Diagnosis and treatment of hypertension. Hypertensive heart disease

Hypertension is formed as an independent disease and is the cause of more than 90% of cases of all persistent arterial hypertension. This most common chronic disease. More than 30% of the world's population suffer from this disease.

Definition of the concept of "hypertension":

• Arterial hypertension should be considered constantly increased rate systolic (SBP) and/or diastolic blood pressure (DBP).
• In digital values, hypertension is evidenced by a stable increase in systolic blood pressure over 140 mm Hg. Art. and / or diastolic blood pressure up to 90 mm Hg. Art. and more. These blood pressure figures should be confirmed by several repeated measurements (at least two to three times on different days for four weeks).
• Hypertension (primary or essential hypertension) must be distinguished from symptomatic (secondary) hypertension, in which an increase in blood pressure is caused by some obvious cause (for example, kidney disease or certain endocrine diseases).

Usually, essential hypertension is formed in middle-aged and older people, however, hypertension is increasingly being recorded even in adolescents. Men and women get sick equally often. Among urban residents, hypertension is diagnosed approximately 25% more often than among rural residents.

CAUSES

The main reason for the formation of essential hypertension is a disorder of the regulatory function of the central nervous system that controls the activity of internal organs and the cardiovascular system in particular.

Great importance in such disorders has the presence of any risk factors, the influence of which increases the likelihood of the formation of this pathology.

Risk factors for primary hypertension:

• Age. It has been established that systolic blood pressure steadily increases with age. Diastolic increases on average up to 55 years, and then changes little.
• Floor. Men get sick more often at a young and middle age (up to 40-45 years). In women, the incidence increases sharply with the onset of the age of menopause (45-55 years).
• Heredity. A close relationship between arterial hypertension in close relatives was revealed.
• Overweight. The risk of arterial hypertension in people with obesity increases several times.
• Excessive consumption of table (table) salt (over 5 grams).
• Abuse of caffeine.
• Bad habits (alcoholism, smoking).
• Unbalanced nutrition.
• Psycho-emotional stress.
• Socio-economic status.
• Lack of physical activity (hypodynamia). However, individuals whose professional duties are associated with physical overexertion have an increased risk of developing arterial hypertension.
• Some somatic diseases that are not direct causes of the formation of essential hypertension, but, especially in combination with other factors, can contribute to its occurrence - diabetes mellitus, atherosclerosis, thyroid pathology, etc.

CLASSIFICATION

Hypertension is classified according to several criteria.

By flow option:

• Benign.
• Malignant.

According to the level of increase in blood pressure:

• Light: SAD 140-159; DBP 90-99 mmHg Art.
• Average: GARDEN 160-179; DBP 100-109 mmHg Art.
• Severe: over 180/110 mmHg Art.

Sometimes isolated systolic hypertension occurs - only an increase in SBP of more than 140 mm Hg is recorded. Art., the value of DBP at the same time remains normal.

In addition to the level of increase in blood pressure, it is important to consider the presence and severity of target organ damage. These include the vessels of the fundus, heart, kidneys and some other structures. Involvement in the pathological process of such organs, even with relatively high level BP exacerbates the course of the disease.

Clinical stages:

• First. Target organs are not involved in the pathological process.
• Second. Available objective symptoms damage to target organs without their obvious damage or dysfunction (left ventricular hypertrophy; microalbuminuria and / or unexpressed creatininemia; narrowing arterial vessels retina; detection of atherosclerotic plaque).
• Third. Obvious damage to target organs with a pronounced violation of their functions (heart attack, retinal hemorrhages, etc.) are revealed, which, in fact, are complications of hypertension.

SYMPTOMS

Hypertension is characterized by quite diverse manifestations, which depend mainly on the magnitude of blood pressure, as well as on the nature of the course of the pathology and the severity of target organ damage.

The main signs of hypertension:

• At the beginning of its development, essential hypertension is characterized by the occurrence of periodic headaches, which are most often localized in the occipital region.
• Headaches in a significant number of cases are accompanied by dizziness, noise and ringing in the ears, a feeling of heaviness and pulsation in the head.
• Often there are sleep disturbances, fatigue, lethargy.
• As the disease progresses, shortness of breath appears with any physical activity (fast walking, running, climbing stairs, etc.).
• With consistently high blood pressure, there is flushing of the face, numbness of the fingers and toes, a feeling of interruptions in the work of the heart and pain in its area, swelling of the face and extremities, especially the lower ones.
• With the defeat of the fundus, the appearance of a “veil” before the eyes, the flickering of “flies”, and a decrease in visual acuity are noted.

DIAGNOSTICS

To detect hypertension, a set of measures is used to establish the fact of an increase in blood pressure, which is not associated with organic causes. It is also necessary to diagnose the presence and severity of damage to target organs.

Principles of diagnosis of hypertension:

• Anamnesis.
• Measurement of blood pressure in both upper and lower extremities.
• Auscultation of the heart, cervical vessels.
• General clinical blood and urine tests.
• Biochemical study of blood.
• Determination of blood electrolytes (Na, K).
• Serum sugar level.
• Electrocardiogram.
• Ophthalmoscopy.
• Ultrasound scanning of the heart and organs of the urinary system.

According to the indications, other studies are also used: dopplerography of the carotid arteries, a study of the level of daily protein in the urine, a glucose tolerance test, etc.

TREATMENT

Therapy of hypertension is based on an integrated approach, which is based on the use of drug and non-drug principles.

Unfortunately, it is impossible to completely cure this disease. However, with the right approach to treatment, you can significantly improve the quality of life and minimize the risk of complications.

Non-drug treatment is aimed at modifying lifestyle, since it is based on the elimination of risk factors that can cause the progression of hypertension.

It is important to note that the treatment of this pathology continues throughout life, since course therapy for hypertension is unacceptable.

Principles of non-drug therapy:

• Measures aimed at reducing weight with concomitant obesity.
• Exclusion of smoking and drinking alcohol.
• Daily physical exercise (mostly dynamic).
• Limiting the daily amount of table salt consumed to a maximum of 5 g.
• A balanced and proper diet that contains sufficient amounts of potassium, calcium and magnesium. You should also reduce your intake of foods containing increased amount saturated fat and cholesterol.

Principles of drug therapy for hypertension:

• It is desirable to prescribe drugs long-acting, since it is these forms that prevent fluctuations in blood pressure throughout the day, and are also more convenient for use.
• Preference is given antihypertensive drugs first line (diuretics, ACE inhibitors, long-acting calcium antagonists, angiotensin II receptor blockers, beta-blockers).
• The dosage, as well as the type of antihypertensive drug, is selected strictly individually and depends on the level of blood pressure and the presence of concomitant complications.
• A combination of antihypertensive drugs is usually prescribed, one of which is a diuretic.
• The goal of antihypertensive therapy is to lower blood pressure to normal levels.
• At home, daily monitoring of blood pressure should be carried out. If necessary, the therapy is adjusted.
• Antihypertensive therapy is used for life.
• Symptomatic treatment of identified concomitant pathology is also carried out.

COMPLICATIONS

Hypertensive disease is dangerous for its complications, the development of which can significantly worsen the prognosis and even lead to death.

by the most frequent complication this disease is development of a hypertensive crisis- an acute condition, which is characterized by a sudden increase in blood pressure to high numbers. Failure to provide emergency medical care is fraught with the development severe consequences up to cerebral stroke and death.

The main complications of hypertension:

• Acute (myocardial infarction) and chronic coronary insufficiency.
• Acute () and transient disorders of cerebral circulation.
• Hypertensive encephalopathy and dementia.
• Hemorrhages and exudative lesions of the retina, often with concomitant papilloedema.
• Violation of the functioning of the kidneys with the development of hypercreatininemia.
• Dissecting aortic aneurysm.
• Occlusive lesion of peripheral arteries, etc.

PREVENTION

The main directions of preventive measures in relation to hypertension are maintaining a healthy lifestyle and elimination of all identified risk factors.

Prevention of hypertension:

• Limiting the use of table salt.
• Overweight correction.
• Restriction on the consumption of alcoholic beverages.
• Refusal of smoking.
• Fight against hypodynamia, moderate physical activity.
• Psycho-emotional unloading, relaxation.

Such prophylaxis reduces the risk of developing essential hypertension by more than half.

PROGNOSIS for hypertension

Plan Forecast full recovery - adverse because the disease is considered incurable. However, with timely and adequate correction of essential hypertension in compliance with all the principles of treatment, it is possible to significantly slow down the progression of the disease and prevent the development of complications.

Malignant course, damage to target organs, the onset of the disease at a young age significantly worsen the prognosis.

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Hypertonic disease- this is one of the common diseases of S.S.S., developing as a result of a primary violation of the vasomotor centers and the mechanisms of neurohumoral and renal genesis following them, which are characterized by increased pressure in the arteries, functional, as well as organic disorders of the central nervous system, heart and kidneys in severe forms of the disease. As a result, hypertension is the highest centers that control and regulate this pressure.

