Arterial hypertension is a pathological or physiological predisposition to a sharp or gradual increase in indicators of both systolic and diastolic components of intravascular blood pressure, which occurs as an independent nosological unit or is a manifestation of another pathology present in the patient.
According to world statistics, the epidemiological situation in terms of the incidence of arterial hypertension is unfavorable, since the percentage of this pathology in the structure of cardiac profile diseases reaches 30%. There is a clear correlation depending on the increase in the risk of developing signs and effects of arterial hypertension with the increase in the patient's age and therefore the main category of increased risk is the persons of mature and adults.
Causes of arterial hypertension
The appearance of signs of high blood pressure in the patient can occur against the background of existing chronic diseases and then we are talking about a secondary or symptomatic version of arterial hypertension. In the event that when arterial hypertension is primary and even after a comprehensive examination of the patient, it is not possible to determine the cause that causes an increase in intravascular blood pressure, the term "hypertension", which is an independent nosological form, should be used.
Primary arterial hypertension is observed in almost 90% of cases of increase in blood pressure and the polyetiological development of this pathological condition is currently considered. Thus, there are unmodified risk factors for arterial hypertension, which is not possible to avoid (sexual, genetic determinism and age), but these provocative factors are not dominant in the development of severe arterial hypertension. To a greater extent, the development of primary arterial hypertension is influenced by the human way of life (not balanced nutrition, bad habits, inaction, psycho -emotional instability). Together, all the above provoking factors early or later create favorable conditions for the pathogenetic development of arterial hypertension.
Many pathogenetic theories about the development of essential arterial hypertension are currently being considered, although these hypotheses have no effect on the patient's tactics and determine the volume of therapeutic measures. The etiopathogens of the development of secondary arterial hypertension should be taken into account to a greater extent, since without the elimination of the etiological factor that causes an increase in blood pressure, in this case you should not wait for positive treatment results.
Thus, with the renovated version of the symptomatic arterial hypertension, the main pathogenetic bond is the stenosis of the renal artery, which is found with its atherosclerotic lesion or fibrous axle dysplasia. An extremely rare etiological factor that affects the renal arteries is systemic vasculitis. The consequence of stenosis is the development of the ischemic lesion of one or the two kidneys that cause the hyperproduction of renin, which has an indirect effect on increased blood pressure.
In the pathogenesis of the development of the endocrine etiologic 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 the syndrome of celenko-blush, congom. And fetomocytoma. Some cardiovascular diseases can act as a major pathology for the development of secondary arterial hypertension, such as aortic coarctation.
Symptoms of arterial hypertension
Clinical manifestations in the initial stage of the development of arterial hypertension may be completely absent and the diagnosis in this case is based only on data from objective and instrumental-laboratory examination.
Complaints presented by patients suffering from arterial hypertension are quite non -specific and therefore the debut of the basic hypertension is significantly difficult. In most cases, with an episode of arterial hypertension, the patient is disturbed by headache with predominant localization in the front and dorsal region, acute dizziness, especially when the body position in space, pathological noise in the ears. These manifestations are not pathognomonic, so it is not advisable to consider clinical criteria for arterial hypertension, since the above symptoms are periodically observed in absolutely healthy people and have nothing to do with the increase in blood pressure. Classic clinical manifestations in the form of respiratory disorders, signs of cardiac dysfunction are observed only in the distant stage of arterial hypertension.
Some etiopathogenetic forms of arterial hypertension are accompanied by the development of specific clinical symptoms in connection with which an experienced specialist can establish a proper diagnosis during the initial examination and careful history collection. For example, with a renovating type of arterial hypertension, an acute debut of clinical manifestations is always noted, which consists in a sharp critical and constant increase in blood pressure indicators mainly due to the diastolic component. Renovation arterial hypertension is not characterized by a crisisal course, but the well -being of the patient 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 hypertonic crises. For this pathology, the patient has a clinical "paroxysmal triad", which consists in the development of acute headaches, pronounced sweating and rapid heartbeat, is characteristic. Patients who are in this pathological condition have exceptional psycho -emotional excitability. The development of a hypertensive crisis occurs most often at night and the duration of clinical manifestations does not exceed more than an hour, after which patients have acute weakness and dull general headache.
Degrees and stages of arterial hypertension
Determining the severity and intensity of the clinical manifestations of arterial hypertension, as well as the stage of development of the disease, is a prerequisite for the selection of adequate treatment regimen. The division of arterial hypertension is based on both primary and symptomatic genesis, the level of increase in the systolic and diastolic component of blood pressure is placed.
Patients with 1 degree of arterial hypertension most often do not indicate a pronounced disorder of their own health due to the fact that the blood pressure numbers in this situation do not exceed 159/99 mm. RT. Art.
2 the degree of arterial hypertension is accompanied by pronounced clinical manifestations and organic changes in the target organs, and blood pressure indicators are in the range of 179/109 mm. RT. Art.
3 degrees of the disease are characterized by an extremely severe aggressive course and a tendency to develop complications from impaired brain and cardiac function. A third degree is noted a critical increase in blood pressure above 180/110 mm. RT. Art.
