Hypertonic disease. Types, degrees and treatment of arterial hypertension. Blood pressure medications. Medical supervision during pregnancy

Hypertension (hypertension) is a serious chronic disease characterized by a persistent increase in blood pressure. A number of practicing doctors call hypertension nothing less than an “invisible killer”, since this diagnosis is often made by resuscitators, and in asymptomatic cases - only by a pathologist.

The danger of hypertension

A person does not always suspect that he has this pathology, since many clinical manifestations of hypertension have obvious similarities with the symptoms of ordinary fatigue. The disease very often leads to the development of severe complications, including life-threatening conditions. In particular, if it was previously believed that myocardial infarction and hemorrhagic strokes are caused by atherosclerotic changes in blood vessels, it has now been established that for the development of these conditions the presence of hypertension alone is quite sufficient.

Arterial hypertension, like a number of other chronic diseases, cannot be completely cured, but its development can be prevented. Even with a diagnosis already made, adequate therapeutic measures can minimize the manifestations of hypertension, greatly improving the patient’s quality of life.

note: the risk of complications almost directly depends on the patient’s age. If hypertension is diagnosed in young man, then the prognosis is less favorable than in patients of the middle age group.

To “catch” the disease at the initial stage, when the changes are reversible, you need to regularly measure your blood pressure. If periodic measurements often reveal values ​​that exceed normal values, blood pressure correction is necessary.

The following numbers are considered normal:

• for people aged 16-20 years – 100/70 – 120/80 mm. rt. Art.;
• at 20-40 years old – 120/70 – 130/80;
• 40-60 – not higher than 135/85;
• 60 years or more – no higher than 140/90.

Symptoms of hypertension

The latent course of hypertension or the initial stage of the disease can be suspected if the following are periodically observed:

• unmotivated feeling of anxiety;
• hyperhidrosis (increased sweating);
• chilliness;
• hyperemia (redness) of the skin of the facial area;
• small spots before the eyes;
• memory impairment;
• low performance;
• irritability for no reason;
• and faces in the morning;
• rapid heartbeat at rest;
• numbness of fingers.

These symptoms may occur regularly or occur quite rarely. One cannot but attach importance to them, since the disease is very insidious. These clinical manifestations require urgent lifestyle changes, since correction not carried out in a timely manner leads to fairly rapid progression of the disease. As the pathology develops, the list of constant symptoms of hypertension expands. Impaired coordination of movements and decreased visual acuity are added.

Note: even having just a few characteristic symptoms from the list above is grounds for an immediate visit to the doctor. You need to listen to your body especially carefully if you have certain risk factors for hypertension. Self-medication is dangerous; uncontrolled use of drugs can only worsen the situation.

Etiology and pathogenesis of hypertension

The onset of hypertension is caused by certain disorders in the central nervous system and the autonomic nervous system, which are responsible for vascular tone.

Important:in men from 35 to 50 years old and in women in menopause the likelihood of developing hypertension increases.

One of the most important risk factors for hypertension is a family history. In patients with a hereditary predisposition, increased permeability of cell membranes is detected.

TO external factors, provoking the development of the disease include strong and frequent psycho-emotional (nervous shocks, difficult experiences). They cause the release of adrenaline, which increases the volume cardiac output and increases the frequency of myocardial contractions. In combination with aggravated heredity, this often leads to the appearance of hypertension.

TO immediate reasons leading to hypertension include:

• dysfunctions of the nervous system;
• disturbances of ion exchange at the cellular and tissue level (increased levels of sodium and potassium ions);
• metabolic disorders;
• atherosclerotic vascular lesions.

Important:in people with overweight the risk of hypertension is 3-4 times higher than that of others.

The risk of hypertension increases significantly with alcohol abuse, nicotine addiction, when consuming large amounts of table salt and physical inactivity.

Periodic increases in blood pressure cause the heart to function faster increased load, which leads to myocardial hypertrophy, and subsequently to wear and tear of the heart muscle. As a consequence, chronic heart failure (CHF) develops, and insufficient nutrition of organs and tissues leads to severe consequences and the development of a number of concomitant diseases. High pressure causes thickening of the vascular walls and narrowing of the lumen of the vessel. Gradually, the walls become brittle, which greatly increases the risk of hemorrhages (including the development of hemorrhagic strokes). Permanent spasm of blood vessels maintains high blood pressure, completing this circle of disorders.

note: Normally, blood pressure fluctuations during the day do not exceed 10 units. In hypertensive patients, the numbers may differ by 50 mm. rt. Art. and more.

Hypertension may result from taking certain pharmacological agents(FS).

The following groups of drugs should be taken with extreme caution:

• glucocorticoids;
• Dietary supplements to suppress appetite;
• some anti-inflammatory drugs (in particular Indomethacin).

Hypertension or hypertension: what is the difference?

Hypertension is defined as a rise in blood pressure above 140/90. We can say that hypertension and hypertension are almost identical concepts. But hypertension is a disease, and hypertension is one of its symptoms. In approximately every tenth patient, abnormally high blood pressure is a manifestation of another pathology.

The following types of symptomatic hypertension are distinguished:

• hemodynamic;
• renal;
• endocrine;
• renovascular.

Classification of hypertension

To choose the optimal treatment tactics, you must first determine the type of this pathology.

According to etiology, it is customary to distinguish:

• primary hypertension(it is also called idiopathic or essential);
• symptomatic hypertension(against the background of other pathologies or taking certain medications).

According to the nature of its course, hypertension is divided into:

• benign(gradually progressive form, including 3 stages);
• malignant(severe, usually of endocrine etiology).

The benign form, which is diagnosed in most cases, is characterized by gradual development with damage to certain organs.

The malignant form is relatively rare and can be detected even in childhood. It is characterized by persistently high blood pressure and severe complications. Decompensated heart failure, hypertensive encephalopathy and a sharp impairment of the functional activity of the kidneys often develop.

According to the degree of increase in blood pressure, the following are distinguished:

• mild hypertension(indicators blood pressure– no higher than 140/90, medication is usually not required);
• moderate form(1-2 stages, pressure up to 180/110 mm Hg);
• severe hypertension(stage 3 or malignant form).

note: The terms “mild” and “severe” speak only about blood pressure numbers, but not about the general condition.

Experts distinguish three stages of hypertension with a benign course:

• 1st (preclinical) stage of hypertension. Moderate headaches and less pronounced sleep disturbances may occur. Blood pressure does not increase above 140-160/95-100 and decreases after proper rest.
• Stage 2 hypertension. There is a narrowing of the arteries and hypertrophy of the left ventricle of the heart. Blood pressure is higher and remains stable, and at rest the numbers reach 160-180/100-110 mm. rt. Art. At laboratory research tests reveal an increase in the level of creatinine in the blood and protein in the urine.
• Stage 3 hypertension. Angina pectoris, impaired cerebral blood flow, hemorrhages in the fundus, and dissection of the aortic walls develop. Particularly high in in this case risk of heart attacks, strokes and vision loss.

Note:some patients may experience the so-called. "White coat hypertension" With it, symptoms appear only in the presence of medical workers.

A special form of pathology is. This is an extreme manifestation of the disease, which is characterized by a sharp increase in blood pressure to critical indicators. A serious condition with intense headache, nausea and vomiting can persist for up to a day. Due to impaired cerebral blood flow, the intracranial pressure. Depending on the mechanism of blood pressure increase, eukinetic, as well as hypo- and hyperkinetic crises are distinguished.

Important: In case of a hypertensive crisis, it is important to provide the patient with first aid and urgently call an ambulance.

Hypertension can be isolated systolic or diastolic. With this form, there is an increase in only the “upper” or only the “lower” numbers of blood pressure.

Refractory hypertension is usually understood as a form of the disease in which therapy using three or more pharmacological agents is ineffective.

Treatment of hypertension

Therapeutic measures for hypertension may include both medications and non-drug methods, as well as traditional medicine.

Medicines indicated for hypertension

Drugs are prescribed if non-drug therapy does not give 1st degree of disease positive effect within 3-4 months or stage 2 of the disease is diagnosed. Monotherapy is indicated (i.e., the use of one PS). The “first-line” agent does not affect the metabolism of lipids and carbohydrates, does not lead to fluid retention, and does not disrupt electrolyte balance, does not have a depressing effect on the central nervous system and does not provoke a sharp increase in blood pressure after discontinuation.

At stages 2-3, combinations of β-blockers with calcium antagonists, diuretics or angiotensin-converting enzyme inhibitors may be indicated. It is also possible to combine ACE inhibitors with diuretics or calcium antagonists.

For severe hypertension, combinations of 3-4 drugs belonging to the groups mentioned above, as well as α-blockers, are sometimes prescribed.

Treatment of hypertension with folk remedies

Non-drug therapy

Non-drug treatment methods are indicated for grade 1. If you have hypertension, it is important to avoid bad habits, follow a diet limited in sodium chloride (salt) and animal fats. An alternative to pharmacological drugs can be acupuncture therapy, acupuncture, auto-training and massage. Patients are advised to strictly adhere to the regimen, take products with antioxidant activity and general tonic herbal remedies.

Gymnastics helps with hypertension. Regular dosed physical activity contributes to the development of a pronounced antihypertensive effect. Exercises should be performed daily for 30 minutes, increasing the load gradually.

