Arterial hypertension is a pathological or physiological predisposition to a sharp or gradual increase in the indicators of systolic and diastolic blood pressure 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 with regard to the incidence of arterial hypertension is unfavorable, as the percentage of this pathology in the structure of cardiological profile disease reaches 30%. There is a clear dependence on the correlation of an increased risk of developing signs and the consequences of arterial hypertension with an increase in the patient's age, and therefore the main category of increased risk are the faces of mature and the elderly.
Causes of arterial hypertension
The appearance of blood pressure increases in the patient can occur against the backdrop of existing chronic diseases and then we are talking about a secondary or symptomatic version of arterial hypertension. In the case where arterial hypertension is primary and even after a comprehensive examination of the patient, it is not possible to determine the cause that provokes an increase in intravascular blood pressure, the term "hypertension" should be used, which is an independent nozological form.
Primary arterial hypertension is observed in almost 90% of cases of an increase in blood pressure, and the poletiological development of this pathological condition is currently considered. Thus, there are non -modified risk factors for arterial hypertension, which is not possible to avoid (sexual, genetic and age determinant), however, these provocative factors are not prevalent in the development of severe arterial hypertension. To a greater extent, the development of primary arterial hypertension is influenced by the way of human living (not balanced nutrition, bad habits, inactivity, psycho -emotional instability). Together, all of the above provocative factors early or later create favorable conditions for the pathogenetic development of arterial hypertension.
Currently, many pathogenetic theories of the development of essential arterial hypertension are considered, although these hypotheses have no effect on the patient's tactics and the determination of the volume of therapeutic masses. Ethiopathogens of development of secondary arterial hypertension should be taken into account to a greater extent, as without the elimination of the etiological factor that provokes an increase in blood pressure, in this case you should not wait for positive treatment results.
So, with the reneal version of symptomatic arterial hypertension, the main pathogenetic binding is the stenosis of the renal artery that occurs with its atherosclerotic lesion or fibrosis-muscular dysplasia. 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 two kidneys that provoke a hyperproduction of renin, which has an indirect effect on an increase in blood pressure.
In the pathogenesis of the development of the etiological endocrine form of arterial hypertension, there is an increase in the level of hormonal substances that have an increase in an increase in intravascular blood pressure, which occurs with cellenko-rush syndrome, Conn syndrome and Feoochromocytoma. Some cardiovascular diseases can act as a background pathology for the development of secondary arterial hypertension, such as aortic coarction.
Symptoms of arterial hypertension
Clinical manifestations at the initial stage of development of arterial hypertension may be completely absent, and the diagnosis in this case is based solely on data from an objective and instrumental laboratory examination.
Complaints filed by patients suffering from arterial hypertension are quite non -specific, and therefore, in 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 localization in the frontal and occipital region, sharp dizziness especially when changing the body's position in space, pathological noise in the ears. These manifestations are not pathognomonic, so it is not advisable to consider those clinical criteria for arterial hypertension, as 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, signs of dysfunction of cardiac activity are only observed at the stage of removal of arterial hypertension.
Some etiopathogenetic forms of arterial hypertension are associated with the development of specific clinical symptoms, with respect to which, an experienced specialist can create an accurate diagnosis during initial examination and completely collect an anamnesis. For example, with a renewal type of arterial hypertension, an acute debut of clinical manifestations has always been observed, which consists of a sharp critical and persistent increase in blood pressure indicators mainly due to diastolic ingredients. Renovascular arterial hypertension is not characterized by a cryis course, however, the patient's well -being with this pathology is extremely severe.
On the contrary, endocrine arterial hypertension is characterized by a tendency for the paroxysmal flow of the disease with the development of classic hypertension crises. For this pathology, the patient has a "paroxysmal trio" clinical trio, which consists of developing a sharp headache, pronounced sweating and rapid palpitations, is characteristic. Patients who are in this pathological condition have extreme psycho -emotional excitation. The development of a hypertensive crisis occurs more often at night, and the duration of clinical manifestations does not exceed more than an hour, after which patients mark sharp weakness and dull headaches.
The grade 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 choosing an adequate treatment regimen. The separation of arterial hypertension is based on primary and symptomatic genesis, the level of growth of the systolic and diastolic component of blood pressure is set.
Patients with 1 degree of arterial hypertension most often do not mark a significant violation of their 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 associated with pronounced clinical manifestations and organic changes in the target organs, and blood pressure indicators are in the interval 179/109 mm. Rt. Art.
3 degree of disease is distinguished by an extremely severe aggressive course and a tendency to develop complications from damaged brain and heart function. With the third degree, there is a critical increase in blood pressure exceeding 180/110 mm. Rt. Art.
In addition to the classification of arterial hypertension in terms of severity, in practical activities, cardiologists use the stadium division of this pathology, the criteria of which are the presence of signs of damage to the target organs.
