Arterial hypertension(hypertension) is the most common disease of the cardiovascular system. Hypertension permanently indicates an increase in blood pressure. An increase in blood pressure occurs when there is a narrowing of the arteries and/or their smaller branches - Arteriole. In some people, arterioles often shrink, first because of the spasm, and later their light remains constantly restricted due to the inspection of the wall, and then, so that the blood flow has passed these narrowing, the work of the heart is increased and more blood is thrown in a vascular direction. In such people, as a rule, hypertension develops.
In our country, about 40% of the adult population has an increase in the blood pressure level. At the same time, about 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 correctly control blood pressure.
Arterial hypertension is a chronic disease, accompanied by a persistent increase in blood pressure above the allowed limits (systolic pressure above 139 mm Hg or (e) diastolic pressure above 89 mm Hg).
In about one of the ten hypertension, the increase in blood pressure is caused by 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 of the increase in blood pressure is at least one level of 139/89 mm Hg, levels recorded at three 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:
- The systolic blood pressure (garden)- reflects the pressure in the arteries, which is created when the heart is reduced and the blood is released in the arterial part of the vascular system;
- The 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 subsequent reduction.
Symptoms of arterial hypertension
Clinic, that is, the manifestations of hypertension does not present specific symptoms. For many years, patients may not know their illness, do not complain, to have high life activities, although sometimes attacks of "malice" can occur, serious weakness and dizziness. But even then everyone believes that this comes from the overload. Even if it is at this moment that you have to think about blood pressure and measure it.
The hypertension complaints arise if the so -called target organs are influenced by the most sensitive to the increase in blood pressure. The occurrence of dizziness, headache, noise in the head, a decrease in memory and performance indicates the initial variations of brain circulation. This is therefore combined with the eyes, shaking with flies, weakness, numbness of the limbs, difficulties in language, but in the initial phase the changes in blood circulation are coming. The phase of extension of arterial hypertension can be complicated by the infarction of the brain or by the cerebral hemorrhage. The first and constant sign of constantly increased blood pressure is an increase or the hypertrophy of the left ventricle of the heart, with the growth of its mass due to the inspection of heart cells, cardiomyocytes.
Firstly, the thickness of the wall of the left ventricle increases and in the future the expansion of this heart 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 a series of epidemiological studies, it has been shown that the appearance of the hypertrophy of the left ventricle significantly increases the risk of sudden death, coronary heart disease, heart failure and ventricular rhythm disorders. The progressive dysfunction of the left ventricle leads to the appearance of symptoms such as: lack of breath to the load, night paroxysmal breathing (cardiac asthma), pulmonary edema (often with crisis), chronic heart failure (congestive). In this context, myocardial infarction, ventricular fibrillation are more common.
With serious morphological changes in the aorta (atherosclerosis), it expands, its stratification can occur, rupture. Reni injuries are expressed by the presence of proteins in the urine, microematuria and cylinder. However, renal failure with hypertension, if there is no evil path, rarely develops. Damage to the eyes can be manifested by compromise 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.
Risk factors of arterial hypertension
Non -fury risk factors include:
- Heredity: 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 arterial hypertension of men is significantly superior to the incidence of women. But the fact is that female sex hormones, estrogen prevent the development of hypertension. But this protection, unfortunately, is short -lived. The period of menopause occurs, the saving effect of estrogen and women are aligned in impact with men and often exceed them.
The modified risk factors include:
- Increase in body weight - in people with excess body weight, the risk of developing arterial hypertension is higher;
- A sedentary lifestyle - in another hypodynamia, a sedentary lifestyle and low physical activity lead to obesity, which in turn contributes to the development of hypertension;
- In alcohol consumption, excessive consumption of alcohol promotes arterial hypertension.
- Eating a large amount of salt in food: a highly salty diet helps to increase pressure. Here arises the question about how much salt can be consumed per day? The answer is short: 4, 5 grams or a teaspoon without top.
- A unbalanced diet with an excess of atherogenic lipids, an excessive content of calories, leading to obesity and promoting the progression of type II diabetes. Aterogenic, that is, literally, "creation of atherosclerosis" lipids are contained in large quantities in all animal fats, meat, in particular pork and lamb;
- Smoking is another variable and formidable factor in the development of arterial hypertension and its complications. The fact is that the tobacco substances, including nicotine, create a constant spasm of the arteries, which is fixed, leads to the rigidity of the arteries, which involves an increase in pressure in the ships;
- Stress - 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 pressure, that is, causing a spasm of arteries, hormones, is thrown into the blood. All this, as for smoking, leads to the rigidity of the arteries and arterial hypertension develops;
- Rough sleep disorders for the type of night apnea syndrome or snoring. Russare is truly a scourge of almost all men and many women. Why is I snoring dangerous? The fact is that it causes an increase in pressure in the chest and abdominal cavity. All this is reflected on ships, leading to their spasm. Arterial hypertension develops.