Remember that if you have been diagnosed with hypertension, then if there is a sharp deterioration in your general condition, you should immediately call a doctor at home! Before his visit, it is better to take a semi-sitting position, take a hot foot bath or put mustard plasters on your calves, take Valocordin (30-35 drops) and your “usual” medicine to lower blood pressure. For chest pain, you need to put a Nitroglycerin capsule under your tongue, and for severe headaches, take a diuretic.

A pathology called essential hypertension is a form arterial hypertension. If the patient complains to the doctor about isolated cases of increased upper pressure of more than 140 mm Hg. Art., then for now it makes no sense to talk about such a diagnosis. But if the pressure stays at this level quite often, then the diagnosis is confirmed. To select treatment methods, the doctor needs to determine the reasons why the patient began to suffer from this disease, as well as the form of the disease and its stage of development.

There is a difference between essential hypertension and arterial hypertension. Doctors classify hypertension as the primary form, and hypertension is a disease that develops against the background of certain chronic diseases. Essential pathology often progresses in the absence of treatment and negatively affects the condition of internal organs and systems.

Reasons for development

There is no single reason for the development of this disease. Rather, a complex of causes and actions leads to the pathology of high blood pressure. Doctors agree that an unhealthy lifestyle, genetic predisposition, reduced immunity and bad habits lead to hypertension. The disease affects mostly middle-aged and elderly people, which is associated with age-related changes in the human vascular system. Hypertension more often affects the male half of the population. According to the experience of most doctors, genetics is the main reason for the development of hypertension.

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Severity of essential hypertension

Depending on blood pressure indicators, hypertension is divided into three stages of development.

The disease also has 3 stages of development:

• Hypertension of 1st degree of severity. In this case, the upper pressure reaches 140-160 mm Hg. Art. Lower 90-99 mm Hg. Art.
• Stage 2 hypertension has values ​​ranging from 160-180 upper pressure and 100-110 mmHg. Art. lower.
• Grade 3 is determined if the upper value reaches more than 180 mmHg. Art., and the lower one - more than 110 mm Hg. Art.

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Symptoms of the disease

Symptoms may not appear for a long time. In addition to stable high blood pressure of 140-160 by 90-95 mm Hg. Art., the patient may not be bothered by anything for a long time. Sometimes essential primary hypertension manifested by pain in the back of the head, tachycardia, double vision and tinnitus. These symptoms intensify with a significant increase in blood pressure. After some time, in the absence of proper treatment, signs of changes in the functioning of blood vessels and internal organ systems begin to appear. First of all, the disease negatively affects the functioning of the heart, brain and kidneys.

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Target organs

1. Heart. In a state of hypertension, the load falls on the heart muscle, resulting in the thickness of the walls of the left cardiac ventricle increases. This complication is even more dangerous than diabetes, cholesterol plaques or smoking. When the ventricle thickens, the heart requires a more intense supply of blood, but this process is disrupted in hypertension. Because of this, patients have a high risk of developing heart attacks, heart failure, and arrhythmia. Sudden death from cardiac arrest may occur.
2. Brain. On initial stages Essential hypertension interferes with blood circulation in the brain. Patients suffer from headaches fast fatiguability from work, ringing in the ears, dizziness. Microinfarcts occur in some parts of the brain. Brain weight decreases due to poor blood supply. The result is a deterioration in intelligence, memory loss, and sometimes dementia.
3. Kidneys. Gradual elastic atherosclerosis of blood vessels and kidney tissue occurs. With a detrimental effect on the kidneys, the water metabolism system is affected and harmful substances remain in the body. Doctors call this impaired kidney function. Moreover, the kidney filtration system is damaged, which does not allow the body to retain protein. This element is vital for humans.

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Diagnostics

To diagnose the disease, pressure is measured using a tonometer using the Korotkoff method.

Diagnosis of the disease in adults and children is carried out by measuring pressure at different conditions. The pressure is measured on a tonometer at least 3 times. The tonometer must be mercury, and the measurement itself is carried out using the Korotkoff method. To diagnose secondary hypertension, doctors refer to ultrasonography, cardiogram and blood test. In individual cases, doctors may find it necessary to use a special device to measure blood pressure throughout the day to determine the most accurate diagnosis. The study makes it possible to track changes in indicators over 24 hours (or more).

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Treatment of the disease

You definitely need to reconsider your bad habits, switch to proper nutrition, bring your weight back to normal.

Treatment of essential hypertension includes several methods. Therapy is selected depending on the course of the disease. First, the doctor must determine the optimal medications to stabilize blood pressure. If you have already been diagnosed with essential hypertension, it is necessary to exclude the development of concomitant diseases: diabetes, etc. You need to remember about the presence of physical exercise on a daily basis, as well as balance sleep and periods of activity.

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Lifestyle

If essential arterial hypertension has symptoms of the initial stages, then doctors will not immediately prescribe complex treatment with the use of various medications. First, a healthier lifestyle will be recommended, which includes the following rules:

1. Complete exclusion alcoholic drinks. They negatively affect the condition of blood vessels.
2. Minimize the amount of salt in your diet. Salt has a detrimental effect on the human circulatory system.
3. To follow the rules healthy eating. Vegetables and fruits, which reduce cholesterol levels in the blood, should predominate in the diet.
4. It is necessary to perform at least minimal physical exercise daily.
5. Normalization of body weight.

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Treating hypertension with medications

The combined drug "Prestance" is used for the treatment of primary and secondary arterial hypertension.

If the disease is aggravated by more and more new symptoms from target organs, then medications are needed. The most commonly prescribed drugs are:

1. Angiotensin-converting enzyme inhibitors. These are substances that have a protective effect on organs susceptible to negative influence. The substance is contained in the preparations “Prestans”, “Zocardis”, “Lorista”.
2. Drugs “Nebilet”, “Betalok”, which bring vascular tone in order. Their active ingredients- calcium antagonists, beta blockers.
3. For swelling, which is reflected externally, medications with a diuretic effect are used. They remove excess water from the body.
4. Medicines for the treatment of complications and consequences in the form of a heart attack. stroke, etc.

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Traditional medicine against hypertension

IN folk recipes you can find a lot effective methods, which will complement drug therapy and will help alleviate the course of the disease in a short time. Among them:

1. Mix 800 ml of beet juice and the same amount of honey in a bowl. Add 1 liter of vodka. The resulting mixture must be infused in a dark place for 14 days. Drink the infusion 3 times a day, 2 tbsp. spoons.
2. Before eating, drink a mixture of onion juice, honey and lemon zest. Everything in equal quantities.
3. Combine 100 g of cranberries and the same amount of honey and lemon juice. Take the mixture for 14 days. You should consult your doctor before taking any mixture.

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Complications of the disease

With absence necessary treatment and prevention, even initial stages Serious complications affecting internal organs may develop:

1. Hypertensive crisis. Sometimes 160 mmHg is enough for the patient to feel unwell, severe persistent headache, and ringing in the ears.
2. Heart pathologies. The heart's ability to contract decreases. The chance of developing a heart attack increases.
3. Detrimental effect on kidney function.
4. The condition of the nervous system is deteriorating. This means a stroke may occur. As the disease progresses, the vision apparatus suffers.
5. Swelling in the lungs.

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How to prevent the development of hypertension?

Those at risk are those who suffer from frequent headaches, dizziness, and nosebleeds. Women of menopausal age and in postoperative period. Those who are often under stress and have a history of kidney disease are also predisposed. To prevent the development of essential hypertension, you must follow balanced diet nutrition, do not overwork in terms of any physical activity. You need to lead an active lifestyle, give up alcohol and smoking, and avoid stress at work and in everyday life.

What is arterial hypertension: causes and treatment of hypertension

Arterial hypertension is chronic illness which suffers a large number of modern people.

The difficulty is that many patients neglect preventive measures and a healthy lifestyle.

It is necessary to know what arterial hypertension is in order to start it in a timely manner. therapeutic procedures, without allowing large-scale complications fraught with death.

The body's vascular system is like a tree, where the aorta is the trunk, which branches into arteries, which are divided into small branches - arterioles.

Their task is to carry blood to capillaries that supply nutrients and oxygen to every cell of the human body. After oxygen is transferred to the blood, they are again returned to the heart through the venous vessels.

In order for blood to flow through the system of veins and arteries, a certain amount of energy must be expended. The force acting on the walls of blood vessels during blood flow is pressure.

Pressure depends on the functioning of the heart and on the arterioles, which are able to relax if it is necessary to lower blood pressure, or to contract if it is necessary to increase it.

Arterial hypertension is a condition that is defined by a persistent increase in systolic pressure up to 140 mmHg. century or more; A diastolic pressure up to 90 mm Hg Art. and more.

There are such periods of changes in blood pressure:

1. decreases from 1 to 5 am,
2. rises from 6 to 8 am,
3. decreases from 23 to 00 o'clock at night.

Blood pressure changes with age:

• indicators in children are 70/50 mm Hg. Art.,
• indicators in older people are more than 120/80.

Causes of arterial hypertension

In many cases, it is not possible to understand how arterial hypertension arose. In this case, they talk about primary essential hypertension. Some doctors believe that the stimulating factors of primary hypertension are:

• accumulation of salt in the kidneys,
• the presence of vasoconstrictor substances in the blood,
• hormonal imbalance.

