Arterial hypertension(Hypertension) is the most common disease of the cardiovascular system. Hypertension indicates an important increase in blood pressure. Increasing blood pressure occurs when there is a narrowing of arteries and / or their smaller branches - arteriole. In some people, arteriols often narrow, first due to cramps, and later their lumen remained constantly due to the thickening of the wall, and the blood flow is covered, and the work of the heart is increasing and more blood is in the vascular direction. In such people, hypertension is generally developed.
In our country, approximately 40% of adult population has increased 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 properly controlled their blood pressure.
Arterial hypertension is a chronic disease, accompanied by persistent increasing blood pressure above the permitted boundaries (systolic pressure above 139 mm HG or (I) diastolic pressure above 89 mm Hg).
In about ten hypertension, increased blood pressure causes the lesion of any organ. In these cases, they speak of medium or symptomatic hypertension. About 90% of patients suffer from primary or essential hypertension. The reference point of increased blood pressure is at least a level of 139/89 mm HG, three - survive levels 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 pressure in the arteries, which is created when the heart is reduced, and the blood is released into the arterial part of the vascular system;
- Diastolic blood pressure (DDAD) - pressure in the artery at the time of the heart relaxation, during which is fulfilled before the next reduction.
Symptoms of arterial hypertension
Clinic, I. E. Manifestations of hypertension do not have certain symptoms. For many years, patients may not know about their disease, they do not complain, they do not have high life activity, although sometimes there can be attacked "bad", strong weaknesses and dizziness. But even then everyone believes that it is from excessive work. Although at this point you need to think about blood pressure and measure it.
Hypertension complaints occur if the so-called target bodies are influenced by the most sensitive to the increase in blood pressure. The appearance of dizziness, headaches, heads in the head, memory and performance indicates initial changes in cerebral circulation. This is then joined in the eyes, floating flies, weakness, stiffness of limbs, speech difficulties, but in the initial phase, changes in blood circulation. Away-original phase of arterial hypertension can be complicated with brain infarction or cerebral bleeding. The earliest and constant sign of the constantly increased blood pressure is an increase or hypertrophy of the left ventricle, with its mass growth due to the thickening of heart cells, cardiomites.
First, the thickness of the left ventricle wall increases, and the expansion of this heart chamber appears in the future. It is necessary to pay close attention to the fact that the hypertrophy of the left ventricle is an unfavorable prognostic sign. In a large number of epidemiological studies, it has been shown that the phenomenon of the left ventricular hypertrophy significantly increases the danger of sudden death, coronary heart disease, heart failure and ventricular rhythm disorders. The progressive dysfunction of the left ventricle leads to the appearance of such symptoms as: breeding breath of cargo, paroxysmal night breath (heart asthma), pulmonary edema, chronic (congestive) heart failure. Against this background, myocardial infarction, ventricular fibrillation are more common.
With gross morphological changes in the aorta (atherosclerosis), its stratification, rupture can occur. Kidney lesions express the presence of urine proteins, microhematuria and cylinders. However, kidney failure with hypertension, if there is no malignant course, rarely develops. Eye damage can be manifested by visually impairment, reducing light sensitivity and development of blindness. So it is quite obvious that hypertension should be treated more carefully.
Risk factors arterial hypertension
The factors of the over-ferred risk include:
- Heredity - people who have patients with hypertension among relatives are most often predisposed to developing this pathology in them.
- Male floor - It was determined that the frequency of men arterial hypertension is significantly higher than the frequency of women. But the fact is that female sex hormones, estrogens interfere with the development of hypertension. But such protection, unfortunately, is short - are guilty. The menopause period happened, the savings of estrogen and women is harmonized in frequency with men and often overtake them.
Changed risk factors include:
- Increased body weight - in people with excessive body weights, the risk of developing arterial hypertension is higher;
- Sedentary lifestyle - in another hypodynamy, a sitting lifestyle and small physical activities lead to obesity, which in turn contributes to the development of hypertension;
- In alcohol consumption, excessive alcohol consumption promotes arterial hypertension.
- Eat a large amount of salt in food - a very salty diet helps increase pressure. Here is the question of how much salt can be consumed per day? The answer is short: 4, 5 grams or tablespoons without the top.
- Unbalanced diet with excess atherogenic lipids, excessive calorie content, leading to obesity and promotion of advancing type II diabetes. Atherogenic, I. E. , literally, "creating atherosclerosis" lipids are in large quantities in all animal fats, meat, especially pork and lamb;
- Smoking is another variable and review factor in developing arterial hypertension and its complications. The fact is that tobacco substances, including nicotine, are creating permanent cramp of arteries, which are fixed, leads to the stiffness of the arteries, which implies an increase in pressure in vessels;
- Stress - lead to the activation of the sympathetic nervous system that performs the function of the current activator of all body systems, including cardiovascular. In addition, the pressure, I. E. , which causes the cramp of arteries, hormones, throws into blood. All this, as well as with smoking, is leading to the stiffness of arteries and arterial hypertension develops;
- Rough sleep disorders type night apnea syndrome or snoring. Snoring is a true driver of almost all men and many women. Why is he sneaking dangerously? The fact is that causing an increase in breast pressure and abdominal cavity. All this is reflected in the vessels, leading to their spasm. Arterial hypertension is being developed.
Causes of arterial hypertension
The cause of the disease remains unknown in 90-95% of patients - it is essential (it is basic) arterial hypertension. In 5-10% of cases, the increase in blood pressure has an established cause - this is symptomatic (or secondary) hypertension.
