Arterial hypertension is a concept of pathophysiological and clinical nature, which combines the conditions accompanying the prolonged increase in pressure in the arteries of the CCB (large circle of blood circulation). Most characteristic for blood pressure is considered to be an increase in diastolic blood pressure, but mainly there is an increase in systolic pressure above the norm.
As a rule, the term "hypertension" refers to the amount of blood pressure in the heart cavities and vessels. And the criteria for "normal" and "increased" pressure are to some extent conditional. The establishment of these indicators is based on the results of a diagnostic examination of a large number of people and the ratio of blood pressure to the risk of kidney, brain and heart complications, as well as premature death. Thus, in adults, arterial hypertension is considered a steady rise in blood pressure above one hundred and forty by ninety. At a systolic pressure it is less than indicators in mm rt. Art. from 130 to 139 and diastolic - from 80 to 89, BP is considered high normal. At a pressure of 140 to 159 (systolic) and ninety mm Hg. (diastolic) condition is regarded as a borderline isolated form of the pathological process. It is also called transient arterial hypertension and prehypertension. At a diastolic pressure less than ninety mm of mercury. Art. and systolic over one hundred and sixty, the condition is considered an isolated form of hypertension. It develops as a result of decreased aortic compliance, as well as large branches as a consequence of atherosclerosis, thyrotoxicosis, severe anemia, insufficiency of the aortic valves, open arterial duct.
The increase in pressure by etiological signs is classified into such forms of arterial hypertension as essential (primary) and symptomatic (secondary). About 90% of cases occur in the essential form, which is characterized by an increase in blood pressure of an unexplained etiology. Also this form is mild, moderate, severe or severe enough, and light hypertension accounts for almost 80%. In addition, all these forms can occur in the form of benign primary and malignant hypertension. Moreover, the latter is characterized by acute development of damage to the walls of vessels with manifestations of severe retinopathy and insufficient kidney function as a result of abrupt and persistent upsurge of blood pressure, regardless of its indices. The diastolic pressure is usually more than one hundred and thirty-one hundred and forty mm Hg. Art. In general, malignant course of the pathological process is observed from the very beginning of the disease. Less often, this course is characterized by persistent benign hypertension, which was not treated.
Depending on the pathogenesis, the increase in blood pressure is distinguished, which is associated with increased MOS and UOS; arterial hypertension resistance as a consequence of increased arteriolar tone and hypervolemic form as a result of polycythemia.
Arterial hypertension causes
Basically for today the reason of development of the given disease (the essential form) on which share it is necessary about 95%, is not established yet.
The classical etiopathogenesis of this pathology includes several theories on the occurrence of arterial hypertension. Among them, a neurogenic theory is distinguished, where the central role in the development of the pathological process is assigned to the central nervous system. As a result of prolonged mental trauma and overexertion of the negative nature of the higher nerve endings, a characteristic disease of regulation is formed. This causes the dysfunction of pressure regulators in the brain and in the center of the hypothalamus as a result of an increase in sympathetic vasoconstrictor impulses along nerve fibers, and an increase in tone in the vessels. And for the realization of all these effects, a hereditary predisposition is necessary.
According to the volume-salt theory, when the excretory function of the kidneys is primarily disturbed due to a delay in the body of sodium and water, there is an increase in MOS and VCP. And local mechanisms of self-regulation of blood flow in response to elevated blood pressure, causes myogenic arteriolar narrowing, which contributes to the normalization of MOS, thereby increasing blood pressure. In addition, excessive intake of salt is a characteristic factor in the development of hypertension.
Also at the basis of the emergence of essential arterial hypertension is the hyperactivation of the sympathetic-adrenal system, which causes augmentation of the heart with increased MOS and peripheral vasoconstriction. To possible etiologic factors of the disease include various stressful situations, genetic disruption of the activity of higher nervous regulators of blood pressure and age-related restructuring of neuroendocrine origin with the involution of sexual glands, as well as increased activity of the adrenal glands. In addition, enhanced adrenergic stimulation plays a significant role in the occurrence of increased blood pressure.
