Arterial hypertension is a pathological or physiological disposition to a sharp or gradual increase in indicators of both systolic and diastolic components of the intravascular blood pressure, which is an independent nosological unit or is a manifestation of another pathology available in the patient.
According to world statistics, the epidemiological situation in relation to the incidence of arterial hypertension is unfavorable, since the percentage of this pathology in the structure of the diseases of the cardiological profile is 30%. There is a clear correlation dependency of an increase in risk, signs and consequences of arterial hypertension with an increase in the patient's age. Therefore, the main category of increased risk is the faces of ripe and older people.
Causes of arterial high blood pressure
The occurrence of signs of increased blood pressure in the patient can occur against the background of existing chronic diseases, and then we talk about a secondary or symptomatic version of arterial hypertension. In this case, if arterial hypertension is primary and even after a comprehensive examination of the patient, the cause that causes an increase in intravascular blood pressure cannot be determined, the term "high blood pressure" is used, which is an independent nosological form.
In almost 90% of the cases of blood pressure, primary arterial hypertension is observed, and the polyetiological development of this pathological state is currently being taken into account. Therefore, there are non -modified risk factors for arterial hypertension that cannot be avoided (sexual, genetic determinism and age). However, these provocative factors do not dominate the development of heavy arterial hypertension. The development of primary arterial hypertension is influenced to a greater extent (non -balanced diet, bad habits, inactivity, psycho -emotional instability). Together or later, all of the above -mentioned factors generate favorable conditions for the pathogenetic development of arterial hypertension.
At the moment, many pathogenetic theories on the development of essential arterial hypertension are taken into account, although these hypotheses have no influence on the patient's tactics and determine the volume of therapeutic measures. The etiopathogenic development of secondary arterial hypertension should be taken into account to a greater extent, since without the elimination of the etiological factor, they do not wait for positive treatment results in this case.
With the renovascular version of the symptomatic arterial hypertension, the main pathogenetic connection is the stenosis of renal artery, which occurs with its atherosclerotic lesion or fibrous muscular dyplasia. An extremely rare etiological factor that affects the renal arteries is systemic vasculitis. The consequence of stenosis is the development of the ischemic lesion of one or both kidneys that cause hyperproduction by Renin, which indirectly affects an increase in blood pressure.
With the pathogenesis of the development of the endocrine etiological form of arterial hypertension, the level of hormonal substances, which have a stimulating effect on an increase in intravascular blood pressure, which occurs in the syndrome of Celenko-Rush, Conn syndrome and the Feooochromocyom. Some cardiovascular diseases can act as a background pathology for the development of secondary arterial hypertension such as aorta co -cardboard.
Symptoms of arterial hypertension
Clinical manifestations in the early stages of the development of arterial hypertension can be completely missing, and in this case the diagnosis is only based on data of an objective and instrumental examination.
Complaints from patients suffering from arterial hypertension are legal, and therefore the diagnosis in the debut of essential hypertension is significantly difficult. In most cases, the patient is disturbed with an episode of arterial hypertension with a headache with predominant localization in the frontal and occipital area, especially if they change the body position in space, pathological noise in the ears. These manifestations are not pathognomonic, so it is not advisable to consider clinical criteria for arterial hypertension, since the symptoms mentioned above are regularly observed in absolutely healthy people and have nothing to do with an increase in blood pressure. Classic clinical manifestations in the form of respiratory diseases, signs of dysfunction of cardiac activity are only observed in the distant stage of arterial hypertension.
Some etiopathogenetic forms of arterial hypertension are accompanied by the development of specific clinical symptoms, in which an experienced specialist can set up a correct diagnosis during the first examination and collect an anamnesis thoroughly. For example, in the case of a renovascular nature of arterial hypertension, an acute debut of clinical manifestations is always determined, which exists mainly due to the diastolic component. The renovascular arterial hypertension is not characterized by a course of crisis. However, the patient's borehole with this pathology is extremely serious.