For diseases such as endocrine, renal, cardiovascular and others, symptomatic or secondary form of hypertension is considered a fundamental symptom that causes damage to organs and the formation of a pathological process in them.

Hypertension today is considered a very common disease of C.S.S., in which blood pressure is repeatedly recorded above 140/90 mm Hg, which in the future increases the risk of developing cerebrovascular and cardiovascular complications. In addition, the disease is equally distributed to both sexes. Thus, 4% of people from 20 to 23 years old have high blood pressure, and at the age of fifty to seventy years it is 50%.

The prognosis of patients diagnosed with hypertension and further tactics therapeutic treatment will depend on blood pressure indicators, contributing factors, “target organs” that are involved in this pathological process, clinical conditions and extent of the disease.

Hypertension causes

The reasons for the development of the disease to date remain not fully understood. Hypertension is characterized by early stages the main pathological moment is a widespread spasm of arterioles, which refers to an objective method for determining increased pressure in the entire system of arterial vessels.

The formation of persistent processes of this disease is influenced by various factors which regulate blood pressure under certain physical conditions.

Predisposing factors for the development of hypertension include hereditary predisposition, emotional and nervous overload, stress, disruption in work endocrine system, nicotine, drinking alcohol, physical inactivity, renal pathology, age, etc.

One of the main causes of an increase in blood pressure is considered to be nervous strain, which can be triggered by acute and chronic psychological and emotional stress, constant mental strain, trauma to the skull or brain, and hypoxia. Particular attention is drawn to itself while appearing accompanied by an increased cardiac output.

Among the pathological factors in the formation of high blood pressure, there are violations of work medulla oblongata and the hypothalamus. And humoral factors, as a rule, are formed in the kidneys. When blood circulation is disturbed in them, renin is produced, which converts hypertensinogen into angiotensin. In this case, the latter substance contributes to vasoconstriction and the production of mineralocorticoid by the adrenal glands. And he, in turn, affects the nephrons, stimulating the absorption of sodium, which retains fluid in the blood vessels and provokes an increase in blood pressure.

In addition, the significant work of the glands of the endocrine system, such as the genital, thyroid and pituitary glands, has some connection with the production of hormones, which are involved in increasing blood pressure.

Factors of food origin can also have a direct impact on the development of hypertension. So, for example, people who consume excessive amounts of table salt are recorded with higher blood pressure. As a result of the fact that sodium is retained in the body, edema of the vessel wall and an increase in blood pressure are noted.

Not the last role in the occurrence of hypertension is assigned to the genetic factor. With heredity of a bilateral nature, the same type of metabolism is inherited, and this causes a violation of the production of substances that regulate this pressure. Under the influence of all these factors, hypertension is finally formed. In addition, a long process of narrowing the arterioles of the pancreas and adrenal glands causes sclerotic changes in them. And in the cerebral, coronary vessels and in the aorta progressively forms, which contributes to impaired blood circulation in the relevant organs and the development of hypertension.

Hypertension symptoms

One of the most common pathological diseases of the entire S.S.S. considered hypertension. Hypertension is persistently high blood pressure. The process of increasing pressure occurs at the moment when the arteries or their smaller branches, that is, arterioles, narrow. Arteries are considered the main transport highways, thanks to which blood enters all organs, as well as tissues of the human body. In most people, arterioles can narrow, initially as a result of spasm, and later on their lumen is constantly in a narrowed state, as a result of a thickened wall, so the blood flow needs to increase cardiac work to overcome these constrictions, and this provokes large ejections of blood into the blood vessels. Thus, blood pressure rises, leading to hypertension in the future.

This pathological process is considered chronic, which is characterized by a persistent increase in blood pressure above systolic pressure at 139 mm Hg. Art. and diastolic - at 90 mm Hg. Art.

If, with increased blood pressure, damage to any organ is noted, then this pathological disease considered a secondary form of hypertension. Almost 90% of people suffer from essential hypertension. As a rule, the countdown of elevated blood pressure begins with the doctor registering a level of 140/90 mm Hg three times. Art. and more in patients who do not take drugs that reduce blood pressure.

It is important to know that an increase in pressure by insignificant but persistent numbers does not yet indicate the presence of hypertension.

Symptoms this disease does not have specific characteristics. In addition, patients for a long period of time may not even be aware of the existing pathology, not make any special complaints, active image life with occasional bouts of dizziness expressed in dizziness and weakness. Many associate this with overwork, although it is necessary now to pay attention to the first signs of the onset of the development of hypertension and, first of all, to measure blood pressure.

Patients in the presence of this disease complain only when there is damage to target organs. They are the most sensitive to pressure rises. In this case, with the initial changes in blood circulation in the brain, the head begins to spin, pain and noise appear in the head, memory and performance decrease. But in the future, the patient may go numb limbs, general weakness appears, flies flash, double vision, speech becomes difficult, but at the very beginning of the development of the disease, all circulatory disorders are characterized by an incoming character. But with an advanced stage of hypertension, a complication may develop in the form of a cerebral infarction or hemorrhage.

The very first and subsequently permanent manifestation of elevated blood pressure is considered to be hypertrophy or an increase in the left ventricle as a result of an increase in its mass due to thickening of cardiomyocytes. First, the LV wall thickens, and then the chambers of the heart themselves expand. At the same time, this hypertrophy refers to an unfavorable prognostic sign of hypertension, as it contributes to the risk of ventricular arrhythmias, heart failure, coronary artery disease, and sudden death. With the progression of LV dysfunction, difficulty breathing appears during exercise, asthma of cardiac origin, against the background of a hypertensive crisis, and congestive heart failure. As a result of this, and quite often arise. And with atherosclerosis, the aorta expands, which can eventually serve as its rupture and dissection.

Renal lesions are characterized by the appearance of protein in the urine, microhematuria and cylindruria. But the development kidney failure against the background of hypertension is detected very rarely. With eye damage, as a consequence of this disease, vision deteriorates, light sensitivity decreases, and sometimes blindness develops. Therefore, it is necessary to be very attentive to hypertension.

A characteristic symptom of the manifestation of hypertension is, which can occur at any time of the day, but mainly at night or in the morning, after sleep. This pain is characterized by heaviness and bursting in the back of the head, but can spread to other parts of the head. As a rule, with hypertension, the pain in the head is shingles. Sometimes the pain is aggravated by coughing, tilting the head, accompanied by slight swelling of the face and eyelids. With the upright position of the patient, muscle activity and massage, venous outflow improves and, as a result, this pain becomes less or completely disappears. In addition, such pain with an increase in blood pressure may occur as a result of tension in the soft muscles of the head or its tendons. Psycho-emotional or physical stress can contribute to its development, but the cessation of this pain is due to rest and resolution of conflict situations. Typically, a headache is referred to as tension pain, which sometimes presents with pressure or tightness of the head, accompanied by nausea and dizziness. But with long-term incessant pain, irritability, irascibility, increased sensitivity to loud music and noise.

With hypertension, characteristic pains in the heart are also observed, which are mainly located at its top or in the left side of the sternum. They occur in a state of absolute rest or against the background of emotional overstrain, and also without provoking physical exertion. These heart pains, not stopped by nitroglycerin, can last for quite a long time.

Against the background of high blood pressure, some patients develop shortness of breath in the form of shortness of breath, first after exercise, and later at rest, which may indicate significant myocardial damage and the formation of heart failure.

In the presence of cardiac pathology in the form of insufficiency, in most patients, the lower limbs begin to swell. This is due to the retention of water and sodium in the body as a result of arterial hypertension due to the intake of certain medicines or violation functional activities kidneys.

In case of visual impairment as a result of hypertension against the background of an increase in blood pressure, flies appear before the eyes, fog or a veil. This symptomatology is characteristic of a functional circulatory disorder in the retina. As a result of gross changes in the retina, such as vascular thrombosis, retinal detachment or hemorrhage, decreased vision, diplopia, and sometimes loss of vision can occur.

Degrees of risk of hypertension

Every year, about such a disease as hypertension, scientific conferences are held, attended by cardiologists from all over the world. To date, there is, adopted in 2003, a unified classification of this disease by degrees. As a result, this pathological process is characterized by three degrees of severity, which are characterized by different indicators HELL. So, normal pressure is an indicator of systolic pressure in the range of 120-129 mm Hg. Art. and diastolic - 80-84 mm Hg. Art.

For the first (mild) degree of hypertension, the corresponding pressure indicators are in mm Hg. Art. from 140/90 to 160/100. In addition, persistent blood pressure without changes in internal organs is noted.

The second (moderate) degree of this disease is characterized by pressure fluctuations from 160/100 to 180/110 mm Hg. Art. This blood pressure is characterized by a stable course, but to bring it back to normal, the use of medications is necessary. As a rule, when examining such patients, an enlarged left ventricle is detected.

With the third (severe) degree of hypertension, persistent blood pressure becomes higher than 180/110 mm Hg. Art. As a result of this condition, various complications develop in the form of circulatory disorders of the brain, kidney failure and heart attack.