About 10% of people have severe hypertension due to taking certain medications or developing another disease. Such arterial hypertension is called secondary hypertension.

The most common causes of hypertension are:

1. Kidney diseases,
2. Renovascular hypertension,
3. Adrenal tumor
4. Pheochromocytoma,
5. Side effects of drugs
6. Increased blood pressure during pregnancy.

If the kidneys retain a lot of salt, the volume of fluid in the body increases. As a result, blood pressure and volume increase. The kidneys also produce the enzyme renin, which plays a key role in determining blood pressure levels.

Renin also increases the production of aldosterone, a hormone responsible for the reabsorption of water and salt.

Severe renovascular hypertension is quite rare and affects the following groups of people:

• aged people,
• smokers,
• Small children.

Renovascular hypertension is diagnosed by injecting a contrast agent into an artery or vein and then examining the blood flow in the kidneys using X-rays.

The adrenal glands are two glands that secrete many hormones, including aldosterone, located at the top of each kidney. Aldosterone, produced by the adrenal glands, regulates salt and water balance in the body.

Extremely in rare cases A tumor of the adrenal glands provokes an increase in the production of aldosterone, which promotes the retention of water and salt in the body, thereby increasing blood pressure. This type of arterial hypertension most often affects young women. There are additional symptoms:

• strong thirst
• excessive urination.

Another rare type of hypertension is pheochromytoma, which is caused by another type of adrenal tumor. At the same time, the pancreas produces more of the hormone adrenaline.

Adrenaline is a hormone that helps the body respond fully to stressful situations. This hormone has the following properties:

1. accelerates heart rate,
2. increases blood pressure
3. promotes blood transport to the muscles of the lower extremities.

With pheochromocytoma, adrenaline causes:

• rapid heartbeat,
• trembling,
• heat.

Some drugs and substances can increase blood pressure, for example:

1. steroids,
2. antipyretics,
3. glyceric acid.

Symptoms of arterial hypertension

As you know, arterial hypertension has the second name “silent killer”, since its symptoms do not appear for a long time. Chronic hypertension is one of the main causes of strokes and heart attacks.

Arterial hypertension syndrome has the following symptoms:

1. pressing headache, which occurs periodically,
2. Whistling or ringing in the ears
3. Fainting and dizziness,
4. "Floaters" in the eyes,
5. Cardiopalmus,
6. Pressing pain in the region of the heart.

With hypertension, symptoms of the underlying disease may be expressed, especially for kidney diseases. Only a doctor can choose medications for the treatment of hypertension.

Arterial hypertension largely contributes to the hardening of the arteries. Great pressure on the walls of blood vessels leads to their susceptibility to the accumulation of fatty elements. This process is called vascular atherosclerosis.

Over time, the appearance of atherosclerosis provokes a narrowing of the lumen of the arteries and angina pectoris. Narrowing of the arteries of the lower extremities causes the following symptoms:

• pain,
• stiffness while walking.

Also, blood clots occur due to hypertension. So, if a thrombus is in the coronary artery, it leads to a heart attack, and if it is in the carotid artery, it leads to a stroke.

Arterial hypertension, treatment of which long time was not carried out, often leads to the formation of a dangerous complication - an aneurysm. Thus, the wall of the artery bulges. An aneurysm often ruptures, causing:

1. internal bleeding,
2. brain bleeding,
3. stroke.

A persistent increase in blood pressure is the cause of deformation of the arteries. The muscle layer that makes up the walls of the arteries begins to thicken, compressing the vessel. This prevents blood from circulating inside the vessel. Over time, thickening of the walls of the blood vessels in the eyes leads to partial or complete blindness.

The heart is always affected due to prolonged arterial hypertension. High blood pressure stimulates the heart muscle to work harder to ensure adequate oxygenation to the tissues.

This condition causes an enlargement of the heart. On early stages An enlarged heart has more strength to optimally pump blood into the arteries when pressure is high.

But over time, the enlarged heart muscle can weaken and become rigid, no longer supplying oxygen fully. Circulatory system must ensure a constant supply of nutrients and oxygen to the brain.

If the human body senses a decrease in the amount of blood that enters the brain, then compensatory mechanisms quickly turn on, they increase pressure, and blood from systems and organs is transferred to the brain. The following changes occur:

• the heart starts beating faster,
• blood vessels of the lower extremities and abdominal region contract,
• goes to the brain large quantity blood.

As you know, with hypertension, the arteries that supply the brain with oxygen can narrow due to the accumulation of fat-like substances in them. This increases the risk of strokes.

If the arteries of the brain are blocked for a short time, then there is a break in the blood supply to a separate part of the brain. This phenomenon in medicine is called a microstroke.

Even if the condition lasts only a minute, it requires immediate medical intervention. If treatment is not carried out, this is fraught with the development of a full-fledged stroke. Repeated micro-strokes lead to weakening of brain functions. This is how dementia develops in people with arterial hypertension.

Each kidney is made of millions of small filters called nephrons. Every day, over one and a half thousand liters of blood passes through the kidneys, where waste and toxins are filtered and excreted in the urine. Beneficial substances enter the bloodstream.

High blood pressure causes the kidneys to work harder. In addition, damage to small vessels within the nephrons reduces the volume of filtered blood. After some time, this leads to a reduction in the filtering function of the kidneys.

Thus, the protein is excreted in the urine before returning to the bloodstream. Waste that needs to be eliminated can enter the bloodstream. This process leads to uremia, and then to renal failure, which requires constant dialysis and blood purification.

As mentioned earlier, at the bottom of the eyeball there are a large number of blood vessels that are very sensitive to increased blood pressure. After several years of AG, the process of destruction may begin retina. Deformation may be due to:

• accumulation of cholesterol in blood vessels,
• insufficient blood circulation,
• local bleeding.

The diagnosis of arterial hypertension, as a rule, is not made after a single pressure measurement, except when it is above 170-180/105-110 mm Hg. Art.

Measurements are taken over a specified period to confirm the diagnosis. It is necessary to take into account the circumstances during which measurements are taken. The pressure gets higher:

• after smoking or drinking coffee,
• against a background of stress.

If an adult's blood pressure is more than 140/90 mm Hg. Art., then repeated measurements are usually performed after a year. In people whose blood pressure is from 140/90 to 160/100 mmHg. st, a repeat measurement is carried out after a short time. With high diastolic pressure from 110 to 115 mm Hg. Art. urgent treatment is needed.

In some cases, older people develop a rare type of arterial hypertension called isolated systolic hypertension. Systolic pressure indicators exceed 140 mmHg. Diastolic pressure remains at 90 mmHg. st or lower. This type The disease is considered dangerous because it provokes strokes and heart failure.

In addition to measuring blood pressure, the doctor should check changes in other organs, especially if pressure readings are constantly at high levels.

The eyes are the only organ of the human body in which blood vessels are clearly visible. Using a bright stream of light, the doctor examines the fundus of the eye special apparatus– an ophthalmoscope, which allows you to clearly see the narrowing or dilatation of blood vessels.

The doctor can see small cracks and hemorrhages, which are the consequences of high blood pressure.

The inspection also includes:

1. listening to heart rhythm sounds with a stethoscope,
2. measuring heart size by palpation,
3. The use of an electrocardiogram helps to study the electrical activity of the heart and also estimate its size.

Besides instrumental studies, the doctor prescribes:

• examination of urine to exclude kidney infections,
• blood sugar test,
• blood test for cholesterol.

The fundus, kidneys and blood vessels are the target organs for pathological blood pressure.

Treatment of arterial hypertension

Around the 1950s of the last century, the pharmaceutical industry recorded an increase in the production and synthesis of new groups of antihypertensive drugs.

Previously, treatment for hypertension included:

1. salt-free diet
2. surgical interventions,
3. phenobarbital as a stress reducer.

There is information that at the beginning of the 1940s, every third or fourth bed in the hospital was occupied by a patient with hypertension or its consequences. In recent years, a large number of studies have been conducted, which has led to an increase in the effectiveness of treatment for arterial hypertension. The number of deaths has now dropped significantly and serious consequences diseases.

In Russia and European countries, the best medical workers worked on research and confirmed that only drug treatment for high blood pressure makes it possible to reduce the risk of:

1. cordially- vascular diseases,
2. strokes,
3. fatalities.

However, some people are convinced that arterial hypertension cannot be treated with medications, since it reduces the quality of life and leads to the development of various side effects, including depression.

Almost all drugs have side effects, but studies show that when using drugs that lower blood pressure, side effects are reported in only 5-10% of patients.

The existing variety of groups of drugs that lower blood pressure allows the doctor and the patient to choose the most optimal treatment. The doctor is obliged to warn the patient about possible side effects drugs used.

Diuretics or blood pressure diuretics treat blood pressure by increasing the kidneys' excretion of water and salt. This creates relaxation of the blood vessels.

Diuretics are considered the oldest group of antihypertensive drugs. These drugs began to be used in the 50s of the 20th century. They are also now widely used, often in combination with other drugs.

Beta blockers were introduced in the 1960s. The drugs were used to treat angina pectoris. Beta blockers reduce blood pressure by affecting the nervous system. They block the effect of beta nerve receptors on the cardiovascular system.

As a result, the heart rate becomes less active and the volume of blood pumped out by the heart per minute decreases, lowering blood pressure. Beta blockers also reduce the effect of certain hormones, so blood pressure also normalizes.

