Arterial hypertension(Hypertension) is the most common disease of the cardiovascular system. Hypertension shows a stable increased blood pressure. An increase in blood pressure occurs when a narrowing of the arteries and/or their smaller branches - arterioles - are narrowed. For some people, arterioles, which often narrow due to cramps, and later their lumen remains constantly narrowed due to the thickening of the wall, and then, so that the blood flow overwhelmed this narrowing, the work of the heart is increased and more blood is thrown into a direction of vessels. In such people, high blood pressure usually develops.
In our country, about 40% of the adult population have increased blood pressure. At the same time, around 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 check their blood pressure correctly.
Arterial hypertension is a chronic disease, accompanied by a continued increase in blood pressure beyond the permissible limits (systolic pressure over 139 mm Hg or (and) diastolic pressure above 89 mm Hg).
In about one of ten high blood pressure, increased blood pressure is caused by the lesion of an 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 increased blood pressure is at least a level of 139/89 mm Hg, three registered mirrors of 139/89 mm rt. Art. And more for people who do not take drugs to reduce the pressure.
Blood pressure
There are two indicators for blood pressure:
- Systolic blood pressure (garden)- reflects the pressure in the arteries that is generated when the heart is reduced and blood is released in the arterial part of the vascular system.
- Diastolic blood pressure (DDAD)-The pressure in the arteries at the time of relaxation of the heart, during which it is filled before the next reduction.
Symptoms of arterial hypertension
The clinic, d. H. The manifestations of high blood pressure have no specific symptoms. The patients do not know anything about their illness for many years, do not complain, have a high level of life activity, although sometimes attacks on "badness", severe weakness and dizziness can occur. But even then everyone believes that this comes from overload. Although at that moment they have to think about blood pressure and measure it.
Complaints for high blood pressure occur if the so -called target organs are affected by the most sensitive blood pressure increases. The occurrence of dizziness, headache, noise in the head, a decrease in memory and performance indicate the initial changes to the brain cycle. This is then connected in the eyes, flickering of flies, weakness, deafness of the limbs, difficulty in language, but in the first stage there are changes in blood circulation. The far -reaching stage of arterial hypertension can be complicated by the infarction of the brain or brain hemorrhage. The earliest and constant sign of an increased blood pressure is an increase or hypertrophy of the left ventricle of the heart, whereby the growth of its mass due to the thickening of the heart cells, cardiomyocytes, a growth of its mass.
First, the thickness of the wall of the left ventricular increases, and in the future the expansion of this cardiac chamber will also occur. It is necessary to ensure that the hypertrophy of the left ventricular is an unfavorable prognostic sign. A number of epidemiological studies showed that the occurrence of hypertrophy of the left ventricle significantly increases the risk of sudden death, diseases of coronary arteries, heart failure and dying rhythm disorders. Progressive dysfunction of the left ventricular leads to the occurrence of symptoms such as: shortness of breath in the case of load, paroxysmal dessatem (heart -asthma), pulmonary edema (often with crises), chronic (congestive) heart failure. Against this background, myocardial infarction and ventricular fibrillation are more common.
With great morphological changes in the aorta (atherosclerosis), it expands, its stratification and layering can occur. The lesions of the kidneys are expressed by the presence of protein in the urine, in the microhematuria and in the cylinder. Renal failure with high blood pressure, however, if there is no malignant course, rarely develops. Eye damage can manifest themselves by impairing vision, a decrease in sensitivity to light and the development of blindness. It is therefore quite obvious that high blood pressure should be treated more precisely.
Risk factors for arterial hypertension
Solated risk factors include:
- Inheritance - people who have patients with high blood pressure among relatives are most predisposed in them for the development of this pathology.
- The male soil - it was found that the incidence of the men's arterial hypertension is significantly higher than the incidence of women. The fact is, however, that female sex hormones, estrogens hinder the development of high blood pressure. But such protection is unfortunately short -lived. The menopausal period occurs, the saving effect of estrogens ends and women are aligned with men in incidence and often overtake them.