In the process of diagnosing a disease, on the basis of modern classification, the degree of hypertension is set strictly taking into account all risk factors, namely those that aggravate the pathological process. Such factors are considered a threat in relation to the formation of cardiovascular complications. In addition, all available factors, as well as their number, will significantly affect the prognosis of hypertension. And in order to determine the degree of risk of this disease, it is important to consider age group patients, their gender, quantitative cholesterol content, metabolic disorders and hereditary factor, as well as physical inactivity, smoking, lesions of organs that act as targets.

There are four degrees of risk of increased blood pressure in hypertension. First degree with low risk typical for such patients in whom during the first ten years from the very beginning of the pathological process, the likelihood of complications is reduced to 15%. For the second degree with an average risk, the probability of complications is almost 20%. The third degree is determined by the risk of complications of about 30%. And the fourth degree is characterized by a fairly high risk of complications, over 30%.

The risk factors that can worsen the course of the disease and its prognosis include correctable and non-correctable. In the first option, when getting rid of factors contributing to the development of hypertension in the form of certain foods, smoking, physical inactivity, it is possible to completely get rid of this pathology. The second option includes: the age of patients, hereditary and racial predisposition.

With the 1st degree of hypertension, there are absolutely no risk factors, so a changed lifestyle, regular medical supervision will help stabilize the patient's condition. And in case of not lowering blood pressure, drug therapy is prescribed.

At the 2nd degree of risk, treatment is prescribed after observation for six months.

Patients with the 3rd degree must undergo an examination with the appointment of drug treatment.

The 4th degree of risk is characterized by an unfavorable prognosis with high probability the occurrence of complications, which requires urgent examination with the immediate appointment of appropriate treatment.

Medical history of hypertension

The medical history is considered the main medical document, which is compiled for each patient applying to any medical or preventive institution.

So, for example, when a patient is admitted to the emergency room with a diagnosis of hypertension, which still needs to be confirmed, passport and general information about the incoming patient. In those cases when the doctor examines the patient initially while still in the emergency room, the medical history is filled in the same place with the appointment of diagnostic methods and drug therapy. But when a patient is admitted immediately to the department of cardiology or intensive care, the initial examination and filling in the medical history is carried out by the doctor directly in the department itself.

To begin with, the patient's complaints are clarified, which give an idea of ​​the characteristic features of this disease, as well as concomitant. Sometimes they are so pronounced that you can immediately assume hypertension. In this case, patients complain about headache in the morning with localization on the back of the head, in combination with heaviness and staleness of the head. At the same time, they complain of poor sleep, irritability, decreased performance and memory. In the future, there may be complaints of pain in the heart, shortness of breath on the background of physical exertion and visual impairment.

Then the attending physician collects an anamnesis of the disease and life, as well as allergic history patient diagnosed with hypertension.

When asked, they find out when and with what symptoms it began. this pathology whether the onset was gradual, acute, or subtle to the patient. Without fail, they ask what the patient himself associates with the beginning of the pathological process. It is important to find out the duration of the course of hypertension, what studies were carried out and the results of the previously prescribed treatment.

When compiling an anamnesis of life, they ask about the relatives and friends of the patient, whether they had any diseases, in particular, hypertension. In the future, the patient is interviewed about lifestyle, bad habits, work, living conditions, diet, which is important in confirming the diagnosis of hypertension. It also turns out mental state patient, related to the situation in the family and at work. And women are asked about menstruation, pregnancy, childbirth or menopause.

Further, the case history is filled with a description general inspection the patient and the condition of the internal organs. In a patient with hypertension, the disease can proceed in three stages. In patients in the first stage, only increased blood pressure is noted, without changes in the internal organs. In the second stage, there is an increased blood pressure and an increase in the left ventricle (after a direct examination of the patient, x-ray, ECG or echocardiographic study). At this time, the kidneys may be involved in the pathological process, so they pay attention to urine tests with traces of protein, single erythrocytes (formed renal atherosclerosis), as well as the rise in temperature. In addition, as a result of atherosclerosis of the coronary arteries, this stage of hypertension is characterized by compressive pain behind the sternum that occurs during exercise and passes after walking or nitroglycerin. But in the third stage, a heart attack, paresis and paralysis may develop against the background of impaired cerebral circulation, as well as a sharp change in vision and even its complete loss. At any stage, a hypertensive crisis can develop, provoking the onset of a stroke or an attack of cardiac-type asthma.

Further, palpation is carried out, due to which the apex of the heart is determined, and percussion - the cardiac boundaries are determined. While listening, attention is paid to heart sounds, its rhythm, as well as the absence or presence of noise, heart rate, and blood pressure is measured.

After the examination, the doctor makes a preliminary diagnosis, draws up an appropriate plan for a diagnostic examination, and prescribes drug therapy depending on the stage of hypertension.

In the case of a hypertensive crisis, an urgent relief is first carried out, and then the medical history is filled out according to relatives or the patient himself.

Mandatory methods for diagnosing hypertension are: measurement of blood pressure, electrocardiography, x-ray examination, phonocardiography, bicycle ergometry, ecocardiography. In addition, appointed laboratory methods tests such as a complete blood count, biochemical research for proteins, C-reactive protein, transaminase, fibrinogen, etc., as well as urinalysis. And only on the basis of all methods of examination is exhibited final diagnosis and complex treatment of hypertension is prescribed.

In the relevant sheets of the medical history, after a daily round, the doctor prescribes the necessary treatment, and also keeps a record of the patient's condition, where all examination analyzes are also attached. In case of intolerance certain drugs, in case of their cancellation or replacement, everything is recorded in the relevant records in the medical history of a particular patient with a diagnosis of hypertension.

After the patient has recovered, a discharge summary is prepared, which briefly describes the date of admission of the patient, his complaints, the nature of the course of hypertension, the results of tests before and after the prescribed treatment, as well as the entire treatment strategy, and at the end a final prognosis is made.

It is mandatory for each patient to be given additional recommendations in writing regarding the observance of the daily regimen, nutrition and drug therapy after discharge from the hospital.

Stages of hypertension

Hypertension according to morphological features is divided into three stages of the course. First of all, this is a transient stage, followed by a stage of widespread pathological changes in the arteries, and the third is a stage with altered organs as a result of disruption of the arterial vessels.

♦ The 1st (transient) stage of hypertension is characterized by a periodic rise in blood pressure as a result of spasm of arterioles, during which the vascular wall receives less oxygen, that is, it experiences starvation, and therefore various dystrophic changes occur in it.

Then the spasm is replaced by paralysis of the arterioles with the preservation of hypoxia of their walls. As a result of this, the walls of the arterioles become highly permeable, their plasmorrhagia develops, which goes beyond the limits of the vessels, therefore, as a result, perivascular edema develops.

After blood pressure is normalized and microcirculation is restored, blood is removed from the perivascular spaces and arterial walls. And as a result of increasing loads on the heart, which are repeated repeatedly, LV hypertrophy of a compensatory form develops. If at this stage the conditions that cause psychological and emotional stress are removed, and then the necessary medical treatment is carried out, then the beginning pathological process of hypertension can be stopped, since there are no irreversible changes in the first stage.

♦ In the 2nd stage, characterized by a widespread change in the arteries, there is a persistent rise in blood pressure. This is all happening as a result of a profound dysregulation of the C.S.S. and its changes.

The transition of the first stage (transient) of high blood pressure to the second (sustained) is due to the actions of several mechanisms of a neuroendocrine nature with the highest value of reflex, renal and endocrine functions. In this case, pressure rises are often repeated, which, as a result, reduce the sensitivity of baroreceptors located on the aortic arch. And they, during normal functioning, weaken the activity of the sympathetic-adrenal system and lower blood pressure. And with the increased influence of this system and spasm of the renal arterioles, renin production is stimulated. This enzyme in the blood promotes the formation of angiotensin, which helps in stabilizing blood pressure at high rates. In addition, this substance enhances the processes of formation and release of mineralocorticoids from the adrenal glands, which further increase pressure and contribute to its stabilization.

But the constantly recurring spasms of arterioles, the increasing processes of plasmorrhagia and the increasing amount of protein mass on the walls of blood vessels, cause the development of hyalinosis or arteriolosclerosis. As a result of this, the walls of the vessels become denser, become less elastic, thicken, and as a result, this leads to a decrease in the lumen of the arterioles. Thus, persistently high blood pressure significantly increases the cardiac load, and this contributes to the development of compensatory hypertrophy. In this case, the heart mass reaches almost 750 grams. Therefore, constant high performance blood pressure increase the load on large arteries and cause atrophy of muscle cells, which leads to loss of elasticity by the vessels themselves.

In combination with altered blood biochemistry, accumulated cholesterol and protein, it becomes possible to form atherosclerotic lesions of large vessels.

♦ The 3rd stage of hypertension is characterized by a change in the organs as a result of the affected arteries. These changes are secondary violations. The severity of these changes, as well as symptomatic manifestations, directly depend on the damage to arterioles and various complications due to altered vessels.

The basis of changes in organs of a chronic nature are violations of their blood supply, an increasing lack of oxygen and sclerotic damage to the organ. At this stage, various complications develop in the form of spasm, thrombosis of arteries and arterioles, their rupture, which causes heart attacks or hemorrhages.

