Arterial hypertension is a pathological or physiological tendency to a sharp or gradual increase in the second indicator of the systolic and diastolic components of intravascular blood pressure, which occurs as an independent nosological unit or is another pathological manifestation of patients.
According to world statistics, epidemiological conditions in terms of the incidence of arterial hypertension are not profitable, as the percentage of this pathology in the cardiological profile disease structure reaches 30%. There is a clear correlation dependence on the increased risk of developing signs and the effects of arterial hypertension with increasing the age of the patient, and thus the main category of increased risk is mature and old.
Causes of arterial hypertension
The appearance of increased blood pressure signs in patients can occur in the background of existing chronic diseases and then we talk about the version of the secondary artery hypertension or symptoms. In cases where arterial hypertension is primarily and even after a comprehensive examination of the patient, it is not possible to determine the cause of increased intravascular blood pressure, the term "hypertension" should be used, which is a nosology form.
Major arterial hypertension is observed in almost 90% of cases of increased blood pressure, and the development of polyethiological conditions of this pathology is now considered. Therefore, there are unregulated risk factors for arterial hypertension, which is unlikely to be avoided (determinism and sexual age, sexual), however, these provocative factors are not dominant in the development of severe arterial hypertension. To the highest, the development of major arterial hypertension is influenced by the human lifestyle (not a balanced diet, bad habits, inactivity, psycho instability). Together, all the provocations of the above slowly create favorable conditions for the pathogenetic development of arterial hypertension.
Currently, many pathogenetic theories of arterial hypertension are important, although these hypotheses do not affect the patient's tactics and determine the number of therapeutic measures. Ethiopathogenes The development of secondary arterial hypertension should be taken into account at a larger level, because without the removal of etiological factors that cause increased blood pressure, in this case, you do not have to wait for positive treatment results.
Therefore, with the renovascular version of the arterial hypertension, the main pathogenetic link is the kidney artery stenosis that occurs with atherosclerotic lesions or fibrous displacements. Very rare etiological factors that affect the kidney artery are systemic vasculitis. As a result of stenosis is the development of one or second ischemic lesions -two kidneys that cause renin hyperproduction, which has an indirect effect on increased blood pressure.
In the developmental pathogenesis of endocrine etiological forms of arterial hypertension, there is an increase in hormone levels that have a stimulating effect on increased intravascular blood pressure, which occurs with celenko-rush syndrome, syndrome and feoochromocytoma. Some cardiovascular diseases can act as a background pathology for the development of secondary artery hypertension, such as aortic connectivity.
Symptoms of arterial hypertension
Clinical manifestations in the early stages of the development of arterial hypertension may not be completely present, and the diagnosis in this case is based solely on data from objective and instrumental-macmal examinations.
The complaints presented by patients suffering from arterial hypertension are quite specific, and therefore, in essential hypertension debut, the diagnosis is very difficult. In most cases, with episodes of arterial hypertension, the patient is disrupted by headaches with major localization in the frontal and occipital regions, sharp dizziness especially when changing body position in space, pathological sounds in the ear. This manifestation is not pathognomonic, so it is not advisable to consider them clinical criteria for arterial hypertension, as the above symptoms are regularly observed in true people -are healthy and have nothing to do with increased blood pressure. Classical clinical manifestations in the form of respiratory disorders, signs of cardiac activity dysfunction are only observed in the remote arterial hypertension.
Some forms of etiopatogenetic arterial hypertension are accompanied by the development of certain clinical symptoms, in relation to which, experienced specialists can establish the correct diagnosis during preliminary examination and collect anamnesis as a whole. For example, with the type of renovascular artery hypertension, acute debut of clinical manifestations is always observed, consisting of critical and continuous increases in blood pressure indicators mainly due to diastolic components. Renovascular artery hypertension is not characterized by a course of crisis, however, the well -being of patients with this pathology is very severe.
Endocrine artery hypertension, on the other hand, is characterized by a tendency to the paroxysmal disease course with the development of classic hypertension crisis. For this pathology, the patient has a clinical "paroxysmal" triad, which consists of the development of sharp headaches, sweat removed and fast -paced, is a feature. Patients who are in this pathological condition have extreme psycho fun. The development of the hypertension crisis occurs most frequently at night, and the clinical manifestation does not exceed one hour, after which the patient has recorded sharp weakness and boring headache.
Degrees and levels of arterial hypertension
Determining the severity and intensity of clinical manifestations of arterial hypertension, as well as the stage of the development of the disease, is a prerequisite for the selection of adequate treatment regimens. The separation of arterial hypertension is based on both primary genesis and symptoms, the level of increased systolic and diastolic components of blood pressure.
Patients with 1 degree arterial hypertension that most often do not pay attention to their own health violations due to the fact that blood pressure numbers in this situation do not exceed 159/99 mm. Rt. Art.
2 degrees arterial hypertension is accompanied by clear clinical manifestations and organic changes in the target organs, and indicators of blood pressure are within 179/109 mm. Rt. Art.