Because beta blockers can cause peripheral blood vessel narrowing, they are not recommended for people with circulatory problems of the upper or lower extremities.

Calcium channel blockers are part of a group of drugs that block the flow of calcium inside muscle cells. Thus, the frequency of their contractions is reduced. All muscle cells need calcium; if it is absent, the muscles cannot contract normally, the blood vessels relax and blood flow improves, which lowers blood pressure.

Angiotensin II receptor blockers are the most modern group drugs. Angiotensin II is an effective vasoconstrictor; its synthesis is carried out under the influence of renin, a kidney enzyme. Angiotensin II has the main property of stimulating the production of aldosterone, which delays the excretion of water and salt by the kidneys.

Drugs that block angiotensin II receptors. Treatment of hypertension cannot be done without these drugs, because they:

1. prevent further narrowing of blood vessels,
2. facilitate the removal of excess water and salt from the body.

Treatment with ACE inhibitors is widely used for hypertension. With the help of drugs, the ratio of compounds changes in favor of vasodilating biologically active substances. Medicines in this group are usually prescribed to people with hypertension due to kidney disease or heart failure.

Alpha blockers act on the nervous system, but through different receptors than beta blockers. Alpha receptors promote contraction of arterioles, so they relax and blood pressure decreases. Alpha blockers have side effects - orthostatic hypotension, that is, a sharp decrease in pressure after a person assumes a vertical position.

Imidazoline receptor agonists are one of the most promising antihypertensive drugs. Treatment with medications of this group eliminates vascular spasm, as a result of which the pressure begins to decrease.

Imidazoline receptor agonists are used to treat moderate forms of hypertension and are routinely prescribed in combination treatment.

Non-drug treatment

Treatment of arterial hypertension without medications involves, first of all, reducing salt intake. It is also important to reconsider the amount of alcoholic beverages you take. It is known that drinking more than 80 grams of alcohol per day increases the risk of developing cardiovascular diseases and hypertension.

Overweight is considered overweight if it exceeds 20% or more of normal body weight depending on height. Obese people are often susceptible to developing arterial hypertension. Their blood cholesterol levels, as a rule, are increased.

Liquidation excess weight will not only help reduce blood pressure, but also help prevent dangerous diseases:

• atherosclerosis,
• diabetes

It is important to remember that there is no one set diet that will ensure that the lost weight will never come back.

Arterial hypertension can reduce symptoms if you adhere to the following therapy: sports activities,

1. limiting salt intake,
2. dietary diet.

Exercising for half an hour three or four times a week will help you achieve weight loss and normalize blood pressure. The educational video in this article will tell you about the dangers of arterial hypertension.

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Arterial hypertension: why it occurs and how to cope with it

Hypertension or other arterial hypertension significantly increases the likelihood of stroke, heart attack, vascular disease and chronic illness kidney Because of its morbidity, mortality, and costs to society, the prevention and treatment of hypertension is an important public health issue. Fortunately, latest achievements and research in this area has led to an improved understanding of the pathophysiology of hypertension and the development of new pharmacological and interventional treatments for this common disease.

Development mechanisms

Why hypertension occurs is still unclear. The mechanism of its development has many factors and is very complex. It involves various chemical substances, vascular reactivity and tone, blood viscosity, work of the heart and nervous system. A genetic predisposition to the development of hypertension is assumed. One of the modern hypotheses is the idea of immune disorders in organism. immune cells permeate target organs (vessels, kidneys) and cause persistent disruption of their functioning. This has been noted, in particular, in persons with HIV infection and in patients who have been taking immunosuppressants for a long time.

Labile arterial hypertension usually develops initially. It is accompanied by instability of pressure numbers, increased heart function, and increased vascular tone. This is the first stage of the disease. At this time, diastolic hypertension is often recorded - an increase in only the lower pressure figure. This happens especially often in young women with overweight body and is associated with edema of the vascular wall and increased peripheral resistance.

Subsequently, the increase in pressure becomes permanent, affecting the aorta, heart, kidneys, retina and brain. The second stage of the disease begins. The third stage is characterized by the development of complications from the affected organs - myocardial infarction, renal failure, visual impairment, stroke and other serious conditions. Therefore, even labile arterial hypertension requires timely detection and treatment.

The progression of hypertension usually looks like this:

• transient arterial hypertension (temporary, only during stress or hormonal imbalances) in people 10–30 years old, accompanied by an increase in blood output from the heart;
• early, often labile arterial hypertension in people under 40 years of age, who already have an increase in resistance to blood flow in small vessels;
• disease with target organ damage in persons 30–50 years old;
• addition of complications in the elderly; At this time, after a heart attack, the heart muscle weakens, heart function and cardiac output decrease, and blood pressure often decreases - this condition is called “decapitated hypertension” and is a sign of heart failure.

The development of the disease is closely related to hormonal disorders in the body, primarily in the renin-angiotensin-aldosterone system, which is responsible for the amount of water in the body and vascular tone.

Causes of the disease

Essential hypertension, which accounts for up to 95% of cases of all hypertension, occurs under the influence of external unfavorable factors in combination with genetic predisposition. However, the specific genetic abnormalities responsible for the development of the disease have never been identified. Of course, there are exceptions when a disruption in the functioning of one gene leads to the development of pathology - this is Liddle syndrome, some types of adrenal pathology.

Secondary arterial hypertension can be a symptom of various diseases.

Renal causes account for up to 6% of all cases of hypertension and include damage to the tissue (parenchyma) and blood vessels of the kidneys. Renoparenchymal arterial hypertension can occur with the following diseases:

• polycystic disease;
• chronic kidney disease;
• Liddle's syndrome;
• compression of the urinary tract by a stone or tumor;
• a tumor that secretes renin, a powerful vasoconstrictor.

Renovascular hypertension is associated with damage to the vessels supplying the kidneys:

• coarctation of the aorta;
• vasculitis;
• narrowing renal artery;
• collagenoses.

Endocrine arterial hypertension is less common - up to 2% of cases. They can be caused by taking certain medications, such as anabolic steroids, oral contraceptives, prednisolone, or non-steroidal anti-inflammatory drugs. Alcohol, cocaine, caffeine, nicotine and licorice root preparations also increase blood pressure.

Increased pressure is accompanied by many diseases of the adrenal glands: pheochromocytoma, increased production of aldosterone and others.

There is a group of hypertension associated with brain tumors, polio, or high intracranial pressure.

Finally, do not forget about such more rare reasons diseases:

• hyperthyroidism and hypothyroidism;
• hypercalcemia;
• hyperparathyroidism;
• acromegaly;
• obstructive sleep apnea syndrome;
• gestational hypertension.

Obstructive sleep apnea syndrome is a common cause of high blood pressure. Clinically, it is manifested by periodic cessation of breathing during sleep due to snoring and the appearance of obstructions in airways. About half of these patients have high blood pressure. Treatment of this syndrome allows normalizing hemodynamic parameters and improving the prognosis of patients.

Definition and classification

Types of blood pressure - systolic (develops in the vessels at the time of systole, that is, contraction of the heart) and diastolic (remains in vascular bed due to its tone during myocardial relaxation).

The classification system is important for deciding the aggressiveness of treatment or therapeutic interventions.

Arterial hypertension is an increase in blood pressure to 140/90 mm Hg. Art. and higher. Often both of these numbers increase, which is called systole-diastolic hypertension.

In addition, blood pressure due to hypertension may be normal in people receiving chronic antihypertensive medications. The diagnosis in this case is clear based on the history of the disease.

Prehypertension is considered to be a blood pressure level of up to 139/89 mm Hg. Art.

Degrees of arterial hypertension:

• first: up to 159/99 mm Hg. Art.;
• second: from 160/from 100 mm Hg. Art.

This division is to a certain extent arbitrary, since the same patient has different pressure readings under different conditions.

The classification given is based on an average of 2 or more values received at each of 2 or more visits after the initial check with the doctor. Extraordinary low readings should also be assessed from the point of view of clinical significance, because they can not only worsen the patient’s well-being, but also be a sign of serious pathology.

Classification of arterial hypertension: it can be primary, developed due to genetic reasons. Wherein the real reason the disease remains unknown. Secondary hypertension is caused by various diseases of other organs. Essential (without apparent cause) arterial hypertension is observed in 95% of all cases in adults and is called hypertension. In children, secondary hypertension predominates, which is one of the signs of some other disease.

Severe arterial hypertension, which cannot be treated, is often associated with an unrecognized secondary form, for example, with primary hyperaldosteronism. The uncontrolled form is diagnosed when, with a combination of three different antihypertensive medications, including a diuretic, the blood pressure does not reach normal.

Clinical signs

Symptoms of arterial hypertension are often only objective, that is, the patient does not feel any complaints until he experiences target organ damage. This is the insidiousness of the disease, because at stages II–III, when the heart, kidneys, brain, and fundus of the eye are already affected, it is almost impossible to reverse these processes.

What signs should you pay attention to and consult a doctor, or at least start measuring your blood pressure yourself using a tonometer and recording it in your self-monitoring diary:

• dull pain in the left side of the chest;
• heart rhythm disturbances;
• pain in the back of the head;
• periodic dizziness and tinnitus;
• deterioration of vision, appearance of spots, “floaters” before the eyes;
• shortness of breath on exertion;
• cyanosis of hands and feet;
• swelling or swelling of the legs;
• attacks of suffocation or hemoptysis.

