Arterial hypertension is a pathological or physiological predisposition to an acute or gradual increase in the indicators of the systemolic and diastolic components of intravascular blood pressure, which occurs as an independent nosological unit or is a manifestation of another pathology available in the patient.
According to world statistics, the epidemiological situation in terms of incidence of arterial hypertension is unfavorable, since the percentage of this pathology in the structure of heart profile diseases reaches 30%. There is a clear dependence on the correlation of an increase in the risk of developing signs and consequences of arterial hypertension with an increase in patient's age and, therefore, the main category of greatest risk is the faces of mature and the elderly.
Causes of arterial hypertension
The appearance of signs of greater blood pressure in the patient can occur in the context of existing chronic diseases and then we are talking about a secondary or symptomatic version of arterial hypertension. In the case in which arterial hypertension is primary and even after an integral examination of the patient, it is not possible to determine the cause that causes an increase in intravascular blood pressure, the term "hypertension" must be used, which is an independent nosological form.
Primary arterial hypertension is observed in almost 90% of cases of an increase in blood pressure, and is currently considered the poleetiological development of this pathological state. Therefore, there are non -modified risk factors for arterial hypertension, which is not possible to avoid (sexual determinism, genetic and age), however, these provocative factors are not dominant in the development of severe arterial hypertension. To a greater extent, the development of primary arterial hypertension is influenced by human lifestyle (not balanced nutrition, bad habits, inactivity, psychomotional instability). Together, all previous provocative factors, sooner or later, create favorable conditions for the pathogenetic development of arterial hypertension.
Currently, many pathogenetic theories of essential arterial hypertension are considered, although these hypotheses have no effect on patient's tactics and determine the volume of therapeutic measures. Ethiopathogens of the development of secondary arterial hypertension must be taken into account to a greater extent, since without the elimination of the etiological factor that causes an increase in blood pressure, in this case the positive results of the treatment should not wait.
Then, with the renovascular version of symptomatic arterial hypertension, the main pathogenetic link is the stenosis of the renal artery that occurs with its atherosclerotic lesion or fibrous-monsus-monscular dysplasia. An extremely rare etiological factor that affects renal arteries is systemic vasculitis. The consequence of stenosis is the development of the ischemic lesion of one or both kidneys that cause renin hyperproduction, which has an indirect effect on an increase in blood pressure.
In the pathogenesis of the development of the endocrine etiological form of arterial hypertension, there is an increase in the level of hormonal substances that have a stimulating effect on an increase in intravascular blood pressure, which occurs with Celenko-Rush syndrome, syndrome and uglyocyocytoma. Some cardiovascular diseases can act as a background pathology for the development of secondary arterial hypertension, such as aorta coarctation.
Symptoms of arterial hypertension
Clinical manifestations in the initial stage of arterial hypertension development may be completely absent, and the diagnosis in this case is based only on data from an objective and instrumental work exam.
Complaints presented by patients suffering from arterial hypertension are quite non -specific and, therefore, in the debut of essential hypertension, the diagnosis is significantly difficult. In most cases, with an episode of arterial hypertension, the patient is disturbed by headache with predominant location in the frontal and occipital region, strong dizziness, especially when changing the position of the body in space, pathological noise in the ears. These manifestations are not pathognomonic, so it is not advisable to consider them clinical criteria for arterial hypertension, since the above symptoms are periodically observed in absolutely healthy people and have nothing to do with an increase in blood pressure. Classical clinical manifestations in the form of respiratory disorders, the signs of cardiac activity dysfunction are observed only in the distant expansion stage of arterial hypertension.
Some etiopathogenetic forms of arterial hypertension are accompanied by the development of specific clinical symptoms, in relation to which, an experienced specialist can establish a correct diagnosis during the initial exam and thoroughly collect an anamnesis. For example, with a renovascular type of arterial hypertension, there is always an acute debut of clinical manifestations, which consists of a critical and constant increase in blood pressure indicators mainly due to the diastolic component. Renovascular arterial hypertension is not characterized by a crisis course, however, the patient's well with this pathology is extremely serious.