3 degrees of the disease are distinguished by very severe aggressive courses and a tendency to develop complications from brain and heart function. With a third degree, a critical increase in blood pressure above 180/110 mm was observed. Rt. Art.
In addition to the classification of arterial hypertension in terms of severity, in practical activities, cardiologists use the separation of this pathological stadium, the criteria that signs damage to the target organs.
In the early stages of arterial hypertension, both primary and secondary genesis, the patient completely lacked manifestations of organic lesions that were sensitive to increased blood pressure and organs.
The second stage of the disease involves the development of detailed clinical symptoms, the intensity of the manifestation that directly depends on the severity of damage to the internal organs. However, in most cases, this level of arterial hypertension is established on the basis of instrumental verification of organ lesions in the form of hypertropic cardiomyopathy of the left ventricle according to echocardioscopy and ECG, narrowing the retina. Increased creatinine levels in level plasma.
The third stage of arterial hypertension is terminal, where patients have an irreversible change in all organs sensitive to increased blood pressure. With regard to the liver in a person who has long experienced increased blood pressure, ischemic myocardial damage develops, shown in the formation of the infarction zone. In the brain structure, arterial hypertension has a negative effect in the form of temporary ischemic attacks, hypertension encephalopathy as well as the formation of ischemic stroke foci. The long systemic improvement in intravascular pressure greatly has a negative effect on the structure of the blood vessels, the result is the formation of bleeding in the retina and optic disc edema.
The terminal level of the development of arterial hypertension is characterized by a significant suppression of kidney function, which is reflected at the level of creatinine, which exceeds the 177 μmol/l indicator.
Diagnosis of arterial hypertension
When conducting clinical examination and instrumental-instrumental patients with arterial hypertension, the main goal is not necessarily to create a fact of increased blood pressure, but to detect the cause of the development of secondary arterial hypertension, signs of damage to the internal organs, as well as evaluate the presence of risk factors for the development of cardiac complications.
With the initial contact with the pain key to create the right diagnosis and determine further treatment tactics, the patient's collection of anamnestic data is a comprehensive collection. Objective examination of patients suffering from arterial hypertension allows you to determine the etiopatogenetic form of the disease due to the detection of certain pathognomonic signs. Therefore, with the existing type of abdominal obesity in the patient, combined with hypertrichosis, hirsutism and continuous improvement in the diastolic component of arterial pressure, the endocrine nature of the disease (Iconko-doll syndrome) should be assumed. With pheochromocytoma, accompanied by severe paroxysmal arterial hypertension, increased skin pigmentation in axillary hole projection is observed. The main diagnostic clinical criterion of renovascular artery hypertension is a vascular sound auscultation in a nearby region's projection.
The number of laboratory research methods for arterial hypertension consists of patient lipidogram analysis, uric acid determination and creatinine, as the main criterion for kidney dysfunction, patient hormone status analysis.
To determine the level of the disease, the required condition is the diagnosis of target organ lesions, that is, the organ where irreversible changes develop due to increased blood pressure. Therefore, to study the heart for affected activities and organic lesions, electrocardiographic registration and ultrasound visualization are used, which is part of the standard examination of all patients suffering from arterial hypertension. To detect retinopathy, which is mainly observed with severe arterial hypertension, the lower part of the patient's eyes must be examined. It is advisable to use visualization radiation methods as an instrumental method for studying kidneys and brain, which is not included in the mandatory list of diagnostic steps, but significantly facilitates the early formation of proper diagnosis (computed tomography, magnetic resonance imaging).
The treatment of arterial hypertension
The basic modern approach to arterial hypertension therapy is to achieve maximum removal of the risk of developing heart profile complications and death levels. In this regard, the priority of the attending physician is to eliminate the reversible (modified) risk factors available to patients with further medications stopping arterial hypertension and clinical manifestations. There are certain standards, consisting of reaching the target boundaries of blood pressure, indicators that cannot exceed 140/90 mm Hg
In what case, antihypertensive therapy is used for arterial hypertension? Cardiologists in their practice use the classification developed, which implies the assessment of "risk of developing cardiovascular complications" patients. According to this classification, combined treatment using lifestyle modification and drug correction is subject to people with high risk of heart profile complications in combination with critical increases in blood pressure. Patients with moderate categories and low risk are subject to dynamic observations for at least three months, and only in the absence of the effect of using non -sinking correction methods should be taken for the treatment of drug antihypertensive.
Principles of correction of arterial hypertension drugs are a gradual decrease in blood pressure to target numbers by using a minimum therapeutic dose of one or more hypotension drugs. In some cases, monotherapy with low doses of hypotension drugs may have a long positive effect in terms of relieving arterial hypertension. Currently, the pharmaceutical market is filled with a variety of antihypertensive drugs, however, a combination of drugs with prolonged hypotension (up to 24 hours).
As a choice of choice related to the first episode of arterial hypertension, priority should be given to diuretic agents that have a variety of positive effects in the form of preventing the development of cardiovascular complications, reducing death, and the prevention of hypertrophic changes in the left ventricle of the heart. Pharmacological effects, accompanied by mild decreases in blood pressure, are determined by decreased water and reabsorption of sodium and decreased vascular resistance.
