Arterial hypertension is a pathological or physiological predisposition for a sharp or gradual increase in indicators and systolic and diastolic components of intravascular blood pressure, which occurs as an independent namelain unit or the manifestation of another pathology is available in the patient.
According to world statistics, the epidemiological situation regarding the frequency of arterial hypertension is unfavorable, because the percentage of this pathology in the structure of the cardiological profile is reached by 30%. There is a clear connection of dependence on increasing the risk of signs and the consequences of arterial hypertension with the increase in the age of the patient, and thus the main category of increased risk are the people of mature and elderly.
Causes of arterial hypertension
The appearance of signs of increased blood pressure in the patient may appear in the background of existing chronic diseases and then we talk about the secondary or symptomatic version of arterial hypertension. In case arterial hypertension is primary and even after a comprehensive patient survey, 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 increasing blood pressure, and the polyethological development of this pathological state is currently being discussed. Thus, there are risk factors for dimodified hypertensions, which cannot be avoided (sexually, genetic determinism and age), however, these causing factors are not dominant in the development of severe arterial hypertension. To a greater extent to the development of primary arterial hypertension affects the human lifestyle (not balanced diet, bad habit, inactivity, psycho - emotional instability). Together, all the above provocating factors sooner or later create favorable conditions for the pathogenetic development of arterial hypertension.
Many pathogenetic theories of the development of essential arterial hypertension, although these hypotheses do not have an impact on the patient's tactics and determining the scope of therapeutic measures are discussed. Ethiopathogenic development of secondary arterial hypertension should be taken into account to a greater extent, because without eliminating the etiological factor, causing blood pressure, in this case you should not wait for positive treatment results.
Thus, with the renovatiuscular version of the symptomatic arterial hypertension, the main pathogenetic connection is the stenosis of the renal artery that occurs with its atheroscleric lesion or fibrous muscle dysplasia. An extremely rare etiological factor that affects renal arteries is systemic vasculitis. The consequence of the stenosis is the development of the ischemic lesion of one or both kidneys causing the hyperproduction of Renin, which has an indirect effect on increasing blood pressure.
In the pathogenesis of the development of endocrine etiological form of arterial hypertension, there is an increase in the level of hormonal substances that have an incentive effect on increasing intravascular blood pressure, which occurs with Connect syndrome syndrome and feochromocytom. Some cardiovascular diseases can act as a background pathology for the development of secondary arterial hypertension, such as aortic coarctation.
Symptoms of arterial hypertension
Clinical manifestations in the initial phase of arterial hypertension can be completely absent, and in this case diagnosis is based only on data from an objective and instrumental laboratory.
The appeals presented by patients suffering from arterial hypertension are quite unspeakable, and therefore, in debut by essential hypertension, diagnosis is significantly difficult. In most cases, with an episode of arterial hypertension, the patient disturbs a headache with overriding localization in the front and occipital region, sharp dizziness, especially when changing the body's position in the ears in the ears. These events are not pathomony, so they are not advisable to consider clinical criteria for arterial hypertension, because the above symptoms are occasionally observed in absolutely healthy people and have nothing to do with increasing blood pressure. Classic clinical manifestations in the form of respiratory disorders, signs of heart rate dysfunction have been observed only in the daleking phase of arterial hypertension.
Some Ethiopathogenetic forms of arterial hypertension are accompanied by the development of specific clinical symptoms, in connection with which an experienced expert can establish a correct diagnosis during the initial review and thoroughly collection of anamnesis. For example, with the renovated types of arterial hypertension, the acute debinity decoration was always observed, which consists of a sharp critical and constant increase in blood pressure indicators mainly due to the diastolic component. However, arenascular arterial hypertension does not characterize the course of the crisis, however, the benefit of the patient with this pathology is extremely difficult.
Endocrine Arterial hypertension, on the contrary, is characterized by the tendency to the paroxysmal course of disease with the development of classical hypertensive crises. For this pathology, the patient has a clinical "paroxysmal triad", which consists in the development of sharp headaches, expressed sweating and fast palpitations, is characteristic. Patients who are in this pathological state have extreme psycho -emotic excitement. The development of a hypertensive crisis occurs usually at night, and the duration of clinical events does not exceed one hour, after which patients record sharp weaknesses and blunt joint headaches.
DEGREES AND PHASES OF ARTERIA HYPERTENCE
Determining the severity and intensity of clinical manifestations of arterial hypertension, as well as the disease development phase, is a prerequisite for selecting the appropriate treatment regime. The separation of arterial hypertension is based on primary and symptomatic genesis, the level of increase in systolic and diastolic components of blood pressure is laid.
Patients with 1 degree arterial hypertension usually does not record a pronounced violation of their own health due to the fact that the figures of blood pressure in this situation do not exceed 159/99 mm. Rt. Art.
2 The degree of arterial hypertension monitors expressed clinical manifestations and organic changes in the target bodies, and blood pressure indicators range from 179/109 mm. Rt. Art.
3 The disease degree is characterized by an extremely strong aggressive exchange rate and tendency to develop complications from the injured parties and heart function. With a third degree, a critical increase in blood pressure is observed greater than 180/110 mm. Rt. Art.