An important part of the fight against hypertension is a timely, comprehensive medical examination, which every person can undergo free of charge in their clinic. There are also Health Centers throughout the country, where doctors will talk about the disease and carry out its initial diagnosis.

Hypertensive crisis and its dangers

During a hypertensive crisis, the pressure increases to 190/110 mmHg. Art. and more. Such arterial hypertension can cause damage to internal organs and various complications:

• neurological: hypertensive encephalopathy, cerebral vascular accidents, cerebral infarction, subarachnoid hemorrhage, intracranial hemorrhage;
• cardiovascular: myocardial ischemia/infarction, acute pulmonary edema, aortic dissection, unstable angina;
• others: spicy renal failure, retinopathy with vision loss, eclampsia in pregnant women, microangiopathic hemolytic anemia.

A hypertensive crisis requires immediate medical attention.

Gestational hypertension is part of the so-called OPG-preeclampsia. If you do not seek help from a doctor, you may develop preeclampsia and eclampsia - conditions that threaten the life of the mother and fetus.

Diagnosis

Diagnosis of arterial hypertension necessarily includes accurate measurement of the patient’s blood pressure, targeted history taking, general examination and obtaining laboratory and instrumental data, including a 12-lead electrocardiogram. These steps are necessary to determine the following provisions:

• damage to target organs (heart, brain, kidneys, eyes);
• probable causes of hypertension;
• baseline indicators for further assessment of the biochemical effects of therapy.

Based on a certain clinical picture or if secondary hypertension is suspected, other tests may be performed - the level of uric acid in the blood, microalbuminuria (protein in the urine).

• echocardiography to determine the condition of the heart;
• ultrasound examination of internal organs to exclude damage to the kidneys and adrenal glands;
• tetrapolar rheography to determine the type of hemodynamics (treatment may depend on this);
• blood pressure monitoring on an outpatient basis to clarify fluctuations during the day and night hours;
• 24-hour electrocardiogram monitoring combined with determination of sleep apnea.

If necessary, an examination by a neurologist, ophthalmologist, endocrinologist, nephrologist and other specialists is prescribed, and a differential diagnosis of secondary (symptomatic) hypertension is carried out.

Treatment

Treatment of arterial hypertension as a first step involves lifestyle modification.

Lifestyle

Reducing blood pressure and heart risk is possible by following at least 2 of the following rules:

• weight loss (with a loss of 10 kg, pressure decreases by 5 - 20 mm Hg);
• reducing alcohol consumption to 30 mg of ethanol for men and 15 mg of ethanol for women of normal weight per day;
• salt intake no more than 6 grams per day;
• sufficient intake of potassium, calcium and magnesium from food;
• to give up smoking;
• reducing the intake of saturated fats (i.e., solid fats, animal fats) and cholesterol;
• aerobic exercise for half an hour a day almost every day.

Drug treatment

If, despite all measures, arterial hypertension persists, there is various options drug therapy. In the absence of contraindications and only after consultation with a doctor, the first-line drug is usually a diuretic. It must be remembered that self-medication can cause irreversible negative consequences in patients with hypertension.

If there is a risk or an additional condition has already developed, other components are included in the treatment regimen: ACE inhibitors (enalapril and others), calcium antagonists, beta blockers, angiotensin receptor blockers, aldosterone antagonists in various combinations. The selection of therapy is carried out on an outpatient basis for a long time until the optimal combination for the patient is found. It will need to be used constantly.

Patient Information

Hypertension is a lifelong disease. It is impossible to get rid of it, with the exception of secondary hypertension. For optimal disease control it is necessary Full time job self-control and drug treatment. The patient should attend the “School for Patients with Arterial Hypertension,” because adherence to treatment reduces cardiovascular risk and increases life expectancy.

What a patient with hypertension should know and do:

• maintain normal weight and waist circumference;
• exercise regularly;
• eat less salt, fat and cholesterol;
• consume more minerals, in particular potassium, magnesium, calcium;
• limit the consumption of alcoholic beverages;
• stop smoking and using psychostimulants.

Regular blood pressure monitoring, doctor visits and behavior correction will help a patient with hypertension maintain high quality life for many years.

Hypertonic disease, GB (Arterial hypertension ) --- a disease, the main symptom of which is persistent high blood pressure, from 140/90 mmHg and above, the so-called hypertension.
Hypertension is one of the most common diseases. It usually develops after 40 years. Often, however, the onset of the disease is observed in at a young age, starting from 20-25 years. Hypertension most often affects women, and several years before the cessation of menstruation. But in men the disease is more severe course; in particular, they have a greater tendency to develop atherosclerosis of the coronary vessels of the heart - and

With significant physical and mental stress, blood pressure can increase for a short period of time (minutes) even in completely healthy people. A more or less prolonged increase in arterial blood pressure also occurs in a number of diseases, in inflammatory processes of the kidneys, in diseases of the glands internal secretion(adrenal glands, epididymis, Graves' disease, etc.). But in these cases it is only one of many symptoms and is a consequence of anatomical changes in the corresponding organs, characteristic of these diseases.
In contrast, in hypertension, high blood pressure is not a consequence of anatomical changes in any organ, but is the main, primary manifestation of the disease process.

Hypertension is based on increased tension (increased tone) of the walls of all small arteries (arterioles) of the body. Increased tone of the walls of arterioles entails their narrowing and, consequently, a decrease in their lumen, which makes it difficult for blood to move from one part of the vascular system (arteries) to another (veins). In this case, the blood pressure on the walls of the arteries increases and, thus, hypertension occurs.

Etiology.
It is believed that the reason primary hypertension is that from the vascular-motor center located in medulla oblongata, along the nerve pathways (vagus and sympathetic nerves) impulses go to the walls of the arterioles, causing either an increase in their tone and, therefore, their narrowing, or, conversely, a decrease in tone and dilation of the arterioles. If the vasomotor center is in a state of irritation, then predominantly impulses go to the arteries, increasing their tone and leading to a narrowing of the lumen of the arteries. The influence of the central nervous system on the regulation of blood pressure explains the connection of this regulation with the mental sphere, which is of great importance in the development of hypertension.

Arterial hypertension (hypertension) characterized by an increase systolic and diastolic pressure.
It is divided into essential and symptomatic hypertension.

• Essential hypertension - primary hypertension
• Symptomatic - secondary hypertension

Exogenous risk factors:

• Nervous stress and mental trauma ( life situations associated with prolonged or frequently recurring anxiety, fear, uncertainty about one’s position, etc.);
• Irrational, excess nutrition, especially meat, fatty foods;
• Abuse of salt, alcohol, smoking;
• Sedentary lifestyle;

Endogenous risk factors:

• All these factors play a decisive role if there is a mandatory presence hereditary predispositions ( norepinephrine deposition gene);
  Supporting factors:
• Kidney diseases ( Chronic Chronic renal failure, etc.);
• Endocrine diseases and metabolic disorders (, etc.);
• Hemodynamic factor - the amount of blood that is released in 1 minute, blood outflow, blood viscosity.
• Disorders of the hepatorenal system,
• Sympathetic-adrenal system disorders

Trigger of hypertension - This increased activity of the sympathetic-adrenaline system influenced increase in pressor And reduction of depressor factors.

Pressor factors: adrenaline, norepinephrine, renin, aldosterone, endotenin.
Depressor factors: prostaglandins, vasokinin, vasopressor factor.

Increased activity of the sympathetic-adrenal system and disruption of the hepatorenal system as a resultleads to spasm of the venules, heart contractions increase, minute blood volume increases, blood vessels narrow, development occurs renal ischemia, death of the adrenal glands,blood pressure rises.

WHO classification.
Normal pressure --- 120/80
High-normal pressure --- 130-139/85-90
Border pressure --- 140/90

Hypertension 1 degree --- 140-145/90-95
Hypertension 2 degrees, moderate --- 169-179/100-109
Hypertension grade 3, severe --- 180 and more / 110 and more.

Target organs .
Stage 1- no signs of damage to target organs.
Stage 2- identification of one of the target organs (left ventricular hypertrophy, narrowing of the retina, atherosclerotic plaques).
3 stage- encephalopathy, hemorrhage of the fundus, swelling of the optic nerve, changes in the fundus according to the Kees method.

Types of hemodynamics.
1. Hyperkinetic type - in young people, an increase in the sympathetic-adrenal system. Increased systolic pressure, tachycardia, irritability, insomnia, anxiety
2. Eukinetic type - damage to one of the target organs. Left ventricular hypertrophy. There are hypertensive crises and attacks
3. Hypokinetic type - signs of displacement of the borders of the heart, clouding of the fundus of the eye, pulmonary edema. In secondary hypertension (sodium-dependent form) - edema, increased systolic and diastolic pressure, adynamism, lethargy, muscle weakness, muscle pain.

There are 2 types of hypertension:
1st form - benign, slow flowing.
2nd form - malignant.
In form 1, symptoms increase over 20-30 years. Phases of remission, exacerbation. Treatable.
In the 2nd form, both systolic and diastolic pressure increases sharply and cannot be treated with medication. Symptomatic hypertension occurs more often in young people with renal hypertension. Malignant hypertension is accompanied by kidney disease. Sharp deterioration of vision, increased creatinine, azotemia.

