Malignant hypertension - is critical blood pressure, wherein the performance exceeds 180/120 mm Hg. Art. The pathological process is accompanied by atherosclerotic changes or thinning of the vascular endothelium, because of which increases the risk of hemorrhage. The disease increases the likelihood of developing edema of the optic nerve, leading to blindness, organ ischemia and tissue hypoxia. Therefore, it is important to diagnose the pathology as quickly as possible and assign the appropriate treatment regimen.
Causes
Malignant hypertension, according to medical statistics, found only in 1% of patients who suffered from chronic hypertension. This form of disease can be triggered by the following diseases:
- renal operation at lupus erythematosus, inflammation due to penetration of tissue infections, systemic sclerosis, organ absence, diabetes;
- essential hypertension;
- the defeat of the renal arteries;
- Endocrine diseases: aldosteronoma, pheochromocytoma, Cushing's syndrome;
- problems with blood clotting, increased risk of blood clots;
- neoplasm malignant or benign character cancerous cell carcinoma, lymphoma, nephroblastoma, eclampsia.
The appearance of pathological blood pressure indicators can cause incorrect medication cyclosporins of group inibitorov MAO drugs.
symptomatology
Malignant hypertension has characteristic symptoms manifested at an advanced stage of development of pathological processes. At the initial stage of the disease occurs in a latent form. At the first signs of the disease the patient begins to suffer from headaches, propagating in the frontal and occipital lobes. Pain syndrome is amplified in the morning. With the dramatic increase in pressure indicators begins nausea accompanied by muscle cramps, fainting and profuse vomiting.
By the headache gradually joined by the following symptoms:
- weight loss for unknown reasons;
- disorder of memory and cognitive functions;
- blurred vision, blindness;
- chest pain, worse after physical exercise;
- hypothermia;
- loss of appetite.
The patient can not concentrate. At periodic increases in blood pressure at night is getting worse sleep quality. A person becomes white shade. In rare cases, if left untreated, there is a risk of hypertensive encephalopathy.
Diagnostics
At detection of signs of malignant hypertension need to be screened for further diagnosis. The attending physician collects history, to obtain complete information about complaints, comorbid conditions, and individual characteristics of the patient. After questioning a medical specialist by inspection. During the procedure, the doctor determines the change in skin color, weight and measures the pressure in the upper and lower extremities. In addition, the patient must undergo the following diagnostic methods:
- pass the common blood and urine tests;
- undergo electrocardiography;
- do an ultrasound in the pericardial cavity and thyroid;
- undergo ultrasound Doppler blood vessels;
- measure your blood pressure throughout the day.
For suspected malignant hypertension shape required to consult with narrow specialists:
- endocrinologist;
- ophthalmologist;
- nephrologist;
- neurologist.
Physicians will help determine the cause of atypically high blood pressure and appoint the most suitable treatment regimen.
Treatment
Malignant form of hypertension developing in a short time, therefore, requires immediate treatment during the first days after the onset of symptomatic picture. Quick medical care helps to prevent serious complications that can cause disruption of the internal organs.
Methods of treatment in most cases aimed at eliminating the disease etiology. In the initial stages of the disease drugs prescribed conservative treatment or prevention. surgery conducted with the ineffectiveness of therapeutic methods.
drug therapy
Upon confirmation of the diagnosis of malignant hypertension is conducted conservative treatment drugs. Drug therapy is complex with more medicaments with the same mechanism of action. Treatment performed using the following groups of drugs:
- diuretics;
- beta-adrenergic receptors;
- psychotropic and nootropics;
- ganglioplegic;
- sympatholytic drugs;
- means for expansion of peripheral blood vessels.
The treatment regimen is chosen individually for each patient depending on the nature and severity of the pathological process. The key point is and the etiology of the disease. To select the medicines you need to evaluate the work of the heart, the kidneys and the dynamics of comorbidities that affect blood pressure.
To improve the condition of the patient is necessary to reduce the pressure by 25% from current levels. If during this time the patient has a good tolerance to medication, the treatment is continued until the lower blood pressure to the natural values.
On average, a patient suffering from malignant hypertension, runs parallel therapy drugs 3-4. The most effective treatment regimen include 3 drug:
- Angiotensin-converting enzyme, whose action enhance diuretics, and calcium antagonists.
- Beta-adrenergic blockers used in conjunction with diuretics and calcium channel blockers.
- Beta-blockers which may be combined with ACE inhibitors, and calcium blockers.
In the presence of renal and hepatic failure prep dosing regimen is adjusted depending on the state of the target organs. Severe renal dysfunction requires dialysis. If the patient is the appearance of puffiness, conducting ultrafiltration of blood plasma is needed. With the ineffectiveness of treatment, the patient stands in a queue for kidney transplantation.
The medical specialist selects drugs that interact well with each other. If there is incompatibility with other pharmaceutical drug agents may be canceled. If the patient is found to malignancy, tumor therapy is required.
The principles of non-drug treatment
In some cases, to improve the effectiveness of drug therapy, your doctor may prescribe non-drug therapies. Additional procedures should be carried out in parallel with taking medication. Treatment of malignant hypertension is possible by using the following methods:
- in the presence of excess weight need to conduct activities to reduce body weight (diet therapy, physical activity);
- complete elimination of bad habits: smoking and alcohol;
- you need to limit the amount of animal fats in the diet;
- required to increase physical activity;
- regularly consume daily rate of calcium, magnesium and potassium needed for normal functioning of the vascular smooth musculature.
It should be remembered that strictly prohibited dramatically reduce the critical blood pressure. Unsystematic treatment of high pressure may disrupt the circulatory system. With a sharp decrease in blood pressure may develop hypoperfusion - reduction of microcirculation in the tissues in a limited area. In 60 minutes the maximum reduction in blood pressure should be 15% or less of the current value.
In order to prevent negative effects and complications of a patient with a malignant form of hypertension is required to periodically visit your doctor. Medical Officer at the reception measures the blood pressure of the patient is directed to the delivery of the analysis and inspection of an ophthalmologist and a cardiologist. If the positive dynamics of drug therapy is not available, the doctor advised to undergo hospital treatment.
Surgical intervention
The cause of malignant hypertension can be to kidney failure. In the case of the transfer of pathology in the chronic form there is a risk of necrosis and other complications (ascites or infectious-inflammatory processes in the abdominal cavity), so that the patient can spend nephrectomy - complete or partial organ removal.
Surgery is performed under conservative treatment of low efficiency. If the positive dynamics after the operation is observed, conduct replacement therapy by hemodialysis.
