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Arterial hypertension - Symptoms and diagnosis
Medical expert of the article
Last reviewed: 04.07.2025
Symptoms of arterial hypertension do not differ significantly from essential arterial hypertension in clinical manifestations and are characterized by a wide variety of symptoms. In glomerulonephritis, the severity of arterial hypertension, as a rule, depends on the morphological and clinical variant of the disease and does not depend on the state of renal functions, however, severe arterial hypertension, sometimes transforming into malignant, can be observed in IgA-GN and membranoproliferative glomerulonephritis even with minor histological changes in the kidneys. In contrast, arterial hypertension in rapidly progressive glomerulonephritis with crescents can be expressed only moderately, despite significant histological changes in the kidneys. The cause of these features is still unknown. Severe arterial hypertension is often observed after cortical necrosis, with hemolytic uremic syndrome, scleroderma kidney and often (but not always) with reflux nephropathy.
In diffuse kidney diseases, a dependence of arterial hypertension on the degree of activity of the renal process is often noted, assessed on the basis of both clinical markers of activity (hematuria, proteinuria) and its morphological signs (cellular infiltration of glomeruli and stroma, proliferation of mesangial, epithelial and endothelial cells, vasculitis, fixation of immunoglobulins, etc.).
In kidney diseases, as in essential arterial hypertension, its frequency is dependent on purine and/or lipid metabolism disorders. In patients with hyperuricemia or hyperlipidemia, arterial hypertension in chronic glomerulonephritis is detected significantly more often compared to patients without metabolic disorders. Hyperuricemia is considered an independent factor in increasing arterial pressure in kidney diseases.
The severity of hypertension syndrome and the risk of damage to target organs in diffuse kidney diseases should be assessed based on the data of daily blood pressure monitoring. Disturbances in the circadian rhythm of blood pressure: insufficient reduction in night blood pressure, "night" arterial hypertension, persistent diastolic arterial hypertension - can develop in the early stages of kidney diseases even under conditions of determining normal values of blood pressure during random measurements and with preserved renal function. Disturbances in the circadian rhythm of blood pressure with its normal values and especially its stable increase early lead to damage to target organs (heart, brain, blood vessels and kidneys).
In conditions of terminal renal failure, the symptoms of arterial hypertension are complicated by metabolic and hormonal disorders characteristic of uremia, which contribute both to the course of arterial hypertension itself and to damage to target organs.
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