a decrease in intelligence, memory, attention, etc. not to mention the strokes themselves.

The kidneys are also a target, as a result of increased pressure, the structures involved in the removal of toxins from the body die. Over time, this can lead to kidney failure.

The organs of vision, another suffering organ, changes occur in the retina - the area of \u200b\u200bthe eye that is responsible for the perception of visual images, if you remember from the anatomy course these are rods and cones, while both a decrease in visual acuity and its complete loss are possible.

Careful monitoring is necessary for all these organs, since by observing certain changes from year to year in dynamics, one can draw a conclusion about the rate of progression of the disease and the effectiveness of treatment.

Normal - systolic 120-129, diastolic 80-84

High normal - systolic 130-139, diastolic 85-89

Arterial hypertension of the 1st degree - systolic 140-159, diastolic 90-99

Arterial hypertension of the 2nd degree - systolic 160−179, diastolic 100−109

Arterial hypertension of the 3rd degree - systolic above 180, diastolic above 110

Isolated systolic hypertension - systolic above 139, diastolic less than 90

Symptoms of this disease are usually absent for a long time. Up to the development of complications, a person does not suspect about his disease if he does not use a tonometer. The main symptom is a persistent increase in blood pressure. The word "persistent" is paramount here, because. a person's blood pressure can also increase in stressful situations (for example, white coat hypertension), and after a while it normalizes. But, sometimes, the symptoms of arterial hypertension are headache, dizziness, tinnitus, flies before the eyes.

Other manifestations are associated with damage to target organs (heart, brain, kidneys, blood vessels, eyes). Subjectively, the patient may notice a deterioration in memory, loss of consciousness, which is associated with damage to the brain and blood vessels. With a long course of the disease, the kidneys are affected, which can be manifested by nocturia and polyuria. Diagnosis of arterial hypertension is based on the collection of anamnesis, measurement of blood pressure, detection of target organ damage.

One should not forget about the possibility of symptomatic arterial hypertension and exclude diseases that could cause it. Mandatory minimum examinations: complete blood count with hematocrit determination, general urinalysis (determination of protein, glucose, urinary sediment), blood sugar test, determination of cholesterol, HDL, LDL, triglycerides, uric acid and creatinine in blood serum, sodium and potassium blood serum, ECG. There are additional examination methods that the doctor may prescribe if necessary.

Differential diagnosis of arterial hypertension is between symptomatic and essential. This is necessary to determine the tactics of treatment. It is possible to suspect secondary arterial hypertension on the basis of certain features:

from the very beginning of the disease, high blood pressure is established, characteristic of malignant hypertension
high blood pressure is not amenable to medical treatment
hereditary history is not burdened by hypertension
acute onset of the disease

Arterial hypertension in pregnant women can occur both during pregnancy (gestational) and before it. Gestational hypertension occurs after the 20th week of pregnancy and disappears after delivery. All pregnant women with hypertension are at risk for preeclampsia and placental abruption. In the presence of such conditions, the tactics of conducting childbirth change.

Methods of treatment of arterial hypertension are divided into drug and non-drug. First of all, you need to change your lifestyle (do physical education, go on a diet, give up bad habits). What is the diet for hypertension?

It includes restriction of salt (2-4 g) and liquid, it is necessary to reduce the intake of easily digestible carbohydrates, fats. Food must be taken fractionally, in small portions, but 4-5 times a day. Drug therapy includes 5 groups of drugs for the correction of blood pressure:

Diuretics
Beta blockers
ACE inhibitors
calcium antagonists
Angiotensin II receptor antagonists

All drugs have different mechanisms of action, as well as their contraindications. For example, thiazide diuretics should not be used during pregnancy, severe chronic renal failure, gout; beta-blockers are not used for bronchial asthma, COPD, severe bradycardia, atrioventricular blockade of 2.3 degrees; angiotensin-2 receptor antagonists are not prescribed in cases of pregnancy, hyperkalemia, bilateral stenosis of the renal arteries).