But the causes of the development of symptomatic arterial hypertension are renal lesions as a result of glomerulonephritis; stenosis of the renal arteries; coarctation of the aorta; foehromotsytomy; hyperaldosteronism; increased thyroid function; consumption of more than sixty milliliters per day of wine alcohol; taking medications such as antidepressants, oral contraceptives, cocaine, etc.
As a rule, before the appearance of various complications, arterial hypertension quite often occurs without any symptoms, and its only manifestation is an increase in blood pressure. Thus patients practically do not make complaints or they are not specific, however, the headache on a nape or in the forehead area is periodically noted, sometimes the head can be turned and it is possible to make noise in ears.
Arterial hypertension is a disease for which a specific specificity is characteristic. In this case, quite a long time, patients may not know about the presence of this disease, do not feel any symptoms and live a habitual way of life, although sometimes they have dizziness and general weakness. However, most people explain this by overwork, but it is at this point that attention should be paid to the appearance of the first signs of this pathology and it is desirable to measure blood pressure.
As a rule, the first complaints of patients appear after the defeat of target organs, since they are considered to be the most sensitive to the rise of blood pressure. In this case, at the first stages of circulatory disturbances in the vessels of the brain, the patients develop a head spin with characteristic pain and noise. Also, such a patient is disturbed by memory, and he can not work. In the future, there are feelings of numbness of limbs, general weakness, flickering flies and double vision in the eyes, patients begin to talk with difficulty. All this symptomatology is mainly characteristic for later stages of development of arterial hypertension, and at the initial stages of the disease the transient nature of this pathological process is noted. In addition, in the latter stages, complications such as hemorrhage or cerebral infarction develop.
Symptomatic of heart disease is characterized by an increase in LV as a result of a compensatory reaction aimed at stabilizing the increased wall tension as a consequence of increased afterload, heart failure, and IHD . The process of increase or hypertrophy of the left ventricle is explained by the growth of its mass due to thickening of cardiomyocytes. In the very beginning, there is a thickening of the walls of the left ventricle, and in the future there is an expansion of even the heart chambers. This change in heart is characterized by an unfavorable prognosis, as it causes heart failure, sudden death, coronary heart disease and the development of abnormalities in ventricular rhythm function.
In the process of progression of LV disorders, patients begin to feel difficulty breathing at the time of physical exertion, cardiac asthma develops, as well as pulmonary edema as a result of hypertensive crisis, and congestive heart failure. Therefore, very often all these symptoms lead to ventricular fibrillation and myocardial infarction, and as a result of atherosclerosis there may be a rupture or aortic dissection after its expansion.
When renal lesions appear in the urine protein, and also observe microhematuria and cylindruria. Rarely enough with arterial hypertension develops kidney failure.
Occasionally, the manifestation of this disease is deterioration of vision in the form of reduced light sensitivity and sometimes even blindness. Therefore, one should not underestimate arterial hypertension, as it is characterized by severe consequences that can cause the patient's death.
One of the symptoms of this disease is a characteristic pain in the head that occurs at any time of the day and night with a big advantage in the morning hours after waking up or at night. Headache in the form of raspiraniya and heaviness is localized mainly at the nape with further spread to other areas of the head. With arterial hypertension, the headache intensifies against a background of cough, and also after the head inclines, which is accompanied by the swelling of the eyelids and the face as a whole. But after the massage, certain muscular movements and in a vertical position, the patients' blood flow in the veins improves, and this, in turn, reduces pain, down to its absolute disappearance.
In some cases, a headache against a background of high blood pressure may appear as a result of the strained soft muscles of the head or tendons. The emergence of this pain can occur after psychoemotional or physical overstrain, and its termination is due to the resolution of conflicts in the family, at work or leisure. Basically, this pain is characterized by stress, as a result of which the head is squeezed or contracted, the patient begins to vomit and his head becomes very dizzy. And as a result of prolonged pains of incessant nature, the patients become irritable, quick-tempered, they have increased sensitivity to noise and loud music sounds.