On the contrary, on the contrary, the endocrine arterial hypertension is characterized by a tendency towards paroxysmal course of the disease with the development of classic hypertensive crises. For this pathology, the patient has a clinical "paroxysmal triad", which exists in the development of sharp headaches, pronounced sweating and fast palpitations. Patients who are in this pathological state have extreme psychoemotional excitability. The development of a hypertensive crisis is most often at night, and the duration of clinical manifestations does not exceed more than an hour, according to which the patients determine a sharp weakness and bluntly common headache.
Degrees and stages of arterial high blood pressure
The determination of the severity and intensity of clinical manifestations of arterial hypertension and the development stage of the disease is a prerequisite for the selection of an appropriate treatment scheme. The separation of arterial hypertension is based on both the primary and the symptomatic genesis, the increase in the systolic and diastolic component of blood pressure is laid.
Patients with 1 degree of arterial hypertension most often do not notice any pronounced violation of their own health, since the blood pressure numbers do not exceed 159/99 mm in this situation. Rt. Art.
2 degrees of arterial hypertension is accompanied by pronounced clinical manifestations and organic changes in the target organs, and the blood pressure indicators are in the range of 179/109 mm. Rt. Art.
3 The degree of the disease differs in an extremely severe aggressive course and the tendency to develop complications through impaired brain and heart function. With the third degree, a critical increase in blood pressure of more than 180/110 mm is found. Rt. Art.
In addition to the classification of arterial hypertension in terms of severity, cardiologists use the stadium separation of this pathology, the criteria of which are the presence of signs of damage to target organs.
In the early stages of arterial hypertension, both primary and secondary genesis, the patient has no manifestations of organic lesions that are sensitive to increase the blood pressure of tissues and organs.
The second stage of the disease includes the development of detailed clinical symptoms, whereby the intensity of the manifestation depends directly on the severity of the damage to the internal organs. In most cases, however, this stage of arterial hypertension is based on the instrumental confirmation of organs lesions in the form of a hypertrophic cardiomyopathy of the left ventricle of the heart according to echocardioscopy and EKG, enlargement of the arterial vessels of the retina, when examining the eyes and the presence of the presence of the introchanalysis in theBay that in the eyes, and the presence of the intra -hanalysis in the bay and the presence of the intra -hanalysis. Creating level in the plasma.
The third stage of arterial hypertension is terminal in which the patient has the development of irreversible changes in all organs sensitive to increased blood pressure. With regard to the heart for a person who has been suffering from an increase in blood pressure, ischemic myocardial damage develops that manifest in the formation of infarction zones. On the structures of the brain, arterial hypertension has a negative impact on a provocation of transient ischemic attacks, high blood pressure -encephalopathy and even the formation of heroffaches of the ischemic stroke. The long -term systemic increase in intravascular pressure influences the structure of blood vessels extremely negatively, whereby the result is the formation of bleeding in the retina and the edema of the optical disc.
The termination stage of the development of arterial hypertension is characterized by significant suppression of kidney function, which is reflected at the level of creatine infinance and exceeds the indicator of 177 μmol/l.
Diagnosis of arterial hypertension
When carrying out a clinical and instrumental examination of patients with arterial high blood pressure, the main goal should not be so much to determine the fact of increasing blood pressure, but the cause of the development of secondary arterial hypertension, signs of damage to internal organs, as well as the evaluation of the presence of the risk factor for the development of the cardisic profile.
With the first contact with a sick key to creating the correct diagnosis and determining further treatment tactics, a thorough collection of the patient's anamnestic data is a thorough collection. An objective examination of a patient who suffers from arterial hypertension enables them to determine the etiopathogenetic form of the disease due to the proof of specific pathognomonic signs. The endocrine nature of the disease (iconko-doll syndrome) should be assumed with the existing grim type of obesity in a patient in combination with hypertrichosis, deerutism and a continuous increase in the diastolic component of arterial pressure. In pheochromocytoma, accompanied by severe paroxysmal painter arterial hypertension, an increase in the pigmentation of the skin is observed in the projection of the axillary hollow. The most important diagnostic clinical criterion of the renovascular arterial hypertension is the auscultation of vascular noise when projection of the almost integrated region.