Causes of symptomatic (secondary) arterial hypertension:
- Primary renal impairment (glomerulonephritis) is the most common cause of secondary arterial hypertension;
- one- or bilateral narrowing (stenosis) kidney;
- Koarctation (inborn narrowing) of aorta;
- Feochromocitoma (adrenal tumor that produces adrenaline and norepinephrine);
- Hyperaldosteronism (adrenal tumor that produces aldosteron);
- thyrotoxicosis (increase in thyroid function);
- Ethanol consumption (wine alcohol) more than 60 ml per day;
- Medications: Hormone medications (including oral contraceptions), antidepressants and others;
Risk factors for cardiovascular complications with arterial hypertension
Basic:
- Men older than 55 years of age;
- Women older than 65;
- The level of total blood cholesterol>6, 5 mmol / l, Increase Lific Propertain Level Level (>4. 0 mmol / l) and low higher Lipoprotein cholesterol;
- Family history of early cardiovascular diseases (in women<65 years, in men<55 year);
- abdominal obesity (volume waist ≥102 cm for men or ≥ 88 cm for women);
- Level C - reactive blood protein ≥1 mg / dl;
- Mellitus diabetes (blood glucose on empty stomak>7 mmol / l).
Additionally:
- Breach of glucose tolerance;
- low physical activity;
- Improving the level of fibrinogen.
Record. The accuracy of determining general cardiovascular risk directly depends on how complete the clinical and instrumental examination is the patient.
Complications for arterial hypertension
Among the most important complications arterial hypertension are:
- Hypertensive crises;
- cerebrovascular disorders (hemorrhagic or ischemic moves);
- myocardial infarction;
- Nephrosclerosis (primary bundle of kidney);
- heart failure;
- In relation to aorta aneurysm.
Arterial hypertension studies
In all patients with arterial hypertension, the following studies need to be performed:
- General blood and urine test;
- blood creatinine level (exclude kidney damage);
- Blood potassium levels outside the use of diuretics (a sharply reduction of the potassium levels are suspected in the presence of the adrenal tumor or the stenosis of renal artery);
- Electrocardiogram (signs of left ventricular hypertrophy - proof of long course arterial hypertension);
- Determination of blood glucose levels (on an empty stomach);
- Blood content of total cholesterol, high and low density cholesterol, triglycerides, urethra;
- Echocardiography (determination of the degree of hypertrophy of the myocardial chamber and the state of contractile capacities)
- Studying the bottom of your eye.
- Chest radiography;
- Kidney ultrasound and adrenal glands;
- Ultrasound of Bracition Phalan and Kidney Arteries;
- C-reactive protein in blood serum;
- Urine analysis for the presence of bacteria (bacteria), quantitative estimation of protein in urine (proteinuria);
- Determination of microalbums in urine (mandatory in the presence of diabetes).
- Assessment of the functional state of cerebral flow of blood, myocardium, kidney;
- Blood testing of aldosterone concentration, corticosteroids, radio activities;
- Determination of catecholamines and their metabolites in daily urine;
- Abdominal aortography;
- Calculated tomography or magnetic resonance imaging adrenal glands and brains.
Treatment of arterial hypertension
The main goal of patient treatment from arterial hypertension is a maximum reduction in the risk of making cardiovascular complications and deaths from them. This is achieved by long-term lifelong therapy intended for:
- Reducing blood pressure to normal level (below 140/90 mm Hg). With a combination of arterial hypertension with diabetes or renal impairment, it is recommended to reduce blood pressure<130 / 80 mm Hg. (but not lower than 110/70 mm Hg);
- "Protection" of targeted organs (brain, heart, kidneys), preventing their further damage;
- The active impact on harmful risk factors (obesity, hyperlipidemia, carbohydrate disorders, surplus salt consumption, hypodynamy), contributing to the advancement of arterial hypertension and the development of its complications.
- Smoking rejection;
- Normalization of body weight (body mass index<25 kg / m2);
- Liquor reduction<30 g alcohol daily in men and 20 g / day in women;
- Increasing physical activity - regular physical activity of 30-40 minutes. at least 4 times a week;
- Reducing table consumption Salt up to 5 g / day;
- Change of diet with increasing food consumption for vegetables, reduction of plant fat consumption, increasing potassium, calcium in vegetables, fruits, cereals and magnesium contained in dairy products.
Basic principles of drug therapy arterial hypertension:
Treatment treatment should begin with minimal doses of any class of antihypertensive drugs (given the appropriate contraindications), gradually increasing the dose to good therapeutic effect.
The choice of medicine should be justified, an antihypertensive drug should ensure a stable effect during the day and be well tolerated by patients.
It is most advisory to use long-acting drugs to achieve a 24-hour effect with one use. The use of such drugs provides a softer hypotensive effect with more intensive protection of target organs.
With the low efficiency of monotherapy (one drug therapy), it is recommended to use optimal drug combinations for achieving maximum hypotensive effects and minimum side effects.
It is necessary to perform a long (practical lifelong) administration of drugs to maintain optimal blood pressure levels and preventing the complications of arterial hypertension.
Selection of the necessary medications:
Seven drug classes are currently recommended for the treatment of arterial hypertension:
- diuretics;
- B-blockers;
- Calcium antagonists;
- Enzymatic enzyme inhibitors;
- Angiotensin receptor blockers;
- Hyganic receptors agonists
- Ad-blockers.
- A vague diagnosis and need for special, more often invasive, research mode for clarification of the forms of arterial hypertension;
- Difficulties in choosing drug therapy are frequent hypertensive crises, refractory arterial hypertension.
- A hypertensive crisis, does not stop in the pregnant phase;
- Hypertensive crisis with expressed manifestations of hypertensive encephalopathy (nausea, vomiting, confusion);
- Complications of hypertension, requiring intensive care and constant medical observation: stroke, subarachnoid bleeding, acute damage to visual visual, etc.