Hypertension - a pathological or physiological predisposition to an abrupt or gradual increase in indicators of both systolic and diastolic components of intravascular blood pressure, arising as a separate disease entities or beinganother manifestation of disease available to patients.
According to world statistics, the epidemiological situation in terms of the incidence of hypertension unfavorable as the percentage of this pathology in the structure of cardiological diseases is 30%.There is a clear correlation increased risk of symptoms and consequences of hypertension with increasing age of the patient, and therefore the main category of increased risk are persons of mature and elderly.
Causes of hypertension
appearance of signs of high blood pressure in a patient can occur on the background of existing chronic diseases and then we are talking about the secondary or symptomatic form of hypertension.In the event that hypertension is the primary character, and even after
Primary hypertension occurs in almost 90% of existing high blood pressure, and is now considered poly etiology of this pathological condition.So, there are no modifiable risk factors of hypertension, to avoid that it is not possible (gender, age, and genetic determinism), but these triggers are not dominant in the development of severe hypertension.To a greater extent on the development of the primary symptoms of hypertension affects a person's lifestyle (not a balanced diet, bad habits, inactive, psycho-emotional instability).Together, all of these triggers will sooner or later create a favorable environment for pathogenic development of hypertension.
is currently being considered are many theories of pathogenesis of essential hypertension, although the tactics of the patient and the determination of the amount of therapeutic interventions these hypotheses have no effect.To a large extent it is considered etiopathogenesis of secondary hypertension, as without removal of the etiological factors causing high blood pressure, in this case, one should not expect positive results of treatment.
So if renovascular hypertension symptomatic form the main pathogenetic link is a stenosis of the renal artery, which occurs when an atherosclerotic lesion or its fibromuscular dysplasia.It is a rare etiologic factor that affects the renal arteries is a systemic vasculitis.The consequence of stenosis of coronary lesions is considered to be one or both kidneys, provoking overproduction of renin, have an indirect effect on the increase in blood pressure.
in the pathogenesis of endocrine etiological forms of hypertension is increasing the level of hormonal substances that have a stimulating effect on the increase in the intravascular blood pressure that occurs in Cushing's syndrome, Conn's syndrome and pheochromocytoma.Some cardiovascular diseases can serve as a background for the development of secondary pathology of hypertension, such as coarctation of the aorta.
symptoms of hypertension
Clinical manifestations in the initial stage of development of hypertension may be absent altogether, and the diagnosis in this case is based only on objective data and instrumental and laboratory examination.
presenting complaints of patients suffering from hypertension rather non-specific, and therefore, in the opening of essential hypertensive disease diagnosis is much more difficult.In most cases, the episode of hypertension patients worried headache preferentially localized in the frontal and occipital sharp dizziness especially when changing body position in space, pathological tinnitus.These symptoms are not pathognomonic, so consider them as clinical criteria of hypertension is not advisable, as the above symptoms occasionally occur in completely healthy people and do not have anything to do with an increase in blood pressure.The classic clinical manifestations of respiratory disorders, signs of cardiac dysfunction are observed only in an advanced stage of hypertension.
etiopathogenetical Some forms of hypertension accompanied by the development of specific clinical symptoms, and therefore, experienced already at the initial examination and careful history can establish the correct diagnosis.For example, in renovascular hypertension type always marked the debut of acute clinical manifestations consisting in sharp critical and constant improvement of blood pressure mainly due to diastolic component.For renovascular hypertension is not typical for krizovoe, however, being patient in this condition is extremely serious.
Endocrine arterial hypertension is characterized opposite tendency to paroxysmal course of disease with the development of classical hypertensive crises.For this pathology characteristic is available patient clinical "paroxysmal triad", is to develop a severe headache, severe sweating, and palpitations.Patients who are in this pathological condition characterized by extreme psychological and emotional excitability.The development of a hypertensive crisis occurs more often at night, and the duration of the clinical manifestations do not exceed more than one hour, after which the patients reported severe weakness and dull common headache.
degrees and stages of hypertension
Determining the severity and intensity of the clinical manifestations of hypertension, as well as the stage of the disease is a prerequisite for the selection of appropriate treatment regimens.The basis of the division of hypertension both primary and symptomatic origin, put the level of increase in systolic and diastolic blood pressure component.
Patients with 1 degree of arterial hypertension often does not notice the global impairment of their health condition due to the fact that the numbers of blood pressure in this situation does not exceed 159/99 mm.Hg.Art.
grade 2 hypertension is accompanied by severe clinical symptoms and organic changes in target organs, and blood pressure are within 179/109 mm.Hg.Art.
grade 3 disease is characterized by an aggressive course extremely difficult and prone to develop complications from the dysfunction of the brain and heart.When third-degree marked a critical increase in blood pressure greater than 180/110 mm.Hg.Art.
addition to the classification of hypertension severity, in the practice of cardiologists used-stage separation of this disease, which is the criteria for signs of organ damage.
In the initial stage of hypertension, both primary and secondary origin, the patient is completely absent manifestation of organic lesions susceptible to high blood pressure tissues and organs.
