Causes of arterial hypotension

A person’s blood pressure level is determined by a combination of various factors that make up a functional system (according to the definition of academician P.K. Anokhin), which maintains its constancy according to the principle of self-regulation.

Currently, primary arterial hypotension is considered a polyetiological disease, in the occurrence of which exogenous and endogenous factors participate, and hereditary predisposition also plays a role.

Hereditary predisposition

To date, the genes responsible for the development of arterial hypotension are unknown. At the same time, in individuals with a hereditary predisposition to arterial hypotension, the disease is more severe. Hereditary predisposition to primary arterial hypotension is traced in families of sick children in 15-70% of cases. Most often, the predisposition to arterial hypotension is transmitted through the maternal line (in 36-54% of cases), less often - through the paternal line (20-23%) or both (13%).

Constitutional features

The role of constitution in arterial hypotension was emphasized by the founder of the theory of hypotonic states A. Ferranini (1903), who introduced the concept of "constitutional hypotension". In this case, the connection of arterial hypotension with asthenic constitution was taken into account. However, other researchers did not confirm this pattern.

Arterial hypotension in pregnant women and perinatal pathology

Women suffering from arterial hypotension often experience a worsening of their general condition during pregnancy. In such cases, low blood pressure becomes a risk factor for the birth of a child with perinatal CNS pathology. A decrease in blood pressure in pregnant women below 115/70 mm Hg should be considered as a risk factor for fetal developmental disorders. Low blood pressure during pregnancy causes a decrease in the respiratory function of the uteroplacental and fetoplacental barrier. In women with arterial hypotension, in 1/3 of cases there is a risk of termination of pregnancy, in 15% - miscarriages, early discharge of amniotic fluid, premature birth occur. The fetus experiences intrauterine hypoxia, fetal hypotrophy and immaturity often develop, hypoxic damage to the CNS occurs. When analyzing the pathology of childbirth depending on the severity of clinical manifestations of arterial hypotension, it was found that in severe cases of the disease, childbirth often occurs with complications (prolonged labor, frequent surgical interventions), asphyxia and/or fetal hypoxia.

Thus, an unfavorable course of the ante- and perinatal period, especially a decrease in blood pressure in the mother during pregnancy, has a pathogenic effect on the developing organism and contributes to the formation of autonomic dysfunction in the child with a tendency to decrease blood pressure.

Age

The period of puberty may be a trigger factor contributing to the development of arterial hypotension. Many researchers have noted that it is during this period that the frequency of arterial hypotension increases significantly. This is probably due to a violation of the vegetative-endocrine regulation of arterial pressure in the pubertal period. A connection has been established between excessively accelerated physical development (acceleration), as well as delayed physical development and the development of arterial hypotension.

Characteristic features of personality

They play an important role in the development of arterial hypotension. Patients suffering from arterial hypotension present a large number of subjective complaints reflecting sensory disorders. Typical complaints include cephalgia of the "hoop" or "tightening bandage" type, cardialgia with a feeling of shortness of breath, a lump in the throat, paresthesia in the extremities, myalgia, and sleep disorders. Among the personality traits, one can note increased vulnerability, an excessive sense of duty, "tense weakness", and inflated self-esteem, which often leads to intrapersonal conflicts. In recent years, it has been suggested that masked depression and arterial hypotension are manifestations of the same disease.

Among the exogenous factors that contribute to the development of arterial hypotension, great importance is attached to chronic psychoemotional stress. In families of children with arterial hypotension, psychotraumatic events often occur (alcoholism of parents, single-parent families, poor housing and social conditions, death of loved ones and serious illnesses of relatives). The state of chronic psychoemotional stress is facilitated by the peculiarities of upbringing and education of schoolchildren. A heavy academic load often leads to mental fatigue and hypodynamia. The frequency of arterial hypotension is significantly higher among children attending specialized schools compared to that in comprehensive schools.

Chronic inflammatory diseases

Chronic infection foci and a high infection index also contribute to the development of arterial hypotension. By changing the body's reactivity, they disrupt the sensitivity of the central nervous system and its vasomotor center to various types of influences.

Thus, arterial hypotension occurs against the background of a hereditary predisposition under the influence of various endogenous (perinatal pathology, foci of chronic infection, puberty) and exogenous (psychogeny, unfavorable socio-economic conditions, disruption of the daily routine, mental fatigue, physical inactivity) factors.

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