Very often, drugs are produced in a combined state (the following combinations are considered the most rational: diuretic + ACE inhibitor, beta-blocker + diuretic, angiotensin-2 receptor antagonists + diuretic, ACE inhibitor + calcium antagonist, beta-blocker + calcium antagonist). There are new drugs for the treatment of hypertension: imidazoline receptor antagonists (they are not in the international recommendations for treatment).

People who are predisposed to this disease are especially in need of prevention of arterial hypertension. As a primary prevention, it is necessary to lead an active lifestyle, go in for sports, as well as eat right, avoid overeating, excessive consumption of fats and carbohydrates, and give up bad habits.

All this is the most effective method of preventing hypertension.

Renal hypertension is an ailment caused by impaired functioning of the kidney and leading to a steady increase in blood pressure. Its treatment is long and necessarily includes a diet. Arterial hypertension of any nature is one of the most common cardiovascular diseases. 90-95% is actually hypertension. The remaining 5% are secondary, in particular, renal hypertension. Its share reaches 3-4% of all cases.

An increase in blood pressure is caused by a violation of any of the factors that regulate the activity of the heart. Moreover, hypertension is caused by emotional overstrain, which, in turn, disrupts the work of cortical and subcortical regulation and pressure control mechanisms. Accordingly, changes in kidney function due to increased pressure are secondary.

The job of the kidneys is to filter the blood. This possibility is due to the difference in the pressure of the incoming and outgoing blood. And the latter is provided by the cross section of the vessels and the difference in arterial and venous pressure. Obviously, if this equilibrium is disturbed, the filtration mechanism will also be destroyed.

With an increase in blood pressure, the volume of blood entering the kidneys also increases markedly. This disrupts the work of the body, since it does not make it possible to filter such an amount to remove all harmful substances.

As a result, fluid accumulates, edema appears, and this leads to the accumulation of sodium ions. The latter make the walls of sauces susceptible to the action of hormones that require a narrowing of the section, which leads to an even greater increase in pressure.

Since the vessels cannot work in this mode, renin is produced to stimulate them, which again leads to water retention and sodium ions. At the same time, the tone of the renal arteries increases, which leads to sclerosis - the deposition of plaques on the inner walls of the vessels. The latter interferes with normal blood flow and causes left ventricular hypertrophy.

In addition, one of the functions of the kidney is the production of prostaglandins, hormones that regulate normal blood pressure. With organ dysfunction, their synthesis decreases, which contributes to a further increase in pressure.

Renal hypertension is not an independent disease, but a consequence of some other primary disease. It is dangerous because it leads to kidney and heart failure, atherosclerosis and other serious diseases.

On the video about what renal hypertension is:

Abnormalities in the functioning of the renal arteries can occur with almost any kidney disease. However, the modern classification distinguishes 3 main groups.

Renoparenchymal - the cause is the defeat of the parenchyma. This is a shell of an organ, consisting of a cortical and medulla layer. Its function is to regulate the accumulation and outflow of fluid. In case of violations in its work, there is a reverse arterial blood flow, swelling, protein enters the blood and urine.

The following diseases cause diffuse changes in the parenchyma:

lupus erythematosus, scleroderma and other systemic diseases;
pyelonephritis and glomerulonephritis are the most common causes;
urolithiasis disease;
renal tuberculosis;
diabetes;
kidney anomalies, both congenital and acquired.

The reason may also be a permanent mechanical factor - squeezing the urinary tract, for example.

Renovascular - in this case, the cross section of one or more arteries is reduced by 75%.

Bilateral stenosis - the actual narrowing of the vessel, or stenosis of one organ very quickly causes kidney failure. Fortunately, renovascular hypertension is not common: only 1-5% of all cases. However, it is she who most often leads to a malignant course of the disease.

