Arterial hypertension is a pathological or physiological predisposition to an acute or gradual increase in the indicators of systolical 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 cardiological profile diseases reaches 30%. There is a clear dependence on correlation of an increased risk of developing signs and consequences of arterial hypertension with an increase in the patient's age, and therefore the main category of increased risk is the face of mature and elderly.
Causes of arterial hypertension
The appearance of signs of increasing blood pressure in the patient can occur against the background of existing chronic diseases and therefore we are talking about a secondary or symptomatic version of arterial hypertension. In the event that arterial hypertension is primary and even after a complete examination of the patient, it is not possible to determine the cause that causes an increase in intravascular blood pressure, the term "hypertension" should be used, which is a form no -nosological independent.
Primary arterial hypertension is observed in almost 90% of cases of increased blood pressure and is currently considered the polyieological development of this pathological state. Therefore, there are risk factors not modified for arterial hypertension, which cannot be avoided (sexual, genetic and age determinism), however, these factors that cause 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, psycho -emotional instability). Together, all the provocative factors mentioned above sooner 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 determine the volume of therapeutic measures. The ethiopathogens of the development of secondary arterial hypertension should be taken to a greater extent, since without the elimination of the etiological factor that cause an increase in blood pressure, in this case it should not be expected positive results of the treatment.
Therefore, with the renewal version of symptomatic arterial hypertension, the main pathogenetic bond is the renal artery stenosis that occurs with its atherosclerotic injury or fibrous-muscular dysplasia. An extremely rare etiological factor that affects the kidney arteries is systemic vasculitis. The consequence of stenosis is the development of the ischemic lesion of one or both kidneys that cause a hyperproduction of the renin, 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 the syndrome of Celenko-Rush syndrome, of the Conn syndrome. Some cardiovascular diseases may act as a basic pathology for the development of secondary arterial hypertension, such as aorta coartation.
Symptoms of arterial hypertension
Clinical manifestations in the initial phase of the development of arterial hypertension can be completely absent and the diagnosis in this case is based only on data from an objective and instrumental-laboratory examination.
The complaints presented by patients suffering from arterial hypertension are quite non -specific and, therefore, at the debut of essential hypertension, the diagnosis is significantly difficult. In most cases, with an episode of arterial hypertension, the patient is disturbed by headaches with predominant location in the frontal and hocpipital region, acute acute acuteness especially when changing the position of the body in space, pathological noise in the ears. These manifestations are not patognomonic, therefore 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, signs of dysfunction of heart activity are observed only in the diffusion phase of arterial hypertension.
Some ethiopathogenetic forms of arterial hypertension are accompanied by the development of specific clinical symptoms, in relation to which an expert specialist can establish a correct diagnosis during the initial examination and carefully collect an anamnesis. For example, with a renewal type of arterial hypertension, an acute debut of clinical manifestations is always noticed, which consists of a strong critical and constant increase in blood pressure indicators mainly due to the diastolic component. Renewal arterial hypertension is not characterized by a crisis path, however, patient well -being with this pathology is extremely serious.
Endocrine arterial hypertension, on the contrary, is characterized by a tendency to the paroxysmal course of the disease with the development of classic hypertensive crisis. For this pathology, the patient has a clinical "paroxysmal triad", which consists in the development of a sharp headache, pronounced sweating and rapid palpitations, is characteristic. Patients who find themselves in this pathological condition have extreme psycho -emotional etchitability. 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 notice acute weakness and common headache.
Degrees and phases of arterial hypertension
Determine the severity and intensity of the clinical manifestations of arterial hypertension, as well as the stage of the development of the disease, is a prerequisite for the selection of an adequate treatment regime. The separation of arterial hypertension is based on both primary and symptomatic genesis, the level of increase in the systolic and diastolic component of blood pressure is laid.
Patients with 1 degree of arterial hypertension more often do not notice a pronounced violation of their health due to the fact that the figures of blood pressure in this situation do not exceed 159/99 mm. Rt. Art.
2 degrees of arterial hypertension are accompanied by pronounced clinical manifestations and organic changes in the target organs and the indicators of blood pressure are in the interval of 179/109 mm. Rt. Art.
3 degree of illness is distinguished by an extremely serious aggressive course and the tendency to develop complications from an altered brain and cardiac function. With the third degree, there is a critical increase in blood pressure greater than 180/110 mm. Rt. Art.
In addition to the classification of arterial hypertension in terms of gravity, in practical activities, cardiologists use the separation of the stadium of this pathology, whose criteria is the presence of signs of damage to the target organs.
