Arterial hypertension(hypertension) is the most common disease of the cardiovascular system. Hypertension indicates stably increased blood pressure. An increase in blood pressure occurs when there is a narrowing of the arteries and/or their smaller branches - arterioles. In some people, arterioles often narrow, first due to spasm, and later their lumen remains constantly narrowed due to thickening of the wall, and then, so that the flow of blood overcame these narrowing, the work of the heart is increased and more blood is thrown into a vascular direction. In such people, as a rule, hypertension develops.
In our country, approximately 40% of the adult population have an increased level of blood pressure. At the same time, about 37% of men and 58% of women know the presence of diseases, and only 22 and 46% of them are treated. Only 5. 7% of men and 17. 5% of women properly control their blood pressure.
Arterial hypertension is a chronic disease, accompanied by a persistent increase in blood pressure above the permissible limits (systolic pressure above 139 mm Hg or (and) diastolic pressure above 89 mm Hg).
In approximately one of ten hypertension, increased blood pressure is caused by the lesion of any organ. In these cases, they speak of secondary or symptomatic hypertension. About 90% of patients suffer from primary or essential hypertension. The reference point of increased blood pressure is at least a level of 139/89 mm Hg, three -registered levels of 139/89 mm RT. Art. And more in persons who do not take drugs to reduce pressure.
Blood pressure
There are two indicators of blood pressure:
- systolic blood pressure (garden)- reflects the pressure in the arteries, which is created when the heart is reduced and blood is released into the arterial part of the vascular system;
- Diastolic blood pressure (DDAD)-the pressure in the arteries at the time of relaxation of the heart, during which it is filled before the next reduction.
Symptoms of arterial hypertension
Clinic, i. e. The manifestations of hypertension does not have specific symptoms. For many years, patients may not know about their illness, do not complain, have high life activity, although sometimes attacks of "badness", severe weakness and dizziness may occur. But even then everyone believes that this is from overwork. Although it is at this moment that you need to think about the blood pressure and measure it.
Complaints for hypertension arise if the so-called target organs are affected by the most sensitive to the rise in blood pressure. The occurrence of dizziness, headaches, noise in the head, a decrease in memory and performance indicate the initial changes in cerebral circulation. This is then joined in the eyes, flickering of flies, weakness, numbness of the limbs, difficulty in speech, but at the initial stage, changes in blood circulation are coming. The far -reaching stage of arterial hypertension can be complicated by the infarction of the brain or cerebral hemorrhage. The earliest and constant sign of constantly increased blood pressure is an increase, or hypertrophy of the left ventricle of the heart, with the growth of its mass due to thickening of the heart cells, cardiomyocytes.
First, the thickness of the wall of the left ventricle increases, and in the future, the expansion of this heart chamber also occurs. It is necessary to pay close attention to the fact that hypertrophy of the left ventricle is an unfavorable prognostic sign. In a number of epidemiological studies, it was shown that the appearance of hypertrophy of the left ventricle significantly increases the risk of sudden death, coronary artery disease, heart failure, and ventricular rhythm disorders. Progressive dysfunction of the left ventricle leads to the appearance of such symptoms as: shortness of breath at load, paroxysmal night breath (heart asthma), pulmonary edema (often with crises), chronic (congestive) heart failure. Against this background, myocardial infarction, ventricular fibrillation are more common.
With gross morphological changes in the aorta (atherosclerosis), it expands, its stratification, rupture can occur. The lesions of the kidneys are expressed by the presence of protein in the urine, microhematuria, and cylinder. However, renal failure with hypertension, if there is no malignant course, rarely develops. Eye damage can be manifested by impairment of vision, a decrease in light sensitivity, and the development of blindness. Thus, it is quite obvious that hypertension should be treated more carefully.
Risk factors of arterial hypertension
Unhanged risk factors include:
- Heredity - people who have patients with hypertension among relatives are most predisposed to the development of this pathology in them.
- The male floor - it has been established that the incidence of men arterial hypertension is significantly higher than the incidence of women. But the fact is that female sex hormones, estrogens impede the development of hypertension. But such protection, unfortunately, is short -lived. The menopausal period occurs, the saving effect of estrogens ends and women are aligned in incidence with men and often overtake them.
