Arterial hypertension(hypertension) is the most common disease in the cardiovascular system. Hypertension shows stable blood pressure. Increased blood pressure occurs when there are narrowing of their smaller arteries and/or branches - arterioles. In some people, arterioles are often narrow, first due to cramps, and then their lumen remains narrow due to wall thickness, and then, so that blood flow overcomes this narrowing, increased heart function and more blood is thrown towards the vascular. In people like that, as a rule, hypertension develops.
In our country, about 40% of adult population has increased blood pressure. At the same time, about 37% of men and 58% of women know the presence of the disease, 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 continuous increased blood pressure above the allowed limit (systolic pressure exceeds 139 mm Hg or (and) diastolic pressure exceeding 89 mm Hg).
In about one of the ten hypertension, increased blood pressure due to any organs. In this case, they talk about secondary hypertension or symptoms. About 90% of patients have major or important hypertension. The blood pressure reference point increased at least 139/89 mm Hg, the three -year -old registered 139/89 mm RT. Art. And more to people who do not take medication to reduce stress.
Blood pressure
There are two indications of blood pressure:
- Systolic blood pressure (garden)- reflects the pressure in the artery, which is created when the heart is reduced and the blood is released to the vascular system;
- Diastolic blood pressure (DDAD)-Pressure in the artery at the time of heart relaxation, where it is filled before the next reduction.
Symptoms of arterial hypertension
The clinic, that is, manifestation of hypertension has no specific symptoms. Over the years, patients may not know about their illness, do not complain, have high life activities, though sometimes "bad" attacks, severe weakness and dizziness may occur. But even though everyone believes that this is from hard work. Although at this time you need to think about blood pressure and measure it.
Complaints for hypertension arise if the target organs called the most sensitive to increased blood pressure. Dizziness, headache, headache, decreased memory and performance show early changes in cerebral circulation. These then combine in the eyes, flickers -flies, weakness, limbs, difficulty in speech, but in the early stages, changes in blood circulation will come. Remote arterial hypertension can be complicated by brain infarction or cerebral bleeding. The earliest signs of increased blood pressure are improvement, or left ventricular hypertrophy of the heart, with its mass growth due to thickening of heart cells, cardiomyocytes.
First, the thickness of the left ventricular wall increases, and in the future, the expansion of this heart space also occurs. It is necessary to pay attention to the fact that the left ventricular hypertrophy is a bad sign of prognostic. In several epidemiological studies, it was shown that the appearance of left ventricular hypertrophy significantly increased the risk of death, coronary artery disease, heart failure, and ventricular rhythm disorders. Left ventricular progressive dysfunction leads to the emergence of symptoms such as: shortness of breath at load, paroxysmal night (heart asthma), pulmonary edema (often with crisis), chronic heart failure (congestive). Against this background, myocardial infarction, ventricular fibrillation is more common.
With gross morphological changes in aorta (atherosclerosis), it develops, stratification, rupture can occur. Wounds -Kidney wounds are expressed by the presence of proteins in urine, microhematuria, and cylinders. However, kidney failure with hypertension, if there is no malignant course, rarely develops. Eye damage can be indicated by the deterioration of vision, decrease in light sensitivity, and the development of blindness. Therefore, it is clear that hypertension needs to be treated more carefully.
The risk factor of arterial hypertension
An unknown risk factor includes:
- Heredity - people with patients with hypertension among siblings - are most vulnerable to the development of this pathology.
- Men's floor - it has been determined that the occurrence of male arterial hypertension is much higher than the occurrence of women. But the fact is that female sex hormones, estrogen inhibit the development of hypertension. But such protection, unfortunately, is short. The period of menopause occurs, the effects of estrogen savings end and women are in line with men's events and often overcome them.
Changed risk factors include:
- Weight gain - in people with overweight, the risk of developing higher arterial hypertension;
- Inactive lifestyle - in other hypodynamia, inactive lifestyle and low physical activity lead to obesity, which in turn contributes to the development of hypertension;
- In alcohol use, excessive alcohol use promotes arterial hypertension.
- Eat lots of salt in foods - a diet of salt that greatly helps increase stress. Here is the question of how much salt can be eaten daily? The answer is short: 4. 5 grams or one teaspoon without the top.
- Diets that are unbalanced with excess atherogenic lipids, excessive calorie content, leading to obesity and promoting the development of type II diabetes. Atherogenic, that is, literally, "creates atherosclerosis" lipid contained in large quantities of all animal fats, meat, especially pigs and goats;
- Smoking is another variable and great factor in the development of arterial hypertension and its complications. The fact is that tobacco material, including nicotine, creates a fixed arterial cramps, prescribed, leading to arterial rigidity, which involves increased pressure in the vessel;
- Pressure - leads to the activation of sympathetic nervous systems that perform immediate functional function of all body systems, including cardiovascular. In addition, the pressor, that is, causes arterial cramps, hormones, removed into the blood. All of these, such as smoking, lead to arterial rigidity and developing arterial hypertension;
- Disorders of rough sleep by the type of night apnea syndrome, or snoring. Scoring is true -the widespread almost all men and many women. Why is snoring dangerous? In fact, it causes increased pressure in the chest and abdominal cavity. All of this is shown on the ship, leading to their cramps. Arterial hypertension develops.
Causes of arterial hypertension
The cause of the disease is still unknown in 90-95 % of patients-this is important (ie, the main) arterial hypertension. In 5-10% of cases, increased blood pressure has a solid cause-this is symptom hypertension (or secondary).