Treatment of hypertension

At the first stages of the disease, the basis of treatment is optimally created conditions for work and rest, as well as prescribed sedative drugs (Elenium, Seduxen, Phenazepane, Tazepan, Valerian, Motherwort, Bekhterev's mixture). In addition, the use of barbiturates as a result of poor sleep is recommended. In this case, it is better to allow the patient to take a sleeping pill so that he can sleep well than to be afraid of a false statement about addiction to drugs and do nothing, and as a result, the patient will not get enough sleep and blood pressure will remain elevated. These principles of treatment are effective for both the second and third stages of hypertension.

Also, everything that contributes to the development of the disease is recommended to be eliminated. At the same time, it is necessary to exclude night shifts in their work and to abandon work where there is an impact of vibration and noise, as well as excessive attention strain.

Essential in the treatment of hypertension is a properly composed diet, which should include products that, in their energy value, will not exceed daily requirement, and with excess body weight will be even lower. At the same time, there is a strict restriction in consumption. table salt(from five to eight grams per day).

The main task of the treatment of hypertension is the selection of a drug that will continue to provide normal blood pressure. It is also important to strive to achieve normal pressure or almost normal, as this prevents the occurrence of complications such as strokes, dynamic disorders of cerebral circulation and renal arteriosclerosis.

Great benefit in the treatment of hypertension comes from the stay of patients in dispensaries and sanatoriums, which are organized at enterprises. Here, patients can stay after work in a semi-hospital environment, where a good rest, physiotherapy, proper nutrition and sleep are created for the patient.

For the treatment of hypertension, a variety of large number of antihypertensive drugs are used, which reduce high blood pressure. Basically, these are drugs that act on the receptors of the nervous genesis of the heart and blood vessels (Inderal, Anaprilin, Obzidan, etc., that is, beta-blockers); drugs that reduce the content of norepinephrine and adrenaline in the central nervous system and blood vessels (Dopegyt, Clonidine, Reserpine).

The appointment of diuretic drugs (Triampur, Furosemide, Hypothiazide) contribute to the release of water and sodium from the body and thus reduce high blood pressure. A hypotensive effect is also possessed by peripheral vasodilators, which are characterized by a different mechanism of action with the expansion of arterioles as a result (Captopres, Kapoten, Captopril, Prazosin, etc.). As a rule, the drug is prescribed mainly by the attending physician.

Today, combined therapy of hypertension is widely used, that is, several drugs are simultaneously prescribed, which are characterized by different mechanisms of action. This method of therapeutic treatment allows you to prescribe drugs in small doses. Among such drugs, Adelfan can be distinguished, which includes Hydralazine, Hypothiazid and Reserpine.

Patients with hypertension are advised to take antihypertensive drugs on an ongoing basis. In addition, the treatment of this pathological disease is carried out under the control of blood pressure. It is also important to remember that there is no forever fixed dose of the drug, so it can both increase and decrease and be prescribed strictly individually, taking into account pressure indicators.

Treatment of patients who suffer from hypertension is carried out mainly on an outpatient basis. And only those patients who need to select a new combination of medications or to clarify the diagnosis are subject to hospitalization.

A serious complication of hypertension is one that needs special treatment and requires urgent measures. All of them are aimed at reducing the sharp rise in blood pressure as soon as possible, improving cerebral and renal circulation. In this case, a physical and mental peace is created for the patient. In addition, the patient should have bed rest during the day with an elevated head end and access fresh air. With a slight hypertensive crisis, distraction therapy is used in the form of mustard plasters on the back of the head, calf muscles, hot foot baths and cold to the head. In those cases when, against the background of an increase in blood pressure, compressive pains in the heart appear, ECG registration, since a hypertensive crisis can provoke the development acute form myocardial infarction.

In an excited state, the patient is given sedatives, and to reduce blood pressure, a Clonidine tablet is first sucked. Sometimes it helps to take Hypothiazid or Furosemide to stop the crisis. With the ineffectiveness of all these measures, Dibazol is administered intravenously for physical therapy. solution. After intravenous administration this drug pressure usually decreases after twenty minutes and the antihypertensive effect will last up to three hours. At the same time, to enhance the action of Dibazol, Furosemide is administered orally. In addition to these drugs, during a hypertensive crisis, Clonidine can be administered intramuscularly or intravenously, after which the patient must be in a horizontal position for at least two hours.

In crises that are severe enough or as a result of a poor decrease from the use of the above drugs, Pentamine is prescribed for intramuscular or slow intravenous administration with mandatory blood pressure control. Injected ganglion blockers can provoke a sharp drop in pressure and the development of collapse, so it is important that the patient lies in bed for two to three hours and his blood pressure is measured every twenty minutes. If an orthostatic collapse occurs, it is necessary to raise the patient's legs, inject Cordiamin subcutaneously or Mezaton intramuscularly.

Complications of hypertension

This pathological disease refers to a serious deviation in the S.S.S., which can cause various complications in the body as a result of constantly increased pressure in the arteries. Patients who suffer from hypertension are much more likely to experience pain in the temples, weakness, dizziness, noise, accompanied by nausea and vomiting. Therefore, treatment of hypertension that has not been started on time can cause serious complications, such as, and a hypertensive crisis. In the second and third stages of the disease can be detected functional disorders brain, heart and kidneys.

The most dangerous complication of hypertension is considered to be a hypertensive crisis, which develops quite rapidly, causing a sharp rise in blood pressure. The symptomatic manifestations of the crisis are in the form of nausea and incessant vomiting. As a rule, the resulting complications as a result of hypertension are dangerous because of their rapid course and negative effects on the body. This, for example, applies to myocardial infarction, which can last several minutes and cause death.

Also, a dangerous complication of the pathological process is considered to be related to the most common pathology of hypertension. During an attack appear strong character dull pain behind the sternum with frequent vomiting and general malaise.

The development of coronary artery disease contributes to the late diagnosis of the underlying disease and non-compliance with all prescriptions for complex treatment. In addition, patients diagnosed with hypertension are at risk of coronary artery disease, which contributes to poor blood flow to the coronary vessels, and the heart, as a result, does not receive the necessary nutrition.

Thus, in order to avoid the development of such complications, it is necessary to take the existing hypertension seriously and responsibly and consult a doctor in a timely manner.

Prevention of hypertension

As a rule, two methods of prevention are used to prevent the development of hypertension: primary and secondary.

Primary prevention is necessary for healthy people whose blood pressure does not exceed normal levels.

All the following preventive health measures will help to maintain normal pressure for a long time, and will also help get rid of extra pounds and significantly improve well-being.

Performing any physical exercise only contributes to increased performance. It can be running, walking, swimming, training on simulators, breathing and general developmental exercises that have a noticeable antihypertensive effect. In addition, it is important to start classes with minor loads of thirty minutes a day, increasing them gradually.

An important preventive measure for hypertension is a low-salt diet and limited intake of animal fats. Therefore, it is necessary to consume no more than one teaspoon of salt per day, also taking into account that many products contain a sufficient amount of it in their composition (canned food, cheeses, pickles, sausages, smoked meats). In addition, salt can be replaced with garlic or spices, or with salt that contains a reduced amount of sodium.

It is also necessary to gradually remove fried foods, lard, sour cream, sausages, cheeses from your diet. butter, supplementing it with vegetables and fruits, vegetable oil and lean fish. And, of course, it is better to give preference to low-fat dairy products. Thus, you can normalize not only your weight, but also prevent the development of atherosclerosis, thereby controlling blood cholesterol. At the same time, the diet is enriched with potassium, which is so necessary with high blood pressure.

Because stressful situations are the leading causes of high blood pressure, it is recommended to master the methods of psychological relief in the form of auto-training, self-hypnosis and meditation. An important point is the desire to find positive sides in almost everything, enjoy life, be tolerant of the shortcomings of others, change your character in better side, look at any situation with optimism, try to be balanced. In addition, hobbies, communication with animals, walks help in maintaining peace of mind.

If there are such bad habits, like smoking and drinking, it is simply urgently necessary to abandon their harmful effects. After all, they and hypertension are a terrible combination that can even lead to death.

But if nevertheless a diagnosis of hypertension was made, then not only primary preventive measures are used, but also secondary ones. Their main task is to protect target organs from negative consequences and the development of possible complications, such as coronary artery disease, cerebral hemorrhage and heart attack.

In addition, it is important to adhere to the previously mentioned diet, it is necessary to normalize sleep in compliance with the daily routine. Can be performed breathing exercises, use massage, acupuncture, acupuncture, reflexology, taking vitamins, restorative herbs and antioxidants. And, of course, measure blood pressure daily at certain hours and record its results for control by your doctor.

Successive stages in the development of this localization of hypertension in the clinic largely repeat the progression of coronary and cardiosclerosis. In addition, hypertension is very often, especially in the presence of heart and coronary insufficiency, accompanied by coronary sclerosis and atherosclerotic cardiosclerosis.
All this makes it expedient to describe the clinic of cardiac manifestations of hypertension in the chapter on myocardial diseases, following the presentation of the clinic of coronary and cardiosclerosis, separately from the presentation common doctrine about hypertension, as well as kidney damage in this disease, nephroangiosclerosis, is set out in the chapter on kidney diseases.

