Hypertension(Hypertension) is the most common disease of the cardiovascular system. Hypertension indicates a stable increased blood pressure. An increase in blood pressure occurs when there is a narrowing of the arteries and/or its smaller branches - arterioles. In some people, arterioles usually narrow, first due to spasm, and later their lumen remains constantly narrow due to wall thickening, and then so that blood flow surpasses these narrowing, heart work is increased and more blood is thrown into a vascular direction. In these people, as a rule, hypertension develops.
In our country, approximately 40% of the adult population has an increased level of blood pressure. At the same time, about 37% of men and 58% of women know the presence of 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.
Hypertension is a chronic disease, accompanied by a persistent increase in blood pressure above allowed limits (systolic pressure above 139 mm Hg or (E) diastolic pressure above 89 mm Hg).
In approximately one of ten hypertension, increased blood pressure is caused by the injury of any organ. In such cases, they speak of secondary or symptomatic hypertension. About 90% of patients suffer from primary or essential hypertension. The reference point for increased blood pressure is at least a level of 139/89 mm Hg, levels recorded in three years of 139/89 mm. Art. And more in people who do not take drugs to reduce the pressure.
Blood pressure
There are two blood pressure indicators:
- Systolic Blood Pressure (Garden)- Reflects pressure on the arteries, which is created when the heart is reduced and the blood is released into the arterial part of the vascular system;
- Diastolic Blood Pressure (DDAD)-The pressure on the arteries at the time of heart relaxation during which it is filled before the next reduction.
Hypertension symptoms
Clinical, that is, manifestations of hypertension have no specific symptoms. For many years, patients may not know about their illness, do not complain, have high activity of life, although sometimes attacks of "evil", a weak weakness and dizziness may occur. But still everyone believes this is overwork. Although it is right now that you need to think about blood pressure and measure it.
Complaints of hypertension arise if the so -called target organs are affected by the most sensitive to increased blood pressure. The occurrence of dizziness, headaches, head noise, a decrease in memory and performance indicates initial changes in brain circulation. This is then united in the eyes, flashing flies, weakness, limb numbness, speech difficulty, but in the early stage, changes in blood circulation are coming. The distant stage of arterial hypertension can be complicated by brain infarction or cerebral hemorrhage. The oldest and most constantly increased blood pressure signal is an increase, or left ventricular hypertrophy of the heart, with the growth of its mass due to the thickening of cardiac cells, cardiomyocytes.
First, the thickness of the left ventricular wall increases and, in the future, the expansion of this heart camera also occurs. It is necessary to pay close attention to the fact that left ventricular hypertrophy is an unfavorable prognosis signal. In several epidemiological studies, it has been shown that the appearance of left ventricular hypertrophy significantly increases the risk of sudden death, coronary arterial disease, heart failure and ventricular rhythm disorders. Progressive left ventricular dysfunction leads to the onset of symptoms such as: load shortness, paroxysmal night breathing (heart asthma), pulmonary edema (usually with crises), chronic heart failure (congestive). In this context, myocardial infarction, ventricular fibrillation is more common.
With gross morphological changes in the aorta (atherosclerosis), it expands, its stratification, rupture may occur. Kidney lesions are expressed by the presence of protein in urine, microhematuria and cylinder. However, renal failure with hypertension, if there is no evil course, rarely develops. Ocular damage can manifest themselves by impairment of vision, a decrease in light sensitivity and blindness development. Thus, it is quite obvious that hypertension should be treated more carefully.
Risk factors of arterial hypertension
Unsaured risk factors include:
- Heredity - People who have patients with hypertension between relatives are more predisposed to the development of this pathology in them.
- The male floor - it was established that the incidence of male arterial hypertension is significantly higher than the incidence of women. But the fact is that female sex hormones, estrogens prevent the development of hypertension. But unfortunately, this protection is short. The menopause period occurs, the savior effect of estrogens and women are aligned in incidence with men and usually surpass them.
Changed risk factors include:
- Higher body weight - In people with overweight body weight, the risk of developing hypertension is greater;
- One sedentary lifestyle - in another hypodinamia, 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 hypertension.
- Eating a large amount of salt in food - a highly salty diet helps increase pressure. Here comes the question of how much salt can be consumed per day? The answer is short: 4, 5 grams or one teaspoon without top.
- An unbalanced diet with excess atherogenic lipids, excessive calorie content, leading to obesity and promoting the progression of type II diabetes. Atherogenic, that is, literally, "creation of 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 fixed arteries, leads to the rigidity of the arteries, which implies an increase in vessel pressure;
- Stress - leads to activation of a sympathetic nervous system that plays the function of an instant activator of all body systems, including cardiovascular. Also, the presidingness, that is, causing a spasm of arteries, hormones, is thrown in the blood. All this, as in smoke, leads to the rigidity of the arteries and hypertension develops;
- Sleep disorders by the type of night apnea syndrome or snoring. Snoring is truly a scourge of almost all men and many women. Why is snoring dangerous? The fact is that it causes an increase in chest pressure and abdominal cavity. All of this is reflected in the ships, leading to your spasm. Hypertension develops.
Causes of hypertension
The cause of the disease remains unknown in 90-95 % of patients-this is essential (ie primary) hypertension. In 5 to 10% of cases, an increase in blood pressure has an established cause-is a symptomatic (or secondary) hypertension.