Endocrine arterial hypertension, on the contrary, is characterized by a trend to the paroxysmal course of the disease with the development of classical hypertensive crises. For this pathology, the patient has a "paroxysmal triad", which consists of the development of sharp headaches, pronounced sweating and rapid palpitations, is characteristic. Patients who are in this pathological condition have extreme psycho -emotional excitability. The development of a hypertensive crisis occurs more frequently at night, and the duration of clinical manifestations does not exceed more than an hour, after which patients notice a strong weakness and a common headache.
Degrees and stages of arterial hypertension
Determining the severity and intensity of the clinical manifestations of arterial hypertension, as well as the stage of development of the disease, is a prerequisite for the selection of an adequate treatment regime. The separation of arterial hypertension is based on the primary and symptomatic genesis, the level of increase in the systolic and diastolic component of blood pressure is placed.
Patients with 1 degree of arterial hypertension often do not indicate a pronounced violation of their own health due to the fact that blood pressure figures in this situation do not exceed 159/99 mm. Rt. Art.
2 Degree of arterial hypertension is accompanied by pronounced clinical manifestations and organic changes in the objective organs, and blood pressure indicators are in the range of 179/109 mm. Rt. Art.
The 3 grade of the disease is distinguished by an extremely severe aggressive course and a tendency to develop complications from the function of the brain and the heart. With the third degree, a critical increase in blood pressure exceeding 180/110 mm is observed. Rt. Art.
In addition to the classification of arterial hypertension in terms of gravity, in practical activities, cardiologists use the separation of the stadium from this pathology, whose criteria are the presence of signs of damage to the target organs.
In the initial stage of arterial hypertension, both the primary and secondary genesis, the patient has no manifestations of organic lesions sensitive to an increase in blood pressure of tissues and organs.
The second stage of the disease implies the development of detailed clinical symptoms, whose intensity of the manifestation depends directly on the severity of the damage to the internal organs. However, in Most Cases, This Stage of Arterial Hypertension is establishing on the basis of instrumental confirmation of organs lesions in the form of hypertrophic cardiomyopathy of the left ventricle of the Heart According to Echocardioscopy and Ecg, narrowing of the arterial vessels of the retina where where where where where where where where where where where where where where where where where where where where where where where where where where where what what when whatles where whenExamining The Eye Bottom and the Replace of Changes in the Biochemical Analysis of Blood, Namely, A moderate increases in creatinine levels in the level plasma.
The third stage of arterial hypertension is the terminal, in which the patient has the development of irreversible changes in all organs sensitive to blood pressure. In relation to the heart in a person who has long suffered an increase in blood pressure, ischemic myocardial damage is developed, manifested in the formation of infarction areas. In brain structures, arterial hypertension has a negative effect in the form of provocation of transient ischemic attacks, hypertension encephalopathy and even the formation of ischemic strokes of stroke. The long -term systemic increase in intravascular pressure extremely negatively affects the structure of blood vessels, whose result is the formation of hemorrhages in the retina and the edema of the optical disc.
The terminal stage of arterial hypertension is characterized by a significant suppression of renal function, which is reflected in the level of creatinine levels, which exceeds the 177 μmol/L indicator.
Diagnosis of arterial hypertension
When performing a clinical and instrumental examination of patients with arterial hypertension, the main objective should not be so much to establish the fact of increasing blood pressure, but to detect the cause of the development of secondary arterial hypertension, the signs of damage to the internal organs, as well as evaluate the presence of the risk factors for the development of the complications of the heart profile.
With the initial contact with a sick key to establish the correct diagnosis and determine more treatment tactics, an exhaustive compilation of the patient's anamnestical data is an exhaustive compilation. An objective examination of a patient suffering from arterial hypertension allows him to determine the ethiopathogenetic form of the disease due to the detection of specific pathognomonic signs. Then, with the existing abdominal type of obesity in a patient, combined with hypertrichosis, hirsutism and a persistent increase in the diastolic component of blood pressure, the endocrine nature of the disease (iconko-doll syndrome) must be assumed. With the pheochromocytoma, accompanied by severe paroxysmal arterial hypertension, there is an increase in skin pigmentation in the projection of axillary holes. The main clinical criterion of diagnosis of renovascular arterial hypertension is the auscultation of vascular noise in the projection of the region close to stained.
