Hypertension – the behind-the-scenes killer of human health
Hypertension is the most common cardiovascular disease and is the most important risk factor for the development and death of heart aortic disease, cerebrovascular disease, and kidney disease. The prevalence of hypertension in our population continues to grow, with an estimated 200 million people now suffering from hypertension and 2 out of every 10 adults being hypertensive. From 1998 to 2003, the prevalence of hypertension almost doubled, and the prevalence among rural residents more than doubled.
The clinical manifestations of hypertension are diverse, mainly including dizziness, headache, head swelling, palpitations, insomnia, memory loss, tinnitus, weakness, dreaminess, weakness of the waist and knees, and numbness of the limbs.
1, heart aortic damage.
The heart changes of hypertension are mainly left ventricular hypertrophy and enlargement, called hypertensive heart disease, which can eventually lead to heart failure. When blood pressure rises, the arterial walls are injured by the pressure of blood, and cholesterol in the blood is deposited in the injured area to produce ulcerative atherosclerosis, which narrows the blood vessels and makes them lose elasticity. If the coronary arteries of the heart become hardened and narrowed, it will cause angina pectoris and myocardial infarction and other coronary heart disease’s.
Hypertension damages the aortic intima, causing atherosclerosis of the aortic wall, and long-term hypertension will lead to chronic expansion or rupture of the diseased aorta, forming various types of aortic lesions.
2. Brain damage.
Blood pressure can lead to cerebral artery spasm, producing symptoms such as headache, vertigo and dizziness. When blood pressure increases suddenly and substantially, it can produce hypertensive encephalopathy with symptoms of cerebral edema and intracranial hypertension such as severe headache and vomiting, loss of vision, convulsions and coma.
When hypertension causes stroke, various signs can be seen, such as weakness and paralysis of one side of the torso or limb, slurred speech, distorted mouth and eyes, and even loss of consciousness.
3. Kidney damage.
The early manifestation is increased nocturia. In severe renal damage, symptoms of chronic renal failure may appear, and patients may have anorexia, nausea, vomiting, drowsiness, proteinuria, hematuria, anemia, weakness, and swelling, along with abnormalities in various renal function tests.
Aortopathy – a life threatening condition in hypertensive patients
Aortic lesions are classified as true aneurysms, pseudoaneurysms and aortic coarctation. A true aneurysm wall includes all three layers of the arterial wall. A pseudoaneurysm is a condition in which the entire arterial wall is destroyed or the middle layer of the intima is destroyed and only the outer aortic membrane remains, with blood spilling out of the lumen and being wrapped in the surrounding tissue. Aortic coarctation is caused by the rupture of the intima of the aorta, and the blood in the aorta enters the middle layer of the aorta via the intima rupture under pressure, causing a tear in the middle layer of the aorta parallel to the lumen of the aorta, and blood flows in the middle layer of the aorta. Aortic lesions can occur in the aortic root, ascending aorta, aortic arch, descending aorta, and abdominal aorta. It is the most dangerous cardiovascular disease.
Common symptoms of true aortic aneurysms and pseudoaneurysms are pain and compression symptoms. The pain is mostly dull, sometimes constant, and may increase with breathing or physical activity. The location of the pain may vary depending on the location of the aneurysm. Aneurysms of the ascending aorta or aortic arch may present with pain behind the sternum or in the neck. Descending aortic aneurysms may present with pain in the interscapular region or left chest pain. Thoracoabdominal and abdominal aortic aneurysms may present with back pain and abdominal pain. Aneurysms of the aortic arch may compress the trachea and bronchi and cause irritating cough and dyspnea, and in severe cases, may cause pulmonary atelectasis, bronchodilation, and bronchial and pulmonary infections. Compression of the superior vena cava may result in progressive head, facial and upper limb edema, which may spread to the neck and chest and back in severe cases, with purplish-red skin and varicose veins in the chest wall. Aneurysms in the arch and isthmus may compress the laryngeal nerve and cause hoarseness and choking. Compression of the cervical sympathetic ganglion may cause unilateral pupil narrowing, eyelid ptosis, eye entropion and facial anhidrosis, which are signs of Horner syndrome. Descending aortic aneurysm can compress the esophagus and cause dysphagia, and compress the bronchus and cause shortness of breath and dyspnea. Abdominal aortic aneurysm may present with digestive disorders and other manifestations.
The prominent symptom of aortic coarctation is severe pain, which may occur in the chest, back, and abdomen depending on the site of occurrence and extent of dissection. Patients may also experience dysfunction or death due to ischemia of the heart, head, spinal cord, kidneys, digestive tract, liver, pancreas, and extremities.
Prevention and treatment – Aortic lesions do not equal death
Although the natural mortality rate of aortic lesions, especially aortic coarctation, is high, active treatment of hypertension can effectively prevent and delay the occurrence and development of aortic lesions. The early use of surgical or interventional treatment methods after the diagnosis of aortic lesions can significantly reduce the mortality and disability rate of patients.
Most patients with aortic lesions have hypertension in combination. Active control of hypertension, especially in patients with risk factors for aortic lesions (e.g., patients with aortic lesions in the family), can effectively prevent and delay the occurrence and development of aortic lesions, and some patients with true aortic aneurysm-like dilatation can be spared surgery for life.
Most patients with true and pseudoaneurysms and type B aortic coarctation can be treated with elective surgery or intervention. type A aortic coarctation, true and pseudoaneurysms that have ruptured require emergency surgical treatment. The traditional concept is that aortic surgery, especially aortic coarctation surgery, is technically complex, surgically traumatic, with high perioperative mortality and complication rates. In recent years, with the development of various aortic surgery techniques, the in-depth study of related theories, especially the proposal and application of refined typing of aortic coarctation, the development and promotion of total aortic arch replacement + thoracic descending aortic pictorial stenting (Sun’s surgery) and intraoperative stenting, the extensive development of thoracic descending aortic and abdominal aortic overlay stenting, the study and application of comprehensive measures of intraoperative extracorporeal circulation and cerebral protection, the time of various aortic surgeries is greatly improved. As a result, the operating time of various aortic procedures has been greatly shortened, and the perioperative mortality and complication rates have been significantly reduced. Most patients undergoing aortic surgery have a good quality of life and life expectancy after surgery during medium- and long-term follow-up.
Aortic lesions can be prevented and treated, and aortic lesions are not equal to death.