Arterial hypertension is a pathological or physiological predisposition to the sharp or gradual growth of systolic and diastolic components of intravascular blood pressure, which occurs as an independent nosological unit or a manifestation of another pathology.
According to world statistics, the epidemiological situation is unfavorable for the occurrence of arterial hypertension, as the percentage of this pathology is 30%in the structure of cardiological profile diseases. There is a clear correlation dependence on the risk of arterial hypertension signs and consequences with an increase in the patient's age, so the main category of increased risk is the face of mature and old people.
Causes of arterial hypertension
The appearance of increased blood pressure signs in the patient may occur in the background of existing chronic diseases, and then a secondary or symptomatic version of arterial hypertension. In the event that arterial hypertension is primary and even after a comprehensive examination of the patient, it cannot be determined that it provokes the increase in intravascular blood pressure, the term "hypertension" should be used, which is an independent form of nosological.
Primary arterial hypertension can be observed in almost 90% of the growth of blood pressure, and the polyethological development of this pathological condition is currently taken into account. Thus, there are non -modified risk factors for arterial hypertension that cannot be avoided (sexual, genetic determinism and age), but these provoking factors do not dominate severe arterial hypertension. The development of primary arterial hypertension is more influenced by the human lifestyle (non -balanced nutrition, bad habits, inactivity, psycho -emotional instability). The above provoking factors will sooner or later create favorable conditions for the pathogenetic development of arterial hypertension.
There are currently many pathogenetic theories of the development of basic arterial hypertension, although these hypotheses do not affect the patient's tactics and determine the amount of therapeutic measures. Ethiopathogene of secondary arterial hypertension should be taken to a greater extent, as the growth of blood pressure would be provoked without removing the etiological factor, in which case you should not wait for positive treatment results.
Thus, with the renovascular version of symptomatic arterial hypertension, the main pathogenetic relationship is the stenosis of kidney artery, which occurs with atherosclerotic lesion or fibrous-muscular dysplasia. The extremely rare etiological factor affecting kidney arteries is systemic vasculitis. The result of stenosis is the development of ischemic lesion of one or both kidneys, which provokes the hyper production of renin, which has an indirect effect on the increase in blood pressure.
The pathogenesis of the developing of the endocrine form of arterial hypertension increases the level of hormonal substances that have a stimulating effect on the increase in intravascular blood pressure, which occurs with the syndrome of Celenko-Rush, CNN syndrome and feooochromocytoma. Some cardiovascular diseases may act as a background to the development of secondary arterial hypertension, such as aortic coarktion.
Symptoms of arterial high blood pressure
Clinical manifestations may be completely absent in the early stages of arterial hypertension, and in this case the diagnosis is only based on data on an objective and instrumental laboratory test.
Complaints submitted by patients with arterial hypertension are quite not specific, so diagnosis is significantly difficult during the debut of essential hypertension. In most cases, an episode of arterial hypertension is disturbed by the patient, the dominant localization of the frontal and occlital region, sharp dizziness, especially when changing the body position, the abnormal noise of the ears. These manifestations are not pathognomonic, so it is not advisable to consider the clinical criteria for arterial hypertension, as the above symptoms are regularly observed in absolute healthy people and has nothing to do with increasing blood pressure. Classic clinical manifestations in the form of respiratory disorders, signs of heartactivity dysfunction only in the far -performing stage of arterial hypertension.
Some etiopathogenetic forms of arterial hypertension are accompanied by the development of specific clinical symptoms, which can create a correct diagnosis of an experienced specialist during the initial examination and thoroughly collect a history. For example, when arterial hypertension is a renovascular type, acute debut of clinical manifestations is always observed, consisting of sharp critical and constant growth of blood pressure, mainly due to the diastolic component. Renovascular arterial hypertension is not characterized by Crisissis, but the patient's well with this pathology is extremely severe.
On the contrary, endocrine arterial hypertone is characterized by a predisposition to the paroxysmal course of the disease by developing classical hypertensive crises. For this pathology, the patient has a clinical "paroxysmal triple" that consists of developing sharp headaches, pronounced sweating and rapid heartbeat. Patients in such an abnormal state have extreme psycho -emotional irritability. The hypertension crisis is most often found at night, and the duration of clinical manifestations does not exceed one hour, after which patients take into account sharp weakness and boring common headaches.
The degree and sections of arterial high blood pressure
Determination of the severity and intensity of clinical manifestations of arterial hypertension and the stage of the disease are a prerequisite for choosing the right treatment. Separation of arterial hypertension is based on both primary and sysis of genesis, and the level of increased blood pressure systolic and diastolic component is laid.
Patients with 1 degree arterial hypertension most often do not take into account expressly violation of their own health, as blood pressure data do not exceed 159/99 mm in this situation. Rt. Art.
2 degrees of arterial hypertension are accompanied by highlighted clinical manifestations and organic changes in the target organs, and blood pressure indicators are 179/109 mm. Rt. Art.
