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 available in the patient.
According to world statistics, the epidemiological situation in terms of incidence of arterial hypertension is unfavorable, since the percentage of this pathology in the structure of diseases of the cardiological profile reaches 30%. There is a clear correlation dependence of an increase in the risk of developing signs and consequences of arterial hypertension with an increase in the age of the patient, and therefore the main category of increased risk is the faces of mature and elderly.
Causes of arterial hypertension
The appearance of signs of increased 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 case when arterial hypertension is primary and even after a comprehensive examination of the patient, it is not possible to determine the cause that provokes 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 an increase in blood pressure, and the polyetiological development of this pathological state is currently considered. Thus, there are non -modified risk factors for arterial hypertension, which is not possible to avoid (sexual, genetic determinism and age), however, these provoking factors are not dominant in the development of severe arterial hypertension. To a greater extent, the development of primary arterial hypertension is influenced by human lifestyle (not balanced nutrition, bad habits, inactivity, psycho -emotional instability). Together, all of the above provoking factors 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 tactics of the patient and determining the volume of therapeutic measures. The etiopathogenes of the development of secondary arterial hypertension should be taken into account to a greater extent, since without the elimination of the etiological factor provoking an increase in blood pressure, in this case you should not wait for positive treatment results.
So, with the renovascular version of the symptomatic arterial hypertension, the main pathogenetic link is the stenosis of the renal artery that occurs with its atherosclerotic lesion or fibrous-muscular 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 both kidneys that provoke a hyperproduction of renin, 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 the syndrome of the celenko-rush, conn syndrome and feoochromocytoma. Some cardiovascular diseases can act as a background pathology for the development of secondary arterial hypertension, such as aorta coarctation.
Symptoms of arterial hypertension
Clinical manifestations in the initial stage of development of arterial hypertension may be completely absent, and the diagnosis in this case is based only on data from an objective and instrumental-laboratory examination.
Complaints presented by patients suffering from arterial hypertension are quite non -specific, and therefore, in the debut of essential hypertension, the diagnosis is significantly difficult. In most cases, with an episode of arterial hypertension, the patient is disturbed by headache with predominant localization in the frontal and occipital region, sharp dizziness especially when changing 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 arterial hypertension, since the above symptoms are periodically observed in absolutely healthy people and have nothing to do with an increase in blood pressure. Classical clinical manifestations in the form of respiratory disorders, signs of dysfunction of cardiac activity are observed only in the far -reaching 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 correct diagnosis during the initial examination and thoroughly collecting an anamnesis. For example, with a renovascular 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. Renovascular arterial hypertension is not characterized by a crisison course, however, 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 classical hypertensive crises. For this pathology, the patient has a clinical "paroxysmal triad", which consists in the development of a sharp headaches, pronounced sweating and rapid palpitations, is characteristic. Patients who are in this pathological condition have extreme 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 one hour, after which patients note sharp weakness and dull common headache.
Degrees and stages of arterial hypertension
Determining the severity and intensity of clinical manifestations of arterial hypertension, as well as the stage of development of the disease, is a prerequisite for the selection of an adequate treatment regimen. The separation 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 laid.
Patients with 1 degree of arterial hypertension most often do not note 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 degree of arterial 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 from impaired brain and heart function. With the third degree, a critical increase in blood pressure exceeding 180/110 mm is noted. RT. Art.
In addition to the classification of arterial hypertension in terms of severity, in practical activities, cardiologists use the stadium separation of this pathology, the criteria of which is the presence of signs of damage to target organs.
In the initial stage of arterial hypertension, both primary and secondary genesis, the patient completely does not have manifestations of organic lesions sensitive to an increase in blood pressure of tissues and organs.
The second stage of the disease involves the development of detailed clinical symptoms, the intensity of the manifestation of which directly depends on the severity of the damage to the internal organs. However, in most cases, this stage of arterial hypertension is established on the basis of instrumental confirmation of organs lesions in the form of hypertrophic cardiomyopathy of the left ventricle of the heart according to echocardioscopy and ECG, narrowing of the arterial vessels of the retina when examining the eye bottom and the presence of changes in the biochemical analysis of blood, namely, a moderate increase in creatinine levels in the levelplasma.
