Hypertonic disease is the most common disease of the circulatory system all over the world. About 30% of the world population suffers from this disorder. In recent years, a significant "rejuvenation" of the disease has been noticed - among the sick, more and more people of young and a half.
Hypertension is full of heavy complications and disabled, often leads to death. At the same time, without prejudice to a series of rules, the occurrence and development of the disease can be delayed of years. Each person should be familiar with risk factors for the development of hypertension, his symptoms and principles of treatment.
What is hypertension
Hypertonic disease or arterial hypertension (synonym: essential hypertension, primary hypertension) - proceeding chronically, subject to progression, in the clinical picture of which the main symptom is a persistent and prolonged increase in blood pressure (i. e. arterial hypertension syndrome).
The criteria for arterial hypertension are considered a systolic blood pressure (blood pressure) from above or equal to 140 mm hg. Art. and/or diastolic blood pressure greater than 90 mm hg. Art.
Etiology of the disease
Hypertonic disease is considered an idiopathic disease, the immediate causes of its presence are not established.
Among the numerous theories of emergency and the development of primary hypertension, classical neurogenic theory is widespread. This concept considers hypertension as a neurotic state of greater nervous activity. The starting mechanism is considered a nervous (acute or prolonged, chronic) overvoltage, which causes a violation of the trophism of the structures of the brain which are responsible for regulating blood pressure. Of particular importance are the emotions that have not received implementation in the motor sphere, the so "non -emotions not react".
In the occurrence of primary hypertension, a genetic predisposition is traced. In 35-50% of people suffering from hypertension, the family nature of the disease is observed. A specific gene has not been detected, whose defect would lead to a persistent increase in blood pressure. Probably, the disease has a polygenic type of inheritance.
Pathogenesis of hypertension
The pathogenesis of primary hypertension is complicated and in different phases it has its characteristics. According to neurogenic theory, under the influence of nervous overexation, the inhibitory effect of the cortex of the large brain hemispheres on subcortical vegetable centers (hypothalamic) is reduced, which causes the activation of the sympathetic system (vasoconstrictor). There is an admission of adrenaline, increases in cardiac expulsion, arteries are restricted (including kidney), increases in blood pressure. The spasm of the kidney arteries activates another powerful pressing-renine-angiotensin-aldosterone system, which gives its significant contribution to the increase in blood pressure. Other vasoconstrictive agents are also connected over time: antidiuretic hormone, prostacilla, endotelin, thrombossano. They are against the vascular prostaglandins of depressive systems, Kallikrein-Chinina and a system of sodium reuteri. A long spasm of the arteries leads to a violation of the function of their internal shell (endothelium), restructuring the walls of the blood vessels and contributes to the development of the atherosclerosis.
Risk factors
The risk factors are attributed to the signs, whose presence in man increases the probability of developing the disease. The variety of risk factors for primary hypertension is divided into two groups, modified and unrealized.
Unrealized risk factors (it is impossible to influence them)
These include:
- The male sex is among the men of a young impact of medium -age hypertension than women at the same age. The low impact in women is explained by the protective effect of estrogen. The prevalence of hypertension in representatives of both sexes over 60 years is approximately the same;
- Age (over 50-60 years)-the prevalence of hypertension increases clearly in old age;
- Heredity: the presence of cases of essential hypertension in a family increases the risk of the disease.
Modified risk factors (influence)
These include:
- Smoking - Nicotine has a powerful vasoconstrictor effect. Active and passive smoke leads to cramps of blood vessels, increased blood pressure;
- Obesity - That is, the body weight index is greater than 30 kg/m2. Clinical studies show that the incidence of hypertension increases as human weight grows. The deposition of subcutaneous fat in the area of life (abdominal obesity) is particularly dangerous, because it is associated with an extremely high risk of primary hypertension. This is due to the stimulation of the syrrivatic surrempathetic system in fatty people. A life of a life greater than 80 cm for women and over 94 cm for men is a serious risk factor for hypertension;
- A sedentary lifestyle (hypodynamia) - insufficient physical activity causes the development of obesity;
- Excess reception of table salt with food products (over 5 g per day);
- excessive drinking (over 30 g of ethyl alcohol per day);
- The unbalanced diet (high caloric, with an excess of saturated fats) - causes obesity;
- stressful situations.