The causes of renovascular hypertension are:

atherosclerosis - in 60–85%, especially in the older age group;
anomaly in the development of blood vessels; mechanical compression - a tumor, hematoma, cyst, lead to the same result.

A distinctive feature of this group is the low effectiveness of antihypertensive drugs, even at very high pressure.

Mixed - this includes any combination of damage to the parenchyma and blood vessels. The cause may be cysts and tumors, nephroptosis, anomalies of arterial vessels, and more.

There are quite a few factors affecting the state and functioning of the cardiovascular system. Most of them can lead to an increase or decrease in blood pressure.

In relation to renal hypertension, there are 3 main causes:

Retention of sodium and water ions is a common mechanism for the formation of hypertension in parenchymal lesions. With an increase in the amount of incoming blood, in the end, it leads to a violation of filtration and a kind of internal edema. The volume of extracellular fluid increases, which provokes an increase in blood pressure. Sodium ions are retained along with water.

In response, the production of digitalis-like factor increases, which reduces sodium reabsorption. But with kidney disease, the hormone is produced too actively, which leads to vascular hypertonicity and, accordingly, increases blood pressure.

Activation of the RAAS renin-angiotensin-aldosterone system. Renin is one of the hormones that promote protein breakdown, and by itself does not affect the state of blood vessels. However, as the arteries narrow, renin production increases.

The hormone reacts with α-2-globulin, together with which it forms an extremely active substance - angiotensin-II. The latter significantly increases the amount of blood pressure and provokes increased synthesis of aldosterone.

Aldosterone promotes the absorption of sodium ions from the interstitial fluid into the cells, which leads to swelling of the walls of blood vessels, and, therefore, to a decrease in the cross section. In addition, it increases the sensitivity of the walls to angiotensin, which further enhances vascular tone.

Inhibition of the depressor system of the kidneys - the medulla of the organ performs a depressor function. The activity of renin, angiotensin and aldosterone causes the production of kallikrein and prostaglandins - substances that actively remove sodium, in particular, from the smooth muscles of blood vessels. However, the possibilities of the adrenal glands are not unlimited, and with pyelonephritis or other types of diseases they are very limited. As a result, the depressor capabilities of the organ are exhausted, and constant high pressure becomes normal.

Renal arterial hypertension is a difficult disease to diagnose due to the vague nature of the symptoms. In addition, the picture is complicated by other diseases: pyelonephritis, cysts, heart failure, and so on.

Common symptoms of renal hypertension include:

a sharp increase in pressure for no apparent reason - 140/120 is the "starting point";
pain in the lumbar region, not dependent on physical effort;
swelling of the hands and feet;
dull headache, usually in the back of the head;
irritability, panic attacks;
usually the disease is accompanied by visual impairment, up to its loss;
weakness, possibly shortness of breath, tachycardia, dizziness.

Confusing renal hypertension with another disease is quite simple. But, given that it is this ailment that takes on a malignant character in 25% of cases, establishing the correct diagnosis is as relevant as possible.

More characteristic signs of arterial hypertension of renal origin, which, however, can only be established during a medical examination, are the state of the left heart ventricle, the magnitude of diastolic pressure and the condition of the fundus. Due to a violation in the blood circulation of the eye, the last sign allows you to diagnose the disease even in the absence of all other symptoms.

In relation to the totality of these signs, 4 symptomatic groups of hypertension are distinguished.

Transient - the pathology of the left ventricle is not detected, the increase in blood pressure is unstable, changes in the fundus are also unstable.
Labile - the increase in pressure is unstable and is of a moderate nature, but it no longer normalizes on its own. Narrowing of the fundus vessels and an increase in the left ventricle are detected during the examination.
Stable - the pressure is constantly high, but antihypertensive therapy is effective. An increase in the ventricle and vascular disturbances are significant.
Malignant - blood pressure is high and stable - about 170 - The disease develops rapidly and leads to damage to the vessels of the eyes, brain and heart. To the usual symptoms are added signs of CNS disorders: vomiting, severe dizziness, memory impairment, cognitive functions.

