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ARTERIAL HYPERTENSION

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ARTERIAL HYPERTENSION (Hypertension) is characterized by a persistent increase in blood pressure above the boundaries of the physiological norm (140/90 mm Hg. Art.). In the overwhelming majority of cases, it is not possible to establish the cause of the increase in blood pressure, while talking about essential hypertension, or hypertension (about 90% of cases of arterial hypertension). Kidney disease (glomerulonephritis, pyelonephritis, narrowing of the renal arteries) cause 2–3%, renovascular hypertension — 1–2%, Cushing’s syndrome — 0.1%, pheochromocytoma — 0.1% of cases of arterial hypertension; other causes may be pathological menopause, thyrotoxicosis, CNS diseases, marked aortic atherosclerosis, etc.

The clinical picture depends on the stage and form of the disease. In the absence of complications, arterial hypertension can be asymptomatic and can only be detected by random measurement of blood pressure. In other cases, patients complain of recurring headache, dizziness, tinnitus, flickering "flies" before the eyes, pain in the heart, heart palpitations. Complaints related to the underlying disease (with nephritis, thyrotoxicosis, etc.) may prevail. At objective research hard, intense pulse, accent of II tone over aorta are determined. With prolonged severe arterial hypertension, signs of target organ damage can be detected: increased work of the left ventricle of the heart leads to the appearance of clinical (expansion of the borders of the heart to the left, increased apical impulse) and electrocardiographic signs of left ventricular hypertrophy, and later to angina pectoris and the development of heart failure; changes in the walls of the arterial vessels of the fundus of the eye - to reduce visual acuity, in the study of the fundus revealed narrowing, sclerosis of retinal arterioles, with malignant hypertension - edema of the optic nerve head (hypertensive retinopathy); lesion of cerebral vessels is manifested by hypertensive encephalopathy and cerebral blood circulation disorders; kidney damage, sclerosis of their glomeruli - a violation of their function and azotemia; atherosclerotic lesion of peripheral vessels develops, the formation of aneurysms is possible.

However, the main method of diagnosing arterial hypertension is the detection of elevated blood pressure. Typically, blood pressure is determined when the patient is sitting; in case of suspected vascular hypertension, as well as in elderly persons with a tendency to orthostatic reactions, it is also advisable to measure blood pressure in the standing and lying position. Typically, blood pressure is determined on the right arm, but if it is found to have elevated values, it is also useful to evaluate the difference in blood pressure in the arms and legs - a pronounced (more than 20 mm Hg) asymmetry in the upper extremities may indicate systemic vascular damage (in atherosclerosis, aortoarteritis) ), lowering blood pressure in the legs with high blood pressure in the upper extremities makes it possible to suspect aortic coarctation as a cause of symptomatic hypertension. Systolic blood pressure is determined by the appearance of the I tone, diastolic - by the complete disappearance of the tones; However, it is necessary to remember about the "auscultatory failure" (temporary disappearance of Korotkoff tones in patients with arterial hypertension), which can lead to a significant difference between the measured and true blood pressure. If blood pressure exceeds 140/90 mm Hg. Art., we can state the presence of hypertension. It should be borne in mind that when measuring blood pressure in an outpatient clinic or in a hospital, it is often higher than at home, since in healthy individuals a physiological increase in blood pressure is possible for a short time (minutes, hours) with considerable physical or emotional stress.

According to the level of blood pressure, mild hypertension is distinguished (blood pressure does not exceed 160/100 mm Hg), moderate (blood pressure reaches 180/110 mm Hg), severe (blood pressure up to 220/120 mm Hg) and very severe (Blood pressure exceeds 220/120 mm Hg. Art.).

During arterial hypertension, there are 3 stages: I - initial, characterized by non-permanent (transient) increase in blood pressure, which quickly normalizes independently; there is no target organ damage at this stage. In stage II, a steady increase in blood pressure is eliminated only by the use of drugs, there are initial signs of damage to one of the target organs. In stage III, whole complexes of signs of target organ damage are detected, caused by organic changes in the vessels and organs supplied by them. At any stage of the disease possible sharp rises in blood pressure - hypertensive crises).

Diagnosis of essential (primary) arterial hypertension is primarily based on the identification of elevated values ​​of systolic and diastolic blood pressure and on the exclusion of the causes of secondary (symptomatic) hypertension. The latter can be suspected in the following cases: with a persistent increase in blood pressure from childhood, in adolescence; during pregnancy (nephropathy pregnant); when the blood pressure in the arms is higher than in the legs, the pulse in the femoral artery is absent or significantly delayed (aortic coarctation); changes in urine, back pain (renal hypertension); in severe crises, accompanied by trembling, sweating, palpitations, tachycardia, decreased visual acuity (pheochromocytoma); with episodes of severe muscle weakness, transient paralysis and paresis, thirst, polyuria (hypokalemia, Cohn's disease); in cases of arterial hypertension resistant to antihypertensive therapy. Such patients should be sent to the hospital for a special examination to clarify the diagnosis.

Treatment begins with non-drug methods, including clinical nutrition (with restriction of fluid intake and salt, with obesity - with the restriction of daily calories); restriction of alcohol intake, smoking cessation, adherence to work and rest, physical therapy, physical therapy (electrosleep, medicinal electrophoresis, warm — coniferous or fresh, radon, carbonic, hydrosulphuric baths, circular and fan douche, etc.).

Drug treatment of arterial hypertension, according to the recommendations of the Moscow Association of Cardiologists, should be carried out in the following cases: with an increase in blood pressure to 160/100 mm Hg. Art. and higher; with blood pressure less than 160/100 mm Hg. Art. in case of ineffectiveness of non-drug treatment; with the involvement of target organs (left ventricular hypertrophy of the heart, changes in the fundus of the eye, changes in urinary sediment and / or an increase in blood creatinine levels); if there are two or more risk factors for coronary heart disease (dyslipidemia, smoking, etc.).

Selection of drug therapy is carried out according to the following step-by-step scheme: Stage 1 - diuretic ion therapy (triampur 2 tablets. In the morning, Arifon - 1 tab. In the morning) or a beta-blocker (preference is given to cardio-selective drugs, usually using atenolol or metropolol 50 mg 2 times a day); Stage 2 - combined treatment with diuretic and beta-blocker; Stage 3 — adding a vasodilator to therapy (angiotensin-converting enzyme inhibitors, for example, rhenithec at a dose of 5–20 mg 2 times a day, or a Norva calcium antagonist at a dose of 5-10 mg 1 time per day, or alpha-adrenoblocker prazozina starting with a dose of 0.5 mg per day).

Treatment can begin at any stage and, if the therapy fails, proceed to the next step; the selection of antihypertensive therapy may take several days or weeks. Treatment should be long (months, years), therapy is reviewed if it ceases to be effective, or if side effects of any prescribed drugs are detected. Hospitalization is necessary in case of failure of adequate outpatient treatment, as well as suspected symptomatic hypertension to clarify the diagnosis.

The prognosis for arterial hypertension is favorable in the early stages of the disease and worsens with its severe course and rapid progression, with pronounced damage to target organs. Therefore, it is important to early detection of the disease by measuring blood pressure during medical examinations.