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Coarctation of aorta
Pregnancy related(preeclampsia, eclampsia)
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Systolic hypertension
Aortic valve insufficiency (regurgitation), thyrotoxicosis, hyperkinetic heart
syndrome, fever, arteriovenous fistula, patent ductus arteriosus.
Secondary hypertension common sigens
Under 25 and over 55 years of age
Hypertension higher than 180/110mmHg
Sudden onset elevated BP in previously normotensive patient during one year
Refractory hypertension not responsive to standard treatment methods
Bad response to previously effective treatment
Paroxysmal hypertension accompanied with palpitation, pallor, perspiration,
tremor.
Multiple organ system complaints during first visit
Non-symmetric peripheral pulse with low BP in lower extremities
Abdominal bruit over renal artery (with diastolic component)
Target organ damage with II degree or higher retinopathy, left ventricular
hypertrophy
Creatinin > 1.5mg/dl
Lab analysis hyperglycemia, hypokalemia, hypercalcemia
Clinical sings in different nosologies of hypertension
Renal hypertension:
In renal parenchymal diseases number of working nephrons decreases .
During greels of immune inflammation in the case of acute nephritis there
issinterstitial swelling, which presses the reels and decreases the filtration surface;
growth of glomerulonephritis can be seen. Vessels lengthening factor production is
disturbed in kidney-endotelial nitrogen oxide, prostaglandins. Elevation of
vasoconstrictors synthesis: endothelin, thromboxane, this brings to activation of
sympathoadrenal system and as a result development of arterial hypertension.
Clinical picture of secondary hypertension usually is similar to that of
essential hypertension, although there are some specificities:
Increase of BP in exacerbation of renal pathologies, and decrease in BP in
case of remission.
Mild decrease in BP at night hours
permanent high diastolic pressure
Exaggerated retinal changes
Hypertension encephalopathy is less expressed
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Existence of Nephrotic syndromes
Rapid growing glomerulonephritis is considered to be an exception,to which
it's typical
Renal failure in 4th or 6th week of glomerulonephritis development(urine
density reduction of , rapid development of isohyposthenuria,increase of
blood urea and creatinine)
Severe retinopathy
Expressed arteria hypertension, (resistant hypertension) which in terminal
period can be malignant
Typical morphological changes in kidney bioptat
Diagnosing renoparenkhimatoz arterial hypertension the following is taken
into consideration;
The appearance of arterial hypertension parallel with pathology
Possible pyelonephritis
In the case of glomerulonephritis-antistreptococal antibody high title, in the
case of pieronefrit-bacteruria
Clinical picture of severe inflammation of renal coil (waist pain, fever, dysuria,
hematuria, proteinuria, cilindruria, failure of Percutaneous Renal Biopsy,
swelling syndrome)
Normalization of blood pressure with the disappearance of clinical and lab
phrases
X-ray and ultrasound changes
Renovascular hypertension arterial hypertension with artery lesion is caused
because of kidney malnutrition. The most common reason of Renovascular
hypertension in the young , is the fibro muscle dysplasia of renal artery.
The diagnose is based on the following:
Renovascular hypertension development before 25 or after 50 y.o.
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Kidney unilateral reduction
Long systolic or systole diastole noise discovery in ribs or in round of navel,
rib-vertebral angels
Sudden disorder of kidney function
Renin activity increase 3-4 days after getting ACE inhibitor
Repeated pulmonary edema during arterial hypertension
Joints syndrome
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Typical clinical picture: Hypertension syndrome with permanent high blood pressure
with crisis, rare permanent arterial hypertension without any crisis process, second
version; transitory increase of blood pressure during neuromuscular flare. But
during the attack blood pressure is normal. From 6% to 8% the arterial hypertension
becomes malignant.
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3 regularly emerging pheochromocytoma crisis, blood pressure is normal out of
crisis, patients wellness is satisfactory /25%/
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dexamethasone injection cortisol quantity decreases by 50% but it's more in
comparison I itial volume, in Cushing's deases high dose of dexamethasone
decreases cortisol level by 50%, but ACTH in blood is normal or high.In Cushing's
syndrome case any dose of dexamethasone can't supress cortisol secretion, and
ACTH isn't found in blood, tomography of abdomen, CT and MRT.
Acromegalia grown limbs, rough facial features, teeth area increase, orbs increase-
divergent squint, arterial hypertension, ischemic disease, SCD. Diagnose is
confirmed according to high level of somatotropin in blood.
hyperthyrosis B-adrenoblockers
isolated systolic
hypertension
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