In the initial stage of arterial hypertension, both primary and secondary genesis, the patient has no fully manifestations of organic lesions sensitive to an increase in blood pressure of tissue and organs.
The second stage of the disease involves the development of detailed clinical symptoms, the intensity of the manifestation of which depends directly on the severity of the damage to the internal organs. Howver, in Most Cases, This Stage of Arterial Hypertension is essential on the basis of instrumental confirmation of organs in the form of hypertrophic cardiomyopathy of the left ventricle of the hearting to echocardioscopy and ecg, narrowing of the arterial vessels of the retina. EYE Bottom and the Presence of Changes in the Biochemical Analysis of Blood, Namely, A Moderate Increatin in Creatinine 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 increased blood pressure. With regard to the heart in a person who has long suffered from an increase in blood pressure, the ischemic myocardial damage develops, manifested in the formation of stroke areas. In brain structures, arterial hypertension has a negative effect on the form of a provocation of transient ischemic attacks, hypertension encephalopathy, and even the formation of ischemic shock seals. Long -term systemic growth in intravascular pressure is extremely adversely affecting the structure of the blood vessels, the result of which is the formation of hemorrhages in the retina and edema of the optical disk.
The terminal stage of development of arterial hypertension is characterized by a significant suppression of renal function, which is reflected at the level of creatinine levels, which exceeds the indicator of 177 µmol/l.
Diagnosis of arterial hypertension
When performing a clinical and instrumental laboratory examination of patients with arterial hypertension, the main goal should not be so much to decide the fact of increased blood pressure, but to detect the cause of the development of secondary arterial hypertension, signs of internal organs damage, as well as assessing risk factors for the development of cardiac profile complications.
With the initial contact with a sick key to establish the correct diagnosis and determination of further treatment tactics, a complete collection of patient's anamight data is a complete collection. An objective examination of a patient suffering from arterial hypertension allows you to determine the etiopathogenetic form of the disease due to the detection of specific pathognomonic signs. So, with the existing type of abdominal abuse in a patient, combined with hypertricosis, hirsutism and a continuous increase in the diastolic ingredient of arterial pressure, the endocrine nature of the disease (iconko-koltuk syndrome) must be assumed. With fechromocytoma, accompanied by severe paroxysmal arterial hypertension, there is an increase in skin pigmentation in the projection of axillary cavities. The main clinical diagnostic criterion of renewal arterial hypertension is auscultation of vascular noise in the projection of the nearby region.
The volume of 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, the analysis of the patient's hormonal status.
To determine the stage of the disease, a necessary condition is the diagnosis of target organs lesions, that is, the organs in which irreversible changes are developing due to an increase in blood pressure. Thus, to study the heart for damaged activity and organic lesion, electrocardiographic recording and ultrasound visualization, which are part of a standard examination of all patients suffering from arterial hypertension, are used. To detect retinopathy, which is mainly observed with prolonged severe arterial hypertension, the end of the patient's eye must be examined. It is advisable to use visualization radiation methods as instrumental methods of kidney and brain study, which are not included in the mandatory list of diagnostic measures, but significantly facilitate the early creation of accurate diagnosis (calculated tomography, magnetic resonance imaging).
Treatment of arterial hypertension
The basic modern approach to arterial hypertension therapy is to achieve the maximum elimination of the risk of developing cardiac profile complications and mortality levels. In this regard, the advantage of the attending physician is to completely eliminate the reversible (modified) risk factors available to the patient with further prohibition of arterial hypertension drugs and simultaneous clinical manifestations. There is a certain standard, which consists of 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 developed classification, which implies an assessment of the "patient's risk of developing cardiovascular complications". According to this classification, a combined treatment using a lifestyle and medication correction is subject to people with a high risk of cardiac profile complications in combination with a critical increase in blood pressure numbers. Patients belonging to the moderate and low risk category are subject to dynamic observation for at least three months, and only in the absence of the effect of using non -Drug of correction should be addressed to antihypertensive drug treatment.
The principles of correction of arterial hypertension drugs are a gradual decrease in blood pressure to target numbers with the method of using the minimum therapeutic dose of one or more hypotensive drugs. In some situations, monotherapy with a low dose of a hypotensive drug can have a long positive effect in terms of ease of arterial hypertension. Currently, the pharmaceutical market is filled with a wide range of antihypertensive drugs, however, combined groups of drugs with prolonged hypotensive effects (up to 24 hours) are more popular.
As chosen medicines 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, and preventing the advancement of hypertrophic changes in the left ventricle. The pharmacological effect, coupled with a mild 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 existing accompanying diseases in the patient. So, with arterial hypertension, combined with signs of cardiac and renal failure, it should be given preference to curve diuretic medicines. Prolonged use diuretic agents can provoke the development of hypocalemic syndrome, and therefore, it is best to use them in combination with aldosterone antagonists.