Pathogenesis heart disease in hypertension has been studied mainly from the point of view of hemodynamic violations - violations general circulation, increased resistance to the advancement of blood by the heart and disorders of the coronary circulation of the heart.
More subtle mechanisms of reflex influences from the receptor fields of individual vascular regions on blood circulation in general and on the activity of the heart muscle, as well as on higher nervous activity - on the activity of a number of organs, as well as violations of the central nervous, including trophic, regulation of the entire cardiovascular of the vascular system, which are of particular importance from the modern point of view on the origin of hypertension, have been studied in the clinic quite insufficiently.
For a normal supply of blood to tissues with a general spasm of arterioles, more vigorous contractions of the left ventricle are required, and thus blood pressure rises; spasm of arterioles contributes to an increase in diastolic pressure, and systolic pressure, due to the inclusion of adaptive mechanisms, is set at a much higher level. The immediate cause of more energetic and shortened heart contractions should be recognized as increased intraventricular pressure during diastole and, possibly, a slightly greater stretching of the left ventricular cavity (outflow tract) due to at least a slight increase in the amount of residual blood, which leads to hypertrophy, tonogenic dilatation of the left ventricle. High pressure in the initial part of the aorta, due to the action of pressure-receptor mechanisms from the carotid node, contributes to a slowdown in heart contractions. Tachycardia in hypertension usually develops only when the heart is decompensated; however, in some cases of early neurogenic hypertension, tachycardia is also observed during normal cardiac activity.
The circulation in the coronary artery system, and hence the myocardial blood supply, suffers due to poorer capillarization of hypertrophied muscle fibers due to the lag in the development of the capillary network, although high pressure at the beginning of the aorta promotes coronary blood flow. Further, in case of hypertension, special pressor substances of renal origin, which are considered to be in Lately a possible humoral factor in hypertension; in the experiment, these substances (for example, angiotoin) have, regardless of the general pressor action, a narrowing effect on the coronary arteries. In hypertension, however, without much constancy, pronounced arteriolosclerotic changes in the vessels of the heart, as well as microscopic hemorrhages and necrosis, are found, apparently in close connection precisely with hypertension as such (angiospastic-ischemic damage to the heart muscle). Recall that in skeletal muscles with more severe forms hypertensive disease naturally find both significant changes in arterpol, and lesions of the muscle fibers themselves. Finally, and this is of particular importance, with relatively advanced hypertension, when obvious signs of heart failure are found in the clinic, atherosclerotic coronary sclerosis is found extremely often (according to some authors, in 90%), the significance of which for myocardial damage in cases of coronary sclerosis and with normal blood pressure is quite obvious.
It can be added that in the presence of atherosclerosis of the aorta, the load on the heart increases even more; Finally, the pathological processes often associated with hypertension are important: general obesity, pulmonary emphysema, and age-related atrophy of the heart muscle.
It is easy to understand that, since hypertension of a large circle causes a lot of work of the left heart, and coronary sclerosis is localized mainly in the left coronary artery, it is the left ventricle that hypertrophies and weakens further, the left heart suffers; simultaneous damage to the right heart. It can be with emphysema, pneumosclerosis.

clinical picture. In the early stage (functional cortical-vegetative, or neurogenic, hypertension), cardiac complaints are usually completely absent or are reduced to atypical pains in the region of the heart, palpitations, sensations of heart failure.
In the future, cardiac complaints come to the fore; shortness of breath on movement, angina pectoris, attacks of cardiac asthma, inability to sleep on the left side and with the head low, palpitations, a feeling of interruption. Objectively, from the side of the heart, only hypertrophy of the left ventricle is noted for a long period without significant expansion of the cavities (tonogenic, or "concentric" hypertrophy). This applies especially to outpatient and dispensary practice and to patients with hypertension at a young age who do not have complaints from the heart. Such persons are capable of performing heavy work for years and even decades. physical work. And even in later periods, especially with insufficient mobility of hypertensive patients, for example, with hemiplegia, the participation of the heart can only be detected with a special study of it.
The most reliable clinical sign of such hypertrophy of the heart during physical examination is the lifting apical impulse, i.e., the impulse that lifts the palpating finger or the stethoscope attached to the chest wall with force. It should not be confused with a diffuse apex beat, which can occur with any expansion of the heart, with thyrotoxic heart, with cardiac neuroses, with retraction of the left lung, etc. good general condition pain-puff. The second tone on the aorta is accentuated; accentuation is auscultated in the second or third intercostal space on the right (can be determined here by hand), sometimes auscultated on the sternum, less often at the tip medially from the nipple. It should be noted that sometimes with hypertension, the accent of the second tone on the aorta is absent, as well as the characteristic apex beat may be absent; this may be in the presence of concomitant pulmonary emphysema with its characteristic significant hypertrophy of the right heart, pushing the left ventricle away from the anterior chest wall, as well as with general obesity; the emphasis on the aorta also weakens with the development of left ventricular failure.
The aorta is elongated and dilated, which leads to a pulsation in the jugular fossa and on the right below under m. sterno-cleido-mastoideus. Muting on the aorta depends in part on the closer fit of the elongated aorta to the chest and its expansion. A systolic murmur is often heard at the apex or base of the heart (due to sclerotic changes). mitral valve and the aorta itself).

With fluoroscopy, left ventricular hypertrophy in the initial stages of hypertension, before the development of heart failure, is detected by a characteristic expansion of the outflow tract of the left ventricle - a typical aortic heart: the apex of the heart is rounded, the angle between the left ventricular arch and the upper left arches decreases, the ascending aortic arch protrudes more to the right , and the upper left arc to the left. The aorta appears to be somewhat enlarged, and most importantly, elongated; in the second oblique position, an increase in the aortic "window" is found. In patients with a small heart before disease, X-ray examination may not give abnormalities.
Electrocardiography can detect various changes depending on the degree of left ventricular hypertrophy, the presence of myocardial damage, and comorbidities.
In the early stages, the most characteristic deviation electrical axis heart to the left, then the perversion of the T wave 1 joins. With the progression of cardiac changes, a perversion of the T 2 wave, a high voltage of the QRS complex, a displacement interval S-T down in the first lead and up in the third lead. In the fourth lead, a large Q wave or a small initial positive R wave of the ventricular complex is found; the T wave can become perverse. With the development of right ventricular failure, left axis deviation may disappear.

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Left ventricular failure syndrome! and the heart is characterized by shortness of breath during work, cardiac asthma (in the absence of venous congestion on the periphery), expansion of the left ventricle, congestion in a small circle and a drop in blood pressure (especially systolic).
Most often, a patient with hypertension leads to a doctor shortness of breath during physical exertion. Shortness of breath comes on when climbing stairs, when walking against the wind, after a heavy meal; it can reach the degree of orthopnea. At the same time, there are no obvious signs of venous stasis and, in particular, swelling of the liver.
Objective changes in left ventricular heart failure are as follows. While pure hypertrophy of the left ventricle does not give any significant increase in the left border of cardiac dullness to the left, the joining expansion changes its contours; the push shifts to the left and down, into the sixth and seventh intercostal spaces, outward from the midclavicular line, sometimes up to the anterior axillary line (in the absence of mitralizacin, the borders increase mainly downward). The push becomes more diffuse, has a greater amplitude, but less force. The pulse quickens. The systolic noise caused by relative insufficiency of the mitral valve is often listened; emphasis on the pulmonary artery indicates a weakening of the left ventricle and stagnation with increased pressure in the small circle. Especially characteristic of severe heart damage in hypertension is the presystolic gallop rhythm, which at first is heard intermittently, only after physical exertion. There is a cough with an admixture of blood in the sputum. At roentgenoscopy, a characteristic picture of stagnation in the lungs is observed, corresponding to the anatomically brown induration. The weakening of the second aortic tone, sharply increased earlier, indicates insufficiency of the left ventricle.

angina pectoris. Pain in the region of the heart is often the first symptom of hypertension; sometimes angina prevails in the entire clinical picture; coronary thrombosis may develop.

Complete heart failure(complete asystole). In patients with hypertension with a cardiac type of development of the disease, there is a further weakening of the right heart as well; sometimes patients come for the first time under the supervision of a doctor with the usual picture of far-reaching insufficiency of the whole heart, relative insufficiency of the tricuspid valve, with large venous congestion. If there is azotemia 1 urinary symptoms, then we are talking about cardio-renal failure, often found in bedridden patients. These patients have a waxy complexion, large edema, relative polyuria, a large hard liver, incapable of regression.
The dullness of the heart extends significantly to the right due to the right atrium. X-ray reveals a round or triangular contour of the heart, flattened on the diaphragm (decreased tonicity), with poorly differentiated segments of the left arch, and the heart pulsation under the screen is extremely weak. X-ray picture may be indistinguishable from changes in late stages valvular lesions or cardiosclerosis. The pulse is often irregular. Arrhythmia is more often the neck of the extrasystolic type or the type of pulsus alternans, when normal waves alternate with waves of smaller magnitude, which is especially clearly visible when determining blood pressure: if the pressure in the cuff is slightly lower than the systolic blood pressure, then every second beat is observed in the radial artery. There are other symptoms of circulatory disorders: cyanosis, shortness of breath, abdominal transudates, congestion in the lungs, swelling of the liver, increased venous pressure, and an increase in the mass of circulating blood. Blood pressure usually remains high, which makes it possible to recognize the underlying disease, even if the patient comes under observation with an excessive expansion of the heart (the so-called "bull" heart, cor bovinum), otherwise indistinguishable from others terminal states heart failure.