The third stage of arterial hypertension is terminal, in which the patient has the development of irreversible changes in all organs sensitive to increased blood pressure. In relation to the heart in a person who has long suffering from an increase in blood pressure, ischemic myocardial damage develops, manifested in the formation of infarction zones. On the structures of the brain, arterial hypertension has a negative effect in the form of a provocation of transient ischemic attacks, hypertension encephalopathy and even the formation of foci of ischemic stroke. Long -term systemic increase in intravascular pressure extremely negatively affects the structure of blood vessels, the outcome of which is the formation of hemorrhages in the retina and edema of the optic disk.
The terminal stage of the development of arterial hypertension is characterized by a significant suppression of the kidney 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 establish the fact of increasing blood pressure, but to detect the cause of the development of secondary arterial hypertension, signs of damage to internal organs, as well as evaluating the presence of risk factors for the development of complications of the cardiac profile.
With the initial contact with a sick key to establishing the correct diagnosis and determining further treatment tactics, a thorough collection of the patient’s anamnestic data is a thorough collection. An objective examination of a patient suffering from arterial hypertension allows you to determine the etiopathogenetic form of the disease due to the detection of specific pathognomonic signs. So, with the existing abdominal type of obesity in a patient, combined with hypertrichosis, hirsutism and a persistent increase in the diastolic component of arterial pressure, the endocrine nature of the disease (iconko-doll syndrome) should be assumed. With pheochromocytoma, accompanied by severe paroxysmal arterial hypertension, an increase in the pigmentation of the skin in the projection of the axillary hollows is observed. The main diagnostic clinical criterion of renovascular 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, as the main criteria for 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 lesions of target organs, that is, organs in which irreversible changes are developing due to an increase in blood pressure. Thus, to study 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 observed mainly with prolonged severe arterial hypertension, the patient's eye bottom must be examined. It is advisable to use radiation methods of visualization as instrumental methods of studying the kidneys and brain, which are not included in the mandatory list of diagnostic measures, but significantly facilitate the early establishment of the correct diagnosis (computed tomography, magnetic resonance imaging).
Treatment of arterial hypertension
The fundamental modern approach to the therapy of arterial hypertension is to achieve maximum elimination of the risk of developing complications of the cardiac profile and the level of mortality. In this regard, the priority of the attending physician is to completely eliminate the reversible (modified) risk factors available to the patient with further drug stopping of arterial hypertension and concomitant clinical manifestations. There is a certain standard, which consists in achieving the target boundary of blood pressure, the indicators of which should not exceed 140/90 mm Hg
In what cases should antihypertensive therapy be used for arterial hypertension? Cardiologists in their practice use the developed classification, which implies an assessment of the patient’s "risk of developing cardiovascular complications". According to this classification, a combined treatment using a modification of lifestyle and drug correction is subject to persons with a high risk of complications of the cardiac profile in combination with a critical increase in blood pressure numbers. Patients belonging to the category of moderate and low risk are subject to dynamic observation for at least three months, and only in the absence of the effect of the use of non -drug methods of correction should be resorted to drug antihypertensive treatment.
The principles of drug correction of arterial hypertension are a gradual decrease in blood pressure to target numbers by the method of using the minimum therapeutic dose of one or more hypotensive drugs. In some situations, monotherapy with a low dose of a hypotensive drug may have a long positive effect in terms of relief of 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 most popular.
As drugs of choice in relation to the first episode of arterial hypertension, preference should be given to diuretic agents that have a wide range of positive effects in the form of preventing the development of cardiovascular complications, reducing mortality, as well as the prevention of progression of hypertrophic changes in the left ventricle of the heart. The pharmacological effect, accompanied by a mild decrease in blood pressure, is determined by a decrease in water and sodium reabsorption and a decrease in vascular resistance.