Changed risk factors include:
- Increased body weight - In people with an excessive body weight, the risk of arterial hypertension is higher.
- A sitting lifestyle - with another hypodynamy, a sitting lifestyle and low physical activity lead to obesity, which in turn contributes to the development of high blood pressure;
- In alcohol consumption, excessive alcohol consumption promotes arterial hypertension.
- Eating a large amount of salt in food - a high -salty diet increases the pressure. Here is the question of how much salt can be consumed a day? The answer is short: 4, 5 grams or a teaspoon without top.
- An unbalanced diet with an excess of atherogenic lipids, excessive calorie content, which leads to obesity and promotes the progression of type -II diabetes. Atherogens, d. H. literally "creation of atherosclerosis" plipids are contained in large quantities in large quantities in all animal fats, especially in pork and lamb.
- Smoking is another variable and impressive factor in developing arterial hypertension and complications. The fact is that tobacco substances, including nicotine, generate a constant cramp of the arteries that is fixed, leads to the stiffness of the arteries, which leads to an increase in pressure in the vessels.
- Tension - lead to an activation of a sympathetic nervous system that performs the function of an immediate activator of all body systems, including cardiovascular. In addition, pressor, i. e. H. thrown into the blood of a cramp of arteries, hormones. All of this leads to the rigidity of the arteries, as in smoking, and arterial hypertension develops;
- Approximately sleep disorders through the type of Nachapnoe syndrome or snoring. Snoring is a really scourge of almost all men and many women. Why is snoring dangerous? The fact is that it causes a pressure increase in the chest and abdominal cavity. All of this is reflected on the vessels and leads to their cramp. Arterial hypertension develops.
Causes of arterial high blood pressure
The cause of the disease is essential in 90-95 % of patients unknown dies (i. e. primary) arterial hypertension. In 5-10% of cases, an increase in blood pressure has a defined cause dies is a symptomatic (or secondary) hypertension.
Causes of symptomatic (secondary) arterial hypertension:
- Primary kidney damage (glomerulonephritis) is the most common cause of secondary arterial hypertension;
- Control or bilateral narrowing (stenosis) of the renal arteries;
- Koarktation (congenital narrowing) of the aorta;
- Feochromocytoma (adrenaline and noradrenaline produces adrenal tumor);
- Hyperaldosteronism (tumor of the adrenal glands that produce Aldosterone);
- Thyrotoxicosis (increase in thyroid function);
- Ethanol consumption (wine alcohol) more than 60 ml per day;
- Medicines: hormonal medication (including oral contraceptives), antidepressants and others;
Risk factors for cardiovascular complications with arterial hypertension
Basic:
- Men over 55 years old;
- Women over 65 years old;
- The overall bulk cholesterol6, 5 mmol/l, an increase in the level of the lipoprotein cholesterol with low density (>4, 0 mmol/l) and lipoprotein cholesterol with high density;
- Family history formerly cardiovascular diseases (in women<65 years old, in men<55 years);
- Obesity abdominal (waist volume ≥ 102 cm for men or ≥ 88 cm for women);
- Level C - Reactive protein in the blood ≥ 1 mg/dl;
- Diabetes mellitus (blood sugar on an empty stomach sex>7 mmol/l).
Additionally:
- Violation of glucose tolerance;
- low physical activity;
- Improvement of the fibrinogen level.
note. The accuracy of determining the general cardiovascular risk directly depends directly on how complete the patient's clinical and instrumental examination was.
Complications for arterial hypertension
The most important complications of arterial hypertension are:
- hypertensive crises;
- cerebrovascular disorders (hemorrhagic or ischemic lines);
- Myocardial infarction;
- Nephrosclerosis (primary wrinkled kidney);
- Heart failure;
- Give the aneurysm of the aorta.