Types of hypertensive crises (according to Kutakovsky).
1. Neurovegetative - the patient is excited, restless, hand tremors, moist skin, tachycardia, at the end of the crisis - excessive urination. The mechanism of the hyperadrenergic system.
2. Edema variant -- the patient is lethargic, drowsy, decreased diuresis, swelling of the face, hands, muscle weakness, increased systolic and diastolic pressure. More often it develops in women after abuse of table salt and liquid.
3. Convulsive variant -- less common, characterized by loss of consciousness, tonic and clonic convulsions. The mechanism is hypertensive encephalopathy, cerebral edema. A complication is hemorrhage in the brain or subarachnoid space.

Clinical symptoms.
Painful signs develop gradually, only in rare cases does it begin acutely, progressing rapidly.
Hypertension goes through a number of stages in its development.

1st stage. Neurogenic, functional stage.
At this stage, the disease can pass without any special complaints, or manifest itself as fatigue, irritability, periodic headaches, palpitations, sometimes pain in the heart area and a feeling of heaviness in the back of the head. Blood pressure reaches 150/90, 160/95, 170/100 mm Hg, which easily drops to normal. At this stage, a rise in blood pressure is easily provoked by psycho-emotional and physical stress.

2nd stage. Sclerotic stage.
Subsequently, the disease progresses. Complaints intensify, headaches become more intense, happen at night, early in the morning, not very intense, in occipital region.There are dizziness, a feeling of numbness in the fingers and toes, a rush of blood to the head, flashing “spots” before the eyes, bad dream, rapid fatigue. The increase in blood pressure becomes persistent over a long period of time. In all small arteries, phenomena of sclerosis and loss of elasticity, mainly of the muscle layer, are found to a greater or lesser extent. This stage usually lasts several years.
Patients are active and mobile. However, malnutrition of organs and tissues due to sclerosis of small arteries ultimately leads to profound disorders of their functions.

3rd stage. Final stage.
At this stage, heart or kidney failure and cerebrovascular accident are detected. At this stage of the disease, its clinical manifestations and outcome are largely determined by the form of hypertension. Persistent hypertensive crises are characteristic.
In the cardiac form it develops (shortness of breath, cardiac asthma, edema, enlarged liver).
At brain shape The disease is mainly manifested by headaches, dizziness, noise in the head, and visual disturbances.
During hypertensive crises, headaches of the cerebrospinal fluid type appear, which intensify with the slightest movement, nausea, vomiting, and hearing impairment appear. At this stage, increases in blood pressure can lead to impaired cerebral circulation. There is a danger of cerebral hemorrhage ().
The renal form of hypertension leads to renal failure, which is manifested by symptoms uremia.

TREATMENT OF HYPERTENSION DISEASE.

Immediate treatment and course of medication.
Immediate treatment is to reduce body weight if you are overweight, sharply limit salt intake, give up bad habits, and medications that increase blood pressure.

Medical treatment.

MODERN HYPOTENSIVE DRUGS.
Alpha blockers, B blockers, Ca antagonists, ACE inhibitors, diuretics.

• Alpha adrenergic blockers.
  1. Prazosin (pratsilol, minipress, adversuten)-- expands the venous bed, reduces peripheral resistance, lowers blood pressure, reduces heart failure. It has a beneficial effect on renal function, renal blood flow and glomerular filtration increase, has little effect on electrolyte balance, which makes it possible to prescribe for chronic renal failure (CRF). Has a mild anticholesterolemic effect. Side effects include postural hypotensive dizziness, drowsiness, dry mouth, impotence.
  2. Doxazosin (Cardura)-- has a longer action than prazosin, otherwise its action is similar to prazosin; improves lipid and carbohydrate metabolism. Prescribed for diabetes mellitus. Prescribed 1-8 mg 1 time per day.
• B-blockers.
  Lipophilic B blockers- Absorbed from the gastrointestinal tract. Hydrophilic B-blockers, excreted by the kidneys.
  B-blockers are indicated for hyperkinetic hypertension. Combination of hypertension with coronary artery disease, combination of hypertension with tachyarrhythmia, in patients with hyperthyroidism, migraine, glaucoma. Not used for AV block, bradycardia, or progressive angina.
  1. Propranolol (anaprilin, inderal, obzidan)
  2. Nadolol (korgard)
  3. Oxprenalol (transicor)
  4. Pindolol (whisken)
  5. Atenalol (atenol, prinorm)
  6. Metaprolol (betaloc, snesiker)
  7. Betaxolol (Locren)
  8. Talinokol (kordanum)
  9. Carvedilol (Dilatrend)
• Calcium Channel Blockers. Sa-antagonists.
  They have a negative inotropic effect, reduces myocardial contraction, reduces afterload, thereby leading to a decrease in total peripheral resistance, reduces Na reabsorption in the renal tubules, dilates the renal tubules, increases renal blood flow, reduces platelet aggregation, has an antisclerotic effect, antiplatelet effect.
  Side effects--- tachycardia, facial redness, “steal” syndrome with exacerbation of angina pectoris, constipation. They are long-acting and act on the myocardium for 24 hours.
  1. Nifedipine (Corinfar, Kordafen)
  2. Riodipine (Adalat)
  3. Nifedipine retard (Foridon)
  4. Felodipine (Plendil)
  5. Amlodipine (Norvax, Normodipine)
  6. Verapamil (Isoptin)
  7. Diltiazem (Altiazem)
  8. Mifebradil (Posinor).
• Diuretics.
  They reduce the content of Na and water in the bloodstream, thereby reducing cardiac output, reducing swelling of the vascular walls, and decreasing sensitivity to aldosterone.

1. THIAZIDES - - act at the level of the distal tubules, suppresses sodium reabsorption. Elimination of hypernatremia leads to a decrease in cardiac output and peripheral resistance. Thiazides are used in patients with preserved renal function; they are used in patients with renal failure. Hypothiazide, Indanamide (Arifon), Diazoxide.

2.LOOP DIURETICS - act at the level of the ascending loop of Henle, have a powerful natriuretic effect; in parallel, the removal of K, Mg, and Ca from the body is indicated for renal failure and in patients with diabetic nephropathy. Furosemide- for hypertensive crises, heart failure, and severe renal failure. Causes hypokalemia, hyponatremia. Uregit (ethacrynic acid).

3. POTASSIUM SPARING DIURETICS. Amiloride-- increases the release of Na, Cl ions, reduces the excretion of K. Contraindicated in chronic renal failure due to the threat of hyperkalemia. Moduretic -- /Amiloride with Hydrochlorothiazide/.
Triamterene-- Increases the excretion of Na, Mg, bicarbonates, K retains. Diuretic and hypotensive effects are mild.

4.SPIRONOLACTONE ( Veroshpiron) -- blocks aldosterone receptors, increases Na excretion, but reduces K excretion. Contraindicated in chronic renal failure with hyperkalemia. Indicated for hypokalemia that has developed with long-term use of other diuretics.

FEATURES OF TREATMENT OF ARTERIAL HYPERTENSION

ATCHRONIC RENAL FAILURE(CRF).

Complex therapy - restriction of table salt, diuretics, antihypertensive drugs(usually 2-3).
1. The most effective diuretics Loop diuretics(Furosemide, Uregit), which increase the glomerular filtration rate (GFR), increasing the excretion of K.

Thiazide diuretics contraindicated! Potassium-sparing too contraindicated!

3. Powerful Vasodilators

• Diazoxide (hyperetate) – 300 mg IV bolus, can be administered for 2-4 days if necessary.
• Sodium nitroprusside -- 50 mg IV drops in 250 ml 5% glucose solution. Can be administered for 2-3 days.

EMERGENCY THERAPY OF HYPERTENSION CRISIS

IN PATIENTS WITH UNCONTROLLED RENAL PRESSURE.

1. Introduction Ganglioblockers-- Pentamin 5% -- 1.0 ml IM, Benzohexonium 2.5% -- 1.0 ml s.c.
2. Sympatholytics-- Clonidine 0.01% - 1.0 ml IM or IV with 10-20 ml physical solution, slowly.
3. Calcium antagonists-- Verapamil 5-10 mg IV bolus.

ICD-10 distinguishes different kinds and subtypes of arterial hypertension: primary (essential) hypertension and secondary (develops against the background of another disease, for example, traumatic brain injury), hypertensive disease with damage to the heart and kidneys. Subtypes of hypertension are associated with the presence or absence of heart and kidney failure.

• no symptoms of internal organ damage;
• with objective signs of damage to target organs (in blood tests, during instrumental examination);
• with signs of damage and the presence clinical manifestations(myocardial infarction, transient cerebrovascular accident, retinal retinopathy).

Depending on the clinical course of the disease (the stability of blood pressure, digital values, the presence of left ventricular hypertrophy, changes in the fundus are assessed), it is customary to distinguish the following types of hypertension:

• transient - a one-time increase in blood pressure was noted during stressful situation, there are no changes in the internal organs, the vessels in the fundus are without pathology, the pressure has returned to normal on its own without treatment;
• labile - more stable, does not decrease on its own, requires medications, narrowed arterioles are detected in the fundus, left ventricular hypertrophy is detected during cardiac examination;
• stable - high persistent blood pressure numbers, pronounced cardiac hypertrophy and changes in the arteries and veins of the retina;
• malignant - begins suddenly, develops quickly to high level Blood pressure that is difficult to treat (especially characterized by an increase in diastolic pressure to 130-140) is sometimes manifested by complications: myocardial infarction, stroke, retinal vascular angiopathy.