The choice of a diuretic drug depends on the existing concomitant diseases in the patient. So, with arterial hypertension, combined with signs of cardiac and renal failure, it should be given preference to loop diuretic drugs. Tiazide diuretic agents with prolonged use can provoke the development of hypokalemic syndrome, and therefore, it 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 cardiovascular insufficiency of a stagnant nature, it is advisable to use a group of water-blockers as drugs of the first row. The mechanism of the antihypertensive effect of these drugs is to reduce the heart release and inhibiting of Renin products. It should be borne in mind that non-compliance with the dosage of the drug of this group can provoke a pronounced decrease in heart rate and bronchoconstrictor frequency, which is an absolute indication for the cancellation of the reception of Ba-blocker.
It is advisable for patients suffering from arterial hypertension against the background of proteinuria. An absolute contraindication for the use of drugs of the ACE inhibitors group is a two -way renal stenosis in the patient. The drugs of the Angiotensin II receptors II receptors group have a similar hypotensive effect with the only difference being that they do not provoke the development of coughing and sapeling of an anhione -European nature, which significantly expands the scope of their application.
Medicines of the group of calcium channel blockers group have a pronounced hypotensive effect, allowing to stop arterial hypertension due to a decrease in calcium content in the vascular wall. The category for prescribing drugs of this group is mainly older patients who, simultaneously with arterial 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 -action 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 rhythm of cardiac activity, it is advisable to use calcium category of phenylaclamins and derivatives of benzotiazepine. An absolute contraindication to the use of this category of drugs is the patient's heart failure, accompanied by a decrease in the emission fraction of less than 45%.
Separately, the drug relief of the hypertension crisis should be considered, in which there is a critical increase in the numbers of intravascular pressure and the acute course of arterial hypertension. In this situation, preference should be given to drugs with a pronounced antihypertensive effect, since with a prolonged course of hypertension crisis, the risk of fatal outcome increases sharply. With the patient’s signs of complicated hypertension crisis, the parenteral path of administration of drugs with a hypotensive effect is preferable. Most groups of hypotensive agents are produced in parenteral forms. As a rule, the hypotensive effect occurs no later than 5 minutes after the administration of the drug.
In the case of uncomplicated hypertensive crisis, there is no need to use parenteral forms of antihypertensive drugs, since in this pathological condition there is no critical increase in blood pressure. The oral intake of antihypertensive agents in adequate dosage allows you to reduce pressure within several hours and maintain target numbers in the future. Of course, at present there are many methods of drug stopping a hypertension crisis, however, to exclude the development of complications, the planned scheme of antihypertensional therapy should be regularly applied.
In the case when arterial hypertension in the patient is secondary in nature and develops as a result of the stenosis of the renal arteries, the fundamental method of treatment is the operational correction of stenosis and revascularization by angioplasty. Operational manuals for renovascular arterial hypertension (bypass by shunting, endarterctomy) are used only for existing contraindications to 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 excision of the tumor substrate) and drug antihypertensional therapy (spironolactone in a daily dose of 200 mg with primary aldosteronism, pcentolamine at a dose of 25 hours with Theochromocytoma) is used.
Prevention of arterial hypertension
Compliance with preventive measures, the action of which is aimed at preventing episodes of increasing intravascular blood pressure, as well as reducing the risk of complications of arterial hypertension, is shown not only to patients who have long suffering from this pathology, but also to healthy persons whose signs of increased pressure may occur.
A scientifically proven fact is a direct correlation dependence of an increase in blood pressure in the human body weight, and therefore, the normalization of the weight of a person suffering from arterial hypertension is the main priority preventive event. In addition, compliance with the rules for the correction of food behavior helps to prevent the progression of atherosclerotic vascular lesions, which is one of the main causes of arterial hypertension.
Recent studies in the field of pharmacology have proven the beneficial effects of omega-3-lushed fatty acids on restoring blood vessels, which can also be considered an effective method for the prevention of arterial hypertension. Given these conclusions, you should use olive oil in sufficient quantities daily and sharply limit animal fat.
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, since 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, to keep a special diary reflecting the effectiveness of the used drug therapy, and if new clinical manifestations are worsening, without postponing the attending physician about this.
Arterial hypertension - which doctor will help? In the presence or suspicion of the development of arterial hypertension, you should immediately seek advice on such doctors as a cardiologist, endocrinologist and nephrologist.