Studies on arterial hypertension
The following studies must be carried out in all patients with arterial hypertension:
- General blood and urine test;
- the creatine indicator in the blood (to exclude kidney damage);
- The potassium level in the blood outside of the diuretics (a strong decrease in potassium levels is suspicious of the presence of a side kidney tumor or a stenosis of renal artery);
- Electrocardiogram (signs of left ventricular hypertrophy - detection of a long course of arterial hypertension);
- Determination of the glucose mirror in the blood (on an empty stomach);
- the content of the blood of the overall cholesterol, cholesterol with high and low density, triglycerides, uric acid;
- Echocardiography (determination of the hypertrophy wheel of the left ventricular myocardium and a state of contractile capacity)
- Examine the eye.
- Brustradiography;
- Ultrasound of the kidneys and adrenal glands;
- Ultrasound of brachiocephal and renal arteries;
- C-reactive protein in the blood serum;
- Urine analysis for the presence of bacteria (bacteriuria), quantitative estimate of the protein in urine (proteinuria);
- Determination of microalbumin in the urine (mandatory in the presence of diabetes).
- Evaluation of the functional state of cerebral blood flow, myocardia, kidneys;
- Examination in the blood of the concentration of aldosterone, corticosteroids, radio activity;
- Determination of catecholamines and their metabolites in daily urine;
- Aortography abdominal;
- Computer tomography or magnetic resonance imaging of adrenal and brain glands.
Treatment of arterial high blood pressure
The main goal of treating patients with arterial hypertension is the maximum decrease in risk of developing cardiovascular complications and death from them. This is achieved by long -term lifelong therapy that aims at it:
- Acceptance of blood pressure to a normal level (below 140/90 mm Hg). With a combination of arterial hypertension with diabetes or kidney damage, the blood pressure is recommended<130/80 mm HG to reduce. (but not lower than 110/70 mm Hg);
- "Protection" of target organs (brain, heart, kidneys) that prevent their further damage;
- Active effects on undesirable risk factors (obesity, hyperlipidemia, carbohydrate disorders, excess salt consumption, hypodynamy) that contribute to the progress of arterial hypertension and develop its complications.
- Rejection of smoking;
- Normalization of body weight (body mass index<25 kg/m2);
- Acceptance of alcoholic beverages<30 G alcohol per day in men and 20 g/day in women;
- Increasing physical activity and regular physical activity of 30 to 40 minutes. at least four times a week;
- Reduction of the consumption of table salt to 5 g/day;
- A change in the diet with an increase in vegetable food consumption, a decrease in vegetable fat consumption, an increase in potassium, calcium in vegetables, fruit, cereals and magnesium, which are contained in dairy products.
The basic principles of drug therapy of arterial hypertension:
Medicine treatment should begin with minimal doses of a class of blood pressure -lowering medication (given the appropriate contraindications), which gradually increases the dose to a good therapeutic effect.
The choice of the drug should be justified, the blood pressure -lowering drug should achieve a stable effect during the day and tolerate well by the patient.
It is most advisable to use long-looking medication to achieve a 24-hour effect with a single use. The use of such medicines offers a softer blood pressure -lowering effect with more intensive protection of the target organs.
With the low effectiveness of monotherapy (therapy with a medication), it is advisable to use the optimal combinations of the medication in order to achieve maximum blood pressure -lowering effects and minimal side effects.
It is necessary to carry out long (practical lifelong) administration of medicinal products in order to maintain the optimal blood pressure level and prevent complications of arterial hypertension.
The choice of the necessary medication:
Seven drug classes are currently recommended for the treatment of arterial hypertension:
- Diuretics;
- B blocker;
- Calcium antagonists;
- Angiotensin reproductive enzymine hibitators;
- Angiotensin receptor blocker;
- Higistical receptor agonists
- Ad blocker.
- The unclear diagnosis and the need for special, frequent invasive research methods to clarify the form of arterial hypertension;
- Difficulties in choosing drug therapy are common hypertensive crises, refractory arterial hypertension.
- Hypertensive crisis, do not stop in the prehospital phase;
- Hypertensive crisis with pronounced manifestations of hypertensive encephalopathy (nausea, vomiting, confusion);
- Complications of high blood pressure that require intensive care and constant medical observation: brainhub, subarachnoid bleeding, acute visual impairment, pulmonary edema, etc.