Arterial hypertension is a pathological or physiological predisposition to a clear or gradual increase in the indicators of systolic 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 hypertension is unfavorable, since the percentage of this pathology in the structure of cardiological profile diseases reaches 30%. There is a clear dependence on the increased risk of developing signs and consequences of hypertension with an increase in the patient's age and, therefore, the main increased risk category is mature and elderly faces.
Causes of hypertension
The appearance of signs of increased blood pressure in the patient may occur in the bottom of existing chronic diseases, and then we are talking about a secondary or symptomatic version of arterial hypertension. In the event that hypertension is primary and even after a comprehensive patient examination, it is not possible to determine the cause that causes an increase in intravascular blood pressure, the term "hypertension" should be used, which is an independent nosological form.
Primary arterial hypertension is observed in almost 90% of cases of increased blood pressure, and the polyetiological development of this pathological state is currently considered. Thus, there are unchanged risk factors for arterial hypertension, which is not possible to avoid (sexual, genetic and age determinism); However, these provocative factors are not dominant in the development of severe hypertension. To a greater extent, the development of primary arterial hypertension is influenced by the human lifestyle (not balanced nutrition, bad habits, inactivity, psycho -emotional instability). Together, all the provocative factors 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 the determination of the volume of therapeutic measures. The etiopatogenes of the development of secondary arterial hypertension should be taken into consideration to a greater extent, because without the elimination of the etiological factor that cause an increase in blood pressure, in this case you should not wait for positive treatment results.
Thus, with the renewing version of symptomatic arterial hypertension, the main pathogenetic connection is renal artery stenosis that occurs with its atherosclerotic lesion or fibrous-muscular dysplasia. An extremely rare etiological factor that affects renal arteries is systemic vasculitis. The consequence of stenosis is the development of the ischemic injury of one or both kidneys that cause renin hyperproduction, 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 Celenko-Rush syndrome syndrome, Conn. Some cardiovascular diseases can act as a background pathology for the development of secondary arterial hypertension, such as aortic coarctation.
Hypertension symptoms
Clinical manifestations at the early stage of development of hypertension may be completely absent, and the diagnosis in this case is based only on data from an objective examination and instrumental laboratory.
Complaints filed by patients suffering from hypertension are quite specific and, therefore, in the premiere of essential hypertension, the diagnosis is significantly difficult. In most cases, with an episode of hypertension, the patient is disturbed by headache with a predominant location in the front and occipital region, sharp dizziness, especially when altering the body position in space, pathological noise in the ears. These manifestations are not pathognomonic, so it is not advisable to consider them clinical criteria for hypertension, as the above symptoms are periodically observed in absolutely healthy people and have nothing to do with an increase in blood pressure. Classic clinical manifestations in the form of respiratory disorders, signs of cardiac activity dysfunction are observed only at the stage of distant height of arterial hypertension.
Some etiopatogenetic forms of arterial hypertension are accompanied by the development of specific clinical symptoms, in connection with which an experienced specialist can establish a correct diagnosis during the initial examination and collect an anamnesis thoroughly. For example, with a renovascular type of hypertension, an acute premiere of clinical manifestations is always observed, which consists of a critical and constant increase in increased blood pressure mainly due to the diastolic component. Renovascular arterial hypertension is not characterized by a crisis course, however, the patient's asset with this pathology is extremely severe.
Endocrine arterial hypertension, on the contrary, is characterized by a tendency to the paroxysmal course of the disease with the development of classic hypertensive crises. For this pathology, the patient has a "paroxysmal triad" clinical, which consists in the development of clear headaches, pronounced sweating and rapid palpitations, is characteristic. Patients in this pathological condition have extreme psycho -emotional excitability. 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 observe marked weakness and common headache.
Degrees and stages of hypertension
Determine the severity and intensity of the clinical manifestations of arterial hypertension, as well as the stage of disease development, is a prerequisite for the selection of a proper treatment regime. The separation of arterial hypertension is based on primary and symptomatic genesis, the level of increased systolic and diastolic component of blood pressure is presented.
Patients with 1 degree of hypertension usually do not observe a pronounced violation of their own health due to the fact that blood pressure numbers in this situation do not exceed 159/99 mm. RT. Art.
2 degree of hypertension is accompanied by pronounced clinical manifestations and organic changes in target organs, and blood pressure indicators are in the range of 179/109 mm. RT. Art.
3 Degree of the disease is distinguished by an extremely severe aggressive course and a tendency to develop complications of impaired brain and heart function. With the third degree, a critical increase in blood pressure exceeding 180/110 mm is observed. RT. Art.
In addition to the classification of arterial hypertension in terms of gravity, in practical activities, cardiologists use the separation of the stadium from this pathology, whose criteria are the presence of signs of damage to the target organs.
