Arterial hypertension(Hypertension) is the most common disease of the cardiovascular system. Hypertension indicates increased blood pressure. There is an increase in blood pressure when there is a narrowing of arteries and/or their smallest branches: arterioles. In some people, the arterioles often narrow, first due to the spasm, and then their light remains constantly reduced due to the thickening of the wall, and then, so that the blood flow exceeded these narrowing, the work of the heart increases and shows more blood in a vascular direction. In such people, as a rule, hypertension develops.
In our country, approximately 40% of the adult population has a higher level of blood pressure. At the same time, approximately 37% of men and 58% of women know the presence of diseases, and only 22 and 46% of them are treated. Only 5. 7% of men and 17 5% of women properly control their blood pressure.
Arterial hypertension is a chronic disease, accompanied by a persistent increase in blood pressure over the allowed limits (systolic pressure above 139 mm Hg or (y) diastolic pressure above 89 mm Hg).
In approximately one of the ten hypertension, blood pressure increases due to the injury of any organ. In these cases, they speak of secondary or symptomatic hypertension. About 90% of patients suffer from primary or essential hypertension. The reference point for the increase in blood pressure is at least a level of 139/89 mm Hg, three registered levels of 139/89 mm RT. Art. And more in people who do not take drugs to reduce pressure.
Blood pressure
There are two blood pressure indicators:
- Systolic blood pressure (garden): reflects the pressure in the arteries, which is created when the heart is reduced and the blood is released to the arterial part of the vascular system;
- Diastolic blood pressure (Ddad): The pressure in the arteries at the time of the relaxation of the heart, during which it is filled before the next reduction.
Symptoms of arterial hypertension
Clinic, that is, the manifestations of hypertension have no specific symptoms. For many years, patients may not know their illness, do not complain, have a high activity of life, although sometimes attacks of "evil", severe weakness and dizziness can occur. But even then, everyone believes that this is excessive. Although it is at this time that you should think about blood pressure and measure it.
They arise that complaints from hypertension if the so -called objective organs are affected by the most sensitive to the increase in blood pressure. The appearance of dizziness, headaches, head noise, a decrease in memory and performance indicate the initial changes in brain circulation. This binds to the eyes, flashing flies, weakness, limb numbness, speech difficulty, but in the initial stage, changes in blood circulation are approaching. The stage of greatest range of arterial hypertension can be complicated by the infarction of the brain or cerebral hemorrhage. The earliest and constantly constant blood pressure sign is an increase or hypertrophy of the left ventricle of the heart, with the growth of its mass due to the thickening of heart cells, cardiomiocytes.
First, the thickness of the wall of the left ventricle increases, and in the future, the expansion of this cardiac chamber also occurs. It is necessary to pay close attention to the fact that the hypertrophy of the left ventricle is an unfavorable prognostic sign. In several epidemiological studies, it was demonstrated that the appearance of hypertrophy of the left ventricle significantly increases the risk of sudden death, coronary artery disease, heart failure and ventricular rhythm disorders. The progressive dysfunction of the left ventricle leads to the appearance of symptoms such as: difficulty breathing in load, paroxysmal night breathing (cardiac asthma), pulmonary edema (often with crisis), chronic heart failure (congestive). In this background, myocardial infarction, ventricular fibrillation is more common.
With gross morphological changes in the aorta (atherosclerosis), it expands, its stratification, rupture can occur. Kidney injuries are expressed by the presence of protein in urine, microhematuria and cylinder. However, renal failure with hypertension, if there is no evil course, it is rarely developed. Ocular damage can be manifested by deterioration of vision, a decrease in sensitivity to light and the development of blindness. Therefore, it is quite obvious that hypertension should be treated more carefully.
Arterial hypertension risk factors
Non -hung risk factors include:
- HERITY: People who have patients with hypertension between relatives are more predisposed to the development of this pathology in them.
- The male floor: it has been established that the incidence of the arterial hypertension of men is significantly greater than the incidence of women. But the fact is that female sex hormones, estrogens prevent the development of hypertension. But such protection, unfortunately, is brief housing. The menopausal period occurs, the effect of salvation of the final estrogens and women are aligned in the incidence with men and often surpass them.