Changed risk factors include:
- Increased body weight - in people with excess body weight, the risk of developing arterial hypertension is higher;
- A sedentary lifestyle - in another hypodynamia, a sedentary lifestyle and low physical activity lead to obesity, which in turn contributes to the development of hypertension;
- In alcohol consumption, excessive alcohol consumption promotes arterial hypertension.
- Eating a large amount of salt in food - a highly salt diet helps to increase pressure. Here the question arises of how much salt can be consumed per day? The answer is short: 4. 5 grams or a teaspoon without a top.
- An unbalanced diet with an excess of atherogenic lipids, excessive calorie content, leading to obesity and promoting the progression of type II diabetes. Atherogenic, i. e. , literally, "creating atherosclerosis" lipids are contained in large quantities in all animal fats, meat, especially pork and lamb;
- Smoking is another variable and formidable factor in the development of arterial hypertension and its complications. The fact is that tobacco substances, including nicotine, create a constant spasm of the arteries, which is fixed, leads to the rigidity of the arteries, which entails an increase in pressure in the vessels;
- Stress - lead to activation of a sympathetic nervous system that performs the function of an instant activator of all body systems, including cardiovascular. In addition, pressor, i. e. , causing an spasm of arteries, hormones, are thrown into the blood. All this, as with smoking, leads to the rigidity of the arteries and arterial hypertension develops;
- Rough sleep disturbances by the type of night apnea syndrome, or snoring. Snoring is a truly scourge of almost all men and many women. Why is snoring dangerous? The fact is that it causes an increase in pressure in the chest and abdominal cavity. All this is reflected on the vessels, leading to their spasm. Arterial hypertension develops.
Causes of arterial hypertension
The cause of the disease remains unknown in 90-95 % of patients-this is essential (that is, primary) arterial hypertension. In 5-10% of cases, an increase in blood pressure has an established cause-this is a symptomatic (or secondary) hypertension.
Causes of symptomatic (secondary) arterial hypertension:
- Primary kidney damage (glomerulonephritis) is the most common cause of secondary arterial hypertension;
- one- or bilateral narrowing (stenosis) of the renal arteries;
- Coarctation (congenital narrowing) of aorta;
- Feochromocytoma (adrenal tumor producing adrenaline and norepinephrine);
- hyperaldosteronism (tumor of the adrenal glands that produces aldosterone);
- thyrotoxicosis (increase in thyroid function);
- ethanol consumption (wine alcohol) more than 60 ml per day;
- Medicines: hormonal drugs (including oral contraceptives), antidepressants and others;
Risk factors for cardiovascular complications with arterial hypertension
Basic:
- Men over 55 years old;
- women over 65 years old;
- The level of total blood cholesterol> 6. 5 mmol/l, an increase in the level of low -density lipoprotein cholesterol (> 4. 0 mmol/l) and low high -density lipoprotein cholesterol;
- family history of early cardiovascular diseases (in women <65 years old, in men <55 years);
- abdominal obesity (waist volume ≥102 cm for men or ≥ 88 cm for women);
- level C - reactive protein in the blood ≥1 mg/dl;
- Diabetes mellitus (blood glucose on an empty stomach> 7 mmol/l).
Additional:
- violation of glucose tolerance;
- low physical activity;
- Improving the level of fibrinogen.
Note. The accuracy of determining the general cardiovascular risk directly depends on how complete the clinical and instrumental examination of the patient was.
Complications for arterial hypertension
Among the most significant complications of arterial hypertension are:
- hypertensive crises;
- cerebrovascular disorders (hemorrhagic or ischemic strokes);
- myocardial infarction;
- nephrosclerosis (primary wrinkled kidney);
- heart failure;
- Relacing the aneurysm of the aorta.
