ARTERIAL HYPERTENSION

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

ARTERIAL HYPERTENSION (Hypertonic disease) is characterized by a persistent increase in blood pressure above the limits of the physiological norm (140/90 mm Hg). In the vast majority of cases, the cause of increased blood pressure can not be established, while they speak of essential hypertension, or hypertension (about 90% of cases of hypertension). Kidney diseases (glomerulonephritis, pyelonephritis, narrowing of the renal arteries) account for 2 - 3%, renovascular hypertension - 1-2%, Cushing's syndrome - 0.1%, pheochromocytoma - 0.1% of cases of arterial hypertension; Its other causes may be pathological menopause, thyrotoxicosis, CNS disease, severe 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 be detected only with a random measurement of blood pressure. In other cases, patients complain of a recurring headache, dizziness, tinnitus, flickering in front of the eyes, pain in the heart, palpitations. Complaints related to the underlying disease may predominate (for nephritis, thyrotoxicosis, etc.). At objective research the firm, intense pulse, an accent of II tone over aorta are defined. With prolonged severe arterial hypertension, signs of target organ damage can be detected: increased left ventricular function leads to the appearance of clinical (widening of the heart to the left, enhanced apical stimulation) and electrocardiographic signs of left ventricular hypertrophy, further to angina pectoris and development of heart failure; Changes in the condition of the walls of the arterial vessels of the fundus - to reduce visual acuity, eye narrowing reveals narrowing, sclerosis of retinal arterioles, and malignant hypertension - edema of the optic nerve (hypertensive retinopathy); The defeat of the cerebral vessels is manifested by hypertensive encephalopathy and disorders of the cerebral circulation; Defeat of the kidneys, sclerosis of their glomeruli - a violation of their function and azotemia; Develops atherosclerotic lesions of peripheral vessels, possibly the formation of aneurysms.

However, the main method for diagnosing arterial hypertension is the detection of elevated blood pressure. Typically, BP is determined in the patient's sitting position; When suspicion of vasorenal hypertension, as well as in elderly people with a tendency to orthostatic reactions, it is also advisable to measure blood pressure in a standing and lying position. Usually, blood pressure is determined on the right hand, but when it is found that it is elevated, it is also useful to evaluate the difference in blood pressure on the arms and legs - a marked asymmetry in the upper limbs (more than 20 mm Hg) may indicate systemic vascular lesions (for atherosclerosis, aortoarteritis ), A decrease in blood pressure on the legs with high blood pressure on the upper limbs allows one to suspect coarctation of the aorta as the cause of symptomatic hypertension. Systolic blood pressure is determined by the appearance of I tone, diastolic - by complete disappearance of tones; It is necessary, however, to remember the "auscultatory failure" (the temporary disappearance of Korotkov's tones in patients with arterial hypertension), which can lead to a significant difference between the measured and true blood pressure. If the blood pressure exceeds 140/90 mm Hg. Article, we can state the presence of hypertension. It should be borne in mind that when measuring blood pressure in a clinic or in a hospital it is often higher than at home, since healthy individuals can physiologically increase blood pressure for a short time (minutes, hours) with significant physical or emotional stress.

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

During arterial hypertension, 3 stages are distinguished: I - initial, characterized by a non-permanent (transient) increase in blood pressure, which quickly normalizes independently; At this stage, there is no defeat of target organs. In Stage II, a stable increase in blood pressure is eliminated only by the use of medicines, there are initial signs of damage to one of the target organs. In the III stage, whole complexes of signs of damage to target organs are revealed, caused by organic changes in blood vessels and blood-supplying organs. In any stage of the disease, sudden increases in blood pressure are possible - hypertensive crises).

Diagnosis of essential (primary) arterial hypertension is based primarily on the detection of elevated systolic and diastolic blood pressure and on eliminating the causes of secondary (symptomatic) hypertension. The latter can be suspected in the following cases: with a persistent increase in blood pressure from childhood, at adolescence; During pregnancy (nephropathy of pregnant women); When the blood pressure is higher than on the legs, there is no or significantly delayed pulse on the femoral artery (coarctation of the aorta); With changes in urine, pain in the lower back (renal hypertension); With severe crises, accompanied by tremors, increased 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 hypertension, resistant to ongoing antihypertensive therapy. Such patients should be referred to a hospital for a special examination in order to clarify the diagnosis.

Treatment begins with non-medicinal methods, including therapeutic nutrition (with limited intake of liquid and table salt, with obesity - with a restriction of daily calories); Restriction of alcohol intake, smoking cessation, observance of the work and rest regime, physical therapy, physiotherapy (electrosleep, drug electrophoresis, warm - coniferous or fresh, radon, carbon dioxide, hydrogen sulphide baths, circular and fan shower, etc.).

Drug treatment of hypertension, according to the recommendations of the Moscow Association of Cardiologists, should be performed 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; When target organs are involved (hypertrophy of the left ventricle of the heart, changes in the fundus, changes in urinary sediment and / or increase in the level of the creatinine of the blood); In the presence of two or more factors of development of the risk of ischemic heart disease (dyslipidemia, smoking, etc.).

Selection of drug therapy is carried out according to the following stepwise scheme: 1st stage - diuretic ion therapy (triampur 2 table in the morning, arifone - 1 table in the morning) or beta-blocker (preference is given to cardioselective drugs, usually use atenolol or metoprolol 50 mg 2 Times per day); 2 nd stage - combined treatment with diuretic and beta-blocker; The third stage is the addition to the therapy of a vasodilator (angiotensin-converting enzyme inhibitors, for example, renitek at a dose of 5-20 mg twice a day, or a calcium antagonist of Norvasca in a dose of 5-10 mg once a day, or an alpha-adrenoblocker of prazosin , Starting at a dose of 0.5 mg per day).

Treatment can begin at any stage and, if the therapy is ineffective, move on to the next step; The selection of antihypertensive therapy may take several days or weeks. Treatment should be long (months, years), therapy reviewed if it ceases to be effective, or if side effects of any prescribed drugs are identified. Hospitalization is necessary if inadequate adequate outpatient treatment is ineffective, as well as when suspicion of symptomatic hypertension is required to clarify the diagnosis.

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