The volume of laboratory research methods for arterial hypertension consists of an analysis of the patient lipidogram, the determination of uric acid and creatinine, such as the main criteria for renal dysfunction, analysis of the hormonal state of the patient.
To determine the stage of the disease, a necessary condition is the diagnosis of lesions of the objective organs, that is, organs in which irreversible changes are developed due to an increase in blood pressure. Therefore, to study the heart for deteriorated activity and organic lesion, the electrocardiographic record and ultrasound visualization are used, which are part of a standard detection exam of all patients suffering from arterial hypertension. To detect retinopathy, which is mainly observed with severe prolonged arterial hypertension, the patient's eye bottom should be examined. It is advisable to use radiation visualization methods as instrumental methods to study kidneys and brain, which are not included in the mandatory diagnostic measures, but significantly facilitate the early establishment of the correct diagnosis (computed tomography, magnetic resonance).
Treatment of arterial hypertension
The fundamental modern approach to arterial hypertension therapy is to achieve maximum elimination of the risk of developing complications of heart profile and mortality level. In this sense, the priority of the attending physician is to completely eliminate the reversible (modified) risk factors available for the patient with a greater detention of arterial hypertension and concomitant clinical manifestations. There is a certain standard, which consists in achieving the target limit of blood pressure, whose indicators should not exceed 140/90 mm Hg
In what cases should antihypertensive therapy for arterial hypertension be used? Cardiologists in their practice use the classification developed, which implies an evaluation of the "risk of developing cardiovascular complications" of the patient. According to this classification, a combined treatment using a modification of lifestyle and drug correction is subject to people with a high risk of complications of heart profile in combination with a critical increase in blood pressure numbers. Patients belonging to the category of moderate and low risk are subject to a dynamic observation for at least three months, and only in the absence of the use of correction methods not drug funds should resort to the antihypertensive treatment of the drug.
The principles of drug correction of arterial hypertension are a gradual decrease in blood pressure to objective numbers by using the minimum therapeutic dose of one or more hypotensive medications. In some situations, monotherapy with a low dose of a hypotensive drug can have a long positive effect in terms of relief of arterial hypertension. Currently, the pharmaceutical market is full of a wide range of antihypertensive medications, however, combined medications groups with prolonged hypotensive effects (up to 24 hours) are more popular.
As drugs of choice in relation to the first episode of arterial hypertension, preference should be given to diuretic agents that have a wide range of positive effects in the form of preventing the development of cardiovascular complications, reducing mortality, as well as the prevention of the progression of hypertrophy changes in the left ventricle of the heart. The pharmacological effect, accompanied by a slight decrease in blood pressure, is determined by a decrease in water and sodium resorption and a decrease in vascular resistance.
The choice of a diuretic medicine depends on the concomitant diseases in the patient. Then, with arterial hypertension, combined with signs of heart and renal failure, preference should be given to diuretic loop drugs. Tiazide diuretic agents with prolonged use can cause the development of hypocalymic and, therefore, it is better to use them in combination with aldosterone antagonists.
In a situation in which the patient has signs of arterial hypertension combined with tachyarrhythmia, angina attacks and chronic cardiovascular insufficiency symptoms of a stagnant nature, it is advisable to use a group of water blockers such as medications in the first row. The mechanism of the antihypertensive effect of these medications is to reduce cardiac release and inhibition of Renin products. It should be taken into account that breach of the dose of the drug of this group can cause a pronounced decrease in heart rate and the frequency of bronchoconstrictor, which is an absolute indication for the cancellation of the reception of the BA blocker.
It is advisable for patients suffering from arterial hypertension against the context of proteinuria. A absolute contraindication for the use of medicines from the group of Ace inhibitors is a two -way renal stenosis in the patient. The medications of the receptor receptor antagonists II of Angiotensin II have a similar hypotensive effect with the only difference is that they do not cause the development of cough and sapel of an exterotic nature, which significantly expands the scope of its application.