Classification of arterial hypertension
Primary hypertension is classified according to the level of arterial hypertension, by nature of the lesion of the target organs.
Classification of arterial hypertension levels (AG)
Sistolic blood pressure category, mm hg. Art. Diastolic blood pressure, mm hg. Art.
- Arterial hypertension I degrees 140-159 90-99
- Arterial hypertension of grade II 160-179 100-109
- Arterial hypertension of grade III ≥180 ≥110
Classification by nature of the defeat of the target organs
The Mishenian organs are called those organs in which pathological changes are born mainly because of hypertension. For primary hypertension, the objectives are heart, kidneys, brain, eye mesh shell, blood vessels.
3 phases of primary hypertension
It is customary to distinguish 3 phases of primary hypertension:
Phase I.-Craticated by the absence of changes from the target organs;
Phase II-Co are changes in the target organs that do not manifest themselves from any symptoms:
- Heart: an increase in the left ventricle (according to the results of ECG or ultrasound of the heart);
- Ships:signs of thickening of the walls, the presence of plates (according to the results of the ultrasound, angiography);
- Renni:decrease in function, microalbuminuria (detection of small portions of protein in the urine);
- The retina: narrowing, impregnation of blood vessels;
Phase III-Co are symptoms of changes from the target organs:
- Heart: ischemic disease, heart failure;
- brain: transitional cerebral blood flow disorder, stroke;
- Renni:renal failure;
- Ships: occlusion of the peripheral blood vessel, which delays the aortic aneurysm;
- Retter of the Eye:Edema, hemorrhages, exudate.
Symptoms of hypertension
In some cases, for a long time the only symptom of essential hypertension remains an increase in blood pressure. It can be accompanied by non -specific complaints of head pain (it occurs in the morning, by the type of "heavy head", with localization in the occipital region), irritability, excessive fatigue, sleep disorders, general weaknesses, vertigo and quick palpitations.
Hypertonic crises are considered a luminous sign of the disease (from 1-2 hours to 2-3 days) of the exacerbation of the disease, manifested by a sudden increase in blood pressure. Occur in about a third of the patients.
There are 2 types of crises for hypertension: first order (adrenal) and second order (norepinephrine).
The hypertensive crisis of the first order develops more often in middle -aged people. The rise of blood pressure occurs at night, accompanied by a headaches, chills, cooling of the ends, anxiety, a rapid heartbeat.
A second hypertensive crisis is characteristic of the elderly. The increase in blood pressure is accompanied by a pronounced headache, compromised visual perception, inhibition, sleepiness, nausea, vomiting.
With a prolonged experience of hypertension in the clinical picture, the driver's place is occupied by the symptoms of the diseases of the target organs: rag pain with Angina pectis, lack of breath, swelling with heart failure, symptoms of a stroke, etc.
Diagnosis of hypertension
In order to establish a diagnosis of hypertension to a person, it is necessary to identify a persistent increase in blood pressure and exclude the presence of other diseases characterized by arterial hypertension syndrome.
An increase in blood pressure is determined using a conventional tometer: hell is measured by a doctor or patient himself. An indispensable condition is to respect the methodology of measuring blood pressure: the measurement is performed after 3-5 minutes of rest in a comfortable, sitting, resting, shoulder and heart environment should be positioned at the same level. The level of blood pressure higher than or equal to 140/90 mm hg. Art. Speaks of suspicion of essential hypertension. In diagnostically complex cases, the methodology of daily blood pressure monitoring is used.
Diseases accompanying hypertension
In addition to hypertension, there are still a number of diseases accompanied by an increase in blood pressure: renal pathology (pyel-/chronic glomerulonefritis), vasorennial hypertension (caused by the narrowing of the renal artery) (endocromic disorder), endocromity sandstone), with an anedooring of endocromity) (defect of endocromity), a defect). Aorta corruption of the emonomino tumor, to confusion of endocromity, to confusion of the Afocomic cancer, to confusion of endocromity, to confusion of congratulations tumor. Illness syndrome, disease. To exclude the presence of these pathologies, the doctor prescribes a complete examination.