Against the background of arterial hypertension, there are certain types of pain in the region of the heart, which mainly arise at absolute rest or after emotional overstrain without using physical exertion. A characteristic manifestation of these chest pains is their non-occlusion with the help of nitroglycerin, as well as a prolonged continuation.
The symptomatic picture of the disease in some patients consists of the signs of dyspnea at the beginning of the pathological process after carrying out insignificant loads, and then already in a state of complete rest. All this indicates a characteristic change in the heart muscle and the development of heart failure . In the presence of this pathology in many patients swollen lower limbs, which is due to the retention of sodium and water ions in the body against the background of hypertension after taking some medications or impaired renal function.
As a result of visual impairment, in connection with an increase in blood pressure, the appearance of flies before the eyes, some fog or shrouds is noted. This is due to functional circulatory disorders in the retina of the eye. And against the background of hemorrhage, retinal detachment, thrombosis of vessels, complications such as diplopia, deterioration of vision or absolute loss of it develop.
Stages of arterial hypertension
This pathological process is characterized by constantly elevated systolic blood pressure and / or diastolic blood pressure. With the primary (essential) form of the disease, there is an increase in pressure without obvious causes. With secondary (symptomatic) - there is a rise in blood pressure with the ability to identify the cause of this increase.
In order to establish the stages of the pathological process, a classification is used that depends on the lesions of target organs. Thus, three stages of arterial hypertension are distinguished.
At the first stage, there are no objective symptoms of violations of target organs.
The second stage is characterized by objective signs of changes in target organs without symptomatology on their part or any violations. This can be LV hypertrophy based on the results of the study using X-rays, echocardiography and electrocardiograms; narrowing of the artery of the retina generalized or focal; a slight increase in creatinine in the blood or microalbuminuria.
The third stage is characterized by objective damage to target organs with certain symptoms and impairments of their functions.
♦ In case of (transient) stage I of arterial hypertension, there is a periodic increase in pressure associated with spasm of arterioles. At this time, the wall of the vessels does not receive enough oxygen, so oxygen starvation occurs and their dystrophic changes occur. Later the spasm is replaced by paralysis of the arterioles, where the hypoxia of the vascular walls is preserved. That is why arterioles can become permeable, and they form plasmorrhagia, which extends beyond the walls of blood vessels, which causes a perivascular edema. After the normalization of blood pressure and restoration of microcirculation, blood from the walls of arteries and perivascular spaces is gradually removed. But after increasing physical exertion with repeated repetition, compensatory hypertrophy of the left ventricle arises. Beginning arterial hypertension can be stopped in its development and progression by eliminating psychological and emotional stresses, as well as timely use of medication and adequate treatment.
♦ Stage 2 arterial hypertension is characterized by a significant violation of the arteries with a persistent rise in blood pressure. As a rule, this is due to profound changes in the regulation of the cardiovascular system and its disturbances. In this case, the transitory stage in its transition to the stable or the second stage of the disease is due to the actions of neuroendocrine mechanisms. In this case, the pressure often rises and the baroreceptor sensitivity, which is on the aorta, decreases. In addition, persistent vessel spasms, plasmorrhagia and an increasing mass of proteins on the vascular walls lead to arteriolosclerosis or hyalinosis. And this, above all, causes compaction of the walls of the vessels, leading to a decrease in elasticity and a gradual thickening of them, thus contributing to the narrowing of the arterioles. As a result of consistently high blood pressure in the background of this pathogenesis, the load on the heart increases and compensatory hypertrophy of the LV develops.
♦ Stage 3 of arterial hypertension is characterized by impaired functioning of the organs as a consequence of the affected and altered arteries. In this case, there are changes in the secondary nature.
Degrees of risk of hypertension
In 2003, a modern classification of the degrees of risk of hypertension was adopted. Therefore, for today, three degrees of the course of this pathological process are distinguished with different indices of arterial pressure. As a rule, systolic blood pressure in mm Hg is considered the norm. Art. from 120 to 129, and diastolic - from 80 to 84.
Thus, there is an easy (1) degree of arterial hypertension, in which the blood pressure is fixed in the range from 140/90 to 160/100 mm Hg. p. moderate (2) degree - from 160/100 to 180/110 mm Hg. p. severe (3) degree - above 180/110 mm Hg. Art.