The volume of the laboratory research methods for arterial hypertension consists of an analysis of the patient's lipidogram, the determination of uric acid and creatinine, as the main criteria for kidney dysfunction, analysis of the patient's hormonal status.
In order to determine the stage of the disease, a necessary disease is the diagnosis of lesions of target organs, ie organs in which irreversible changes develop due to an increase in blood pressure. In order to examine the heart for impaired activity and organic lesion, electrocardiographic registration and ultrasound visualization are used, which are part of a standard screening examination of all patients with arterial hypertension. In order to grasp the retinopathy, which is mainly observed with longer severe arterial hypertension, the patient's eye floor must be examined. It is advisable to use radiation methods of visualization as an instrumental methods for examining the kidneys and brain that are not included in the obligatory list of diagnostic measures, but rather facilitate early determination of the correct diagnosis (computer tomography, magnetic resonance imaging).
Treatment of arterial high blood pressure
The basic modern approach to the therapy of arterial hypertension is to achieve the maximum elimination of the risk of developing complications of the heart profile and the level of mortality. In this regard, the priority of the applicable doctor is to fully remove the reversible (modified) risk factors that are available to the patient with other medicines of arterial hypertension and simultaneous clinical manifestations. There is a certain standard that consists of it
In which cases should blood pressure -lowering therapy for arterial hypertension be used? Cardiologists use the developed classification in their practice, which evaluate an evaluation of the "risk of the patient, cardiovascular complications". After this classification, a combined treatment using a modification of lifestyle and drug correction is subject to people with a high risk of complications of the heart profile in combination with a critical increase in blood pressure numbers. Patients who belong to the category of moderate and low risk are subject to at least three months of dynamic observation, and only in the absence of the effect of the use of correction methods without printing should be used for a drug antihypertensive station.
The principles of pharmaceutical correction of arterial hypertension are a gradual decrease in blood pressure in order to aim the numbers using the method for using the minimal therapeutic dose of one or more bloodidable medication. In some situations, monotherapy with a low dose of a blood -pressure -lowering drug can have a long positive effect with regard to relieving arterial hypertension. The pharmaceutical market is currently filled with a variety of blood pressure -lowering medication. Combined groups of medicines with longer blood pressure -lowering effects (up to 24 hours) are most popular.
As medication of choice in relation to the first episode of arterial hypertension, diuretic remedies should be preferred that have a wide range of positive effects to prevent the development of cardiovascular complications, reduce mortality, as well as to prevent the progress of hypertrophic changes in the heart of the heart of the heart. The pharmacological effect, 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 a diuretic drug depends on the patient's simultaneous diseases. With arterial hypertension, combined with signs of heart and kidney failure, it should prefer diuretic loop medication. Tiazide diuretics with longer use can provoke the development of the hypocalaemic syndrome, 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 in combination with tachyarrhythmia, angina attacks and symptoms of chronic cardiovascular insufficiency in nature, it is advisable to use a group of water blockers as medication in the first row. The mechanism of the blood pressure -lowering effect of this medicinal product is to reduce heart release and inhibition of renin products. It should be taken into account that the non-compliance with the dose of the drug of this group can cause a pronounced acceptance of the heart rate and broncho-container frequency, which represents an absolute indication for the cancellation of the reception of BA-blockers.
It is advisable for patients who suffer from arterial hypertension against the background of the proteinuria. An absolute contraindication for the use of pharmaceuticals from the ACE inhibitor group is a two -street kidney stenosis of the patient. The drugs of Angiotensin II receptors II receptor antagonists have a similar blood pressure -lowering effect, whereby the only difference is that they do not provoke the development of cough and sapeling of an anhioneurotic nature, which significantly expands the scope of their application.