The reason for the examination is usually an increase in blood pressure and associated symptoms. In the absence of the latter - for example, with vasorenal hypertension, the disease can be detected by chance.

The first stage of the examination is the change in blood pressure at different positions of the body and when performing certain exercises. The change allows you to localize the site.
Blood and urine tests - in case of violations in the work of the kidneys, the protein in the blood confirms the diagnosis. In addition, blood is taken from the veins of the kidney to detect an enzyme that increases blood pressure.
Vasorenal hypertension is accompanied by systolic murmur in the umbilical region.
Ultrasound - allows you to establish the condition of the kidneys, the presence or absence of cysts, tumors, inflammation, pathologies.
If a malignant course is suspected, an MRI is prescribed.
Examination of the fundus - vasoconstriction, edema.
Radioisotope rheography is carried out using a radioactive marker. Allows you to set the degree of functionality of the body. In particular, the rate of urine excretion.
Excretory urography - examination of the urinary tract.
Angiography - allows you to evaluate the condition and work of blood vessels.
Biopsy - for cytological examination.

Treatment is determined by the severity of the lesions, the stage of the disease, the general condition of the patient, and so on.

Its purpose is to preserve the functionality of the kidney and, of course, cure the underlying disease:

With transient hypertension, diet is often dispensed with. Its main principle is to limit the intake of sodium-containing products. This is not only table salt, but also other sodium-rich foods: soy sauce, sauerkraut, hard cheeses, seafood and canned fish, anchovies, beets, rye bread and so on.
Patients with renal hypertension are prescribed dietary table No. 7, which involves reducing salt intake and gradually replacing animal proteins with vegetable ones.
If sodium restriction does not give the desired result or is poorly tolerated, then loop diuretics are prescribed. With insufficient effectiveness, increase the dose, and not the frequency of administration.
Drugs for the treatment of renal hypertension are prescribed when vasoconstriction does not leave a mortal danger.
Of the medicines, drugs such as thiazide diuretics and andrenoblockers are used, which reduce the activity of angiotensin. Antihypertensive agents are added to improve organ function. Treatment must be combined with diet. Moreover, in both the first and second cases, the doctor must monitor the implementation of the diet, since the latter at first can lead to a negative sodium balance.
In the terminal stages, hemodialysis is prescribed. In this case, antihypertensive treatment continues.
Surgical intervention is carried out in extreme cases, as a rule, when the damage to the kidney is too large.
With stenosis, balloon angioplasty is indicated - a balloon is inserted into the vessel, which is then inflated and holds the walls of the vessel. This intervention does not yet apply to surgical intervention, but the results are encouraging.

Balloon angioplasty

If the plastic was ineffective, an arterial resection or endarterectomy is prescribed - removal of the affected area of the vessel in order to restore the patency of the artery.
Nephropexy can also be prescribed - while the kidney is fixed in its normal position, which restores its functionality.

The syndrome of renal arterial hypertension is a secondary disease. However, it leads to consequences quite serious, so it is necessary to pay special attention to this ailment.

High blood pressure is a life-threatening condition that occurs in the vast majority of adults. In order to effectively treat this disease, you need to know about the causes of its occurrence. In addition to defects in the heart muscle and atherosclerosis of blood vessels, which act as causes of hypertension, there is also the so-called renal hypertension.

Renovascular hypertension

Renal pressure, or, as the pathology is officially called in medicine - renovascular hypertension, is a disease whose prevalence, according to statistics, is increasing every year. However, unlike arterial hypertension, renal pressure is more common in young patients than in the elderly.

Causes of the disease

The basis of the formation of renal high blood pressure is always damage to the vessels of the kidneys. This often happens for various reasons. For example, in the course of autoimmune diseases resulting from staphylococcal or streptococcal infections, antibodies of the immune system begin to attack body tissues, in particular, kidney tissues, rather than antigens. This condition is called glomerulonephritis. If not only kidney tissues are affected, but also other tissues of the body, then there is a systemic autoimmune disease, for example, systemic lupus erythematosus, vasculitis, Sjögren's syndrome.