To date, the severity of hypertension is directly dependent on risk factors. Risk is the development of cardiovascular complications against the background of increased blood pressure. And depending on these complications, the prognosis of the consequences of hypertension is also diagnosed.
The risk factors that worsen the course of the disease and its prognosis are: age category (men after fifty years, and women after sixty years); abuse of nicotine; increased cholesterol in the blood; hereditary predisposition, as well as obesity , hypodynamia, high risk groups of ethnic and socioeconomic nature, diabetes mellitus .
As a rule, these factors can be correctable (can be eliminated) and uncorrectable. The first group includes diabetes, hypodynamia, high cholesterol, smoking. Incorrect factors include race, family history, age.
Thus, based on the degree of arterial hypertension and contributing factors of the disease, the prognosis is diagnosed with the development of various complications in the form of a heart attack or stroke for the next ten years.
With a mild degree of arterial hypertension without the presence of risk factors, the occurrence of complications SSS. is reduced to a minimum for the next ten years. In a percentage ratio, this is about 15%. Non-drug treatment for one year and changing their lifestyle are characteristic methods of treatment of this degree. And in case of stability, blood pressure is more than 140/90 mm Hg. Art. medication is prescribed.
The average degree of risk is characterized by the development of complications as a result of arterial hypertension for ten years in a ratio of 20%. Treatment is the same as with a low degree of risk, but with control over the dynamics for six months. With poor blood pressure and stable preservation of it, they switch to medication therapy.
With a high degree of risk, the occurrence of complications increases to 30%. In this case, patients are prescribed a full examination and drug treatment in combination with non-drug therapy.
For a very high risk, an excess of 30% in the development of complications of S.S.S. In this case, the patient needs an urgent examination and immediate start of treatment with the help of medications.
Arterial hypertension medical history
Whenever any medical or preventive institution is admitted to the hospital, a history of his illness is compiled for each patient, which is considered one of the most basic medical documents.
As a rule, its filling begins with the receiving rest, where the patient comes in with a diagnosis of hypertension.
For a start, general information about the patient with passport data, place of work and residence is recorded in the medical history. Then proceed to clarify the patient's complaints, which allow us to present all the features of this disease with characteristic concomitant pathologies. In some cases, they are so pronounced in the form of high blood pressure values that you can immediately diagnose arterial hypertension.
These patients have a strong headache (especially in the morning) in the region of the occipital part, causing a feeling of heaviness and stiffness of the head. In addition, patients complain of poor sleep, reduced working capacity and memory, as well as characteristic irritability. Some patients complain of pain behind the sternum, difficulty breathing after physical work and visual impairment.
After this, they begin to collect an anamnesis of arterial hypertension and an anamnesis of life that influences the development of this pathological process. As a rule, they clarify the nature of the onset of a symptomatic picture of the disease, and also ask the patient himself about the possible causes that triggered the development of hypertension. In addition, find out the duration of the pathological disease, the previous methods of examination and previous treatment.
Hereditary anamnesis includes the presence of relatives with hypertension, and then they are asked about the life of the patient, the place of his birth, the age of the parents at the birth of the patient, the nature of nutrition, living conditions when the work began. Also determine the state of the patient's psyche, which is related to the situation at home and at work. Substantial importance is given to the detection of intoxication of domestic character as a result of alcohol and smoking. Women learn about the onset of menstruation, their periodicity and duration, the presence of pregnancies, their course, childbirth . It is also necessary to know the time of cessation of menstruation (climacteric period), the nature of its course (hot flashes, heart beat, increased blood pressure, irritability).
Further they proceed to general examination of the patient and his somatic organs with further filling in the medical history of all the results.