In addition to the classification of arterial hypertension in terms of severity, in practical activities, cardiologists use the separation of the stadium of this pathology, whose criteria are the presence of signs of damage to the target bodies.
In the initial stage of arterial hypertension, both primary and secondary genesis, the patient has no manifestations of organic lesions sensitive to the increase in blood pressure of the tissues and organs.
The second stage of the disease involves the development of detailed clinical symptoms, the intensity of the manifestation of which depends directly on the severity of the damage to the internal organs. However, in Most Cases, This Stage of Arterial Hypertension Is Establised on the Basis of Instrumental Confirmation of Organs Lesions in the Form of Hypertrophic Cardiopathy of the LeftEchocardioscopy and ECG, Narrowing of the Arterial Vessels of the Retina When Examining the Eye Bottom and the Precious Changes in the BioChemical Analysis of Blood, Namely, A Moderate Increase in Creat
The third stage of arterial hypertension is a terminal in which the patient has the development of irreversible changes in all organs sensitive to high blood pressure. In connection with the heart, in a person who has long suffered from an increase in blood pressure, ischemic damage to the myocardium develops, manifested in the formation of infarction areas. In brain structures, arterial hypertension has a negative effect in 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 the blood vessels, the result is the formation of hemorrhages in the retina and the swelling of the optical disc.
The terminal stage of the development of arterial hypertension is characterized by significant suppression of renal function, which is reflected on the level of creatinine levels, which exceeds the indicator of 177 μmol/l.
Diagnosis of arterial hypertension
When conducting a clinical and instrumental-laboratory examination of patients with arterial hypertension, the main goal should be not so much to determine the fact of increased blood pressure, but to detect the cause of the development of secondary arterial hypertension, signs of impairment of the internal organs.
With the initial contact with a patient key to establish the correct diagnosis and determination of more tactics of treatment, in -depth collection of the anamnestic data of the patient is a thorough collection. An objective examination of a patient suffering from arterial hypertension allows you to determine the etipatogenetic form of the disease due to the detection of specific pathognomonic signs. So, with the existing type of obesity in a patient, combined with hypertrichosis, hirsutism and a constant increase in the diastolic component of blood pressure, the endocrine nature of the disease (icon-dollar syndrome) should be taken. In pheochromocytoma, accompanied by severe paroxysmal arterial hypertension, there is an increase in skin pigmentation in the projection of axillary cavities. The main diagnostic clinical criterion for renovating arterial hypertension is the auscultation of vascular noise in the projection of the nearby area.
The volume of methods of laboratory tests for arterial hypertension consists in the analysis of the patient's lipidogram, determination of uric acid and creatinine, as the main criteria for renal dysfunction, analysis of the hormonal status of the patient.
In order to determine the stage of the disease, the necessary condition is the diagnosis of lesions of the target organs, that is, organs in which irreversible changes develop due to an increase in blood pressure. Thus, to examine the heart for impaired activity and organic lesion, electrocardiographic registration and ultrasound visualization are used, which are part of a standard screening examination of all patients suffering from arterial hypertension. In order to detect retinopathy, which is mainly observed with prolonged severe arterial hypertension, the bottom of the patient's eyes must be examined. It is advisable to use radiation methods for visualization as instrumental methods for studying the kidneys and brain, which are not included in the compulsory list of diagnostic measures, but greatly facilitate the early establishment of the correct diagnosis (computed tomography, magnetic resonance).
Treatment of arterial hypertension
The main modern approach to the treatment of arterial hypertension is to maximize the elimination of the risk of developing cardiac profile complications and the level of mortality. In this regard, the priority of the attending physician is to eliminate fully reversible (modified) risk factors available to the patient with a more discontinuation of arterial hypertension and concomitant clinical manifestations. There is a certain standard that consists in achieving the target border of blood pressure whose indicators should not exceed 140/90 mm Hg
In what cases should antihypertensive therapy for arterial hypertension be used? Cardiologists in their practice use the developed classification, which implies an assessment of the "patient risk of developing cardiovascular complications". According to this classification, a combination treatment using lifestyle modification and drug correction is subject to high -risk persons in combination with a critical increase in blood pressure. Patients belonging to the category of moderate and low risk have been subjected to dynamic monitoring for at least three months and only in the absence of the effect of the use of non -targeted correction methods should be resorted to drug antihypertensive treatment.
The principles of correction of the drug of arterial hypertension are a gradual decrease in the blood pressure of target numbers by the method of using the minimum therapeutic dose of one or more hypotensive drugs. In some situations, low -dose monotherapy can have a long positive effect on relieving arterial hypertension. Currently, the pharmaceutical market is filled with a wide range of antihypertensive drugs, but combined drug groups with prolonged hypotensive effects (up to 24 hours) are most popular.