Causes of arterial hypertension
The cause of the disease remains unknown in 90-95 % of patients, this is essential (i. e. 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 (glomerulonefrite) is the most common cause of secondary arterial hypertension;
- Single or bilateral narrowing (stenosis) of kidney arteries;
- Coartation (congenital narrowing) of the aorta;
- Feochromocytoma (adrenal tumor that produces adrenaline and norepinephrine);
- hyperaldosteronism (tumor of the adrenal glands that produces aldosterone);
- tireotoxicosis (increase in thyroid function);
- Consumption of ethanol (wine alcohol) more than 60 ml per day;
- Medicines: hormonal drugs (including oral contraceptives), antidepressants and others;
Risk factors for cardiovascular complications with arterial hypertension
Basic:
- Men over the age of 55;
- women over the age of 65;
- The level of blood cholesterol Total>6, 5 mmol/l, an increase in the level of low density lipoproteic cholesterol (>4, 0 mmol/l) and high density high density lipoprotein cholesterol;
- family history of the first cardiovascular diseases (in women<65, in men<55);
- abdominal obesity (life volume ≥102 cm for men or ≥ 88 cm for women);
- Level C - Reactive protein in the blood ≥1 mg/dl;
- Diabetes Mellito (Stomach Glick EPPERA>7 mmol/l).
Further:
- violation of glucose tolerance;
- low physical activity;
- Improve the level of fibrinogen.
Note. The accuracy of the determination of 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 rugoso kidney);
- heart failure;
- Reflecting the aneurism of the aorta.
Studies for arterial hypertension
In all patients with arterial hypertension, the following studies should be conducted:
- 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 is suspicious of the presence of adrenal cancer or renal artery stenosis);
- Electrocardiogram (signs of left ventricular hypertrophy - evidence of a long course of arterial hypertension);
- determination of the glucose level in the blood (on an empty stomach);
- the content of the blood of total cholesterol, high and low density cholesterol, triglycerides, uric acid;
- Echocardiography (the degree of hypertrophy of the left ventricular myocardium and a state of contractile capacity is decisive)
- Study of the bottom of the eyes.
- thoracic radiography;
- Ultrasound of the kidneys and adrenal glands;
- Ultrasound of brachyocephalic and kidney arteries;
- C-reactive protein in blood serum;
- Urine analysis due to the presence of bacteria (bacteriuria), quantitative esteem of the protein in the urine (proteinuria);
- Determination of microalbumin in the urine (mandatory in the presence of diabetes).
- Evaluation of the functional state of the cerebral blood flow, myocardias, kidneys;
- Blood examination of the concentration of aldosterone, corticosteroids, radio activities;
- determination of catecholamines and their metabolites in daily urine;
- abdominal aortography;
- Complacency tomography or magnetic resonance imaging of the adrenal glands and the brain.
Treatment of arterial hypertension
The main objective of the treatment of patients with arterial hypertension is the maximum reduction in the risk of developing cardiovascular complications and death from them. This is obtained from therapy throughout the long -term life aimed at:
- decrease in blood pressure at a normal level (less than 140/90 mm hg). With a combination of arterial hypertension with diabetes or kidney 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), preventing their further damage;
- Active impact on adverse risk factors (obesity, hyperlipidemia, carbohydrate disorders, excess salt consumption, hypodynamia), contributing to the progression of arterial hypertension and the development of its complications.
- Refusal of smoking;
- normalization of body weight (body mass index<25 kg/m2);
- decrease in alcoholic beverages<30 g of alcohol per day in men and 20 g/day in women;
- Increase in physical-regular physical activity of 30-40 minutes. at least 4 times a week;
- reduction of the consumption of 5 g/day table salt;
- A change in the diet with an increase in the consumption of vegetable foods, a decrease in vegetable fat consumption, an increase in potassium, a vegetable, fruit, cereals and magnesium calcium contained in dairy products -caseari.
The basic principles of drug therapy of arterial hypertension:
The treatment of drugs should start with minimal doses of any class of antihypertensive drugs (given appropriate contraindications), gradually increasing the dose up 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 long action drugs to obtain a 24 -hour effect with a single use. The use of these drugs provides a softer hypotensive effect with a more intense protection of the target organs.
With the low effectiveness of monotherapy (therapy with a drug), it is advisable to use the optimal combinations of drugs to obtain the highest hypotensive effects and minimum side effects.
It is necessary to carry out a long administration of drugs (practically permanent) to maintain the optimal level of blood pressure and prevent complications of arterial hypertension.
The choice of the necessary drugs:
There are currently seven classes of drugs for the treatment of arterial hypertension:
- diuretics;
- B-blockers;
- Calcium antagonists;
- Elderly-reproductive enzyme inhibitors;
- angiotensin receptor locks;
- Higanist receptor agonists
- B-blockers.
- The unclear diagnosis and the need for special research methods, more often invasive to clarify the form of arterial hypertension;
- The difficulties in the selection of drug therapy are frequent hypertese crises, refractory arterial hypertension.
- Hypertensive crisis, not stopping in the preospedaliera phase;
- Hypertensive crisis with pronounced manifestations of hypertensive encephalopathy (nausea, vomiting, confusion);
- Complications of hypertension, which require intensive care and constant medical observation: cerebral stroke, sub -tubaracnoid hemorrhage, acute visual impairment, pulmonary edema, etc.