In the early stage of arterial hypertension, primary and secondary genesis, the patient does not completely have manifestations of organic lesions sensitive to an increase in blood pressure from tissues and organs.
The second stage of the disease involves the development of detailed clinical symptoms, the intensity of the manifestation depends directly on the severity of damage to the internal organs. However, In Most Cases, This Stage of Arterial Hypertension is stablished on the basis of organ confirmation in the form of hypertrophic cardiomyopathy of the left ventricle of the heart according to echocardioscopy and ecg, narrowing of the arterial vassels of the retinal whether the retina whether when the retinal whenceExamining the Eye Bottom and the Presence of Changes in the Biochemical Analysis of Blood, Namely, the Moderate Increase in levelinine levels in the level plasma.
The third stage of hypertension is the terminal, in which the patient has the development of irreversible changes in all organs sensitive to increased blood pressure. Regarding the heart of a person who has long suffered from an increase in blood pressure, the ischemic damage of myocardial develops, manifested in the formation of infarction zones. In brain structures, hypertension has a negative effect on 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 affects the structure of blood vessels, whose result is the formation of retinal hemorrhages and optic disc edema.
The terminal stage of the development of arterial hypertension is characterized by a significant suppression of renal function, which is reflected in the level of creatinine levels, which exceeds the 177 μmol/L indicator.
Hypertension Diagnosis
By performing a clinical and instrumental-laboratory examination of patients with arterial hypertension, the main objective should be both to establish the fact that it increases blood pressure, but to detect the cause of secondary arterial hypertension, signs of damage to internal organs, as well as assess the presence of risk factors for the development of developmental development development of complications of internal organs, as well as evaluating the presence of risk factors for riskThe development of development development development development development development development development developmental development.
With initial contact with a sick key to establish the correct diagnosis and determine additional treatment tactics, a complete collection of patient's anamnestic data is a complete collection. An objective examination of a patient who suffers from hypertension allows to determine the etiopathogenetic form of the disease due to the detection of specific pathognomonic signals. 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 assumed. With feochromocytoma, accompanied by severe paroxysmal arterial hypertension, an increase in skin pigmentation is observed in the projection of axillary cavities. The main clinical criterion for the diagnosis of renewing arterial hypertension is the auscultation of vascular noise in the projection of the near -Bundle region.
The volume of laboratory research methods for arterial hypertension consists of an analysis of the patient's lipidogram, determination of uric acid and creatinine, such as the main criteria of renal dysfunction, analysis of the patient's hormonal status.
In order to determine the stage of the disease, a necessary condition is the diagnosis of organ lesions, ie organs in which irreversible changes are developing due to increased blood pressure. Thus, to study the heart for impaired activity and organic injury, electrocardiographic registration and ultrasound visualization, which are part of a standard screening of all patients suffering from hypertension. To detect retinopathy, which is observed mainly with prolonged severe hypertension, the patient's eye bottom should be examined. It is advisable to use visualization radiation methods as instrumental methods to study the kidneys and brain, which are not included in the mandatory list of diagnostic measures, but significantly facilitate the premature establishment of correct diagnosis (computed tomography, magnetic resonance imaging).
Hypertension Treatment
The fundamental modern approach to hypertension therapy is to obtain the maximum elimination of the risk of developing cardiac profile complications and the level of mortality. In this sense, the priority of the assistant physician is to completely eliminate the reversible (modified) risk factors available to the patient with the highest standstill of hypertension and concomitant clinical manifestations. There is a certain standard, which consists of reaching the target limit of blood pressure, whose indicators should not exceed 140/90 mm hg
In what cases should anti -hypertensive therapy be used for hypertension? Cardiologists in their practice use the developed classification, which implies an assessment of the "risk of developing cardiovascular complications of the patient". According to this classification, combined treatment using a lifestyle modification and medicine correction is subject to people with high risk of heart profile complications in combination with a critical increase in blood pressure number. 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 -Drug correction methods should be resorted to anti hypertensive drug treatment.
The principles of drug correction of hypertension are a gradual decrease in blood pressure to achieve the number by the method of using the minimum dose of one or more hypotensive medications. In some situations, monotherapy with a low dose of a hypotensive medicine can have a long positive effect in terms of hypertension relief. Currently, the pharmaceutical market is full of a wide range of anti -hypertensive drugs, however combined groups of prolonged hypotensive effects (up to 24 hours) are more popular.
As drugs of choice in relation to the first episode of hypertension, preference should be given to diuretic agents that have a wide range of positive effects in the way to prevent the development of cardiovascular complications, reducing mortality and prevention of hypertrophic changes in the left ventricle of the heart. The pharmacological effect, accompanied by a slight decrease in blood pressure, is determined by a decrease in water reabsorption and sodium and a decrease in vascular resistance.