The risk factors changed include:
- Less body weight: in people with excess body weight, the risk of developing arterial hypertension is greater;
- A sedentary lifestyle: in another hypodinamia, a sedentary lifestyle and low physical activity lead to obesity, which in turn contributes to the development of hypertension;
- In alcohol consumption, excessive alcohol consumption promotes arterial hypertension.
- Eating a lot of salt in food: a highly salt diet helps increase pressure. Is the question of how much salt you can consume per day arises here? The answer is short: 4. 5 grams or a teaspoon without an upper part.
- An unbalanced diet with an excess of atherogenic lipids, excessive calorie content, that leads to obesity and promotes the progression of type II diabetes. Aterogenic lipids, that is, literally, of "creation of atherosclerosis" are contained in large quantities in all animal fats, meat, especially pig and lamb;
- Smoking is another variable and formidable factor in the development of arterial hypertension and its complications. The fact is that tobacco substances, including nicotine, create a constant spasm of the arteries, which is fixed, leads to the rigidity of the arteries, which implies an increase in vessel pressure;
- Stress: It leads to the activation of a sympathetic nervous system that performs the function of an instant activator of all body systems, including cardiovascular. In addition, the presor, that is, that causes a spasm of arteries, hormones, throw themselves into the blood. All this, like smoking, leads to the rigidity of the arteries and develops arterial hypertension;
- Dream disturbances rough by the type of night apnea or snoring syndrome. Conglids is a true scourge of almost all men and many women. Why are snoring dangerous? The fact is that it causes an increase in chest pressure and abdominal cavity. All this is reflected in the vessels, which leads to your spasm. Arterial hypertension is developed.
Causes of arterial hypertension
The cause of the disease is still unknown in 90-95 % of patients, this is essential (that is, primary arterial hypertension). In 5-10% of cases, an increase in blood pressure has an established cause, this is a symptomatic (or secondary) hypertension.
Causes of symptomatic arterial hypertension (secondary):
- Primary renal damage (glomerulonephritis) is the most common cause of secondary arterial hypertension;
- narrowing one or bilateral (stenosis) of renal arteries;
- Coarstation (congenital narrowing) of Aorta;
- Pheochromocytoma (adrenal tumor produced by adrenaline and norepinephrine);
- Hyperalderonism (tumor of the adrenal glands produced by aldosterone);
- thyrotoxicosis (increased thyroid function);
- ethanol consumption (wine alcohol) more than 60 ml per day;
- Medications: hormonal medications (including oral contraceptives), antidepressants and others;
Risk factors for cardiovascular complications with arterial hypertension
Essential:
- Men over 55 years old;
- women over 65 years old;
- The totalxz blood cholesterol level>6. 5 mmol/L, an increase in the low density lipoprotein cholesterol (>4. 0 mmol/l) and high density lipoprotein cholesterol;
- family history of early cardiovascular diseases (in women<65 years, in men<55 years);
- Abdominal obesity (waist volume ≥102 cm for men or ≥ 88 cm for women);
- Level C - Blood reactive protein ≥1 mg/dl;
- Diabetes mellitus (blood glucose on an empty stomach>7 mmol/l).
Additional:
- violation of glucose tolerance;
- low physical activity;
- Fibrinogen level improvement.
Note. The precision of determining the general cardiovascular risk depends directly on how complete the patient's clinical and instrumental examination was.
Complications for arterial hypertension
Among the most significant complications of arterial hypertension are:
- hypertensive crisis;
- Cerebrovascular disorders (hemorrhagic or ischemic blows);
- Myocardial infarction;
- nephrosclerosis (primary wrinkled kidney);
- heart failure;
- Relating the aorta aneurysm.