The medications of the group of calcium channel blockers have a pronounced hypotensive effect, which allows to stop arterial hypertension due to a decrease in calcium content in the vascular wall. The category to prescribe medications in this group are mainly older patients who, simultaneously with arterial hypertension, observe signs of ischemic myocardial damage, manifested in the development of angina attacks. In cardiological practice, exclusively prolonged forms of calcium channel blockers are used due to the fact that short -acting calcium antagonists significantly increase the risk of provocation of acute myocardial infarction.
In a situation in which arterial hypertension in the patient is combined with a violation of the rhythm of cardiac activity, it is advisable to use the category of calcium of phenylaclamins and derivatives of benzotiazepine. A absolute contraindication for the use of this category of medications is the patient's heart failure, accompanied by a decrease in the emission fraction of less than 45%.
Separately, the relief of medications of the hypertension crisis should be considered, in which there is a critical increase in the intravascular pressure number and the acute course of arterial hypertension. In this situation, preference should be given to medicines with a proclaimed antihypertensive effect, since with a prolonged course of hypertension crisis, the risk of fatal results increases considerably. With the signs of the patient of complicated hypertension crisis, the parenteral route of medication administration with a hypotensive effect is preferable. The majority of hypotensionic agents are produced in parenteral forms. As a rule, the hypotensive effect occurs no later than 5 minutes after the administration of the medication.
In the case of the uncomplicated hypertensive crisis, there is no need to use parenteral forms of antihypertensive drugs, since in this pathological condition there is no critical increase in blood pressure. The oral intake of antihypertensive agents in adequate doses allows you to reduce pressure in several hours and keep the target numbers in the future. Of course, there are currently many drug detention methods a hypertension crisis, however, to exclude the development of complications, the planned scheme of antihypertensional therapy must be applied regularly.
In the case in which arterial hypertension in the patient is of secondary nature and develops as a result of the stenosis of the renal arteries, the fundamental method of treatment is the operational correction of stenosis and revascularization by angioplasty. Operating manuals for renovascular arterial hypertension (bypass bypass, endotomy) are used only for the contraindications existing to the use of transluminal angioplasty. If the patient has signs of an aggressive arterial hypertension course due to severe unilateral nephrosisis, the only treatment is nephrectomy.
With endocrine secondary arterial hypertension, a combination of surgical treatment (radical tumor substrate split) and antihypertensional drug therapy
Arterial hypertension prevention
The fulfillment of preventive measures, whose action is intended to prevent episodes of the increase in intravascular blood pressure, as well as reducing the risk of complications of blood pressure, shows not only patients who have long suffered this pathology for a long time, but also healthy people whose signs of greater pressure can occur.
A scientifically proven fact is a direct correlation dependence on an increase in blood pressure in human body weight and, therefore, the normalization of the weight of a person suffering from high blood pressure is the main preventive event of priority. In addition, compliance with the rules for the correction of food behavior helps prevent the progression of atherosclerotic vascular lesions, which is one of the main causes of arterial hypertension.
Recent studies in the field of pharmacology have demonstrated the beneficial effects of fatty acids with Omega-3 in the restoration of blood vessels, which can also be considered an effective method for prevention of arterial hypertension. Given these conclusions, you must use olive oil in sufficient amounts daily and abruptly limit animal fat.
Of course, if you want to get rid of the manifestations of arterial hypertension, you must abandon bad habits in the form of smoking and drink alcoholic beverages, since nicotine and alcohol particles can increase intravascular blood pressure even in microdosis.
People who have already observed episodes of arterial hypertension as secondary preventive measures should be measured daily by blood pressure, to maintain a special newspaper that reflects the effectiveness of used drugable therapy, and if the new clinical manifestations worsen, without postponing the doctor who attended to this.
Arterial hypertension - What doctor will help? In the presence or suspicion of the development of arterial hypertension, you must seek advice immediately about doctors such as cardiologist, endocrinologist and nephrologist.