Arterial hypertension(Hypertension) is the most common disease of the cardiovascular system. Hypertension shows a steady high blood pressure. An increase in blood pressure occurs when there is a narrowing of the arteries and/or their smaller branches - arterioles. In some people, the arterioles are often narrow, first due to a spasm, and later their lumen remains constantly narrowed due to the thickening of the wall, and then, so that the flow of blood overcomes this narrowing, the work of the heart increases and more blood is thrown. In such people, as a rule, hypertension develops.In Bulgaria, approximately 40% of the adult population have an elevated blood pressure level. At the same time, about 37% of men and 58% of women know the presence of diseases, 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 a constant increase in blood pressure above the allowable limits (systolic pressure above 139 mm Hg or (s) diastolic pressure above 89 mm Hg).
In approximately one of the ten hypertension, increased blood pressure is caused by the lesion of each organ. In these cases, they speak of secondary or symptomatic hypertension. About 90% of patients suffer from primary or basic hypertension. The reference point of high blood pressure is the low level of 139/89 mm Hg, three registered levels of 139/89 mm RT. Art. And more in people who do not take drugs to reduce pressure.Blood pressure
There are two indicators of blood pressure:Systolic blood pressure (garden)- reflects the pressure in the arteries, which is created when the heart is reduced and the blood is excreted in the arterial part of the vascular system;Diastolic Blood Pressure (DDAD)-Palming in the arteries at the time of relaxation of the heart during which it is filled before the next decrease. Symptoms of arterial hypertension
Clinic, that is, the manifestations of hypertension have no specific symptoms. For many years, patients may not know about their illness, do not complain, have high vital activity, although attacks of "casualty", severe weakness and dizziness can sometimes occur. But even then everyone believes it is fatigue. Although at this point you should consider your blood pressure and measure it.
Complaints of hypertension occur if the so-called target organs are affected by the most sensitive to blood pressure. The appearance of dizziness, headache, head noise, memory reduction and performance shows initial changes in cerebral circulation. He then joins the eyes, flips the flies, weakness, limb numbness, difficulty in speech, but at the initial stage there are changes in the bloodstream. The distant stage of arterial hypertension can be complicated by the infarction of the brain or cerebral hemorrhage. The most early and constant sign of constant high blood pressure is an increase or hypertrophy of the left ventricle of the heart, with the growth of its mass due to the thickening of the heart cells, cardiomyocytes.
First, the thickness of the left ventricle wall increases, and in the future there is an extension of this heart chamber. It is necessary to pay much attention to the fact that the hypertrophy of the left ventricle is an unfavorable prognostic sign. A number of epidemiological studies have shown that the onset of left ventricular hypertrophy significantly increases the risk of sudden death, coronary artery disease, heart failure and disorders of the ventricular rhythm. The progressive left ventricular dysfunction leads to the appearance of such symptoms as: shortness of breath, paroxysmal night breathing (heart asthma), pulmonary edema (often with crises), chronic (congestive) heart failure. Against this background is a more common myocardial infarction, ventricular fibrillation. With gross morphological changes in the aorta (atherosclerosis), it expands, its stratification, rupture can occur. Kidney lesions are expressed by the presence of protein in the urine, microhematuria and cylinder. However, renal failure with hypertension, if there is no malignant course, rarely develops. Eye damage can be manifested by vision damage, reducing the sensitivity of light and the development of blindness. In this way, it is quite obvious that hypertension should be treated more carefully.Risk factors of arterial hypertension
Unmanaged risk factors include:Heredity - People who have patients with hypertension among relatives are most predisposed to the development of this pathology in them.The male floor is found that the incidence of men arterial hypertension is significantly higher than the frequency of women. But the fact is that female sex hormones, estrogens prevent the development of hypertension. But such protection, unfortunately, is short. The menopause period occurs, the saving effect of estrogens ends, and women are aligned with men and often outstrip them.