In addition to the classification of arterial hypertension in terms of seriousness, in practical activities, cardiologists use the separation of the stadium of this pathology, the presence of the presence of signs of damage to the targeted authorities.
In the initial phase of arterial hypertension, and primary and secondary genesis, the patient has a wholly no manifestation of organic lesions sensitive to increasing blood pressure of tissues and bodies.
The second phase of the disease includes the development of detailed clinical symptoms, the intensity of the event whose directly depends on the weight of harm internal bodies. However, this phase of arterial hypertension was established on the basis of an instrumental authority in the form of hypertrophic cardiomyatia of the left ventricial from the Echocardioscopy and ECG, the biochemical blood analysis, namely, the level of levels of levels in plasma levels.
The third phase of arterial hypertension is the terminal, in which the patient has irretrievable changes in all bodies sensitive to increased blood pressure. Compared to the heart in a person who long suffering from the increase in blood pressure, ischemic myocardial damage is developed in the formation of infarction zones. On the brain structures, arterial hypertension is a negative effect in the form of provocation of transient ischemic attacks, hypertension encephalopathy, and even the formation of the hotplate of ischemic strokes. The long-term systemic increase in intravascular pressure is extremely negatively affected by the structure of blood vessels, whose outcome is the formation of bleeding in the retina and the Optical Disk Edem.
The terminal phase of the development of arterial hypertension is characterized by significant combustion of renal function, which is reflected on the levels of creatinine levels, which exceeds the 177 μmol / l indicator.
Diagnosis of arterial hypertension
When carrying out the clinical and instrumental laboratory testing with arterial hypertension, it is not as for the fact that the increase in blood pressure, but to detect the cause of the secondary arterial hypertension, as well as the assessment of the risk factor for the development of heart profiles.
When the initial contact with a sick key to establish a correct diagnosis and determining further treatment tactics, the thorough collection of patients's anamnestic data is a fundamental collection. An objective testing of a patient suffering from arterial hypertension allows you to determine the Ethiopathogenetic form of the disease due to detecting specific pathomic characters. Thus, with the existing type of obesity in the patient, in combination with hypertrichosis, Hirsutism and persistent increasing the diastolic component of arterial pressure, the endocrine nature of the disease (icon-doll) should be assumed. With pheochromocytom, accompanied by heavy paroxysmal artery hypertension, the increase in skin pigmentation in the projection of axillary recesses is observed. The main diagnostic clinical criterion of renoviscular arterial hypertension is auscultation of vascular noise in projection near the Blindle region.
The volume of laboratory research methods for arterial hypertension consists of an analysis of the patient's lipidogram, the determination of urinary acids and creatinins, as the main criteria for kidney dysfunction, analysis of the patient's hormonal status.
In order to determine the disease phase, the condition of the diagnosis of target bodies, ie bodies in which irrevurable changes are developed due to increasing blood pressure. Thus, for the study of the heart for weakened activities and organic lesions, electrocardialographic registration and ultrasound visualization, which are part of the standard inspection of all patients who suffer from arterial hypertension. To discover retinopathy, which is noticed mainly with extended severe arterial hypertension, the patient's bottom of the eyes must be examined. It is recommended to use visualization methods as instrumental methods of kidney and brain studies, which are not included in the mandatory list of diagnostic measures, but significantly facilitate the early establishment of the correct diagnosis (calculated tomography, magnetic resonance.
Treatment of arterial hypertension
Basic modern approach to arterial hypertension therapy is to achieve maximum risk elimination on the development of a heart profile complications and mortality levels. In this regard, the priority of the present doctor is fully eliminated by reversible (modified) risk factors that are the patient for further ceasing medications of arterial hypertension and simultaneous clinical manifestations. There is a certain standard consisting of achieving the target border of blood pressure, whose indicators must not exceed 140/90 mm HG
In what cases should antihypertential therapy be used for arterial hypertension? Cardiologists in their practice use a developed classification, which implies an assessment of the patient's "risk of cardiovascular complications. "According to this classification, the combined treatment using the modification of lifestyle and drug correction is subject to high risk of heart profiles complications in combination with a critical increase in blood pressure numbers. Patients belonging to a category of moderate and low risk are subject to dynamic observation for at least three months, and only in the absence of the use of correction correction methods should be resorted to antihypertensively medications.
The principles of correction of arterial hypertension hypertension are a gradual reduction of blood pressure to target numbers by using the minimum therapeutic dose of one or more hypotensive drugs. In some situations, monotherapy with a small dose of hypotensive medicine can have a long positive effect in terms of relief arterial hypertension. Currently, the pharmaceutical market is filled with a wide range of antihypertensive drugs, however, combined groups of drugs with prolonged hypotensive effects (up to 24 hours) are the most popular.
As choices of elections compared to the first episode of arterial hypertension, diuretic agents that have a wide range of positive effects in the form of preventing cardiovascular complications, reducing mortality, as well as prevention of hypertrophic changes in the left ventricular. Pharmacological effect, accompanied by a slight reduction in blood pressure, is determined by reducing water and sodium reabsorption and reducing vascular resistance.