3 degrees of the disease are prone to distinguishing between an extremely severe aggressive path and complications of the damaged brain and heart function. With the third degree, a critical increase in 180/110 mm blood pressure is observed. Rt. Art.
In addition to classifying arterial hypertension in severity, cardiologists use this pathology stadium separation in practical activities, which is a criterion for the damage to the target organism.
During the initial stages of arterial hypertension, both primary and secondary genesis, the patient does not completely have manifestations of organic lesions sensitive to the increase of tissues and organs.
The second stage of the disease includes the development of detailed clinical symptoms, the intensity of which is directly dependent on the severity of the damage to the internal organs. However, this stage of arterial hypertension was created in most cases based on instrumental reinforcement of organ injuries in the form of a left ventricular hypertrophic cardiomyopathy, echocardioscopy and ECG, reducing the arterial vessels of retina, raising the eye pain, and the lower part of the blood. Blood, biochemical analysis, biochemical analysis, biochemical analysis, biochemical analysis, biochemical analysis, and biochemical analysis. Blood plasma.
The third stage of arterial hypertension is the terminal, in which the patient has irreversible changes in all organs sensitive to increased blood pressure. Compared to the heart, a person who has long suffered from an increase in blood pressure develops ischemic myocardial damage, which is manifested in the development of infarction zones. On the brain structure, arterial hypertension has a negative effect on the provocation of transient ischemic attacks, hypertension encephalopathy, and even ischemic stroke focuses. Long -term systemic growth of intravascular pressure is extremely negatively affecting the structure of blood vessels, the outcome of which is the formation of bleeding in the retina and the optical disk edema.
The terminal section of the formation of arterial hypertension is characterized by a significant suppression of renal function, which reflects the level of creatinine, which exceeds the indicator of 177 μmol/l.
Diagnosis of arterial hypertension
When performing clinical and instrumental laboratory examination of patients with arterial hypertension, the main purpose is not to determine the fact of increasing blood pressure, but to detect the development of secondary arterial hypertension and to detect signs of internal organ damage and to evaluate the risk of sword profile complications.
In order to make the correct diagnosis and to determine further treatment tactics, the patient's anamnic data is thoroughly a thorough collection by initial contact with the patient. An objective study of a patient with arterial hypertension allows you to determine the etiopathogenetic form of the disease due to the detection of specific pathogenomic symptoms. Thus, the patient, in combination with hypertrichosis, hirsutism, and in combination with the permanent increase in the diastolic component of the arterial pressure, must be assumed in combination with the endocrine nature of the disease (iconko-doll syndrome). With feochromocytoma, with severe paroxysmal arterial hypertension, an increase in skin pigmentation in the projection of axillary cavities can be observed. The main clinical criterion for renovascular arterial hypertension is the auster of vascular noise in the projection of the nearby Bundle region.
The amount of arterial hypertension's laboratory research methods consists of analysis of the patient's lipidogram, uric acid determination and creatinine determination, as the main criterion for kidney dysfunction, analysis of the patient's hormonal condition.
In order to determine the stage of the disease, the necessary condition is to diagnose the lesions of the target organs, ie organs in which irreversible changes due to the increase in blood pressure. Thus, the use of electrocardiographic registration and ultrasound display to study the heart of impaired activity and organic lesion, which include all patients with arterial hypertension. In order to detect retinopathy, which is mainly observed with long -term, severe arterial hypertension, the bottom of the patient's eyes should be examined. It is recommended that the broadcasting methods of display are used as instrumental methods for studying the kidneys and the brain, which are not included in the mandatory list of diagnostic measures, but greatly facilitates early diagnosis (computer tomography, magnetic resonance imaging).
Treatment of arterial hypertension
The basic modern approach to arterial hypertension is to reach the risk of developing heart profile complications and levels of death. In this regard, the participating doctor's priority is to completely eliminate the reversible (modified) risk factors available to the patient by further stopping arterial hypertension and concomitant clinical manifestations. There is a certain standard consisting
When to apply antihypertensive therapy to arterial hypertension? Cardiologists use the developed classification during their practice, which includes the patient's "risk of developing cardiovascular complications". According to this classification, the combined treatment using a lifestyle and medicine correction is subject to persons whose heart profile complications have a high risk in combination with the critical increase in the number of blood pressure. Patients in moderate and low -risk categories should be considered as dynamic observation for at least three months and only in the absence of non -drug correction methods should be used to use medication.
Principles of arterial hypertension are the principles of the target numbers using a minimal dose of one or more hypotensive drugs. In certain situations, monotherapy with a low dose hypotensive drug can have a long positive effect on relief of arterial hypertension. Currently, the drug market is full of a wide range of antihypertensive drugs, but the most popular (up to 24 hours) combined groups are the most popular.
Because there are drugs chosen compared to the first episode of arterial hypertension, it should be preferred diuretics that have a widespread positive effect on preventing the development of cardiovascular complications, reducing mortality, and preventing hypertrophic changes in the heart company. The pharmacological effect, which is accompanied by a slight decrease in blood pressure, is determined by a decrease in water and sodium reabsorption and a decrease in vascular resistance.