Causes of symptomatic (secondary) arterial hypertension:
- Damage to primary kidneys (glomerulonephritis) are the most common cause of secondary arterial hypertension;
- bilateral narrowing (stenosis) of the renal arteries;
- Coarctation (congenital narrowing) of the aorta;
- Feochromocytoma (adrenal tumor producing adrenaline and norepinephrine);
- hyperaldosteronism (adrenal glands tumor that produces aldosterone);
- thyrotoxicosis (increased thyroid function);
- Ethanol consumption (wine alcohol) greater than 60 ml per day;
- Medicines: hormonal medications (including oral contraceptives), antidepressants and others;
Risk factors for cardiovascular complications with arterial hypertension
Basic:
- Men over 55;
- women over 65;
- The level of cholesterol in the total blood>6, 5 mmol/L, an increase in low density lipoprotein level (>4, 0 mmol/l) and high density high density lipoprotein cholesterol;
- Family history of early cardiovascular disease (in women<65 years, in men<55 years);
- Abdominal obesity (waist volume ≥102 cm for men or ≥ 88 cm for women);
- Level C - Blood reactive protein ≥1 mg/dL;
- Diabetes mellitus (blood glucose in stomach Voadio>7 mmol/l).
Additional:
- Violation of glucose tolerance;
- low physical activity;
- Improving fibrinogen level.
Observation. The accuracy of the determination of general cardiovascular risk depends directly on how complete the patient's clinical and instrumental examination was.
Complications for hypertension
Among the most significant complications of arterial hypertension are:
- hypertensive crises;
- cerebrovascular disorders (hemorrhagic or ischemic blows);
- myocardial infarction;
- nephrosclerosis (primary wrinkled kidney);
- heart failure;
- Relating the aorta aneurysm.
Studies for Hypertension
In all patients with hypertension, the following studies need to be performed:
- General blood and urine test;
- the level of creatinine in the blood (to exclude kidney damage);
- The potassium level in the blood outside the use of diuretics (a sharp decrease in potassium levels suspected of the presence of an adrenal tumor or renal artery stenosis);
- Electrocardiogram (Left Ventricle Hypertrophy Signs - Evidence of a Long Course of Arterial Hypertension);
- Determination of blood glucose level (in the empty stomach);
- The blood content of total cholesterol, high and low density cholesterol, triglycerides, uric acid;
- Echocardiography (determining the degree of left ventricular myocardial hypertrophy and a state of contractile capacity)
- Eye bottom study.
- thoracic radiography;
- Ultrasound of the adrenal kidneys and glands;
- Ultrasound of brachiocephalous and kidney 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).
- Evaluation of the functional state of cerebral blood flow, myocardium, kidneys;
- Examination in the blood of the concentration of aldosterone, corticosteroids, radio activity;
- Determination of catecholamines and their metabolites in the daily urine;
- Abdominal aortography;
- Computed tomography or magnetic resonance tomography of the adrenal glands and the brain.
Hypertension Treatment
The main objective of treating patients with hypertension is the maximum decrease in the risk of developing cardiovascular complications and death. This is achieved by lifelong therapy in the long run, intended for:
- decreased blood pressure to a normal level (below 140/90 mm hg). With a combination of hypertension with diabetes or kidney damage, it is recommended to reduce blood pressure<130/80 mm Hg. (but not less than 110/70 mm hg);
- "Protection" of the organs -Alv (brain, heart, kidneys), preventing their additional damage;
- Active impact on adverse risk factors (obesity, hyperlipidemia, carbohydrate disorders, excessive salt consumption, hypodinamia), contributing to the progression of hypertension and the development of its complications.
- Smoking refusal;
- body weight normalization (body mass index<25 kg/m2);
- decrease in alcoholic beverages<30 g alcohol per day in men and 20 g/day in women;
- Increased physical activity of physical activity of 30 to 40 minutes. At least 4 times a week;
- Reduction in table salt consumption to 5 g/day;
- A change in diet with an increase in plant food consumption, a decrease in plant 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:
Drug treatment should start with minimal doses of any class of anti -hypertensive drugs (given the appropriate indications), gradually increasing the dose to a good therapeutic effect.
The choice of the drug should be justified, the anti -hypertensive drug should provide a stable effect during the day and be well tolerated by patients.
It is more advisable to use prolonged action medicines to get a 24 -hour effect with a single use. The use of such drugs provides a smoother hypotensive effect, with more intense protection of the alive organs.
With the low effectiveness of monotherapy (therapy with a medicine), it is advisable to use the ideal combinations of medications for maximum hypotensive effects and minimal side effects.
It is necessary to perform a long (practically throughout life) administration of medicines to maintain the ideal level of blood pressure and avoid complications of hypertension.
The choice of necessary medicines:
Currently, seven classes of drugs are recommended for the treatment of hypertension:
- diuretics;
- B blockers;
- Calcium antagonists;
- angiotensin reproductive enzyme inhibitors;
- angiotensin receptors blockers;
- Hypanist receiver agonists
- Ad blockers.
- The little clear diagnosis and the need for special research methods, more often invasive to clarify the form of hypertension;
- Difficulties in the selection of drug therapy are frequent hypertensive crises, refractory arterial hypertension.
- Hypertensive crisis, not stopping at the pre -hospital stage;
- Hypertensive crisis with pronounced manifestations of hypertensive encephalopathy (nausea, vomiting, confusion);
- Complications of hypertension, requiring intensive care and constant medical observation: stroke, subarachnoid bleeding, acute visual impairment, pulmonary edema, etc.