Arterial hypertension(Hypertension) is the most common disease in the cardiovascular system. Hypertension indicates a steady increase in blood pressure. Blood pressure increases when arteries are stenosis and/or their arterioles are stenosis. In some people, arterioles are usually narrowed due to spasms and are then continually narrowed due to thickening of the walls. Then, the flow of blood overcomes these narrow stenosis, the work of the heart is increased, and more blood is thrown in the direction of the blood vessels. Usually, in such people, hypertension develops.
In our country, blood pressure levels in about 40% of the adult population increase. Meanwhile, about 37% of men and 58% of women are aware of the disease, and only 22% and 46% of women are treated. Only 5. 7% of men and 17. 5% of women control their blood pressure appropriately.
Arterial hypertension is a chronic disease accompanied by a continuous increase in blood pressure above the permissible limit (systolic blood pressure above 139 mm Hg or (and) diastolic blood pressure above 89 mm Hg).
Of the ten types of hypertension, about one, elevated blood pressure is caused by any organ lesions. In these cases, they talked about secondary or symptomatic hypertension. About 90% of patients suffer from primary hypertension. The reference point for blood pressure elevation was at least 139/89 mm Hg level, and the three registered levels were 139/89 mm RT. Art. There are many more people who don’t take drugs to relieve stress.
blood pressure
There are two indicators of blood pressure:
- Systolic blood pressure (garden) - reflects the pressure of the artery, which is generated when the heart is reduced and released to the arterial part of the vascular system;
- Diastolic blood pressure (DDAD) - The pressure of the artery is filled before the next reduction when the heart is relaxed.
Symptoms of arterial hypertension
There are no specific symptoms in the clinic, i. e. the manifestation of hypertension. Over the years, patients may not know their illness, don't complain, and live a high life, although sometimes "badness", serious weaknesses and dizzy attacks. But even then, everyone thinks it is due to overwork. Although for the moment you need to consider your blood pressure and measure it.
If the so-called target organ is affected by increased blood pressure, complaints of hypertension will occur. Dizziness, headache, the occurrence of head noise, memory loss and performance decreases indicate initial changes in brain circulation. Then connect it to the eyes, flies flash, weakness, numbness of limbs, difficulty in speaking, but in the initial stage, changes in blood circulation are coming. Infarctions in cerebral or cerebral hemorrhage may complicate the distant extension stage of arterial hypertension. The earliest and constant sign of increasing blood pressure is hypertrophy or hypertrophy in the left ventricle of the heart, due to thickening of heart cells, thickening of cardiomyocytes, and growth of its mass.
First, the thickness of the left ventricle wall increases, and this expansion of the heart chamber will occur in the future. It is necessary to pay close attention to left ventricular hypertrophy as an adverse prognosis sign. In many epidemiological studies, the emergence of left ventricular hypertrophy significantly increases the risk of sudden death, coronary artery disease, heart failure and ventricular rhythmic diseases. Progressive dysfunction in the left ventricle leads to symptoms such as short circuits in breathing, paroxysmal night breathing (heart asthma), pulmonary edema (usually with a crisis), chronic (congestive) heart failure. In this context, myocardial infarction and ventricular fibrillation are more common.
As the aorta (atherosclerosis) changes in morphology, it expands, stratifies, ruptures. Lesions in the kidney are expressed through the presence of proteins in urine, microscopic and cylinders. However, renal failure and hypertension rarely develop without a malignant course. Vision impairment, reduced light sensitivity, and development of blindness can show damage to the eyes. Therefore, it is obvious that hypertension should be treated more carefully.
Risk factors for arterial hypertension
Inanimate risk factors include:
- Genetics - This pathological development is most likely to occur among relatives with hypertension.
- Male Flooring - The incidence of arterial hypertension in men has been determined to be significantly higher than that in women. But the fact is that female sex hormones, estrogens, hinder the development of hypertension. Unfortunately, this protection is short-lived. The period of menopause occurs, and the saving effect of estrogen and women and men occur and often exceeds them.
Risk factors for change include:
- Weight gain - People who are overweight are at a higher risk of arterial hypertension;
- A sedentary lifestyle – In another sexual sex, a sedentary lifestyle and lower physical exercise lead to obesity, which in turn leads to the development of high blood pressure.
- During alcohol consumption, excessive drinking can promote arterial hypertension.
- Eat a lot of salt in foods - A high-salt diet helps increase stress. The question here is how much salt can be consumed every day? The answer is short: 4. 5 grams or no teaspoon on top.
- An imbalanced diet, excessive atherosclerotic lipids, excessive calorie content, leads to obesity and promotes progression of type II diabetes. Atherosclerosis, i. e. , literally, "produce atherosclerosis" lipids are contained in a large amount in all animal fats, meat, especially pork and lamb;
- Smoking is another variable and powerful factor in the development of arterial hypertension and its complications. The fact is that tobacco substances, including nicotine, produce constant spasms of fixed arterial spasms, resulting in rigidity of the arteries, which leads to increased pressure in the blood vessels.
- Stress - causes activation of the sympathetic nervous system, which performs the functions of instant activators (including cardiovascular) of all body systems. In addition, the applicator, that is, causes arterial spasm, and hormones, are thrown into the blood. Like smoking, all of this can lead to rigidity in arterial and arterial hypertension.
- Night apnea syndrome or type of sleep disorders that are called Nor. Beating S is the real scourge of almost all men and many women. Why is it dangerous to sniff nores? The truth is, it causes increased pressure in the chest and abdominal cavity. All of this is reflected in the blood vessels, causing them to spasm. Arterial hypertension develops.
Causes of arterial hypertension
The cause of the disease remains unknown in 90-95% of patients - this is essential (i. e. , major) arterial hypertension. In 5-10% of cases, the increase in blood pressure has an established cause - this is a symptomatic (or secondary) hypertension.