Forecast and work capacity. In the early stage, before the development of signs of heart failure, those suffering from hypertension are almost completely able-bodied even with moderate or severe physical exertion. They indicate that under certain conditions, for example, with a decrease in pressure during infections, anesthesia, a hypertrophied heart can even more successfully provide blood circulation.
With the development of insufficiency of the heart muscle, depending on the degree of shortness of breath, etc., as well as coronary insufficiency, the working capacity of patients is significantly reduced. It should be borne in mind that it is precisely the signs of left heart failure and coronary insufficiency, even in the presence of myocardial infarction in the recent past, that are not evident during a quick examination (no edema, congestive liver, cyanosis): hence the need for detailed questioning and research, often using electrocardiography, etc.

Diagnosis. Elevated arterial blood pressure - systolic and diastolic - allows you to correctly distinguish hypertension with heart failure from rheumatic defects, heart damage with emphysema, cardiovascular syphilis, etc. For the recognition of hypertension, an anamnesis is important, as well as the detection of high blood pressure , the development of left ventricular failure first and only after that complete heart failure, the presence of a typical gallop rhythm, a levogram on an electrocardiogram, etc. With decompensation of rheumatic heart disease or heart disease with emphysema, congestive hypertension may temporarily develop, passing with the cessation of venous stasis in areas of the vasomotor center and in the kidneys. With hypertension complicated by myocardial infarction or cerebral hemorrhage, blood pressure can drop to normal levels for months and years.
Coronarosclerosis with cardiosclerosis is clinically indistinguishable from heart disease in hypertension and, as mentioned above, almost always accompanies hypertension in the stage of heart failure.

Treatment. In the treatment and prevention of heart failure in hypertension, one should proceed from the complex cortico-visceral pathogenesis of the disease, strive to resolve the highest nervous activity patient, to counteract adverse reflex effects on blood circulation from various foci of irritation, and also to use funds aimed more directly at unloading blood circulation and the activity of blood vessels and heart muscle. It is extremely important to limit physical activity patients with hypertension already at the first signs of insufficiency of the left heart (shortness of breath during work, asthma attacks, angina pectoris); restriction of salt and liquid, afternoon rest, prohibition of abundant food and drink at night, etc. are shown.

With severe attacks of cardiac asthma, the restriction of salt and water is carried out even more strictly: days of dry eating, curd, milk regimen are prescribed; merkusal is administered periodically (it is contraindicated in the stage of advanced nephroangiosclerosis, with a specific gravity of urine not higher than 1018; at this stage, due to the threat of increasing the retention of toxins in the blood, dry eating is also contraindicated). Bloodletting is beneficial to those suffering from hypertension, mainly in acute left ventricular failure, in impending pulmonary edema and severe complete heart failure, as in cases of heart failure in other diseases. It should be noted that bloodletting, carried out periodically in order to lower blood pressure, prevent or alleviate already developed hypertensive crises, is much less effective.
Digitalis in small and medium doses (0.03-0.05 3 times a day) is also useful for insufficiency of the hypertrophied left heart in patients with hypertension, especially with strict bed rest, etc.; digitalis should be prescribed with extreme caution in the presence of coronary insufficiency, since digitalis can cause an increase in angina attacks. In severe cases of cardiac asthma, threatening pulmonary edema or complete heart failure, they resort to intravenous administration of strophanthin preparations (0.25-0.5 mg of strophanthin or 2 drops of tincture), which generally has an advantage in hypertension as a drug that does not have such an adverse effect on coronary circulation. Hypertonic glucose solution improves coronary circulation, but in large quantities it increases blood mass mainly due to osmotic action and, by increasing the flow of tissue fluid into the vessels, at a critical moment, it can further increase the load on the heart.
On the contrary, diuretin, eifillin are indicated for hypertension, and not so much to lower blood pressure or increase diuresis, but to improve coronary circulation and blood redistribution with a decrease in pulmonary congestion. Just as in the presence of Cheyne-Stokes respiration, these drugs, especially intravenous eifillin, are indicated to improve the blood supply to the brain centers.

A common companion of the elderly is hypertension - an increase in blood pressure. Hypertension is an insidious disease. High blood pressure can lead not only to heart overload, heart pain, but also to a heart attack. The load increases not only on the heart, but also on the vessels. The result can be a stroke. With a stroke, death often occurs and very often paralysis of the limbs.

An upper blood pressure of no more than 100 plus age is considered safe, and 110 plus age is considered critical. It is not recommended to exceed this value. The optimal upper blood pressure is considered to be 90 plus age, although this figure is very individual. In many people, the pressure remains stable until the age of 50-60 and does not exceed 120/80. In children, blood pressure is usually 100/60. In youth, about 110/70-120/80. For most people, blood pressure gradually increases with age.

For timely diagnosis and control of blood pressure, it is necessary to use tonometers. Today there are several types of blood pressure monitors on the market: mechanical, which are suitable only for use by specialists, blood pressure monitors on the shoulder and blood pressure monitors on the wrist. Today, there are several major manufacturers on the market, but according to the results of the examination of the Cardiocenter, the Omron M6 tonometer was recognized as the most accurate.

The biggest and, unfortunately, the most common mistake in the treatment of hypertension is case-by-case treatment. It should not be forgotten that only 1 second of high pressure is enough for a stroke to occur. Therefore, it is necessary to maintain a stable pressure. Treatment should begin smoothly and gradually end, and in old age with chronic hypertension- treatment is permanent, with a carefully selected dosage.

Dizziness, nausea, weakness, headaches, pain in the heart - each individually or together, these signs can be a consequence of hypertension and are grounds for measuring pressure and contacting a competent doctor. Age-related changes in pressure are very slow, so an increase in pressure of only 10 units per day can cause symptoms of hypertension.

There are many reasons for the occurrence of hypertension. It could be:

Essential hypertension (hypertension)- This is a disease, the main symptom of which is an increase in blood pressure due to neuro-functional disorders of vascular tone. Men and women are equally affected by hypertension. Usually the disease begins after 40 years. This is a very common pathology. It is called the disease of the autumn of life, although in recent decades, hypertension has become much younger.

Hypertension- one of the causes of disability and mortality in patients with disorders of the cardiovascular system.

Causes and risk factors

One of the reasons - prolonged and frequent neuropsychic stress, prolonged stress.

Very often, hypertension occurs in people whose work is associated with constant emotional stress. Often it affects people who have suffered a concussion.

The second reason is hereditary predisposition. Usually, patients with a survey can reveal the presence of relatives with the same disease.

One of the important causes of hypertension is hypodynamia.

Age-related restructuring in the body (in particular, the central nervous system) also affects the appearance and development of the symptoms of this disease. The high frequency of hypertension (hypertension) among the elderly is due to changes in blood vessels due to the addition of atherosclerosis. There is a certain relationship between these diseases. GB contributes to the increased development and progression of atherosclerosis. This combination is dangerous because with a strong vasospasm, the blood flow to the organs (to the brain, heart, kidneys) is insufficient. With excessive spasm and the presence of plaques on the walls of blood vessels, blood can stop circulating through the artery. In this case, a stroke or myocardial infarction occurs.

In women, GB often begins during menopause.

Also of some importance are excessive consumption of table salt (namely, sodium, which is part of this salt), smoking, alcohol abuse, overweight, which increases the load on the cardiovascular system.

The main links in the occurrence of GB are:

• violation of the processes of excitation and inhibition in the central nervous system;
• overproduction of substances that increase blood pressure. One of them is the stress hormone adrenaline. In addition, renal factor is also isolated. The kidneys produce substances that can raise and lower blood pressure. Therefore, when signs of GB appear, the patient needs to check the functioning of the kidneys;
• contraction and spasm of the arteries.

What is blood pressure (systolic and diastolic)

Pressure should be measured at rest - physical and emotional.

Upper (systolic) pressure corresponds to the moment of contraction of the heart muscle, and inferior (diastolic)- the moment of relaxation of the heart.

In young healthy people, normal blood pressure is defined as 110/70-120/80 mm Hg. Art. But, given the dependence of blood pressure figures on age, individual characteristics, fitness, we can name the boundaries of 125/65-80 mm Hg. Art. in men and 110-120 / 60-75 mm Hg. Art. among women.

With age, blood pressure increases, for middle-aged people, normal numbers are close to 140/90 mm Hg. Art.