Medicines of the group of the calcium channel blocker group have a pronounced blood pressure -lowering effect, which enables arterial hypertension to stop in the vascular wall due to a decrease in calcium content. The category to prescribe medication in this group are mainly older patients who also observe signs of ischemic myocardial damage with arterial hypertension that manifest themselves in the development of angina attacks. In cardiological practice, only extended forms of calcium channel blockers are used, since short 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 heart activity, it is advisable to use the calcium category of phenylaclamines and derivatives of benzotiazepine. An absolute contraindication to the use of this drug category is the patient's heart failure, accompanied by a decrease in the emission fraction of less than 45%.
Regardless of this, the drug relief of the high blood pressure crisis should be taken into account, in which the number of intravascular pressure and the acute course of arterial hypertension trees. In this situation, medication should be granted with a pronounced blood pressure -lowering effect preference, since the risk of a fatal result increases significantly with a longer course of the high blood pressure crisis. With the signs of the patient of a complicated hypertension crisis, the parenteral path to administration of medicinal products with a blood pressure -lowering effect is preferable. Most groups of blood -part active ingredients are produced in parenteral forms. As a rule, the effect of blood pressure occurs at least 5 minutes after the drug has been administered.
With an uncomplicated hypertensive crisis, there is no parenteral forms of blood -pressure -lowering drugs, since there is no critical increase in blood pressure in this pathological state. The oral intake of blood pressure -lowering active ingredients in appropriate dosage enables you to reduce the pressure within several hours and maintain the target numbers in the future. There are currently many methods to end a high blood pressure crisis to rule out the development of complications. The planned scheme of antihypertension therapy should be used regularly.
In this case, when arterial hypertension is secondary in the patient and develops as a result of the stenosis of the renal arteries, the basic treatment method is the operational correction of stenosis and revascularization through angioplasty. Operating manuals for renovascular arterial hypertension (bypass by shunt, end arterectomy) are only used for existing contraindications for the use of transuminal angioplasty. If the patient has signs of an aggressive course of arterial hypertension due to severe one -sided nephrosclerosis, the only treatment is nephrectomy.
In the case of endocrine secondary arterial hypertension, a combination of surgical treatment (radical excision of the tumor substrate) and medicines -antihypertension therapy (spironolactone in a daily dose of 200 mg with primary aldosteronism is used, pcentolamine with a dose of 25 hours with thechromocytom)).
Prevention of arterial high blood pressure
Compliance with the preventive measures, the effect of which episodes with increasing intravascular blood pressure and the risk of complications of arterial hypertension should reduce not only patients who suffer from this pathology for a long time, but also for healthy people whose signs of increased pressure can occur.
A scientifically proven fact is a direct correlation dependency of an increase in blood pressure in the human body weight, and therefore the normalization of the weight of a person who suffers from arterial hypertension is prevented. In addition, compliance with the rules for correcting food behavior helps to prevent atherosclerotic vascular lesions from progressing, which is one of the main causes of arterial hypertension.
Recent studies in the field of pharmacology have demonstrated the advantageous effects of omega-3 fraudulent fatty acids on the restoration of blood vessels, which can also be regarded as an effective method to prevent arterial hypertension. In view of these conclusions, you should use olive oil every day in sufficient quantities and limit a limited animal fat every day.
If you want to get rid of the manifestations of arterial high blood pressure, you should of course give up bad habits in the form of smoking and drinking alcoholic beverages, since nicotine and alcohol particles can also increase intravascular blood pressure in microdoses.
People who have already found episodes of arterial hypertension as secondary preventive measures should be measured by blood pressure every day to keep a special diary that reflects the effectiveness of the drug therapy used, and if new clinical manifestations deteriorate without shifting the coveted doctor about it.
Arterial hypertension - which doctor helps? In the presence or suspicion of the development of arterial hypertension, you should immediately obtain advice such as cardiologist, endocrinologist and nephrologist.