In the initial phase of arterial hypertension, both primary and secondary genesis, the patient has no completely manifestations of organic injuries sensitive to an increase in the blood pressure of the fabrics and organs.
The second phase of the disease involves the development of detailed clinical symptoms, the intensity of the manifestation depends directly on the severity of the damage to the internal organs. However, in most cases, this phase of arterial hypertension is established on the basis of the instrumental confirmation of organ injuries in the form of hypertrophic cardiomyopathy of the left ventricle of the heart based on ecocardioscopy and ECG, to an arterial reducer of the retina retina when examining the levels of echocardiums based on emergency blood, to an increase in ecological creates, in slowing downArterial of the way in which the arterial levels of the creation of emerging in a moderate way is examined, an increase in ecological creates, in the arterial slowdown in the way in which the level plasma artery levels is examined.
The third stage of arterial hypertension is the terminal, in which the patient has the development of irreversible changes in all organs sensitive to the increase in blood pressure. In relation to the heart in a person who has long suffering from an increase in blood pressure, ischemic myocardial damage develops, manifested in the formation of areas of heart attack. On brain structures, arterial hypertension has a negative effect in the form of a provocation of transient ischemic attacks, hypertension encephalopathy and even the formation of ischemic stroke outbreaks. The long -term systemic increase in intravascular pressure extremely negatively influences the structure of the blood vessels, the result of which is the formation of bleeding in the retina and edema of the optical disc.
The terminal stage of the development of arterial hypertension is characterized by a significant suppression of the renal function, which is reflected on the level of creatinine levels, which exceeds the indicator of 177 μmol/l.
Diagnosis of arterial hypertension
When conducting a clinical and instrumental-laboratory 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 to evaluate the presence of risk factors for the development of the complications of the cardiac profile.
With the initial contact with a sick key to establish the correct diagnosis and determine further processing tactics, an in -depth collection of the patient's anamnestic data is an in -depth collection. An objective examination of a patient who suffers from arterial hypertension allows to determine the ethiopathogenetic form of the disease due to the detection of specific pathognomonic signs. Therefore, 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) should be taken. With feocromocytoma, accompanied by severe paroxysmal arterial hypertension, an increase in skin pigmentation in the projection of the axillary cavities is observed. The main diagnostic clinical criterion of renewal arterial hypertension is the auscultation of vascular noise in the projection of the neighbor's region.
The volume of laboratory research methods for arterial hypertension consists of an analysis of the patient lipidogram, the determination of uric acid and creatinine, as the main criteria for renal dysfunction, analysis of the patient's hormonal state.
In order to determine the stadium of the disease, a necessary condition is the diagnosis of target organ injuries, or organs in which irreversible changes are being developed due to an increase in blood pressure. Therefore, to study the heart for compromised activity and organic injury, electrocardiographic recording and ultrasound view are used, which are part of a standard screening examination of all patients suffering from arterial hypertension. In order to detect retinopathy, which is mainly observed with a serious prolonged arterial hypertension, it is necessary to examine the fund of the patient's eyes. It is advisable to use radiation display methods as instrumental methods for studying kidneys and brain, which are not included in the compulsory list of diagnostic measures, but significantly facilitate the early institution of correct diagnosis (computerized tomography, magnetic resonance imaging).
Treatment of arterial hypertension
The fundamental modern approach to arterial hypertension therapy is to achieve maximum elimination of the risk of developing complications of the cardiac profile and the level of mortality. In this regard, the priority of the attending physician is to completely eliminate the reversible risk factors (modified) available for the patient with further pharmacological arrest of arterial hypertension and concomitant clinical manifestations. There is a certain standard, which consists in reaching the target limit of blood pressure, whose indicators should not exceed 140/90 mm hg
In which cases should antihypertensive therapy for arterial hypertension be used? Cardiologists in their practice use developed classification, which implies an assessment of the "risk of developing cardiovascular complications" of the patient. According to this classification, a combined treatment that uses a modification of the lifestyle and the drug correction is subject to people with a high risk of complications of the cardiac profile in combination with a critical increase in the number of blood pressure. 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 the use of non -pharmacological correction methods must be recurring to drug antihypertensive treatment.
The principles of correction of the drug of arterial hypertension are a gradual reduction in blood pressure for 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 an 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 drugs, however, combined groups of drugs with prolonged hypotensive effects (up to 24 hours) are more popular.