Since the arterial hypertension occurs in three stages, in the patient at the first stage of the disease, only a rise in blood pressure is noted without characteristic violations of the internal organs. In the second stage, too, an increase in blood pressure is observed, and after additional examinations, radiography, echocardiography and electrocardiograms, an enlarged left ventricle is diagnosed. In addition, arterial hypertension affects the functioning of the kidneys, which is characterized by the presence of traces of protein and single red blood cells in the urine, as well as an increase in body temperature. In coronary artery atherosclerosis, there are pains of a compressive nature in the heart area as a result of certain loads that disappear after a nitroglycerin pill under the tongue or walking. But the third stage of the disease is dangerous with the development of myocardial infarction, paresis and paralysis as a result of circulatory disorders in the brain, as well as a sharp violation of vision, up to absolute blindness.
Then the history of the disease with hypertension is filled with the results of palpation and percussion. When listening, special attention is paid to heart tones, its rhythm, absence or presence of cardiac murmurs, heart rate and, of course, measure pressure. And only now the doctor can set a preliminary diagnosis, prescribe methods of diagnosis and drug treatment, given the established stage of hypertension.
And if the patient enters the cardiological or resuscitation department with hypertensive crisis, the history of the disease is filled with the words of the relatives or the patient himself after the arrest of the attack.
The mandatory methods of diagnosing the disease include measurement of blood pressure, electrocardiography, x-rays, phonocardiography, echocardiography and veloergometry. Additional methods of investigation are urine analysis, as well as general and biochemical blood analysis.
Thus, after receiving the results of the examination, examination, questioning, anamnesis of the patient, the attending physician makes a diagnosis and appoints in the complex therapeutic treatment of arterial hypertension, documenting all this in the sheets of destination. Also in the medical history, the doctor keeps a daily record of the patient's condition, describes all the recommendations, appointments and attachs the results of the tests, as well as the examinations.
In addition, in every medical history, drugs that are not tolerated by the patient or if made a substitute are necessarily noted.
After the passed treatment, repeated examination and for certain indications of the patient, a special epicrisis is prepared and prepared, which also indicates the patient's data, complaints, degree, stage of arterial hypertension, the patient's condition at admission and at discharge, all methods of diagnostic examination with their results before treatment and after. Also describes the entire tactics of ongoing treatment of hypertension. And at the end of the medical history the final diagnosis is issued with some recommendations in the form of observing the correct regime of the day, medical treatment and nutrition on out-patient treatment.
Symptomatic arterial hypertension
This disease is causally associated with some pathological processes or damage to systems or organs that are involved in the regulation of blood pressure. Symptomatic arterial hypertension accounts for up to 15% of cases.
As a rule, more than seventy diseases are the etiological factors of the onset of symptomatic arterial hypertension. This is mainly a disease of the urinary system, renal arteries and kidneys acquired and congenital in nature; endocrine and cardiac pathology, as well as disorders of the central nervous system.
Thus, symptomatic arterial hypertension is classified into four main groups, such as nephrogenic, endocrine, hemodynamic and centrogenic. There is also a combination of several pathological diseases that can cause increased blood pressure. This is possible with neoplasm in the kidney, the code has atherosclerosis of the aorta and cerebral vessels; diabetic glomerulosclerosis and chronic pyelonephritis ; atherosclerotic stenosis of the renal arteries and chronic glomerulonephritis, etc. Besides, arterial hypertension caused by exogenous factors in the form of cadmium poisoning, thallium, lead, and also medicinal preparations is also isolated.
Symptomatic arterial hypertension is mainly composed of symptoms associated with increased blood pressure and underlying pathology. As a result of high pressure, the patient has pain in the head, she starts spinning, flies flashing before her eyes, noises and rings in her ears, pains in the heart and other sensations of a subjective nature are noted. Also, with a stable increase in pressure, hypertrophy of the LV with an accent of the second tone over the aorta is detected. In addition, there are certain changes in the vascular base of the eye.
Symptomatology of the main pathological process can be clearly expressed, then the nature of symptomatic arterial hypertension is established due to the clinical picture of a particular disease. And there may be no symptoms, then only a rise in blood pressure is observed. In this case, the nature of this arterial hypertension can be assumed by such criteria as the development of the disease at a young age or after fifty years; acute progression and characteristic stabilization of pressure at high rates; asymptomatic course of the disease; resistance to treatment with antihypertensive drugs; malignant course of the pathological process.
