Arterial hypertension is a pathological or physiological tendency that is a sharp or gradual increase in the systolic and diastolic components of blood pressure in the blood vessels, an independent pathological unit, or another pathological manifestation available to the patient.
According to world statistics, epidemiological conditions are disadvantageous in terms of the incidence of arterial hypertension, as this pathology reaches 30% of the structure of heart disease. There is a clear correlation between the risk of signs of development and the risk of consequences as patients age, and therefore, the main categories of increased risk are mature and older faces.
Causes of arterial hypertension
Signs of elevated blood pressure in patients may occur in the context of existing chronic diseases, and then we are talking about secondary or symptomatic arterial hypertension. Arterial hypertension is the primary, and even after a comprehensive examination of the patient, it is impossible to determine the cause of the elevated blood pressure in the blood vessels. The term "hypertension" should be used, which is an independent form of disease.
Primary arterial hypertension is observed in almost 90% of cases of elevated blood pressure, and multisex development of this pathological state is currently being considered. Therefore, there are non-modified risk factors for arterial hypertension, which is impossible to avoid (sexuality, genetic certainty and age), but these provocative factors are not major in the development of severe arterial hypertension. To a large extent, the development of primary arterial hypertension is affected by human lifestyle (not balanced nutrition, bad habits, inactivity, psychological and emotional instability). At the same time, all the above-mentioned triggers will sooner or later create good conditions for the pathogenic development of arterial hypertension.
Currently, although these hypotheses have no effect on the patient’s strategy and determine the number of treatment measures, many pathogenic theories for the development of fundamental arterial hypertension are considered. Pathogens of secondary arterial hypertension development should be considered to a greater extent, because in this case you should not wait for positive treatment results if etiological elevations are eliminated.
Therefore, with the renal vascular version of symptomatic arterial hypertension, the main pathogenic link is the stenosis of the renal artery, its atherosclerotic lesions or fiber-muscle dysplasia. The extremely rare cause that affects renal arteries is systemic vasculitis. The result of stenosis is the development of ischemic lesions in one or both kidneys, causing renin overproduction of the kidneys, which has an indirect effect on elevated blood pressure.
During the development of endocrine etiology of arterial hypertension, the levels of hormone substances are increased, which is stimulating for the increase in blood pressure in the blood vessels, which occurs due to the syndrome of Celenko-Rush, Conn syndrome and feoochromocytoma. Some cardiovascular diseases can serve as the background pathology of secondary arterial hypertension (such as aortic abbreviation).
Symptoms of arterial hypertension
Clinical manifestations in the initial stages of arterial hypertension development may be completely absent, in which case the diagnosis is based solely on objective and instrumental laboratory data.
Complaints filed by patients with arterial hypertension are very nonspecific and therefore, diagnosis is very difficult in the first appearance of hypertension. In most cases, as arterial hypertension occurs, patients are disturbed by headaches, mainly located in the frontal lobe and occipital area, especially dizziness, especially pathological noise in the ears when changing the body position in the space. These manifestations are not pathological and therefore they are not recommended to be considered as clinical criteria for arterial hypertension, as the above symptoms are regularly observed in absolutely healthy people and are not related to elevated blood pressure. Classic clinical manifestations are in the form of respiratory disease, and signs of cardiac activity dysfunction are observed only in the distant stages of arterial hypertension.
Certain forms of therapy for arterial hypertension are accompanied by the development of specific clinical symptoms, and in connection with the fact that experienced experts can establish the correct diagnosis and thoroughly collect anatomy during the initial examination. For example, using renal vascular type arterial hypertension, an acute debut of clinical manifestations consisting of a sharp critical and constant increase in blood pressure indicators, mainly due to diastolic components. The characteristic of renal vascular arterial hypertension is not a crisis course, but the patient has this pathology that is very serious.
On the contrary, endocrine arterial hypertension is characterized by tending toward the paroxysmal course of the disease as the classical hypertension crisis develops. For this pathology, the clinical "paradox triad" of patients is unique, including developmental sharp headaches, obvious sweating and rapid respiratory symptoms. Patients in this pathological condition have extreme psychological and emotional excitement. The development of hypertension crisis most often occurs at night, with clinical manifestations not exceeding one hour, after which the patient notices sharp weaknesses and dull headaches.
The degree and stage of arterial hypertension
Determining the severity and intensity of the clinical manifestations of arterial hypertension, as well as the stage of the disease development, is a prerequisite for choosing an appropriate treatment plan. The isolation of arterial hypertension is based on the primary and symptomatic origin, the increased levels of systolic blood pressure and diastolic blood pressure components.
Patients with 1 degree arterial hypertension usually do not notice obvious violations of their health, as the amount of blood pressure in this case does not exceed 159/99 mm. RT. Art.
2-degree arterial hypertension is accompanied by obvious clinical manifestations and organic changes in the target organ, and the blood pressure index ranges from 179/109 mm. RT. Art.