A further examination is aimed at detecting the pathologies of the target organs. It allows you to clarify the stage of hypertension, prescribe adequate treatment.
Diagnostic measures include:
- ECG: there may be signs of an increase in the left ventricle (hypertrophy), ischemic changes, signs of an acute myocardial infarction.
- X -Ray of the thoracic organs: changes can be detected in the outline of the heart (manifestation of the hypertrophy of the left ventricle);
- Echocardiography (ultrasound of the heart): it can be detected through hypertrophy of the left ventricle, expansion of the heart cavities, a decrease in its work;
- Fondo study: the restricted arteries of the retina, the expanded veins, in the following stages: hemorrhages, exudate, swelling;
- Blood test: the quantity of cholesterol, the kidneys of the kidneys (creatinine, urea) are determined;
- Urine Analysis: Disorders of the Reni function, microalbuminuria, etc. are detected.
Hypertension treatment
In the treatment of primary hypertension, the non -pharmacological methods and drugs that are completed are successfully used.
Non -pharmacological methods for the treatment of arterial hypertension
They are prescribed to all patients with hypertension, even if a person receives drugs to control blood pressure. These measures imply the elimination of risk factors by modifying the established lifestyle and human habits. Scientists have shown that non -pharmacological treatment in some cases is not less than treatment with drugs.
The main directions:
- Limit the amount of table salt from food (up to 5-6 g per day). This implies a complete refusal of foods such as sausages, sausages, savory cheeses, canned foods, salty fish. It should also be taken into consideration that a significant amount of salt is contained in the oven products;
- The fight against overweight: people who suffer from primary hypertension is recommended to reduce the calorie content of the food diet by limiting the use of fats;
- Limitation of the use of drinks containing alcohol - up to 30 g of ethyl alcohol per day;
- A complete and rigorous refusal of smoking-if necessary, resorts to the help of a narcologist;
- Regular physical activity is moderate, preferably every day, which lasts at least half an hour. Fresh air events are preferred: jogging, walking at an accelerated pace, cycling.
Pharmacological treatment of arterial hypertension
Implies the use of drugs.
For effective treatment of primary hypertension, different classes of drugs are recommended by experts, reduce blood pressure, influencing the different phases of the disease of the disease.
Main Drugs classes:
- Angiotenzinoproding - IAC enzyme inhibitors;
- Angiotensin receptors - Sartans;
- Calcium antagonists;
- diuretics;
- blocking;
- Renin inhibitors;
- Central action drugs (cerebral);
- Alpha-blockers.
Combinations of drugs for the treatment of arterial hypertension
In the treatment of hypertension, the combinations of drugs of various groups are widely used, for example IACD + diuretic, calcium antagonist + IACF, -Blocco + Sartan + diuretic. The modern pharmaceutical industry produces a large number of ready -made drugs, which significantly simplifies drugs.
It should be noted that the treatment of hypertension is carried out under the continuous control of a doctor-therapist or cardiologist. The doctor determines the volume of medical measures, the moment of prescription of drugs, dosage, etc.
The independent prescription of antihypertensive drugs is unacceptable. With the development of malignant hypertension, which is not susceptible to the effects of drugs, it is possible to carry out the surgical treatment of hypertension (stimulation of baroreceptors of the bullshit breast, renal detention, etc. ).
Hypertension prevention
Primary hypertension prevention must be carried out by childhood. Children, teenagers, young people should regularly undergo medical exams with the measurement of blood pressure. Prevention should affect the risk factors of the disease. Children are shown a rational muscle load, an excess of nutrition, excessive consumption of salt food is unacceptable. Secondary prevention aims to prevent the progression of the disease. People who suffer from hypertension are contraindicated at night, extraordinary work and combined with nervous overloads.