Also, symptomatic arterial hypertension is benign and malignant, which is associated with the nature of the course of the disease. As a rule, several groups of the pathological process are distinguished. For example, renal hypertension is considered the most common cause of symptomatic hypertension (75%). And they, in turn, are divided into renovascular arterial hypertension, increased pressure in the pathology of the kidney parenchyma, and as a result of a violation of the outflow of urine. In this case, the symptomatology of arterial hypertension of renal etiology consists of an increase in blood pressure and the pathology of sediment in the urine, fever, noise above the arteries of the kidneys and tumors in the abdominal cavity.
Endocrine hypertension is characterized by an increase in blood pressure with simultaneous sympathetic-adrenal crises, muscle weakness and bladder syndrome; obesity and a tumor (rarely). Diagnosis of all these signs suggests the patient has an arterial hypertension of endocrine origin. If, during the examination of the patient, complaints are noted about the development of the hypertensive crisis accompanied by palpitations, muscle tremors, profuse sweats and pallor of the skin, headaches, and compressing pain behind the chest, it can be assumed pheochromocytoma. When these complaints occur, concomitantly with fever, weight loss, and abdominal pain, pheochromoblastoma is suggested. But with a tendency to fainting as a result of permanently elevated blood pressure, pheochromocytoma is characteristic without hypertensive crises.
When patients complain of lifting BP and muscle weakness, reduced physical endurance, in a significant amount of urination and thirst, consider a classic symptomatic picture of Cohn's syndrome. In the presence of these symptoms with fever and epigastric pain, adenocarcinoma of the adrenal gland can be assumed.
At the time of development of hypertension with simultaneous increase in body weight, violation in the genital area, anxiety in the form of thirst, polyuria and skin itching suggest syndrome Itenko-Cushing .
Hemodynamic hypertension is characterized by the defeat of large vessels and the heart, which are represented by systolic hypertensions against aortic insufficiency, bradycardia and atherosclerosis; regional with coarctation of the aorta; hyperkinetic circulatory syndrome with arteriovenous fistulas; ischemic congestive hypertension on the background of mitral malformation and CH. All data arterial hypertension are in direct connection with pathological processes in the heart and large vessels, thus contributing to the rise of blood pressure. In addition, there is a systolic blood pressure of an isolated or predominant increase.
Centrogenic arterial hypertension is characterized by lesions of the central nervous system of an organic nature. In this case, patients experience a rise in BP in combination with headaches, head twists and various manifestations of a vegetative nature, and sometimes an epileptiform syndrome. In the anamnesis there are traumas, encephalitis, arachnoiditis , concussion. All the above symptoms with the presence of an appropriate history speak of a neurogenic genesis of symptomatic arterial hypertension.
Diagnosis of arterial hypertension
The main tasks of diagnosing this pathological process are to determine a stable and elevated degree of blood pressure, to exclude or detect symptomatic arterial hypertension, to assess the overall risk of SS.
As a rule, the results of repeated pressure measurements are used to diagnose the disease; collection of anamnesis of the disease; examination of a physical nature; instrumental and laboratory methods of examination.
When collecting anamnesis, the age of the patient is a special indicator. The disease, which has arisen from forty to fifty years, is basically considered an essential arterial hypertension. And if there are signs of increased pressure, from twenty to thirty years with its rapid stabilization on high figures and early complications, one can assume that there is symptomatic arterial hypertension. Also, when making a diagnosis, pay attention to alcohol abuse and smoking; characteristic signs of abdominal obesity; physical activity, as well as the personal qualities of the patient. Of course, take into account the presence of various complications and complaints of patients, which indicate the involvement of target organs in this pathological process.
Then proceed to the physical examination of the patient with a diagnosis of hypertension, which is associated with the identification of risk factors for various complications, secondary symptoms of the disease and lesions of certain organs.
The main method of diagnosing arterial hypertension is sphygmomanometry. As a rule, the final diagnosis can be made thanks to a two-time measurement of blood pressure when visiting a doctor.