Studies for arterial hypertension
In all patients with arterial hypertension, the following studies need to be carried out:
- general blood and urine test;
- the level of creatinine in the blood (to exclude kidney damage);
- the level of potassium in the blood outside the use of diuretics (a sharp decrease in potassium levels is suspicious of the presence of an adrenal tumor or stenosis of the renal artery);
- electrocardiogram (signs of left ventricular hypertrophy - evidence of a long course of arterial hypertension);
- determination of the level of glucose in the blood (on an empty stomach);
- the content of the blood of total cholesterol, cholesterol of high and low density, triglycerides, uric acid;
- Echocardiography (determining the degree of hypertrophy of the left ventricular myocardium and a state of contractile capacity)
- Study of the eye bottom.
- chest radiography;
- Ultrasound of the kidneys and adrenal glands;
- Ultrasound of brachiocephalous and renal arteries;
- C-reactive protein in blood serum;
- urine analysis for the presence of bacteria (bacteriuria), quantitative estimate of protein in the urine (proteinuria);
- Determination of microalbumin in the urine (mandatory in the presence of diabetes).
- Assessment of the functional state of cerebral blood flow, myocardial, kidneys;
- Examination in the blood of the concentration of aldosterone, corticosteroids, radio activity;
- determination of catecholamines and their metabolites in daily urine;
- abdominal aortography;
- Computed tomography or magnetic resonance tomography of the adrenal glands and brain.
Treatment of arterial hypertension
The main goal of treating patients with arterial hypertension is the maximum decrease in the risk of developing cardiovascular complications and death from them. This is achieved by long -term lifelong therapy aimed at:
- decrease in blood pressure to a normal level (below 140/90 mm Hg). With a combination of arterial hypertension with diabetes or kidney damage, it is recommended to reduce blood pressure <130/80 mm Hg. (but not lower than 110/70 mm Hg);
- "Protection" of target organs (brain, heart, kidneys), preventing their further damage;
- Active impact on adverse risk factors (obesity, hyperlipidemia, carbohydrate disorders, excess salt consumption, hypodynamia), contributing to the progression of arterial hypertension and the development of its complications.
- Refusal of smoking;
- normalization of body weight (body mass index <25 kg/m2);
- decrease in alcoholic beverages <30 g of alcohol per day in men and 20 g/day in women;
- Increase in physical activity-regular physical activity of 30-40 minutes. at least 4 times a week;
- reduction in consumption of table salt to 5 g/day;
- A change in the diet with an increase in vegetable food consumption, a decrease in vegetable fat consumption, an increase in potassium, calcium in vegetables, fruits, cereals, and magnesium contained in dairy products.
The basic principles of drug therapy of arterial hypertension:
Medication treatment should begin with minimal doses of any class of antihypertensive drugs (given the appropriate contraindications), gradually increasing the dose until a good therapeutic effect.
The choice of the drug should be justified, the antihypertensive drug should provide a stable effect during the day and be well tolerated by the patients.
It is most advisable to use long-acting drugs to achieve a 24-hour effect with a single use. The use of such drugs provides a softer hypotensive effect with a more intense protection of target organs.
With the low effectiveness of monotherapy (therapy with one drug), it is advisable to use the optimal combinations of the drugs to achieve maximum hypotensive effects and minimal side effects.
It is necessary to carry out a long (practically lifelong) administration of drugs to maintain the optimal level of blood pressure and prevent complications of arterial hypertension.
The choice of the necessary drugs:
Currently, seven classes of drugs are recommended for the treatment of arterial hypertension:
- diuretics;
- b-blockers;
- calcium antagonists;
- angiotensin-reproductive enzyme inhibitors;
- angiotensin receptor blockers;
- Higanist receptor agonists
- AD-blockers.
- The unclear diagnosis and the need for special, more often invasive, research methods to clarify the form of arterial hypertension;
- Difficulties in the selection of drug therapy are frequent hypertensive crises, refractory arterial hypertension.
- Hypertensive crisis, not stopping at the prehospital stage;
- Hypertensive crisis with pronounced manifestations of hypertensive encephalopathy (nausea, vomiting, confusion);
- Complications of hypertension, requiring intensive care and constant medical observation: brain stroke, subarachnoid hemorrhage, acute visual impairment, pulmonary edema, etc.