Changed risk factors include:Increased body weight - in people with excess weight, the risk of developing arterial hypertension is higher;A sedentary lifestyle - in another hypodynamia, a sedentary lifestyle and low physical activity lead to obesity, which in turn contributes to the development of hypertension;When consuming alcohol, excessive consumption of alcohol promotes arterial hypertension. Eating a large amount of salt in food - a diet with a strong salt helps to increase the pressure. The question is how many salt can be consumed per day? The answer is short: 4, 5 grams or a teaspoon without a tip.An unbalanced diet with excess atherogenic lipids, excessive calorie content, leading to obesity and promotion of type II diabetes. Atherogenic, that is, literally, the lipids "creating atherosclerosis" are contained in large quantities in all animal fats, meat, especially pork and lamb;Smoking is another variable and great factor in the development of arterial hypertension and its complications. It is a fact that tobacco substances, including nicotine, create a constant spasm of the arteries, which is fixed, leads to firmness of the arteries, which leads to an increase in pressure in the vessels;Stress - leads to the activation of a sympathetic nervous system that performs the function of an immediate activator of all systems of the body, including cardiovascular. In addition, the press, that is, causing spasm from arteries, hormones, are thrown into the blood. All this, as with smoking, leads to the firmness of the arteries and develops arterial hypertension;Rough sleep disorders of the type of night apnea syndrome or snoring. Snoring is really a scourge of almost all men and many women. Why is snoring dangerous? The fact is that it causes an increase in chest and abdominal pressure. All this affects the vessels, leading to their spasm. Arterial hypertension develops.Causes of arterial hypertensionThe cause of the disease remains unknown in 90-95 % of patients-this is essential (ie primary) arterial hypertension. In 5-10% of cases, an increase in blood pressure has an established cause-this is symptomatic (or secondary) hypertension.
Causes of symptomatic (secondary) arterial hypertension:Primary kidney damage (glomerulonephritis) is the most common cause of secondary arterial hypertension;one- or bilateral narrowing (stenosis) of the renal arteries; Coarctation (congenital narrowing) of the aorta;Pheochromocytoma (adrenal tumor producing adrenaline and norepinephrine);Hyperaldosteronism (a tumor of the adrenal glands that produces aldosterone);Thyrexicosis (increase in thyroid function);Consumption of ethanol (wine alcohol) more than 60 ml per day;Medicines: hormonal drugs (including oral contraceptives), antidepressants and others;Risk factors for cardiovascular complications with arterial hypertensionBasic:Men over 55;women over 65;Total blood cholesterol level level>6, 5 mmol/l, raising the level of low density lipoprotein cholesterol (>4, 0 mmol/l) and low -density lipoprotein cholesterol;Family History of Early Cardiovascular Diseases (in Women<65 years, in men<55 years);obesity of the abdomen (waist volume ≥102 cm for men or ≥ 88 cm for women);Level C - reactive protein in the blood ≥1 mg/dl;Diabetes Sugar (blood glucose on an empty stomach>>7 mmol/l).
Further:violation of glucose tolerance;low physical activity;Improve the level of fibrinogen.
RemarkSThe accuracy of determining the total cardiovascular risk directly depends on how completed the clinical and instrumental examination of the patient is.Complications for arterial hypertension
Among the most significant complications of arterial hypertension are:hypertensive crises;cerebrovascular disorders (hemorrhagic or ischemic strokes);myocardial infarction;nephrosclerosis (primary wrinkled kidney);heart failure;Connection of the aorta aneurysm.