Causes of symptomatic (secondary) arterial hypertension:
- Primary renal injury (glomerular nephritis) is the most common cause of secondary arterial hypertension.
- Single or bilateral stenosis of renal artery (stenosis);
- shortening of the aorta (congenital stenosis);
- pheochromocytoma (adrenal tumor that produces epinephrine and norepinephrine);
- Thyroidosis (tumors of the adrenal gland produce aldosterone);
- Thyroid toxicity (increased thyroid function);
- Ethanol consumption (wine) exceeds 60 ml per day;
- Drugs: Hormonal drugs (including oral contraceptives), antidepressants, etc. ;
Risk factors for cardiovascular complications with arterial hypertension
Basic:
- Men over 55 years old;
- Women over 65 years of age;
- Total blood cholesterol >6. 5 mmol/L level, LDL cholesterol (>4. 0 mmol/L) and LDL cholesterol levels increased;
- Family history of early cardiovascular disease (in<65 years old female, male<55 years old);
- Abdominal obesity (waist circumference of men ≥102cm, women ≥88cm);
- Grade C - Reactive protein in the blood ≥1mg/dL;
- Diabetes (blood sugar on an empty stomach >7 mmol/L).
Additional:
- Invasion of glucose tolerance;
- Low physical exercise;
- Improve fibrinogen levels.
notes. The accuracy of determining general cardiovascular risk depends directly on the patient's clinical and instrumental examination intact.
Complications of arterial hypertension
One of the most important complications of arterial hypertension is:
- Hypertension crisis;
- Cerebrovascular disease (hemorrhage or ischemic stroke);
- Myocardial infarction;
- renal sclerosis (primary kidney);
- Heart failure;
- Aneurysm that releases the aorta.
Arterial hypertension study
In all patients with arterial hypertension, the following studies are required:
- General blood and urine tests;
- creatinine levels in the blood (ruling out kidney damage);
- Use levels of potassium in the blood other than diuretics (potassium levels are sharply reduced, and the presence of adrenal tumors or renal artery stenosis is believed to be present);
- ECG (signs of left ventricular hypertrophy - long-term evidence of arterial hypertension);
- Determine glucose levels in the blood (fasting);
- Total cholesterol, high and low density, triglycerides, uric acid blood content;
- Echocardiography (determines the hypertrophy and contractility status of the left ventricular myocardium)
- Study the fundus.
- Chest radiography;
- Ultrasound of the kidneys and adrenal glands;
- Ultrasound of the carpal bone and renal artery;
- C-reactive protein in serum;
- Urine analysis of the presence of bacteria (bacteria), quantitative estimate of protein in urine (proteinuria);
- Determination of microalbumin in urine (the presence of diabetes).
- Assess the functional status of cerebral blood flow, myocardium, and kidneys;
- Check for aldosterone concentrations, corticosteroids, radio activity blood;
- Determination of catecholamines and their metabolites in daily urine;
- Abdominal aortic angiography;
- Computed tomography or magnetic resonance tomography of the adrenal glands and brain.
Arterial hypertension treatment
The main goal of treating patients with arterial hypertension is to develop cardiovascular complications and the greatest risk of death. This is achieved through long-term lifelong therapy.
- Lower blood pressure to normal levels (below 140/90 mm Hg). It is recommended to lower blood pressure by combining arterial hypertension with diabetes or kidney damage<130/80 mm Hg. (but not less than 110/70 mm Hg);
- "Protection" of the target organ (brain, heart, kidney) to prevent further damage;
- Positive effects on adverse risk factors (obesity, hyperlipidemia, carbohydrate disease, excessive salt consumption, hypoarthritis) contribute to the development of arterial hypertension and its complications.
- Refuse to smoke;
- Normalization of weight (BMI)<25 kg/m2);
- Daily alcoholic beverages for men<30 g alcohol consumption and female 20 g/day reduction;
- Increase sports activities by 30-40 minutes. At least 4 times a week;
- Reduce salt consumption to 5 g/day;
- Diet changes as plant food consumption increases, vegetable fat consumption decreases, potassium increases, calcium in vegetables, fruits, grains and magnesium, dairy products contain dairy products.
The basic principles of arterial hypertension drug treatment:
Drug treatment should start with the minimum dose of any class of antihypertensive drugs (considering appropriate contraindications) and gradually increase the dose until good therapeutic effect.
The choice of this drug should be reasonable, and antihypertensive drugs should provide stable effects during the day and be tolerated by the patient.
It is most recommended to use long-acting drugs to achieve 24 hours of effect in one use. The use of this drug provides a softer antihypertensive effect and provides stronger protection to the target organs.
Because of the low effectiveness of monotherapy (one drug treatment), it is recommended to use the best combination of drugs to achieve maximum blood pressure and minimal side effects.
It is necessary to administer the drug for a long (actually) period to maintain optimal blood pressure levels and prevent arterial hypertension complications.
Select the necessary medications:
Currently, it is recommended to use seven types of drugs to treat arterial hypertension:
- diuretics;
- Block B;
- calcium antagonists;
- Angiotensin-optimized enzyme inhibitor;
- angiotensin receptor blockers;
- Higanist receptor agonist
- Advertising block.
- Unclear diagnosis and the need for clarification of the special, invasive research methods in the form of arterial hypertension;
- Difficulty in choosing medications is a common hypertension crisis, refractory arterial hypertension.
- Hypertension crisis does not stop in the pre-hospital stage;
- Hypertension crisis, with obvious signs of hypertensive encephalopathy (nausea, vomiting, confusion);
- Complications of hypertension require intensive care and continuous medical observation: brain, subarachnoid hemorrhage, acute visual disorders, pulmonary edema, etc.