In a situation where the patient has signs of arterial hypertension combined with carryarrhythmia, angina attacks and symptoms of chronic cardiovascular insufficiency of a stagnant nature, it is advisable to use a water blocking group as first row drugs. The mechanism of the antihypertensive effect of these drugs is to reduce the release of the heart and inhibit renin products. It should be borne in mind that failure to comply with the dose of the drug of this group can provoke a significant reduction in the heartbeat and the frequency of bronchoconstrictor, which is an absolute indication of cancellation.
It is advisable for patients suffering from arterial hypertension against proteinuria background. An absolute contraindication to the use of ACE inhibitory group medication is a two -way renal stenosis in the patient. The medicines of angiotensin II receptor antagonists have a similar hypotensive effect with the only difference that they do not provoke the development of coughing and sapling of an anhioneurotic nature, which significantly expands their application.
Calcium channel blocker group drugs have a pronounced hypotensive effect, allowing for stopping arterial hypertension due to a decrease in calcium content in the vascular wall. The category for describing the drugs of this group is mainly elderly patients, who, at the same time 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 for the fact that short -acting calcium antagonists significantly increase the risk of provocating acute myocardial infarction.
In a situation where arterial hypertension in the patient is combined with a violation of the rhythm of cardiac activity, it is advisable to use the category of phenyllamines calcium and benzothiazepine derivatives. An absolute contraindication to the use of this category of medication is the patient's heart failure, accompanied by a decrease in emission fraction of less than 45%.
Separately, relief of hypertension crisis medication should be taken into consideration, in which there is a critical increase in the intravascular pressure number and acute flow of arterial hypertension. In this situation, preference should be given to medication with a pronounced antihypertensive effect, as with a prolonged course of the hypertension crisis, the risk of fatal outcome increases significantly. With the signs of the patient of the complicated hypertension crisis, the parenteral route of administering medication with a hypotensive effect is preferable. Most groups of hypotensive agents are produced in parenteral forms. As a rule, the hypotensive effect occurs no later than 5 minutes after drug administration.
In the case of uncomplicated hypertensional crisis, there is no need to use parenteral forms of antihypertensive drugs, as in this pathological condition there is no critical increase in blood pressure. Oral intake of antihypertensive agents at adequate dose allows you to reduce the pressure within hours and keep the target numbers in the future. Of course, there are currently many drug methods that stop a hypertension crisis, however, to exclude the development of complications, the planned scheme of antihypertensional therapy should be applied regularly.
In the case where arterial hypertension in the patient is a secondary nature and develops as a result of renal artery stenosis, the basic method of treatment is operational correction of stenosis and revascularization by angioplasty. Operational manuals for rhinovor arterial hypertension (bypass from shunting, endarterctomy) are used only for existing contraindications for the use of transluminal angioplasty. If the patient has signs of an aggressive course of arterial hypertension due to severe unilateral nephrosclerosis, the only treatment is nephrectomy.
With secondary arterial endocrine arterial hypertension, a combination of surgical treatment (radical excision of the tumor substrate) and antihypertensional drug therapy (spironolactone at a daily dose of primary aldosteronism, pentolamine at a dose of 25 hours with theocromocytoma).
Prevention of arterial hypertension
Compliance with preventive measures whose action is aimed at preventing episodes of intravascular blood pressure growth, as well as reducing the risk of arterial hypertension complications, is indicated not only for patients who have long suffered from this pathology, but also for healthy persons, whose signs may occur.
A scientifically proven fact is a direct dependence of the correlation of an increase in blood pressure in the weight of the human body, and therefore, the normalization of a person's weight suffering from arterial hypertension is the main preventive event of priority. Moreover, compliance with the rules for correcting food behavior helps prevent the advancement of atherosclerotic vascular lesions, which is one of the leading causes of arterial hypertension.
Recent studies in the field of pharmacology have proven the beneficial effects of omega-3 fatty acids on the restoration of blood vessels, which can also be considered an effective method for preventing arterial hypertension. Given these conclusions, you should use olive oil in sufficient quantities daily and severely limit the animal's fat.
Of course, if you want to get rid of arterial hypertension manifestations, you should abandon bad habits in the form of smoking and drinking alcoholic beverages, as nicotine and alcohol particles can increase intravascular blood pressure even in microdosis.
Persons who have already noticed episodes of arterial hypertension as secondary preventive measures should be measured daily by blood pressure to keep a special diary that reflects the effectiveness of the used medication therapy, and if the new clinical manifestations are deteriorating, without pushing the physician attending this.
Arterial hypertension - which doctor will help? In the presence or suspicion of developing arterial hypertension, you should immediately seek advice for doctors such as a cardiologist, endocrinologist and nephrologist.