During the examination of the patient pay attention to the presence of flushing or pale skin, a constitution, existing swelling and other signs of organ damage. In general, hypertension is characterized by hyperemia of the face and upper body, and sometimes by the addition of cyanosis . Pale skin appears during the hypertensive crisis, a significant decrease in renal function. Also worsening the prognosis of the disease is obesity. With edema of the lower extremities, there are suspicions of HF. In addition, pay attention to the presence of noise in the head, changes in the vessels of the fundus, disruption of the heart rhythm, asymmetry, weakening or lack of pulse and cold extremities.
Also important monitoring method of monitoring is the monitoring of pressure throughout the day, providing the necessary information about the mechanisms of cardiovascular regulation with daily variability of blood pressure, nighttime hypertension or hypotension, uniformity of antihypertensive action of drugs.
From the laboratory and instrumental methods of examination, the following are used: X-ray, electrocardiography, phonocardiography, echocardiography, bicycle ergometry, as well as general urine analysis and biochemical blood test for protein, fibrinogen, C-reactive protein, cholesterol, transaminase content and, of course, urine.
Treatment of arterial hypertension
The main principles of treatment of any degree of hypertension consist in lowering blood pressure. This allows to reduce the development of serious complications in target organs within five years from 55 to 18%.
If the patient has a first degree of disease with a systolic pressure less than 160 mm Hg. and a diastolic one is less than one hundred, then repeated blood pressure measurements are carried out for four weeks without the prescription of medications. And in the event that the indicators turn out to be normal (20-30%), then non-drug therapy with the recommendation of repeated blood pressure measurements every three months for a whole year is avoided. At increased pressure in this four-week period, the question of prescribing certain drugs is being considered. And if this pathological process is joined by other risk factors for the development of SSC, immediately prescribed antihypertensive drugs. The same applies to the detection of the second and third degree of hypertension, even in the absence of additional risk factors.
Isolated systolic hypertension in elderly people undergo immediate medical treatment, but the mild form of this disease in young and younger generation is treated, as a rule, by non-drug therapy.
The main directions of such treatment are getting rid of bad habits, increasing physical activity, normalizing weight and reducing the intake of salt in your diet.
It is also necessary to create optimal conditions for the patient to work and rest, sometimes even prescribe soothing drugs in the form of Bechterew's, Shepherd's, Valerian's, Tazepan's, Fenazepan's, Seduxen's, Elenium's. And with a bad dream, barbiturates are prescribed.
Thanks to the use of rational diet therapy, it is possible to reduce the level of pressure in the mild form of arterial hypertension, as with monotherapy with antihypertensive agents. In general, the positive effect of this method is achieved in elderly people. Patients with hypertension are advised to reduce the intake of salt to one teaspoon or use it in the form of food salting. In addition, the diet should include those products that, according to their energy value, do not exceed daily consumption, and with obesity should be even less.
Also an important point in the treatment of patients with arterial hypertension is an individual selection of a drug that will help stabilize blood pressure indicators. In addition, it is necessary to try to normalize or practically normalize blood pressure, to prevent strokes, dynamic circulatory disorders in the brain and renal arteriosclerosis.
Positive dynamics can be achieved with the stay of patients in health-improving facilities in the form of sanatoriums and dispensaries organized at enterprises. Here patients can receive physiotherapy, a full and healthy sleep, as well as good and proper nutrition.
In the treatment of hypertension, a wide variety of drugs that reduce blood pressure are widely used. First of all, for this use means that affect the nervous receptors of the cardiovascular system, such as beta-blockers (Anaprilin, Inderal and Obzidan), as well as drugs that reduce the amount of epinephrine and norepinephrine in the vessels and the central nervous system (Reserpine, Clophelin, Dopegit) . A positive effect in reducing blood pressure is obtained with the appointment of diuretics in the form of Triampur, Furosemide, Hypothiazide, which promote the release of sodium and water ions from the patient's body, which bring the blood pressure to normal levels. Also, the pressure is well reduced by vasodilators (Prazosin, Captopril, Kapoten, Kaptopres), characterized by different mechanisms of action, which expand the arterioles as a result. But all these drugs should be prescribed only by a doctor, taking into account all the individual characteristics of the body.