As medicines optional in connection with the first episode of arterial hypertension, diuretic agents, which have a wide range of positive effects in the form of prevention of cardiovascular complications, reduces mortality, as well as preventing the progression of hypertrophic changes in the left vent should be given. The pharmacological effect, accompanied by a slight decrease in blood pressure, is determined by a decrease in water and sodium reabsorption and a decrease in vascular resistance.
The choice of diuretic drug depends on the existing concomitant diseases in the patient. So, with arterial hypertension, combined with signs of cardiac and renal failure, a preference for wild drugs should be preferred. Tiazid diuretic agents with prolonged use can provoke the development of hypocalic syndrome and therefore 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 cardiovascular failure of stagnant nature, it is advisable to use a group of water blockers such as first row drugs. The mechanism of the antihypertensive 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 dose of the drug in this group can cause a pronounced decrease in the heart rate and frequency of the bronchoconstrictor, which is an absolute indication of the cancellation of BA-Blocker.
It is recommended for patients suffering from arterial hypertension against the background of proteinuria. An absolute contraindication to the use of drugs in the ACE group inhibitors is bilateral renal stenosis in the patient. Angiotensin II receptor receptors II receptor receptors have a similar hypotensive effect, the only difference is that they do not provoke the development of cough and the sapling of anhioneurotic character, which significantly expands the scope of their administration.
Medicines of the group of calcium channel blockers have a pronounced hypotensive effect, which allows to stop arterial hypertension due to a decrease in calcium content in the vascular wall. The category of prescribing drugs in this group is mainly older patients who, at the same time as arterial hypertension, observe signs of ischemic myocardial damage manifested in the development of angina attacks. In cardiac practice, extremely prolonged forms of calcium channel blockers are used due to the fact that short -action calcium antagonists significantly increase the risk of acute myocardial infarction.
In a situation where arterial hypertension in the patient is combined with a disorder of the rhythm of cardiac activity, it is advisable to use a category of phenylaclaclam and benzothiazepine derivatives. An absolute contraindication to the use of this category of drugs is the patient's heart failure, accompanied by a reduction in the emission fraction below 45%.
Separately, the relief of the drug with hypertension should be taken into account, with a critical increase in the number of intravascular pressure and an acute course of blood hypertension. In this situation, preferences of drugs with pronounced antihypertensive effect should be given, as with a prolonged course of hypertension crisis the risk of fatal result increases sharply. With the signs of the patient for a complex crisis of hypertension, it is preferable to the parenteral pathway to administer drugs with a hypotensive effect. Most groups of hypotensive agents are produced in parenteral forms. As a rule, the hypotensive effect occurs not later than 5 minutes after administration of the drug.
In the case of uncomplicated hypertensive crisis, it is not necessary to use parenteral forms of antihypertensive drugs, since there is no critical increase in blood pressure in this pathological condition. Oral administration of antihypertensive agents in an adequate dose allows you to reduce the pressure within a few hours and maintain target numbers in the future. Of course, there are currently many methods of stopping the drug, which stops the crisis of hypertension, but to exclude the development of complications, the planned antihypertension scheme of therapy should be regularly administered.
In the case where arterial hypertension in the patient is secondary and develops as a result of stenosis of the renal arteries, the main method of treatment is the surgical correction of stenosis and revascularization through angioplasty. Renov -shaped hypertension operating manuals (bypass by maneuvering, endartoctomy) are used only for existing contraindications for the use of transumenal angioplasty. If the patient has signs of an aggressive course of arterial hypertension due to severe unilateral nephrosclerosis, the only treatment is nephrectomy.
In endocrine secondary arterial hypertension, a combination of surgical treatment (radical excision of the tumor substrate) and drug antihypertensive therapy (spironolactone at a daily dose of 200 mg with primary aldosteronism, percectolamine at a dose of 25 hours with theoochromocyrito is used.
Prevention of arterial hypertension
Compliance with preventive measures, the action of which is aimed at preventing episodes of increased intravascular blood pressure, as well as reducing the risk of complications of arterial hypertension, is indicated not only on patients who have long suffered from this pathology, but also to healthy persons whose signs may occur.
A scientifically proven fact is a direct dependence of the correlation of the increase in blood pressure in the weight of the human body weight and therefore normalizing the weight of a person suffering from arterial hypertension is the main priority preventive event. In addition, compliance with the rules for correcting food behavior helps prevent the progression of atherosclerotic vascular lesions, which is one of the main causes of arterial hypertension.
Recent pharmacology studies have proven the beneficial effects of omega-3-exposed fatty acids on the restoration of blood vessels, which can also be considered an effective method to prevent arterial hypertension. Given these conclusions, you should use olive oil in sufficient quantities a day and sharply limit animal fats.
Of course, 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 microdoses.
Persons who have already noted episodes of arterial hypertension as secondary preventive measures should be measured daily by blood pressure in order to preserve a special diary that reflects the effectiveness of the drug therapy used, and if the new clinical manifestations worsen without delaying the doctor.
Arterial hypertension - which doctor will help? In the presence or suspicion of the development of arterial hypertension, you should immediately seek advice for such doctors as a cardiologist, endocrinologist and nephrologist.