How to measure blood pressure correctly

It is measured by a special device - tonometer which can be bought at a pharmacy. Pressure is measured after 5 minutes of rest. It is recommended to measure it three times and consider the final result of the last measurement. The interval between measurements should be at least 3 minutes. Healthy people can measure their blood pressure once every few months. Patients with GB need to measure blood pressure at least once a day.

Symptoms of hypertension

Headache is one of the most common manifestations of high blood pressure. This symptom is caused by spasm of cerebral vessels. In this case, tinnitus, flickering of "flies" before the eyes, blurred vision, weakness, decreased performance, insomnia, dizziness, heaviness in the head, and palpitations often occur. These complaints in the early stages of the development of the disease are neurotic in nature.

The main symptom is an increase in blood pressure up to 140-160/90 mm Hg. Art. According to modern ideas about hypertension, one can speak if the pressure during the year rose twice to 140/90 mm Hg. Art. or at least once exceeded this mark. When examining a patient, heart murmurs, arrhythmias, and expansion of the borders of the heart to the left are detected.

In the later stages, heart failure may occur due to overwork of the heart muscle due to increased pressure.

With the progression of the process, there is a decrease in visual acuity. During the examination of the patient's fundus, his pallor, narrowing and tortuosity of the arteries, slight dilation of the veins, and sometimes hemorrhages in the retina are noted. When cerebral vessels are damaged under the influence of increased blood pressure, cerebrovascular accidents can occur, leading in some cases to paralysis, impaired sensitivity in the extremities due to vasospasm, thrombosis, and hemorrhage.

It is necessary to single out a complex of symptoms that are characteristic of GB, but are not signs of GB.

These are the so-called secondary hypertension. They arise as a result various diseases and are considered as their symptoms. Currently, there are more than 50 diseases that occur with an increase in blood pressure. These include kidney and thyroid diseases.

What are hypertensive crises?

Hypertensive crisis- This is one of the formidable manifestations of hypertension. At sharp rise pressure, all of the above symptoms of GB may be accompanied by nausea, vomiting, sweating, decreased vision. Crises can last from several minutes to several hours.

In this case, patients are usually excited, tearful, complain of palpitations. Often red spots appear on the chest and cheeks. There is an increase in heart rate. An attack may result in profuse urination or loose stools.

Such crises are typical for early stages GB, they are more often observed in women in menopause, after emotional stress, when the weather changes. They often occur at night or in the afternoon.

There are other types of hypertensive crises. They have more severe course but develop gradually. Their duration can reach 4-5 hours. They occur in the later stages of GB against the background of high initial blood pressure. Quite often, crises are accompanied brain symptoms: impaired speech, confusion, change in sensitivity in the limbs. At the same time, patients complain of severe pain in the heart.

Degrees of hypertension

Allocate 3 degrees of GB.

• I degree- blood pressure 140-159 / 90-99 mm Hg. Art. It can periodically return to normal levels and rise again.
• II degree- blood pressure ranges from 160-179 / 100-109 mm Hg. Art. This degree is characterized by a more frequent increase in pressure, it rarely returns to normal.
• III degree– 180 and above / PO mm Hg. Art. and higher. Blood pressure is elevated almost all the time, and its decrease can be a symptom of a malfunction of the heart.

GB must begin to be treated in the I degree, otherwise it will certainly reach the II and III degrees.

How GB proceeds at different ages

The most serious form of GB is malignant hypertension. In this case, diastolic pressure rises above 130 mm Hg. Art. This form is typical for young people 30-40 years old and is not observed in patients older than 50 years. This pathology develops very quickly, blood pressure can reach 250/140 mm Hg. Art., while the vessels of the kidneys change very quickly.

GB in the elderly has its own characteristics of the course. This so-called systolic arterial hypertension. Systolic pressure is close to 160-170 mm Hg. Art. At the same time, the lower (diastolic) pressure was not changed. There is a large interval between systolic and diastolic pressure. This difference is called pulse pressure and is normally 40 mm Hg. Art. This feature in older people causes a number of discomfort especially since these patients have a weakness of the cardiovascular system. But some of them do not feel this gap.

Diagnostics

To establish the correct diagnosis in identifying this disease, it is important to interview the patient in order to identify genetic predisposition. Information about the state of the cardiovascular system in close relatives - parents, siblings - is very important.

Another important link in the diagnosis is the patient's complaints about repeated rises in blood pressure. To make a correct diagnosis, it is necessary to regularly measure the pressure of the patient.

In the conditions of the clinic, a number of studies are also carried out: electrocardiography (ECG), examination of the fundus by an oculist, general analyzes blood and urine.

Those patients who do not have a sufficient effect of the prescribed treatment, as well as patients with suspected secondary hypertension, are sent to specialized hospitals to exclude diseases of the kidneys, thyroid gland, and tumors.

Treatment of hypertension

success medical measures is determined by the normalization of blood pressure figures in accordance with age, good health, and the absence of complications from the treatment.

Treatment of hypertension should be comprehensive.

When choosing drugs, drugs that reduce pressure are used. This is a large group of drugs with various actions. In addition to them, vasodilators and diuretics are used. medicinal substances. big role in successful treatment sedatives play. Doses and duration of medication are selected only by a doctor, individually for each patient!

When prescribing treatment, doctors pay great attention to indicators of systolic and diastolic pressure. If there is an increase in systolic pressure, then preference is given to a "braking" effect on the heart.

The patient must also observe the regime of rational work and rest, sleep should be sufficient, desirable afternoon rest. Of great importance are physical training- exercise therapy, walking within reasonable limits that do not disrupt the work of the heart. The patient should not experience discomfort, discomfort behind the sternum, shortness of breath, palpitations.

Recommendations regarding the diet include certain restrictions: reducing the intake of table salt (no more than 5 g per day), liquids (no more than 1.5 liters per day), refusal of alcoholic beverages. Patients who are overweight need to reduce the calorie content of food, eat more vegetables and fruits.

Physical factors in the treatment of GB are increasingly used. At the same time, a physiotherapist prescribes soothing, relaxing procedures: electrosleep, electrophoresis of medicinal substances.

Treatment with a low-frequency magnetic field (magnetotherapy) produces a pronounced positive effect due to the ability of this physical factor lower blood pressure and relieve pain.

Currently, there are a large number of devices that generate a low-frequency magnetic field. Among them are portable, easy to use, they can be purchased at pharmacies. The area of ​​influence of the magnetic field in GB is the back surface of the neck.

In addition, various therapeutic baths are very useful - coniferous, carbonic, pearl, hydrogen sulfide, as well as therapeutic showers.

Most patients with the initial stages of GB can be treated at home, with periodic supervision of therapists in the clinic, following the recommendations for organizing a regimen, diet, and physical training.

Folk remedies for the treatment of hypertension

Phytotherapy is of no small importance in the complex of means of treating GB. First of all, these are sedative herbs and fees. They can be used in ready-made(extracts, tinctures and tablets).

These are mainly preparations of valerian, motherwort, hawthorn. Among the plants that have a calming effect, also include chamomile, lemon balm, peppermint, hop cones and many others.

Traditional medicine advises patients with GB to eat honey, chokeberry (200-300 g per day), citrus fruits and rose hips in the form of a drink, green tea. All of these foods reduce high blood pressure and are rich in vitamin C, which is necessary for a weakened heart muscle.