Causes of arterial hypertension (secondary) Symptoms:
- Major kidney damage (glomerulonephritis) is the leading cause of secondary artery hypertension;
- narrowing one or two (stenosis) of the kidney artery;
- Coarctation (congenital narrowing) aorta;
- Feochromocytoma (adrenal tumors that produce adrenaline and norepinephrine);
- Hyperaldosteronism (adrenal gland tumor producing aldosterone);
- thyrotoxicosis (increased thyroid function);
- The use of ethanol (wine alcohol) more than 60 ml per day;
- Medicines: hormone drugs (including oral contraceptives), antidepressants and others;
Risk factors of cardiovascular complications with arterial hypertension
Basics:
- Men over 55 years old;
- women over 65 years old;
- Blood cholesterol levels>6. 5 mmol/l, Increased low levels of lipoprotein cholesterol -density (>4. 0 mmol/l) and high lipoprotein cholesterol -low;
- Family history of early cardiovascular disease (in women<65 years, on 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 vacant stomach>7 mmol/l).
Additional:
- violations of glucose tolerance;
- low physical activity;
- Increase the level of fibrinogen.
Note. The accuracy of determining general cardiovascular risk directly depends on how to complete the patient's clinical and instrumental examination.
Complications for arterial hypertension
Some of the most significant complications of arterial hypertension are:
- hypertension crisis;
- cerebrovascular disorders (hemorrhagic or ischemia);
- myocardial infarction;
- nephrosclerosis (major wrinkled kidneys);
- heart failure;
- Issue aortic aneurysm.
A study for arterial hypertension
In all patients with arterial hypertension, the following studies should be conducted:
- general blood and urine tests;
- the level of creatinine in the blood (to exclude kidney damage);
- Potassium levels in the blood outside the use of diuretic (sharp decreases in potassium levels are suspicious of the presence of adrenal tumors or kidney artery stenosis);
- Electrocardiogram (signs of left ventricular hypertrophy - long -term evidence of arterial hypertension);
- determination of glucose levels in the blood (on an empty stomach);
- blood content of cholesterol, high and low density cholesterol, triglycerides, uric acid;
- Echocardiography (determining the level of left ventricular myocardial hypertrophy and contraction capacity state)
- Study of the bottom of the eye.
- Chest radiographs;
- Kidney ultrasound and adrenal glands;
- Brachiocephalous artery ultrasound and kidneys;
- C-reactive protein in blood serum;
- Urine analysis for the presence of bacteria (bacteriuria), quantitative estimates of protein in urine (proteinuria);
- Determination of microalbumin in urine (mandatory with the presence of diabetes).
- Assessment of the condition of the function of the blood flow of the cerebral, myocardium, the kidneys;
- Examination in blood concentrations aldosterone, corticosteroids, radio activities;
- determination of catecholamines and their metabolites in daily urine;
- abdominal aortography;
- Calculated tomography or magnetic resonance tomography of the adrenal gland and brain.
The 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 a long lifetime therapy aimed at:
- Reduction of blood pressure to normal level (below 140/90 mm Hg). With the 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), prevent further damage;
- The active effects of adverse risk factors (obesity, hyperlipidemia, carbohydrate disorders, excessive use of salt, hypodynamia), contribute to the development of arterial hypertension and its development of complications.
- The refusal of smoking;
- weight normalization (body mass index<25 kg/m2);
- decreased alcoholic beverages<30 g of alcohol daily in men and 20 g/day in women;
- Increased physical activity of physical activity 30-40 minutes. at least 4 times a week;
- reduction of table salt use up to 5 g/day;
- Changes in the diet with increased use of vegetable foods, decreased use of vegetable fats, increased potassium, calcium in vegetables, fruits, cereals, and magnesium contained in dairy products.
The basic principle of arterial hypertension drug therapy:
Drug treatment should start with a minimum dose of any antihypertensive drug (given appropriate contraindications), gradually increasing the dose to good therapeutic effects.
The choice of medicine should be allowed, antihypertensive drugs should have a stable effect during the day and are well received by the patient.
It is best to use long-acting drugs to achieve a 24-hour effect with a single use. The use of these drugs has a softer hypotension effect with more intense target organ protection.
With the effectiveness of low monotherapy (therapy with one drug), it is advisable to use the optimal combination of drugs to achieve maximum hypotension effect and minimal side effects.
It is necessary to carry out long medication administration (practical lifetime) to maintain optimal blood pressure levels and prevent complications of arterial hypertension.
The choice of medication required:
Currently, seven classes of drugs are recommended for the treatment of arterial hypertension:
- diuretics;
- B-blockers;
- calcium antagonists;
- an angiotensin-recroductive enzyme inhibitor;
- Angiotensin receptor blockers;
- Higanis Receptor Agonis
- Ad blocker.
- Unclear diagnosis and the need for special research methods, more often invasive, to explain the form of arterial hypertension;
- Difficulty in selection of drug therapy is a frequent crisis of hypertension, refractory artery hypertension.
- Hypertension crisis, does not stop at the prehospital level;
- Hypertension crisis with manifestations of encephalopathy hypertension (nausea, vomiting, confusion);
- Hypertension complications, which require intensive care and continuous medical observation: brain stroke, subarachnoid bleeding, acute visual disorders, pulmonary edema, etc.