The 3 degrees of the disease are characterized by a very severe aggressive course and tend to develop complications from complications of impaired brain and heart function. In the case of the third stage, a critical increase in blood pressure exceeding 180/110 mm was noted. RT. Art.
In addition to classification of arterial hypertension to severity, cardiologists also use the pathology’s stadium isolation, which is a criterion for signs of damage to the target organ.
During the initial stage of arterial hypertension, which occurs primarily and secondaryly, the patient has no manifestations of organic lesions that are sensitive to elevated tissue and organ blood pressure.
The second stage of the disease involves the development of detailed clinical symptoms, the intensity of its manifestation directly depends on the severity of internal organ damage. However, in most cases, based on the tool confirmation of robotic lesions based on the form of hypertrophic cardiomyopathy in the left ventricle of the heart, this arterial hypertension was established based on the form of echocardiography and ECG, and the range of echocardiography and ECG was gradually formed when the field of view was narrowed down. In plasma.
The third stage of arterial hypertension is the end, where the patient develops irreversible changes to elevated blood pressure in all organs. It ischemic myocardial injury occurs in people with long-term elevated blood pressure, which is reflected in the formation of infarction areas. In the structure of the brain, arterial hypertension has a provocative ischemic attack, hypertensive encephalopathy, and even ischemic stroke lesions. Long-term systemic increase intravascular pressure is extremely negatively affecting the structure of the blood vessels, and the result is the formation of hemorrhage in the retina and edema of the optic disc.
The terminal stage of arterial hypertension development is characterized by a significant inhibitory effect on renal function, which is reflected in the level of creatinine, exceeding the 177 μmol/L index.
Diagnosis of arterial hypertension
When performing clinical and instrumental labor examinations in patients with arterial hypertension, the main goal should not be to determine the fact of elevated blood pressure, but to detect the causes of secondary arterial hypertension, signs of damage to internal organs, and to evaluate the presence of risk factors for cardiac profile concurrent risk factors.
Patient phagocytosis data were thoroughly collected by initially establishing the correct diagnosis with the sick key and determining the key to further treatment strategies. Objective examination of patients with arterial hypertension can allow you to determine the disease's form of disease due to the discovery of specific pathological symptoms. Therefore, as patients have existing obesity in the abdominal type, the continuous increase in diastolic components combining hypertrophy, polymyosoma and arterial pressure, the endocrine nature of the disease (ICONKO-DOLL syndrome). In conjunction with pheochromocytoma, accompanied by severe paroxysmal arterial hypertension, an increase in skin pigmentation in axillary projection was observed. The main diagnostic clinical criteria for renal vascular arterial hypertension is vascular noise auditory in projection of near-blocked areas.
The number of laboratory research methods for arterial hypertension includes the determination of the patient's fat chart, uric acid and creatinine, as the main criteria for renal dysfunction, analyzing the patient's hormonal status.
In order to determine the stage of the disease, the necessary condition is to diagnose the target organ lesions, that is, the organ that causes irreversible changes due to increased blood pressure. Therefore, to study the activity of the heart and impaired organic lesions, electrocardiogram registration and ultrasound visualization were used, as part of a standard screening examination for all patients with arterial hypertension rates. In order to detect retinopathy, this is mainly due to long-term severe arterial hypertension, the patient's fundus must be examined. Visual radiation methods are recommended as a tool for studying the kidneys and brain, which are not included in the mandatory list of diagnostic measures, but significantly facilitate the early establishment of correct diagnosis (computed tomography, magnetic resonance imaging).
Arterial hypertension treatment
The basic modern approach to treating arterial hypertension is to maximize the elimination of risk and mortality levels of cardiac profile complications. In this regard, the attending physician's priority is to completely eliminate the patient's reversible (modified) risk factors and further stop arterial hypertension and the subsequent clinical manifestations. There are certain standards, including the target boundary of blood pressure, whose index should not exceed 140/90 mm Hg
Under what circumstances should antihypertensive therapy be used for arterial hypertension? Cardiologists use well-developed classifications in practice, which means assessing patients' "risk of cardiovascular complications". According to this classification, combined treatment using modified lifestyle and drug correction is at high risk of cardiac profile complications, combined with a sharp increase in blood pressure. Patients who fall into the moderate and low-risk categories must undergo dynamic observations for at least three months, and drug-lowering treatment should be used only if the use of non-pharmacological correction methods is not used.
By using the minimum therapeutic dose of one or more antihypertensive drugs, the principle of drug correction of arterial hypertension is that blood pressure gradually decreases the number of targets. In some cases, a single therapy with low doses of low doses of drugs may have a long positive effect in relieving arterial hypertension. Currently, the pharmaceutical market is full of a wide range of antihypertensive drugs, but the most popular combination of antihypertensive effects (up to 24 hours) is the most popular.
As the drug of choice related to the first episode of arterial hypertension, diuretics should be favored, which have broad positive effects in preventing the development of cardiovascular complications, reducing mortality, and preventing the progression of changes in left ventricular flexion in the heart. Pharmacological effects are accompanied by mild decreases in blood pressure, depending on the decrease in water and sodium absorption and the decrease in vascular resistance.