In addition, today a combination therapy with various mechanisms of action is widely used. This allows you to use drugs in fairly low doses. These drugs include Adelfan, consisting of Hydralazine, Hypothiazide and Reserpine.
A characteristic feature of the treatment of hypertension is the constant intake of antihypertensive drugs with mandatory blood pressure control and a change in the dose of the drug in the direction of increasing or decreasing, which will already depend on the course of arterial hypertension and the characteristics of the patient.
With easily flowing form of the disease, outpatient treatment of the pathological process is allowed. And only such patients who need to choose a new combination of drugs or clarify the diagnosis, as well as in the case of hypertensive crisis, are subject to scheduled or urgent hospitalization.
With hypertensive crisis, urgent actions are quickly performed, and then they start special treatment. All this is connected with the rapid decrease of sharply increased blood pressure, improvement of cerebral and renal circulation. In this case, the patient is provided with absolute rest and raised the head end with mandatory access to fresh air. If the pressure values correspond to insignificant figures, then diverting therapy is applied in the form of an ice-to-head bubble, foot baths in hot water, setting mustard plasters on the occiput and calf muscles. And at occurrence of compressing pains behind a thorax necessarily do an electrocardiogram, for exception of a myocardial infarction at a hypertensive crisis.
In those moments when the patient is somewhat aroused, a calming therapy is prescribed, and in order to stabilize high blood pressure give tableted Clofelin under the tongue. In addition, when hypertensive crisis is used, Furosemide or Hypothiazide is used, and in the case of a negative result, dibazol is injected intravenously in a physiological solution. In this case, the antihypertensive effect comes after twenty minutes after the administration of this drug, which lasts almost three hours. And to increase the action of Dibazolum simultaneously inside take Furosemide.
In some cases, if hypertensive crisis is not possible, Clopheline may be administered intravenously or intramuscularly with the mandatory horizontal position of the patient within two hours after the administration of this drug.
Also, for heavily undergoing crises or poor blood pressure reduction results, Pentamine is administered intramuscularly or intravenously and, of course, is necessarily controlled by blood pressure.
Prevention of arterial hypertension
The main methods of prevention is the primary form, conducted for healthy people with normal BP and secondary, when making a diagnosis of hypertension.
As a rule, the prevention of this disease consists in observing proper nutrition and in performing physical exercises that significantly improve the health of patients or healthy people.
Any physical exercise in the form of running, walking, swimming, exercising on the simulators and respiratory exercises only contribute to the increase of work capacity and significantly stabilize the increased pressure. And to begin any physical training is necessary with small loads of thirty minutes with a gradual increase.
Also, an important measure of prevention of hypertension is the restriction of salt and animal fats in their diet. It is advisable to cook food without salt, given that such products as cheeses, smoked foods, canned food and sausages already contain salt initially, so it should not be in other foods. It can also be replaced with some spices or salt with a lower sodium content. In addition, it is necessary to exclude fried, fatty, spicy and salty foods from your diet, replacing them with vegetable products with a preference for low-fat dairy products. All this will help to normalize the body weight, enrich the diet with potassium and reduce the amount of cholesterol in the blood, which contributes to the onset of atherosclerosis.
As a preventive measure, it is recommended to master the methods of psychological auto-training, meditation and self-hypnosis to control stressful situations, which are the underlying causes of the development of hypertension. Thus, it is desirable to find positive things in everything, be optimistic, find a hobby that would bring only positive moments, communicate with animals, walk on foot before going to sleep for peace of mind. Of course, immediately abandon cigarettes and alcohol. After all, they are in close connection with arterial hypertension, which can cause death.
In the case when the diagnosis of hypertension is exposed, then secondary prevention measures are used that protect the target organs from the possibility of heart attacks, strokes and coronary artery disease. At the same time, all measures of primary prevention with the addition of breathing exercises, massage, acupuncture, acupuncture, reflexotherapy, intake of herbs, vitamins and antioxidants are observed. It is also important to observe the regime of the day, normal sleep, constantly measure and record the results of blood pressure in order to have all this data during the appointment with your doctor.