In its development, hypertension goes through three stages:

• in stage 1 there is no damage to target organs (heart, brain, kidneys);
• in the 2nd - one or all organs are affected;
• in the 3rd stage, clinical complications of hypertension appear.

Why does hypertension develop?

In Russia, doctors continue to use the division of hypertension (hypertension) into hypertension and symptomatic hypertension that arises from various diseases of the internal organs.

For pathological conditions for which arterial hypertension syndrome is one of the leading clinical factors, accounts for about 10% of hypertension. Currently, more than 50 diseases are known that are accompanied by increased blood pressure. But in 90% of cases, true hypertension is confirmed.

Let's look at the causes of arterial hypertension and the distinctive symptoms of various diseases.

Neurogenic hypertension - develops with damage to the brain and spinal cord as a result of disruption of the function of control over vascular tone. It manifests itself in injuries, tumors, and cerebral vascular ischemia. Characteristic symptoms: headaches, dizziness, convulsions, drooling, sweating. The doctor detects eye nystagmus (twitching of the eyeballs), a bright skin reaction to irritation.

Nephrogenic (renal) hypertension is possible in two types.

• Renal parenchymal - formed in inflammatory diseases of the renal tissue (chronic pyelonephritis, glomerulonephritis, polycystic disease, renal tuberculosis, kidney stone disease, traumatic injury). Hypertension does not appear in the initial stage, but when chronic renal failure develops. The patients are young, have a malignant course, and do not have damage to the brain or heart.
• Vasorenal - depends on damage to the vessels of the kidneys. In 75% of cases, it is formed due to atherosclerotic changes, leading to narrowing of the renal artery and impaired nutrition of the kidneys. A faster option is possible due to thrombosis or embolism of the renal artery. In the clinic, lower back pain predominates. There is no response to conservative therapy. Urgent surgical treatment is required.

Adrenal hypertension depends on the occurrence of tumors and their release of hormones into the bloodstream.

• Pheochromocytoma - it accounts for about half a percent of all cases of symptomatic hypertension. The tumor produces adrenaline and norepinephrine. The course of the disease is characterized by crises with high blood pressure, headaches, severe dizziness, heartbeat.
• Another type of adrenal tumor causes an increase in the production of the hormone aldosterone, which retains sodium and water in the body and increases the excretion of potassium. This mechanism causes a persistent increase in blood pressure.
• Itsenko-Cushing syndrome is a tumor that produces glucocorticoid hormones, manifested by obesity, a round, moon-shaped face, persistent high blood pressure, a benign, crisis-free course.

To pathology endocrine system refers to hypertension in thyrotoxicosis (increased function thyroid gland). Complaints of palpitations and severe sweating are typical. Upon examination, changes in the eyeball (exophthalmos) and hand tremors can be detected.

Menopausal hypertension is caused by a decrease in the production of sex hormones. It develops at a certain age in men and women and is accompanied by hot flashes, a feeling of heat, and unstable mood.

Narrowing of the aorta (coarctation) is associated with a malformation of this vessel; it is detected in children under the age of five; after the age of 15, the increase in blood pressure disappears. A characteristic difference is between blood pressure in the arms (increased) and legs (lower), decreased pulsation in the arteries of the feet, only the upper pressure numbers increase.

Dosage form - caused by the vasoconstrictor effect of nasal drops containing ephedrine and its derivatives, some types of contraceptive pills, hormonal anti-inflammatory drugs. Long-term use These drugs lead to persistent arterial hypertension.

To distinguish true hypertension from symptomatic hypertension, the doctor has some signs.

• Absence of predominant lesions in the “able-bodied” age group. Symptomatic hypertension occurs more often in young patients under 20 years of age and in elderly patients over 60.
• More typical is a rapid increase in blood pressure and the development of persistent arterial hypertension (tendency to a malignant course).
• By carefully questioning the patient, signs of other relevant diseases can be identified.
• Difficulty selecting standard drug therapy suggests an atypical form of hypertension.
• Significant increase lower pressure more typical for kidney disease.

Diagnostics

To identify kidney diseases, blood tests are performed for urea and creatinine, urine for protein and red blood cells, filtration tests, ultrasound of the kidneys, angiography of vessels with a contrast agent, urography with examination of renal structures, radioisotope scanning kidney

Endocrine pathology is detected by testing blood for corticosteroids, catecholamines, thyroid-stimulating hormone, estrogens, and blood electrolytes. Ultrasound allows you to determine the enlargement of the entire gland or part of it.

Coarctation of the aorta is visible on plain radiograph chest, to clarify the diagnosis, aortography is performed.

IN mandatory a study of the heart is carried out (ECG, ultrasound, phonocardiography, Doppler observation), the fundus of the eye, as a “mirror” cerebral vessels, to establish the stage of the disease. The diagnosis of hypertension is described in more detail here.

Treatment

Therapy for hypertension is selected and carried out according to the following scheme:

• a work-rest regime is necessary for all types of hypertension; recommendations for eliminating stress, normalizing sleep, and controlling weight should be strictly followed;
• a diet limiting animal fats, sweets, salt and liquids if necessary;
• use of drugs from different groups, acting on the endurance of the heart muscle and vascular tone;
• diuretics;
• soothing herbal teas or stronger medications.

For symptomatic hypertension, the same treatment is prescribed, but the main focus is on the effect on the affected organ that caused the increase in blood pressure.

In the case of renal parenchymal hypertension, treatment is carried out inflammatory process, kidney dialysis for failure. In the treatment of vascular changes conservative therapy will not help. Surgery to remove the blood clot, balloon dilatation, placement of a stent in the renal artery, or removal of part of the artery and replacement with a prosthesis is required.

Treatment endocrine pathology associated with a preliminary determination of the level of specific hormones and the prescription of replacement therapy or antagonist drugs, restoration of the electrolyte composition of the blood. Lack of treatment effect requires surgical removal tumors.

Narrowing of the aorta rarely leads to a severe course of the disease; it is usually detected and treated promptly in childhood.

Lack of or delayed treatment causes complications of arterial hypertension. They may be irreversible. Maybe:

• heart damage in the form of myocardial infarction, development of heart failure;
• cerebrovascular accident (stroke);
• damage to the blood vessels of the retina, leading to blindness;
• the appearance of renal failure.

Prevention of arterial hypertension requires a healthy diet from childhood, without excesses, limiting animal fats and increasing the proportion of vegetables and fruits. Weight control, stopping smoking and overeating, playing sports at any age - this is the main prevention of all diseases and their complications.

If hypertension is detected, there is no need to despair; it is important, together with your doctor, to take an active part in selecting effective treatment.

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• Treatment of joints
• weight loss
• Varicose veins
• Nail fungus
• Fighting wrinkles
• High blood pressure (hypertension)

Arterial hypertension: what is it?

Arterial hypertension is a condition in which a persistent increase in blood pressure is determined to be 140/90 mm Hg. Art. This pathology is detected in 40% of the adult population of Russia and often occurs not only in older people, but also in adolescents, young people and pregnant women. It has become a real “epidemic of the 21st century” and doctors in many countries urge everyone to regularly measure their blood pressure, starting at the age of 25.

According to statistics, only 20-30% of patients with arterial hypertension receive adequate therapy, and only 7% of men and 18% of women regularly monitor their blood pressure. In the initial stages, arterial hypertension is asymptomatic or is detected accidentally during examinations or when patients visit a doctor for treatment of other diseases. This leads to the progression of pathology and a significant deterioration in health. Many patients with arterial hypertension who do not seek medical help or simply ignore doctor’s recommendations and do not receive constant treatment to correct blood pressure levels up to normal indicators(no more than 130/80 mm Hg), there is a risk of severe complications of this pathology: stroke, myocardial infarction, heart failure, etc.

Development mechanisms and classification

The rise in blood pressure occurs due to a narrowing of the lumen of the main arteries and arterioles (smaller branches of the arteries), which is caused by complex hormonal and nervous processes. When the walls of blood vessels narrow, the work of the heart increases and the patient develops essential (i.e., primary) hypertension. This pathology occurs in 90% of patients. In the remaining 10%, hypertension is symptomatic (i.e., secondary) and is caused by other diseases (usually cardiovascular).

Essential hypertension (or hypertension) does not develop as a result of damage to any organs. Subsequently, it leads to target organ damage.

Secondary hypertension is provoked by disturbances in the functioning of systems and organs that are involved in the regulation of blood pressure, i.e., an upward change in blood pressure is a symptom of the underlying disease. They are classified into:

• renal (parenchymal and renovascular): develop as a result of congenital or acquired hydronephrosis, acute or chronic glomerulo- and pyelonephritis, polycystic kidney disease, radiation sickness kidney, diabetic glomerulonephrosis, etc.;
• hemodynamic (mechanical and cardiovascular): develop with insufficiency aortic valves, complete atrioventricular block, atherosclerosis of the aorta, open aortic duct, coarctation of the aorta, Paget's disease, arteriovenous fistulas, etc.;
• endocrine: develop with pheochromocytoma (a hormonally active tumor of the adrenal glands), paragangliomas, Cohn syndrome, acromegaly, Itsenko-Cushing syndrome or disease, etc.;
• neurogenic: develop with diseases and focal lesions of the spinal cord and brain, hypercapnia (increased number carbon dioxide in the blood) and acidosis (displacement acid-base balance towards acidity);
• others: develop with late toxicosis during pregnancy, thallium and lead poisoning, carcinoid syndrome (blood poisoning by excessive amounts of hormones), porphyria (hereditary disorder of pigment metabolism), overdose of glucocorticoids, ephedrine, catecholamines, hormonal contraceptives, eating foods containing tyramine while taking MAO inhibitors.