The choice of diuretics depends on the patient's existing concomitant disease. Therefore, circulating diuretics should be given priority when using arterial hypertension, coupled with signs of heart and renal failure. Long-term use of yellow nitride epidiuretics can cause the development of hypokalemia syndrome, so it is best to use them in combination with aldosterone antagonists.
In the case of signs of arterial hypertension, coupled with the symptomatic stagnation of arrhythmia, angina attack and chronic cardiovascular disease, it is recommended to use a set of water blocks as the medication in the first row. The mechanism of antihypertensive effects of these drugs is to reduce cardiac release and inhibition of renin products. It should be kept in mind that the dosage of the drug that does not meet this group will cause significant decreases in heart rate and bronchial contraction frequency, which is an absolute indication of canceling BA-Blocker reception.
Recommended for patients with arterial hypertension in the context of proteinuria. The absolute contraindication for the use of drugs in the ACE inhibitor group is the patient's two renal stenosis. Drugs of angiotensin II receptor II receptor antagonists have similar antihypertensive effects, with the only difference being that they do not cause the development of coughing and nostrilic properties, thus significantly expanding the scope of their applications.
The drugs in a group of calcium channel blockers have obvious antihypertensive effects. Due to the decrease in calcium content in the blood vessel wall, arterial hypertension can be stopped. The prescription category of this group was mainly in older patients who observed signs of ischemic myocardial injury at the same time as arterial hypertension, which was manifested in the development of angina attack. In cardiology practice, an extended form of calcium channel blockers is used because short-term calcium antagonists significantly increase the risk of provocation for acute myocardial infarction.
In the case where arterial hypertension in patients is combined with a rhythm of violation of heart activity, it is recommended to use the phenyl las chain calcium class and the calcium class of benzodiazepine derivatives. The absolute contraindication for using this class of drugs is heart failure in patients, accompanied by a decrease in emissions of less than 45%.
In addition, drug relief for hypertension crisis should be considered, where the amount of intravascular pressure and the acute course of arterial hypertension increase dramatically. In this case, drugs with significant antihypertensive effects should be preferred, because the risk of fatal outcomes increases dramatically as the hypertension crisis prolongs. With signs of a complex hypertensive crisis in the patient, parenteral routes of drugs with antihypertensive effects may be preferred. Most antihypertensive drugs are produced in parenteral form. Typically, antihypertensive effects occur within 5 minutes after drug administration.
In the case of a simple hypertension crisis, there is no need to use parenteral antihypertensive drugs, because in this pathological state, there is no urgently needed increase in blood pressure. Oral intake of antihypertensive drugs The appropriate dose allows you to lower stress within a few hours and maintain the target quantity in the future. Of course, there are many ways to prevent the hypertension crisis at present, but in order to rule out the development of complications, anti-hypertensive treatment plans should be regularly adopted.
When the patient's arterial hypertension is essentially secondary and develops due to stenosis of the renal artery, the basic approach to treatment is surgical correction of stenosis and revascularization through angioplasty. The surgical manual for renal vascular arterial hypertension (by shunt, bypassing internal angiography) is only used for existing contraindications for the use of prone angioplasty. If the patient has an aggressive course of arterial hypertension due to severe unilateral nephrosclerosis, the only treatment is nephrectomy.
By endocrine secondary hypertension, surgical treatment (subsequent resection of tumor substrate) and drug-anti-exercise therapy (using 200 mg of spiroketone daily, with primary aldosterone protease, p-type methylamine daily dose was 200 mg, and using rational cell tumors for 25 hours).
Prevent arterial hypertension
Adhering to preventive measures, which are intended to prevent the onset of elevated blood pressure intravascular and to reduce the risk of complications of arterial hypertension, not only show patients with long-term pathology, but also healthy people who may have signs of increased stress.
A scientifically proven fact is the direct correlation dependence of increased body weight blood pressure, so normalization of weight in people with arterial hypertension is the major preventive event. In addition, following rules that correct food behavior can help prevent the progression of atherosclerotic vascular lesions, one of the main causes of arterial hypertension.
Latest research in the field of pharmacology has demonstrated the beneficial effects of omega-3 soaking fatty acids in restoring blood vessels, which can also be regarded as an effective method to prevent arterial hypertension. Given these conclusions, you should use sufficient amounts of olive oil every day and sharply limit animal fat.
Of course, if you want to get rid of the manifestations of arterial hypertension, you should give up bad habits in the form of smoking and drinking alcoholic beverages, because even in microdoses, nicotine and alcohol particles can increase blood pressure in the blood vessels.
People who have noted arterial hypertension as a secondary preventive measure should use blood pressure measurements daily to maintain a special diary to reflect the effectiveness of used medications and should the new clinical manifestations worsen without delaying attending a physician.
Arterial hypertension - Which doctor will help? In the presence or suspicion of arterial hypertension, you should seek advice immediately from a cardiologist, endocrinologist, and nephrologist.