As favorite drugs in relation to the first episode of arterial hypertension, preferences should be administered to diuretic agents who have a wide range of positive effects in the form of prevention of the development of cardiovascular complications, reducing mortality, as well as the prevention of the progression of hypertrophic changes in the left Ventrigliano 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 concomitant diseases existing in the patient. Therefore, with arterial hypertension, combined with signs of heart and kidney failure, preference should be given to diuretic drugs in loop. Tiazide's diuretic agents with prolonged use can cause the development of hypokalemic 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 combined with tachyarritmia, angina attacks and symptoms of chronic cardiovascular insufficiency of a stagnant nature, it is advisable to use a group of water blocking such as drugs of the front row. The mechanism of the antihypertensive effect of these drugs is to reduce the release of the heart and the inhibition of Renina products. It should be borne in mind that non -compliance with the dosage of the drug of this group can cause a pronounced declaration of the heart rate and the frequency of bronchoconstrictor, which is an absolute indication for the cancellation of the reception of the BA blocker.
It is recommended for patients suffering from arterial hypertension against the background of proteinuria. An absolute contraindication for the use of drugs of the ACE inhibitory group is a two -way renal stenosis in the patient. The drugs of angiotensin receptors II II antagonists have a similar hypotensive effect with the only difference that do not cause the development of the cough and the looting of an anhioneurotic nature, which significantly expands the scope of their application.
The medicines of the group of the group of blockers of the football channel have a pronounced hypotensive effect, allowing to stop the arterial hypertension due to a decrease in the calcium content in the vascular wall. The category for the prescription of drugs of this group is mainly older patients who, at the same time as arterial hypertension, observe signs of ischemic myocardial damage, manifested in the development of angina attacks. In cardiological practice, exclusively prolonged forms of blockers of the football channel are used due to the fact that the short -action calcium antagonists significantly increase the risk of provocation of the 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 Fenilaclaminine football category and benzotiazepine derivatives. An absolute contraindication to the use of this category of drugs is the patient's heart failure, accompanied by a decrease in the emission fraction of less than 45%.
Separately, the relief of the drug of the hypertension crisis should be considered, in which there is a critical increase in the number of intravascular pressure and the acute course of arterial hypertension. In this situation, preference should be given to drugs with a pronounced antihypertensive effect, since with a prolonged course of hypertension crisis, the risk of fatal outcome increases clearly. With the signs of the patient of complicated hypertension crisis, the parenteral path of administration of drugs with an 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 the administration of the drug.
In the case of the simple hypertensive crisis, it is not necessary 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 dosage allows you to reduce the pressure within several hours and maintain the target number in the future. Of course, at the moment, there are many drug methods that stop a hypertension crisis, however, to exclude the development of complications, the planned antihypertensional therapy scheme should be regularly applied.
In the event that the arterial hypertension in the patient is secondary and develops following the stenosis of the kidney arteries, the fundamental method of treatment is the operational correction of stenosis and re -rivascularization through angioplasty. Operating manuals for renewal arterial hypertension (bypass by shunt, endartertomy) are used only for the contraindications existing to the use of transminal angioplasty. If the patient has signs of an aggressive course of arterial hypertension due to the serious unilateral nephrosclerosis, the only treatment is neflectomy.
With Endocrine secondary arterial hypertension, a combination of surgical treatment (radical excision of the tumor substrate) and antihypertensional pharmacological therapy (spironolattone in a daily dose of 200 mg with primary aldosteronism, Pccololamine at the dose at a dose with theochromocytoma) is used) is used.
Prevention of arterial hypertension
Respect for preventive measures, whose action aims to prevent episodes of increased intravascular blood pressure, as well as to reduce the risk of complications of arterial hypertension, is shown not only to patients who have long suffering from this pathology, but also to healthy people whose signs of increase in pressure can occur.
A scientifically proven fact is a direct correlation of an increase in blood pressure in human body weight and, therefore, normalization of the weight of a person suffering from arterial hypertension is the main preventive event. In addition, respect for the rules for the correction of food behavior helps to 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 shown 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. Give these conclusions, it is necessary to use olive oil in sufficient quantities every day and strongly limit animal fat.
Of course, if you want to get rid of the manifestations of arterial hypertension, you should abandon bad habits in the form of smoke and drink alcoholic beverages, since nicotine and alcohol particles can increase intravascular blood pressure even in microdosis.
People who have already noticed episodes of arterial hypertension as secondary preventive measures should be measured daily by blood pressure, to maintain a special diary that reflects the effectiveness of used drug therapy and if they are worsening new clinical manifestations, without postponing the doctor present in this regard.
Arterial hypertension: which doctor will help? In the presence or suspicion of the development of arterial hypertension, it is necessary to immediately ask for advice on these doctors as cardiologist, endocrinologist and nephrologist.