Studies on arterial hypertensionIn all patients with arterial hypertension, the following studies should be performed: General blood and urine test;blood creatinine levels (to exclude kidney damage);The level of potassium in the blood beyond the use of diuretics (a sharp decrease in potassium levels is suspicious of the presence of adrenal tumor or stenosis of the renal artery);Electrocardiogram (signs of left ventricular hypertrophy - evidence of a long course of arterial hypertension);determination of blood glucose levels (on an empty stomach);Blood content of total cholesterol, high and low density cholesterol, triglycerides, uric acid;Echocardiography (determining the degree of myocardial hypertrophy of the left ventricle and a state of contractile capacity)Exploring the bottom of the eyes.In addition, recommended studies:Breast radiography;Ultrasound of the kidneys and adrenal glands;Ultrasound of brachiocephalic and renal arteries;C-reactive protein in blood serum;Urine analysis for the presence of bacteria (bacteriuria), a quantitative assessment of protein in the urine (proteinuria);Determination of microalbumin in the urine (necessarily in the presence of diabetes).In a long study:Evaluation of the functional state of brain blood flow, myocardium, kidneys;Examination in the blood of aldosterone concentration, corticosteroids, radio activity; Determination of catecholamines and their metabolites in daily urine; abdominal aortography; Computed tomography or magnetic resonance imaging of the adrenal glands and the brain.Treatment of arterial hypertension The main goal of treating patients with arterial hypertension is to maximize the risk of developing cardiovascular complications and death. This is achieved through long -term lifelong therapy aimed at: Reducing blood pressure to normal levels (below 140/90 mm Hg). With a combination of arterial hypertension with diabetes or kidney damage, it is recommended to reduce blood pressure<130/80 mm Hg. (but not smaller than 110/70 mm Hg);"Protection" of the target organs (brain, heart, kidneys), preventing their more damage;Active effects on adverse risk factors (obesity, hyperlipidemia, carbohydrate disorders, unnecessary consumption of salt, hypodynamia), contributing to the progression of arterial hypertension and the development of its complications.Treatment without a medicine for arterial hypertensionSmoking refusal;Normalizing body weight (body mass index<25 kg/m2);reduce alcoholic beverages<30 g alcohol per day in men and 20 g/day in women;Increasing physical activity-regulatory physical activity of 30-40 minutes. at least 4 times a week;reducing salt consumption at the table up to 5 g/day;Change in diet with increased consumption of vegetable foods, reducing the consumption of vegetable fats, increased potassium, calcium in vegetables, fruits, cereals and magnesium contained in dairy products.The basic principles of drug therapy for arterial hypertension:Treatment of drugs should be started with minimal doses of each class of antihypertensive drugs (given the appropriate contraindications), as a gradual increase in the dose to a good therapeutic effect.
The choice of the drug should be justified, the antihypertensive drug should have a stable effect during the day and be well tolerated by patients.It is most advisable to use long-acting medicines to achieve a 24-hour effect with one use. The use of such drugs provides a softer hypotensive effect with more intensive protection of the target organs.
With the low efficacy of monotherapy (one drug therapy), it is advisable to use the optimal combinations of medicines to achieve maximum hypotensive effects and minimal side effects.
It is necessary to carry out a long (practically lifelong) administration of medicines to maintain the optimal blood pressure level and to prevent the complications of arterial hypertension.
Choosing the necessary medicines:Seven classes are currently recommended for the treatment of arterial hypertension:diuretics;B-blockers;calcium antagonists;Angiotensin-re-productive enzyme inhibitors;Angiotensin receptor blockers;Agonists of hyganist receptorsAdvertising blockers.Hospitalization indicationsPatients with arterial hypertension serve:The unclear diagnosis and the need for special, more invasive, research methods for clarifying the form of arterial hypertension;Difficulties in selection of drug therapy are frequent hypertensive crises, refractory arterial hypertension.Emergency Hospitalization indications:Hypertensive crisis without stopping at the previous stage;Hypertonic crisis with pronounced manifestations of hypertensive encephalopathy (nausea, vomiting, confusion);Complications of hypertension requiring intensive treatment and constant medical monitoring: stroke, subarachnoid hemorrhage, acute visual impairment, pulmonary edema, etc.