The choice of diuretic drug depends on existing simultaneous illnesses in the patient. Therefore, with arterial hypertension, in combination with the signs of heart and renal failure, the advantage should be given to loop diuretic drugs. Tiazide Diuretic agents with extended use can cause the development of hypokalem syndrome, so it is better to use them in combination with the aldosterone antagonists.
In a situation in which the patient has signs of arterial hypertension in combination with tachyarrhythmia, angina attacks and symptoms of chronic cardiovascular insufficiency, it is recommended to use a group of water blockers as medicines in the first place. The mechanism of the antihypertensive effect of these medicines is to reduce the release of the heart and inhibiting renin products. It should be borne in mind that the inconsistency with a dose of this group can cause a pronounced drop in the heart rate and bronchoconstrictor frequency, which is an absolutely indication of cancellation of Ba-Blocker.
It is advisable for patients suffering from arterial hypertension on the background of proteinuria. Absolute contraindication for the use of the Drug ACE inhibitor group is two kidney stenosis in the patient. Angiotenzin II medicines II II antagonist receptor have a similar hypotensive effect with je differences that they are not provoking the development of coughs and the assemblies of anhioneurotic nature, which significantly expands the scope of their application.
The drugs of the group of calcium channels are a pronounced hypotensive effect, allowing the arterial hypertension to stop due to the reduction of calcium content in the vaccular wall. The category for prescribing drugs of this group is mainly older patients who are simultaneously with arterial hypertension, observe the signs of myocardial damage, manifested in the development of angina attacks. On exclusively extended forms of calcium channel blockers are used in cardiaological practice due to the fact that short calcium antogonists significantly increase the risk of provoking an acute myocardial infarction.
In a situation where arterial hypertension in the patient combines with a violation of the rhythm of heart activity, it is advisable to use calcium category of phenelaclamines and benzotiazepine derivatives. Absolute contraindication The use of this category of drugs is the patient's heart failure, accompanied by a decline in the share of emissions less than 45%.
Separate, drug mitigation should be considered, in which there is a critical increase in the number of intravascular pressure and the acute course of arterial hypertension. In this situation, preferences should be given to drugs with pronounced antihypertensive effect, because with an extended exchange rate of a hypertension crisis, the danger of death is rapidly increasing. With the patient's signs of a complicated hypertension crisis, the parenteral path of medication administration with a hypotensive effect is more desirable. Most groups of hypotensive funds are manufactured in parelarial forms. As a rule, a hypotensive effect does not occur no later than 5 minutes after the drug application.
In the event of an uncomplicated hypertensive crisis, there is no need to use parentary forms of antihypertensive drugs, because there is no critical increase in blood pressure in this pathological condition. The oral intake of antihypertensive agents in adequate dosing allows you to reduce the pressure within a few hours and maintain targeted numbers in the future. Of course, there are currently many methods of stopping drugs hypertension, however, exclusion of complications, the planned antihypertesionezional therapy scheme should be applied regularly.
In the case of arterial hypertence in the patient secondary in nature and develops as a result of kidney stenosis, the basic method of treatment is the operational correction of stenosis and revascularization by angioplasty. Operational manuals for renoviscular arterial hypertension (detention bypass, endartectomy) are used only for existing contraindications for the use of transcuminal angioplasty. If the patient has signs of aggressive flow of arterial hypertension due to severe unilateral nephrosclerosis, the only treatment is nephrectomy.
With the endocrine of the secondary arterial hypertension, the combination of surgical treatment (radical experimentation of the tumor substrate) is used in a daily dose of 200 mg with primary aldosteronism, pcentolamine in a dose of 25 hours with theocromocite).
Prevention of arterial hypertension
Compliance with preventive measures, whose action is on the prevention of an increase in intravascular blood pressure, as well as a reduction in the risk of arterial hypertension, not only patients who can occur to the signs of increased pressure.
A scientifically proven fact is a direct connection of dependence on increasing blood pressure in the severity of the human body, and thus, the normalization of the weight of the person suffering from arterial hypertension is a major priority preventive event. In addition, compliance with the rules for correcting food behavior helps prevent the progress of atherosclerotic vascular lesions, which is one of the main causes of arterial hypertension.
Recent pharmacology studies have proven beneficial effects of omega-3-3-halhine fatty acids, which can be considered an efficient method for preventing arterial hypertension. Given these conclusions, you should use olive oil in sufficient quantities a day and a sharp border limit of animal fat.
Of course, if you want to get rid of arterial hypertension manifestation, you should leave bad habits in the form of smoking and drinking alcohol, because nicotine and alcohol particles can increase intravascular blood pressure even in microdes.
People who have already noticed the episodes of arterial hypertension as secondary preventive measures, to maintain a special diary that reflect the efficiency of drug therapy, and if new clinical manifestations are deterioration without delaying a doctor attending attending attendance.
Arterial hypertension - which doctor will help? In the presence or suspicious development of arterial hypertension you should immediately seek advice on such doctors as a cardiologist, endocrinologist and nephrologist.