Studies for arterial hypertension
In all patients with arterial hypertension, the following studies should be carried out:
- General blood and urine test;
- the level of creatinine in the blood (to exclude renal damage);
- The level of potassium in the blood outside the use of diuretics (a strong decrease in potassium levels suspicion of the presence of a adrenal tumor or stenosis of the renal artery);
- Electrocardiogram (signs of left ventricular hypertrophy - evidence of a long arterial hypertension course);
- Determination of blood glucose level (with empty stomach);
- the content of the blood of total cholesterol, high and low density cholesterol, triglycerides, uric acid;
- Echocardiography (determining the degree of left ventricular myocardium hypertrophy and a state of contractile capacity)
- Study of the bottom of the eye.
- chest x -ray;
- Ultrasound of the kidneys and adrenal glands;
- Brachiocephal and renal arteries ultrasound;
- CT protein reactive in blood serum;
- Urine analysis for the presence of bacteria (bacteriuria), quantitative estimation of protein in urine (proteinuria);
- Determination of microalbumin in urine (mandatory in the presence of diabetes).
- Evaluation of the functional status of cerebral, myocardial, kidneys;
- Blood examination of aldosterone concentration, corticosteroids, radio activity;
- Determination of catecholamines and their metabolites in daily urine;
- abdominal aortography;
- Computerized tomography or magnetic resonance tomography of the adrenal glands and the brain.
Treatment of arterial hypertension
The main objective of treating patients with arterial hypertension is the maximum decrease in the risk of developing cardiovascular complications and their death. This is achieved through long -term life therapy aimed at:
- Decrease in blood pressure at a normal level (below 140/90 mm Hg). With a combination of arterial hypertension with diabetes or renal damage, it is recommended to reduce blood pressure<130/80 mm Hg. (but not less than 110/70 mm Hg);
- "Protection" of the target organs (brain, heart, kidneys), avoiding their greater damage;
- Active impact on adverse risk factors (obesity, hyperlipidemia, carbohydrate disorders, excess salt consumption, hypodinamia), contributing to the progression of arterial hypertension and the development of its complications.
- Smoking rejection;
- Body weight standardization (body mass index<25 kg/m2);
- Decreased alcoholic beverages<30 g of alcohol per day in men and 20 g/day in women;
- Increased regular physical activity of physical activity of 30-40 minutes. at least 4 times a week;
- Reduction in table salt consumption at 5 g/day;
- A change in diet with an increase in the consumption of plant foods, a decrease in vegetable fat consumption, an increase in potassium, calcium in vegetables, fruits, cereals and magnesium contained in dairy products.
The basic principles of pharmacological therapy of arterial hypertension:
The treatment with medications should begin with minimal doses of any kind of antihypertensive medications (given the appropriate contraindications), gradually increasing the dose to a good therapeutic effect.
The choice of the drug should be justified, the antihypertensive drug should provide a stable effect during the day and be well tolerated by patients.
It is more advisable to use prolonged action medications to achieve an effect of 24 hours with a single use. The use of such drugs provides a softer hypotensive effect with a more intense protection of the target organs.
With the low effectiveness of monotherapy (therapy with a medication), it is advisable to use the optimal combinations of medicines to achieve maximum hypotensive effects and minimum side effects.
It is necessary to carry out a long (practically for life) administration of medicines to maintain the optimal level of blood pressure and prevent complications of arterial hypertension.
The choice of the necessary drugs:
Currently, seven classes of medicines for the treatment of arterial hypertension are recommended:
- diuretics;
- B-blockers;
- calcium antagonists;
- Enzyme-productive angiotensin inhibitors;
- Angiotensin receptor blockers;
- Higanist receptor agonists
- Ads blockers.
- The unclear diagnosis and the need for special research methods, more often invasive, to clarify the form of arterial hypertension;
- The difficulties in selecting pharmacological therapy are frequent hypertensive crises, refractory arterial hypertension.
- Hypertensive crisis, not stopping in the prehospital stage;
- Hypertensive crisis with pronounced manifestations of hypertensive encephalopathy (nausea, vomiting, confusion);
- Complications of hypertension, which require intensive care and constant medical observation: stroke stroke, subarachnoid hemorrhage, acute visual deterioration, pulmonary edema, etc.