The choice of diuretic medicine depends on the patient's concomitant diseases. So, in combination with arterial hypertension, signs of heart and kidney failure, loop -diuretic drugs should be given. Longer -used thiazide diuretics can provoke the development of hypokalemic syndrome, so it is better to combine them with aldosterone antagonists.
In a situation where the patient has signs of arterial hypertension, combined with the symptoms of tachyarrhythmia, angina attacks and stagnant chronic cardiovascular insufficiency, it is advisable to use the group of water blockers as the first row. The mechanism of the antihypertensive effect of these drugs is to reduce the heart rate and inhibition of renin products. It should be borne in mind that not observing this group may provoke an extremely reduction in the frequency of heart rate and bronchial bonus, which is an absolute indication of deleting the BA blocking reception.
It is advisable for patients with arterial hypertension against proteinuria background. The absolute contraindication of the drugs of the ACE inhibitors group is two -way kidney stenosis in the patient. The drugs of the Angiotensin II receptors II receptor antagonists have a similar hypotensive effect, the only difference is that they do not provoke the coughing and recovery of anhioneurotic nature, which significantly extends their application.
The groups of the calcium channel blocks groups have an outstanding hypotensive effect, allowing for stopping arterial hypertension as the calcium content on the vascular wall is reduced. The category of prescribing drugs for this group is primarily elderly patients who, at the same time as arterial hypertension, observe signs of ischemic myocardial injuries that are manifested in the development of angina attacks. In cardiological practice, only longer forms of calcium channel blockers are used only due to the fact that short -term calcium antagonists significantly increase the risk of provocation of acute myocardial infarction.
In a situation where the patient's arterial hypertension is combined with violation of the rhythm of the heart activity, it is advisable to use the calcium category of phenylaclamines and benzotiazepine derivatives. An absolute contraindication to the use of this category of drugs is the patient's heart failure, accompanied by a reduction of less than 45%in the emission fraction.
Otherwise, the alleviation of the hypertension crisis, in which there is a critical increase in intravascular pressure and acute course of arterial hypertension. In this situation, drugs with highlighted antihypertensive effects should be preferred because, due to the prolonged effect of the hypertensive crisis, the risk of deadly result is suddenly increased. With signs of complicated hypertension crisis, the parenteral path of hypotensive drugs is more advantageous. Most groups of hypotensive agents are produced in parenteral form. As a general rule, the hypotensive effect occurs at the latest 5 minutes after the drug has been administered.
The non -complicated hypertensive crisis does not require the use of parenteral forms of antihypertensive drugs, as there is no critical growth of blood pressure in this pathological condition. Oral administration of antihypertensive agents in proper dosage allows you to reduce pressure within several hours and maintain targets in the future. Of course, there are currently many ways to stop the hypertension crisis, but to exclude complications, the planned schema of antihypertension therapy should be used regularly.
In the event that the patient's arterial hypertension develops as a result of stenosis of the kidney arteries, the basic method of treatment is the functioning of stenosis and angioplasty revascularization. Renovascular arterial hypertension (bypass, endarterctomy bypass) is only used to contraindicate the use of transluminal angioplasty. If the patient has signs of the aggressive course of arterial hypertension due to severe unilateral nephrosclerosis, then the only treatment is nephrectomy.
Endocrine secondary arterial hypertension, surgical treatment (radical expression of tumor substrate) and drug antiHiptulation therapy (spironolactone at 200 mg daily with primary aldosteronism, pentolamine for 25 hours, Theochromocytoma).
Preventing arterial hypertension
Compliance with preventive measures aimed at preventing episodes of intravascular blood pressure and reducing the risk of complications of arterial hypertension not only for patients who have long suffered from this pathology, but also to healthy persons with increased pressure.
The scientifically proven fact is the direct correlation dependence of the increase in blood pressure in the human body weight, and therefore the weight of a person with arterial hypertension is the main priority preventive event. In addition, compliance with the rules on food allegation promotes the progress of atherosclerotic vascular lesions, which is one of the main causes of arterial hypertension.
In the field of pharmacology, the latest studies have shown the beneficial effects of omega-3-laza fatty acids on the restoration of blood vessels, which can also be considered an effective method for preventing arterial hypertension. For these conclusions, olive oil should be used in sufficient quantities daily and sharply restricts animal fats.
Of course, if you want to get rid of arterial hypertension, leave bad habits in the form of smoking and drinking alcoholic beverages, as nicotine and alcohol parts can increase intravascular blood pressure even in microdoses.
Persons who have already been taken into account as a secondary preventive measure of arterial hypertension should be measured daily to reflect a special diary to the effectiveness of the medication used and, if the new clinical manifestations are exacerbated, without postponing the participating physician.
Arterial hypertension - Which doctor will help? In the presence or suspicion of arterial hypertension, seek advice immediately with doctors as a cardiologist, endocrinologist and nephrologist.