• Dissolve a tablespoon of honey in 1 glass of mineral water, add the juice of half a lemon. Drink on an empty stomach in one go. The duration of treatment is 7-10 days. The remedy is used for hypertension, insomnia, increased excitability.
• Grind 2 cups of cranberries with 3 tablespoons of powdered sugar and eat daily at one time an hour before meals. This remedy is used in mild forms of hypertension.
• Beetroot juice - 4 cups, honey - 4 cups, marsh cudweed herb - 100 g, vodka - 500 g. Combine all components, mix thoroughly, leave for 10 days in a tightly sealed container in a dark cool place, strain, squeeze. Take 1-2 tablespoons 3 times a day half an hour before meals. The drug is used for hypertension I-II degree.
• Onion juice helps to lower blood pressure, so it is recommended to prepare the following remedy: squeeze juice from 3 kg of onion, mix it with 500 g of honey, add 25 g of films walnut and pour 1/2 liter of vodka. Insist 10 days. Take 1 tablespoon 2-3 times a day.
• St. John's wort (herb) - 100 g, chamomile (flowers) - 100 g, immortelle (flowers) - 100 g, birch (buds) - 100 g. The components are mixed, ground in a coffee grinder and stored in a glass jar with a lid. The daily dose is prepared in the evening: brew 1 tablespoon of a mixture of 0.5 liters of boiling water and leave for 20 minutes. Then filter through the canvas and wring out the residue. Half of the infusion with 1 teaspoon of honey is drunk immediately, and the rest is heated in the morning to 30-40 ° C and drunk 20 minutes before breakfast. Treatment is carried out daily until the mixture is completely used. Used for heart attack and hypertension.
• 10 g of viburnum fruits are poured with a glass of boiling water, heated under a lid in a water bath for 15 minutes, cooled for 45 minutes, filtered, squeezed and adjusted to 200 ml. Drink 1/3 cup 3-4 times a day. Store the infusion for no more than 2 days.
• To normalize blood pressure, you need to take a long time alcohol tincture calendula (at a ratio of 2:100 at 40-degree alcohol) 20-40 drops 3 times a day. At the same time, headaches disappear, sleep improves, efficiency and vitality increase.
• It is very useful to drink a mixture of a glass of beet juice, a glass of carrot, half a glass of cranberry, 250 g of honey and 100 g of vodka. Take 1 tablespoon 3 times a day. You can also prepare the following mixture: 2 cups of beetroot juice, 250 g of honey, juice of one lemon, 1.5 cups of cranberry juice and 1 cup of vodka. It should be taken 1 tablespoon 3 times a day one hour before meals.
• 100 g of pitted raisins, pass through a meat grinder, pour a glass cold water, cook for 10 minutes over low heat, strain, cool and squeeze. Drink the entire dose during the day.
• Chokeberry juice should be taken half an hour before meals, 1/3 cup 3 times a day. The course of treatment is 2 weeks.
• Blackcurrant juice or a decoction of its berries take 1/4 cup 3-4 times a day.
• Decoction of viburnum berries take half a glass 3 times a day.
• A mixture of half a glass of beetroot juice, the same amount of lemon juice and 1 glass of linden honey, take 1/3 cup 1 hour after eating.
• Eat 1 glass of cranberries every morning and take 5-10 drops of hawthorn flower tincture with water.
• Soak socks in vinegar essence, diluted with water in a ratio of 1: 1, and put them on at night, wrapping your feet tightly.
• Collect the ingredients in the following proportions: five-lobed motherwort herb - 4 parts, marsh cudweed herb - 3 parts, blood-red hawthorn fruits - 1 part, peppermint leaf - 1/2 part, grass shepherd's bag- 1 part, black chokeberry fruits - 1 part, garden dill fruits - 1 part, flax seed - 1 part, wild strawberry leaf - 2 parts. Pour two or three tablespoons of the mixture (depending on the patient's body weight) into a thermos with 2.5 cups of boiling water. Leave for 6-8 hours. The next day, take the entire infusion warm in 3 divided doses 20-40 minutes before meals.
• Drink fresh juice of chokeberry fruits (chokeberry) 1/2 cup per reception for 2 weeks. You can grind 1 kg of washed and slightly dried fruits with 700 g of granulated sugar. Take 75-100 g 2 times a day.
• A glass of crushed garlic cloves is infused in 0.5 liters of vodka in a dark and warm place. Infusion take 1 tablespoon 3 times a day before meals.
• In equal parts in 1 liter of boiling water, brew 1 cup of motherwort grass, marsh cudweed, hawthorn flowers and white mistletoe, insist and take 100 ml 3 times a day for half an hour before meals.
• Mix herbs in the following proportions: hawthorn (flowers) - 5 parts, motherwort (grass) - 5 parts, cudweed (grass) - 5 parts, chamomile (flowers) - 2 parts. Two tablespoons of the mixture pour 1 liter of boiling water, leave for 20 minutes, strain. Drink 100 ml of infusion 3 times a day.
• Mix herbs in the following proportions: cumin (fruits) - 1 part, valerian (root) - 2 parts, hawthorn (flowers) - 3 parts, white mistletoe (grass) - 4 parts. Two tablespoons of the mixture pour 400 ml of boiling water, leave for 2 hours, strain. Drink during the day.
• Mix lemon or orange gruel with peel, but no seeds, with granulated sugar to taste. Take a teaspoon 3 times a day before meals.
• Mix herbs in the following proportions: common yarrow herb - 3 parts; blood-red hawthorn flowers, horsetail grass, white mistletoe grass, small periwinkle leaves - 1 part each. Pour a tablespoon of the collection with a glass of hot water and leave for 3 hours, boil for 5 minutes, cool and strain. Take 1/3-1/4 cup 3-4 times a day.
• Mix herbs in the following proportions: blood-red hawthorn flowers, white mistletoe grass - equally. Pour a teaspoon of the collection with a glass of boiling water, leave for 10 minutes and strain. Take 1/3 cup 3 times a day one hour after meals.
• A tablespoon of the fruits of mountain ash, brew 1 cup boiling water, insist until cool, strain. Drink 0.5 cup 2-3 times a day.
• Collect the ingredients in the following ratios: marsh cudweed herb, five-lobed motherwort grass - 2 parts each, blood-red hawthorn flowers, horsetail grass - 1 part each. Pour 20 g of the collection into 200 ml of water, heat in a boiling water bath for 15 minutes, cool for 45 minutes, strain and add boiled water to the original volume. Take 1/4-1/3 cup 3-4 times a day.
• Collect the ingredients in the following ratios: tansy (inflorescences), high elecampane (root) - equally. Pour a teaspoon of the mixture with 2 cups of boiling water, boil in a water bath for 1.5 hours, strain. Drink 100 ml 3 times a day 2 hours before meals.
• Pass 3 large heads of garlic and 3 lemons through a meat grinder, brew 1.25 liters of boiling water, close tightly and insist in a warm place for a day, stirring occasionally, then strain. Drink 1 tablespoon 2-3 times a day 30 minutes before meals.
• For hypertension with atherosclerosis, chop 2 large heads of garlic and pour 250 ml of vodka, leave for 12 days. Take 20 drops 3 times a day 15 minutes before meals. To improve the taste, mint infusion can be added to the tincture. The course of treatment is 3 weeks.
• Dilute 3 drops of fresh aloe juice in a teaspoon of cold boiled water. Take daily on an empty stomach 1 time per day. The course of treatment is 2 months. The pressure is back to normal.
• Grind 250 g of horseradish (washed and peeled), pour 3 liters of cold boiled water, boil for 20 minutes. Drink 100 ml 3 times a day. After several doses, the pressure drops to normal.
• Pour 20 g of chopped bean leaves with 1 liter of water, boil in a water bath for 3-4 hours, cool, strain. Decoction drink 0.5 cup 4-5 times a day.
• 10 g of spring adonis flowers, buckwheat flowers, lily of the valley roots, crushed valerian roots, 1 glass of vodka.
  Pour the crushed collection with 1 glass of vodka. Insist in a dark place in a glass container with a lid for 20 days.
  Take 3 times a day, 25 drops per 1 tbsp. l. water 30 minutes before meals.
• 60 g of dry grape wine, 20 drops of fresh yarrow juice, 20 drops of rue juice, 10 g of buckwheat grass.
  Mix the ingredients, insist for a day in a dark glass vessel in a warm place.
  Take 1 time per day in the morning, 30-40 minutes before meals.
• 5 g of water willow bark, 1 g of wormwood herb, 15 g of yarrow herb, 10 g of ground flaxseed, 150 ml of boiling water.
  1 st. l. collection, pour into an enamel bowl, pour boiling water, cover, leave for 30 minutes. Strain the resulting infusion, squeeze the raw material.
  Take 2 times a day 30 minutes before meals for a month.
• 10 g leaves of lemon balm, 20 g corn silk, juice of 1 lemon, 0.5 l of boiling water.
  Squeeze juice from lemon. Pour the resulting collection into an enamel bowl, pour boiling water. Keep in a water bath for 20 minutes. Insist until cool. Drain the infusion, squeeze out the raw materials. Add to the resulting infusion lemon juice.
  Take 1/2 cup 3 times a day 30 minutes after meals. Conduct 3 courses of 7 days with a weekly interval.
• 20 g of rue herb, corn stigmas, 10 g of valerian root, peppermint leaves, 1 cup of boiling water.
  Mix all ingredients, 2 tbsp. l. collection place in an enamel bowl, pour boiling water. Boil in a water bath for 20 minutes. Insist until cool. Strain, squeeze raw materials.
  Take 2-3 times a day with meals for a month.
• 30 g of valerian roots, common anise herb, motherwort herb, 20 g of dried sunflower petals, yarrow herb, 1 cup of boiled water.
  2 tbsp. l. collection place in an enamel bowl, cover with a lid. Infuse in a water bath for 20 minutes. After cooling, strain, squeeze the raw material.
  Take 1/3 cup 2-3 times daily with meals.

Diet

First of all, it is necessary to exclude fatty foods and foods rich in cholesterol from the diet; eat less sweets as well fresh bread, replacing it with breadcrumbs or rice. All products that delay the development of atherosclerosis are useful: fruits, cottage cheese, dairy products (especially yogurt and whey), egg white, cabbage, peas, boiled beef, etc., as well as foods rich in vitamin C: radishes, green onions, horseradish, black currants, lemons. This diet reduces the level of toxins in the body. Salt intake should not exceed 3 grams, or half a teaspoon per day.

Recent studies have found a link between the presence of calcium and potassium in the body and blood pressure. People who consume large amounts of foods high in potassium have normal blood pressure without even controlling their salt intake. Calcium and potassium contribute to the removal of excess sodium and control the state of the vascular system. Potassium is found in large quantities in vegetables and fruits, calcium - in cottage cheese.