The second stage involves the development of the disease developed clinical symptoms, the intensity of the manifestations of which depends on the severity of internal organ involvement.However, in most cases, this stage of hypertension is established on the basis of instrumental confirmation of organ damage in the form of hypertrophic cardiomyopathy of the left ventricle of the heart according to echocardiography and ECG, the narrowing of blood vessels of the retina in the fundus examination and the presence of changes in the parameters of the biochemical analysis of blood - namely, a moderate increase in the level ofplasma creatinine.
third stage of hypertension is a terminal at which the patient marked the development of irreversible changes in all organs that are sensitive to high blood pressure.With regard to the heart of man, long suffering from high blood pressure, developing ischemic myocardial injury, which manifests itself in the formation of zones of a heart attack.On the structure of the brain arterial hypertension has a negative impact in the form of provocation transient ischemic attacks hypertensive encephalopathy, and even the formation of foci of ischemic stroke.Prolonged systemic increase in intravascular pressure negatively affects the structure of the retinal vessels, the outcome of which is the formation of hemorrhages in the retina and optic disc edema.
for end-stage development of hypertension is characterized by a significant inhibition of renal function, which is reflected in the performance of creatinine, which exceeds the figure of 177 mmol / l.
Diagnosis of hypertension
in clinical and instrumental and laboratory examination of patients with hypertension the main goal should be not so much the finding of high blood pressure, as the detection of the causes of secondary hypertension, signs of internal organ involvement, as well as assessing the availability ofrisk factors for complications of the cardiac profile.
In the primary contact with the patient the key to establish the correct diagnosis and further treatment strategy is a thorough collection of anamnestic data of the patient.An objective examination of the patient suffering from arterial hypertension in some cases to determine the etiopathogenic form of the disease, by detecting specific pathognomonic signs.Thus, when an existing abdominal type of obesity in a patient, combined with hypertrichosis, hirsutism and persistent increase in diastolic blood pressure component must assume the nature of endocrine diseases (Cushing's syndrome).When pheochromocytoma, accompanied by severe paroxysmal hypertension observed increase in pigmentation of the skin in the projection armpits.The main clinical diagnostic criterion of renovascular hypertension is considered a vascular auscultation noise in the projection of the umbilical region.
volume of laboratory studies in hypertension is an analysis of the patient's lipid profile, determination of uric acid and creatinine, as the main criteria for renal dysfunction, the analysis of the hormonal status of the patient.
order to determine the stage of disease diagnosis is a prerequisite for target organ damage, ie bodies that develop irreversible changes caused by high blood pressure.So, for the study of the heart for disorders of organic lesion and is used electrocardiographic recording and ultrasound imaging, which are part of standard screening of all patients with hypertension.In order to detect retinopathy, which occurs mainly during prolonged severe course of hypertension, it is necessary to investigate the fundus of the patient.As an instrumental studies the kidneys and the brain is advisable to use ray imaging techniques, which are not included in the mandatory list of diagnostic measures, but greatly facilitate the early establishment of the correct diagnosis (computed tomography, magnetic resonance imaging).
Treatment of hypertension
principal modern approach to the treatment of hypertension is to achieve maximum elimination of the risk of complications of the cardiac profile and the level of mortality.In this regard, priority PCP is the complete elimination of reversible (modifiable) risk factors, existing in a patient with a further medication cupping of hypertension and related clinical manifestations.There is a norm, it is to achieve a target blood pressure of the border, which indicators should not exceed 140/90 mm Hg
In which cases should be applied antihypertensive therapy for hypertension?Cardiologists use in their practice developed a classification implies the assessment available to the patient, "the risk of cardiovascular complications."According to this classification, the combined treatment with lifestyle modification and drug correction subject person with a high risk profile of cardiac complications in conjunction with the critical increase in blood pressure numbers.Patients classified as moderate and low risk, are subject to dynamic observation for at least three months, and only in the absence of effect of the correction is not medical methods should be used to medical antihypertensive treatment.
principles of medical correction of hypertension are in the gradual reduction of blood pressure to the target figures by the application of the minimum therapeutic dose of one or more antihypertensive drugs.In some situations, a low-dose antihypertensive monotherapy drug may have a positive effect in the long term relief of hypertension.Currently, the pharmaceutical market is filled with a wide range of antihypertensive drugs, but the most popular are the combined group of drugs that have prolonged hypotensive effect (up to 24 hours).
as drugs of choice in respect of new-onset episodes of hypertension should be preferred diuretic, has a broad spectrum of positive effects in the form of preventing the development of cardiovascular complications, reduce mortality and prevent the progression of hypertrophic changes in the myocardium of the left ventricle.Pharmacological action, accompanied by a mild decrease in blood pressure is caused by a decrease in reabsorption of sodium and water and a reduction in vascular resistance.
Choice diuretic drug depends on the existing co-morbidities in the patient.Thus, when combined with arterial hypertension signs of cardiac and renal failure, preference should be given loop diuretics (furosemide at a daily dose of 40 mg).Thiazide diuretics (hydrochlorothiazide 12.5 mg daily dose) for long-term use can predispose gipokaliemicheskogo syndrome, and therefore, it is better to use them in combination with the aldosterone antagonists.
In a situation when the patient signs of hypertension combined with tachyarrhythmia, angina and symptoms of chronic cardiovascular disease stagnant, as the first-line drugs is advisable to use a group of B-blockers (atenolol in a daily dose of 50 mg of metoprolol 100 mgtwice daily Bisoprolol 2.5 mg in the morning).The mechanism of antihypertensive effect of these drugs is to reduce cardiac output and inhibiting production of renin.