The choice of diuretic drug depends on the same disease that is present in the patient. Therefore, with arterial hypertension, combined with signs of heart and kidney failure, it should be given priority to diuretic loop. Tiazide diuretic agents with prolonged use can lead to the development of hypokalemic syndrome, and therefore, it is best to use it in combination with aldosterone antagonists.
In situations where patients have signs of arterial hypertension combined with tachyarrhythmia, angina attacks and symptoms of chronic cardiovascular deficiency, it is advisable to use a group of water blockers as the first line drug. The mechanism of antihypertensive effects of these drugs is to reduce heart release and prevent renin products. Keep in mind that non-compliance with the dose of this group can cause a decrease in heart rate and the frequency of bronchoconstrictor, which is an absolute indication of the cancellation of BA-blocker acceptance.
It is advisable for patients suffering from arterial hypertension to the background of proteinuria. Absolute contraindications to the use of drugs -ACE inhibitors are two -way kidney stenosis in patients. Angiotensin II II receptor antagonist drugs have the same hypotension effect as one difference that they do not cause the development of cough and anhioneurotic properties, which expands the scope of their application.
Drugs of groups of calcium channel blockers have a clear hypotension effect, which allows to stop arterial hypertension due to decreased calcium content on the vascular wall. The category for prescribing drugs of this group is older patients who, simultaneously with arterial hypertension, observe the signs of ischemic myocardial damage, which is shown in the development of angina attacks. In cardiological practice, the exclusive form of calcium channel blocker is used due to the fact that short calcium antagonists significantly increase the risk of provocative acute myocardial infarction.
In cases where arterial hypertension in patients is combined with rhythm infringement of heart activity, it is advisable to use the calcium phenylaclamins and benzotizepine derivatives. Absolute contraindications to the use of this drug category is the patient's heart failure, accompanied by a decrease in the release of less than 45%.
Separately, the release of hypertension crisis should be considered, where there is a critical increase in the number of intravascular pressures and acute courses of arterial hypertension. In this case, priority should be given to drugs with clear antihypertensive effects, as with prolonged hypertension crisis, the risk of fatal outcome increases significantly. With the signs of complicated hypertension crisis, the parenteral road administration of the drug -the treatment of the hypotension is better. Most groups of hypotension agents are produced in parenteral form. As a rule, the hypotension effect occurs no later than 5 minutes after drug administration.
In the case of uncomplicated hypertension crisis, there is no need to use the parenteral form of antihypertensive drugs, as in this pathological condition there is no critical increase in blood pressure. The oral intake of antihypertensive agents in sufficient doses allows you to reduce stress within hours and maintain the target number in the future. Of course, there are currently many drug methods that stop the hypertension crisis, however, to exclude the development of complications, the planned scheme of antihypertensive therapy should be used regularly.
In cases when arterial hypertension in patients is secondary and develops due to kidney artery stenosis, the basic method of treatment is the correction of stenosis and revascularization by angioplasty. The operating manual for renovascular arterial hypertension (bypass by shunting, endarterctomy) is only used for existing contraindications for transuminal angioplasty use. If the patient has signs of aggressive arterial hypertension course caused by severe unilateral nephrosclerosis, one treatment is nephrectomy.
With endocrine secondary arterial hypertension, a combination of surgical treatment (radical separation of tumor substrates) and drug antihypertensive therapy (Spironolactone in daily dose of 200 mg with primary aldosteronism, pcentolamine at a 25 -hour dose with theochromocytoma) is used.
Prevention of arterial hypertension
Compliance with preventive measures, actions aimed at preventing episodes of increased intravascular blood pressure, as well as reducing the risk of complications of arterial hypertension, shown not only to patients who have long suffered from this pathology, but also to healthy people with increased signs of stress.
Scientifically proven facts are direct correlation dependence on increased blood pressure in human weight, and therefore, the normalization of the weight of a person suffering from arterial hypertension is a major preventive event. In addition, compliance with regulations for correction of food behavior helps prevent the development of atherosclerotic vascular lesions, which is one of the leading causes of arterial hypertension.
Recent studies in the field of pharmacology have shown a profitable effect on omega-3-lushed fatty acids on restoring blood vessels, which can also be considered an effective method for the prevention of arterial hypertension. Given this conclusion, you should use olive oil in sufficient quantities daily and limit animal fat.
Of course, if you want to get rid of the manifestation of arterial hypertension, you should leave bad habits in the form of smoking and drinking alcoholic beverages, as nicotine and alcohol particles can increase intravascular blood pressure even in microdose.
People who have recorded episodes of arterial hypertension as secondary precautions should be measured daily with blood pressure, to maintain a special diary that reflects the effectiveness of drug therapy used, and if new clinical manifestations worsen, without postponing the attending physician.
Arterial hypertension - which doctor will help? With the presence or suspicion of the development of arterial hypertension, you should seek advice on the doctor as a cardiologist, endocrinologist and nephrologist.