The choice of a diuretic drug depends on the concomitant diseases in the patient. Therefore, with arterial hypertension, combined with signs of heart and kidney failure, it should preference to diuretic drugs. Diuretic agents with prolonged tiazide can cause the development of the hypocalêmic syndrome and therefore is better to use them in combination with aldosterone antagonists.
In a situation where the patient has signs of arterial hypertension combined with tachyarrhythmia, angina attacks and symptoms of chronic stagnant cardiovascular failure, it is advisable to use a group of water blockers as first line medicines. The mechanism of the anti -hypertensive effect of these drugs is to reduce the release of the heart and the inhibition of renin products. It should be borne in mind that non-compliance with the drug dose of this group may cause a pronounced decrease in heart rate and bronchoconstricient frequency, which is an absolute indication for canceling the reception of the bolloker.
It is advisable for patients suffering from hypertension against the background of proteinuria. An absolute against the use of drugs from the ECA inhibitors group is a two -way renal stenosis in the patient. Angiotensin II II receptor antagonists drugs have a similar hypotensive effect, with the only difference that they do not cause the development of cough and sapel of anionurotic nature, which significantly expands the scope of its application.
Drugs of the calcium channel blockers group have a pronounced hypotensive effect, allowing to interrupt high blood pressure due to a decrease in calcium content on the vascular wall. The category to prescribe medications of this group are mainly older patients who, simultaneously with hypertension, observe signs of ischemic myocardial damage, manifested in the development of angina attacks. In cardiological practice, exclusively prolonged forms of calcium channel blockers are used due to the fact that short calcium antagonists significantly increase the risk of provocation of acute myocardial infarction.
In a situation where arterial hypertension in the patient is combined with a violation of the pace of cardiac activity, it is advisable to use the category of phenylaclamines and benzotiazepine derivatives. An absolute against the use of this category of drugs is the patient's heart failure, accompanied by a decrease in the fraction of less than 45%.
Separately, relief from the drug of the hypertension crisis should be considered, in which there is a critical increase in the intravascular pressure number and acute course of arterial hypertension. In this situation, it should be granted preference to drugs with a pronounced anti -hypertensive effect, because with a prolonged course of hypertension crisis, the risk of fatal result increases markedly. With the signs of the patient of complicated hypertension crisis, the parenteral path of drug administration with a hypotensive effect is preferable. Most groups of hypotensive agents are produced in parenteral forms. As a rule, the hypotensive effect occurs the late 5 minutes after administration of the drug.
In the case of non -complicated hypertensive crisis, there is no need to use parenteral forms of anti -hypertensive drugs, because in this pathological condition there is no critical increase in blood pressure. Oral intake of anti -hypertensive agents in proper dosage allows to reduce pressure within several hours and keep target numbers in the future. Obviously, there are today many drug stop methods in a hypertension crisis, however, to exclude the development of complications, the planned anti -hypertensional therapy scheme should be applied regularly.
In the event that arterial hypertension in the patient is secondary in nature and develops as a result of renal arteries stenosis, the fundamental method of treatment is the operational correction of stenosis and revascularization by angioplasty. Operational manuals for renewing arterial hypertension (deviation deviation, endartractomy) are used only for existing -indications for the use of transluminal angioplasty. If the patient has signs of an aggressive course of arterial hypertension due to severe unilateral nephrosclerosis, the only treatment is nephrectomy.
With endocrine secondary arterial hypertension, a combination of surgical treatment (radical tumor substrate excision) and anti -hypertensional drug therapy (spironolactone in a daily 200 mg dose with primary aldosteronism, pcentolamine at a 25 -hour dose with telomocistoma) is used.
Hypertension Prevention
Compliance with preventive measures, whose action aims to prevent episodes of increased intravascular blood pressure, and reducing the risk of hypertension complications, is shown not only to patients suffering a lot from this pathology, but also for healthy people whose signs of pressure increase may occur.
A scientifically proven fact is a direct dependence on the correlation of an increase in blood pressure on human body weight and, therefore, the normalization of the weight of a person who suffers from hypertension is the main preventive priority event. In addition, compliance with the rules for the correction of food behavior helps to prevent the progression of atherosclerotic vascular lesions, which is a major cause of arterial hypertension.
Recent studies in the field of pharmacology have proven 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. Given these conclusions, you should use the olive oil in sufficient amounts daily and markedly limit animal fat.
Obviously, if you want to get rid of the manifestations of arterial hypertension, you should abandon bad habits in the form of smoking and drinking alcoholic beverages as nicotine and alcohol particles can increase intravascular blood pressure even in microdes.
People who have already observed episodes of hypertension as secondary preventive measures should be measured daily by blood pressure, to maintain a special diary reflecting the effectiveness of used drug therapy and if new clinical manifestations are worsening without postponing the assistant doctor about it.
Hypertension - Which doctor will help? In the presence or suspicion of the development of hypertension, you should immediately seek advice on doctors such as cardiologist, endocrinologist and nephrologist.