Also, damage to the renal artery can occur for mechanical reasons, for example, due to the presence of a calculus in the kidneys. In this case, the artery is either directly affected or causes blockage of the ureter and hydronephrosis, which damages the tissues of the kidneys, including the vessels.

Less commonly, the cause is thrombosis or thromboembolism of the renal artery, damage to the vessels in the zone of the mouths (places of their branching), a genetic anomaly in the structure of the organs of the urinary system.

Pathogenesis

Hypertension against the background of nephrogenic causes proceeds according to two scenarios:

The first involves a decrease in renal function, which entails not only the inability to filter all decay products from the blood, but also remove excess fluid from the body. It accumulates not only in the form of edema, but also in the circulatory system, increasing blood volume, therefore, blood pressure on the walls of blood vessels, which is the definition of arterial hypertension.
There is another option for the development of pathology, in which renal hypertension is formed as a result of the production of renin. In this case, the blood flow rate inside the kidneys drops, while in other parts of the vascular system it may remain normal or even be increased. But for a normal level of filtration, the speed of blood flow inside the kidneys must be high enough, so renin enters the bloodstream, which contributes to an increase in blood pressure.

Symptoms

Symptoms of renal hypertension can be divided into two conditional categories. The first is characteristic of hypertension of any origin, the second reflects the specific signs of high blood pressure of a nephrogenic nature.

directly elevated pressure indicators during measurement;
headache;
fatigue;
irritability;
bouts of tachycardia.

diastolic pressure increased more than systolic;
pressure increase occurs suddenly, for no apparent reason;
lower back pain;
swelling of the extremities, pastosity of the face and eyelids;
optic nerve damage.

Renal hypertension has another symptom that can be considered non-specific: it is very difficult to stabilize the pressure of a nephrogenic nature, conventional drugs do not help to normalize the indicators, or the effect does not last long.

Diagnostics

In order to make a diagnosis of "renovascular or renal hypertension", it is necessary to examine both the vascular and urinary systems. When examining a patient, the doctor notices signs that indicate problems with the kidneys.

To examine the cardiovascular system, blood pressure is monitored, which is done by measuring indicators at least twice a day or using a special apparatus for 24 hours. Along with this, an electrocardiogram, ultrasound of the heart, ultrasound of the vessels is performed. This is necessary both to identify the causes of the pathology, and in order to assess the degree of damage caused by hypertension.

Diagnosis of the urinary system includes laboratory tests and functional tests:

complete urinalysis;
clinical blood test for the level of sodium, uric acid, potassium, urea, creatinine;
Reberg's test;
Zimnitsky test;
Ultrasound of the kidneys;
renography of the kidneys;
MRI or CT of the urinary system.

With hypertension against the background of increased renin, the most accurate analysis is to take blood to study the concentration of renin directly from the renal artery. But such a procedure is very traumatic, therefore, in most cases, doctors do not resort to renal artery catheterization, but make a diagnosis based on a combination of studies and differential analysis.

Treatment

Like any therapy, the treatment of renal hypertension includes two directions: the elimination of the root cause of the disease and its symptoms.

The nephrogenic cause is eliminated depending on the identified disease: in autoimmune processes, glucocorticosteroids are prescribed that suppress the activity of the immune system; in case of urolithiasis, drugs for dissolving stones or surgery are prescribed. When the kidneys lose their function, hemodialysis is prescribed.

Symptomatic treatment includes taking drugs that normalize and stabilize blood pressure levels. As a rule, with hypertension of nephrogenic origin, a complex of drugs is prescribed: ACE inhibitors, beta-blockers and calcium channel blockers. Also, the doctor will select drugs of "quick" action to relieve high blood pressure during a hypertensive crisis.