According to the nature of the course, arterial hypertension can be:

• transient: a rise in blood pressure is observed sporadically, lasts from several hours to several days, normalizes without the use of medications;
• labile: blood pressure increases due to the influence of some provoking factor (physical or psycho-emotional stress), medication is required to stabilize the condition;
• stable: the patient has a constant increase in blood pressure, and serious and constant therapy is required to normalize it;
• crisis: the patient experiences periodic hypertensive crises;
• malignant: blood pressure rises to high levels, the pathology rapidly progresses and can lead to severe complications and death of the patient.

According to severity, arterial hypertension is classified as follows:

With isolated systolic hypertension, only an increase in systolic pressure above 140 mmHg is typical. Art. This form of hypertension is more often observed in people over 50-60 years of age, and its treatment has its own characteristic features.

Signs of arterial hypertension

Patients with arterial hypertension may experience headaches and dizziness.

For many years, patients may not be aware of the presence of arterial hypertension. Some of them during initial period hypertension is marked by episodes of weakness, dizziness and discomfort in the psycho-emotional state. With the development of stable or labile hypertension, the patient begins to complain of:

• general weakness;
• flickering of flies before the eyes;
• nausea;
• dizziness;
• throbbing headaches;
• numbness and paresthesia in the limbs;
• shortness of breath;
• difficulty speaking;
• heartache;
• swelling of the limbs and face;
• visual impairment, etc.

When examining the patient, lesions are revealed:

• kidneys: uremia, polyuria, proteinuria, renal failure;
• brain: hypertensive encephalopathy, cerebrovascular accident;
• heart: thickening of the cardiac walls, left ventricular hypertrophy;
• vessels: narrowing of the lumen of arteries and arterioles, atherosclerosis, aneurysms, aortic dissection;
• fundus: hemorrhages, retinopathy, blindness.

Diagnosis and treatment

Patients with signs of arterial hypertension may be prescribed the following types of examinations:

• blood pressure measurement;
• general urine and blood tests;
• biochemical blood test to determine the level of total cholesterol, lipoprotein cholesterol, creatinine, potassium, glucose and triglycerides;
• Echo-CG;
• fundus examination;
• Ultrasound of the kidneys and abdominal cavity.

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What is chronic circulatory failure?

Chronic circulatory failure (CCF) is serious illness, which is characterized by the inability of the heart and blood vessels to deliver the required volume of blood to cells and tissues for their normal functioning at rest and during exercise. Pathology, unlike acute failure, develops gradually and is much more common. Symptoms increase slowly. The degree of heart damage in this condition is much deeper. Timely diagnosis and efficient health care will help ensure full-fledged work of cardio-vascular system and prevent life-threatening complications.

General characteristics of circulatory failure

There are two forms of CNC:

1. Heart failure is accompanied by myocardial damage.
2. Vascular insufficiency is characterized by circulatory disorders due to weak tone vessels, narrowing their lumen.

The stages of chronic heart failure (CHF) are designated 1, 2A, 2B, 3. Depending on which ventricle is affected, the following types of CHF are distinguished:

• left ventricular;
• left atrial;
• right ventricular

Causes of heart failure:

• • atherosclerosis of the coronary arteries is the most common factor causing chronic circulatory disorders;
  • heart defects;
  • arterial hypertension;
  • inflammatory lesions of the heart muscle - myocarditis;
  • inflammation of the pericardium - pericarditis;
  • cardiomyopathy;
  • hyperthyroidism;
  • anemia;

• chronic pulmonary heart disease;

In medicine, heart failure in chronic form often called congestive heart failure.

Reasons why vascular insufficiency develops:

• heart pathologies;
• chronic infections;
• damage to the nervous system;
• insufficiency of the adrenal glands, which produce important hormones that regulate the condition of blood vessels.

Symptoms of chronic heart and vascular failure

Congestive heart failure of any type is characterized by two general symptoms:

1. An increase in heart rate (heart rate) - tachycardia.
2. Rapid breathing - shortness of breath.

These symptoms appear first in the initial stages of CHF as compensatory mechanisms that support the pumping function of the myocardium. Stage 1 CHF is characterized by the development of such symptoms only during exercise. During the transition to stages 2 and 3, tachycardia and shortness of breath also appear at rest.

Symptoms of left ventricular and left atrial CHF:

• pulmonary edema - a serious condition, accompanied by fear of death, forced sitting position, discharge of pink sputum in the form of foam - hemoptysis;
• cardiac asthma, manifested by nocturnal shortness of breath, deterioration of pulmonary ventilation, decreased heart activity;
• inspiratory dyspnea - difficulty breathing;
• dry cough;
• cold sweat;
• severe weakness;
• cyanosis of the skin.

Symptoms of right ventricular heart failure, which often occurs as a result of left ventricular heart failure:

• • increase in liver size (stage 2A);
  • Plesh's symptom - when pressure is applied to the liver area, the veins in the neck swell;
  • enlarged spleen;
  • acute abdominal pain, bouts of vomiting, and lack of appetite are often considered early signs;
  • swelling in the legs (stage 2B);
  • hypertrophy of the right ventricle and atrium;
  • swelling of veins in the neck;

• night dry cough;
• swelling throughout the body - anasarca (stage 3);
• decrease in urine volume;
• blue skin on the ears, tip of the nose, lips, phalanges of the fingers;
• the appearance of protein and red blood cells in the urine;
• night diuresis - nocturia;
• the appearance of fluid in the abdominal cavity - ascites.

Vascular circulatory failure in chronic form develops rarely, symptomatically corresponding to congestive heart failure. More often, this disorder occurs in an acute form in the form of fainting, collapse, shock. If we are talking about chronic vascular insufficiency, then more often it occurs in the form of hypotension - low blood pressure. For hypotension systolic pressure in the vessels drops below 75 mm Hg. Art. At the same time, the decrease in the indicator occurs gradually.

Symptoms of the disease help to establish the type of heart failure and its stage, in order to subsequently prescribe adequate treatment.

Diagnosis and complications of the disease

Methods for diagnosing CHF:

1. Questioning and inspection.
2. Laboratory methods.
3. Instrumental methods.

Using laboratory methods, the following is determined:

• blood protein composition;
• plasma content of electrolytes and colloidal complexes;
• volume of circulating blood and plasma;
• amount of Na, K, Ca and Mg;
• average red blood cell volume;
• plasma osmolarity;
• hemoglobin level, red blood cell count;
• urine analysis for protein and red blood cell content.

Instrumental research methods:

1. Electrocardiogram.
2. ECHO - ultrasound examination of the heart. Allows you to identify hypertrophied sections, decreased contractility, etc.
3. ECHO with Dopplerography makes it possible to establish a violation of blood flow, myocardial stroke volume, and an increase in blood volume.
4. X-ray studies can establish the presence of myocardial hypertrophy and blood stagnation.

Complications of circulatory failure are:

• • myocardial infarction;
  • hypoxia of the myocardium and brain;

• stroke;
• chronic hypotension and hypertension;
• death;
• suffocation;
• pulmonary edema;
• diseases of internal organs due to slowdown of blood flow in them.

Features of treatment and prognosis of the disease

Treatment congestive failure blood circulation is always complex, since it is necessary to simultaneously influence several symptoms and mechanisms of disorders. Timely treatment maintenance doses of medications play an important role in maintaining myocardial function and blood flow in the body at an optimal level.

Areas of treatment for CHF:

• stimulation of myocardial function. For this purpose, cardiac glycosides are widely used - Strophanthin, Digoxin, etc.;
• normalization (lowering) of blood pressure. Most effective groups drugs - adrenergic blockers (Dopamine), calcium channel antagonists (Amlodipine) and ACE inhibitors, that is, angiotensin-converting enzymes (Captopril, Enalapril);
• potassium preparations to normalize metabolism in the heart;
• ATP (adenosine triphosphoric acid) is prescribed to improve energy processes in the heart muscle;
• B vitamins to normalize the conduction of nerve impulses in the myocardium;
• amino acids and multivitamin complexes;
• diuretics to reduce the volume of fluid in the body, which increases the load on the heart (Furosemide, Veroshpiron);
• vasodilators - Caffeine-sodium benzoate, Nitroglycerin, Apressin, Sodium nitroprusside, etc.;
• oxygen therapy to eliminate hypoxia;
• massage, physiotherapy, baths to improve the tone of the heart and vascular walls.

Prognosis of CHF depends on the severity of the disease, timeliness of therapy, presence accompanying pathologies, aggravating the course. Thus, stages 1 and 2A of CHF have a favorable course against the background of constant maintenance therapy, stage 2B is considered serious and is accompanied by a significant deterioration in the condition of the cardiovascular system; Stage 3 is characterized by an unfavorable course and may result in death.