Scientific editor: OA Strokina practicing therapist, doctor of functional diagnostics.
September 2018.
Hypertension (high blood pressure, hypertension) - a condition in which blood pressure is equal to or greater than 140 mm Hg (As a result of at least three measurements made at different times on the background of a calm environment; thus it is impossible to take medication, either increase or decrease the pressure).
If you can identify the causes of hypertension, it is considered secondary or symptomatic. If there is no obvious reason it's called primary or idiopathic disease. The latter are much more likely to suffer from it more than 90% of people with high blood pressure.
Hypertension suffers from 30-45% of the adult population. Up to 50 years of age the disease is more common in men after 50 years - for women.
Causes
The causes of hypertension is now clear is far from complete. However, according to recent studies, there are several main reasons:
- Genetic predisposition;
- The development of the disease are important as internal (hormonal, nervous system) and external factors (excessive consumption of salt, alcohol, smoking, obesity );
- Disorders of lipid metabolism;
- Sugar diabetes;
- kidney disease;
- Stress;
- stiffness;
- Smoking.
The following blood pressure levels adopted by the World Health Organization:
| Categories Blood Pressure | systolic (Top) |
diastolic (Bottom) |
|
| optimal | < 120 | and | < 80 |
| normal | 120 – 129 | and / or | 80 – 84 |
| high normal | 130 – 139 | and / or | 85 – 89 |
| AG 1st degree | 140 – 159 | and / or | 90 – 99 |
| AG 2nd degree | 160 – 179 | and / or | 100 – 109 |
| AG 3rd degree | ≥ 180 | and / or | ≥ 110 |
| Isolated systolic hypertension (ISAH) | ≥ 140 | and | < 90 |
How to measure the pressure correctly
The ideal goal BP level measurement is considered a mechanical tonometer and stethoscope. Such a method is maximally accurate. But self-control at home, you can use automatic or semi-automatic blood pressure monitor.
- Measuring should be carried out after five minutes' rest.
- 30 minutes before the meal is not recommended, the use of coffee, alcohol, physical activity, smoking.
- Legs in the measurement should not be crossed, feet should be on the floor, back - lean back in his chair.
- Hand needs emphasis, the bladder to the measurement need to be emptied.
Failure to follow these conditions may lead to increased blood pressure.
The shoulder should not be squeezed clothes (unacceptable measurement through clothing). Blood pressure was measured at least twice on one and the same hand. When detecting difference of blood pressure on one arm and a 5 mm Hg spend an additional third dimension. As a result, the average value is recorded. During the first measurement pressure is measured at both arms, in the following - at the arm where it was above. The difference in blood pressure in the left and right hand should not exceed 10 mm Hg. Art. More significant differences must guard against vascular disease of the upper extremities.
Symptoms of hypertension
The main symptom - headacheOften on waking, and, as a rule, in the occipital region.
Also, patients may complain of dizziness, blurred vision, the appearance of "flies" before the eyes, tinnitus, palpitations, heart pain, shortness of breath.
Meets arterial disease. Then, in the list of complaints added to cold extremities, intermittent claudication.
Blood pressure exceeds 140 mm Hg. Art. (As a result of at least three measurements made at different times on the background of a calm environment; thus it is impossible to take medication, either increase or decrease the pressure).
Often hypertension does not have any symptoms.
Dangerous complication of hypertension - hypertensive crisis, An acute condition characterized by sudden severe pressure rise. In most cases the hypertonic crisis occurs when the systolic pressure of 180 mm Hg. Art. or higher diastolic or 120 mm Hg. Art. and higher. This condition is accompanied by pronounced symptoms in the flesh to the neurological and often requires calling an ambulance.
Diagnostics
The doctor at the reception will be first to find out the complaints that bother the patient, and to collect the anamnesis (medical history and life). Then be sure to measure the blood pressure and perform a complete inspection.
If you suspect that hypertension should maintain control of pressure and heart rate for at least 1-2 weeks. If the blood pressure is higher than 140/90 mm Hg more than three times as measured in different times, we can talk about hypertension.
Next, you need to eliminate the so-called symptomatic hypertension when increased pressure is a consequence of other diseases and conditions. To do this, perform the following lab tests:
- ECG (signs of increased stress on the heart, possible arrhythmias), complete blood count and glucose analysis (Exclusion or confirmation of diabetes) must in any case
- renal ultrasound , Urinalysis, determination of urea, creatinine in the blood necessary to exclude renal disease nature
- US adrenal performed in suspected pheochromocytoma (adrenal gland tumor, which causes the most severe hypertensive crises)
- Ultrasound thyroid hormones analysis T3, T4 , TSH (Hypertension may be one of the symptoms of hyperthyroidism)
- MRI of the brain (AD increases with tumors adenomas pituitary)
- You should also consult a neurologist and an ophthalmologist for target organ damage for hypertension (the brain and blood vessels eye).
Increased blood pressure is possible
- at anomalies vascular development, such as coarctation - aortic constriction, or narrowing of the vascular lumen, for example subclavian arteries, atherosclerotic plaques in varying degrees (in these cases, the pressure on the right and left hands can be different)
- when taking certain medications (corticosteroids, oral contraceptives)
- menopausal women.
In the case of secondary hypertension treatment is aimed at eliminating its causes.
Before initiating therapy, it is advisable to perform a few more surveys:
- Determining the level of cholesterol (+ Lipid), hepatic parameters (ALT, AST) - to decide on the appointment of statins (drugs is for the treatment of atherosclerosis)
- Know the performance of K and Na in the blood - it is necessary for the appointment of diuretics
- Analysis for microalbuminuria (earliest sign of renal lesions in arterial hypertension)
- ECG can help identify contraindications to certain groups of drugs (beta-blockers, calcium channel blockers)
- echocardiography (Ultrasound of the heart) when it detects a heart murmur, and to identify various body changes;
- US brachiocephalic blood vessels (arteries and veins of the neck and head) for atherosclerosis
- US renal arteries to detect major contraindications to the use of preparations of high pressure (ACE inhibitors)
treatment of hypertension
The goal of treatment of hypertension - reducing the risk of organ damage (heart, brain, kidneys), as these bodies suffer from high blood pressure in the first place, even if subjectively any unpleasant sensations no.
The young and middle-aged, as well as in patients with diabetes need to maintain the pressure at 140/90 mm Hg In the elderly target level pressure - up to 150/90 mm Hg
General principles of treatment of hypertension following:
When light, first, the degree of disease non-drug methods used:
- limiting salt intake to 5g / day (more about proper nutrition at an elevated pressure can be found in our a separate article ),
- weight normalization in its excess,
- moderate exercise 3-5 times a week (walking, jogging, swimming, physiotherapy)
- to give up smoking,
- reducing alcohol intake,
- sedatives using plant with increased emotional excitability (e.g., broth valerian).
In the absence of the effect of the above methods for the treatment of hypertension of 1 degree, as well as patients with 2 or 3 degrees of hypertension, proceed to receive medication.
It should be noted that currently in pharmacies a wide range of different drugs for the treatment of hypertension, both new and well-known for many years. Under different tradenames can be manufactured with drugs of the same active substance. Quite difficult to understand in layman them, but, despite the abundance of drugs, they can identify the main groups, depending on the mechanism of action:
diuretics are the drugs of choice for the treatment of hypertension, especially in the elderly. The most common - is thiazides (indapamide 1,5 or 2 and 5 mg per day, hydrochlorothiazide 12.5 to 100 mg per day in one time in the morning)
ACE inhibitors It has been used for many years, well-researched and effective. It's such popular drugs as a
- enalapril (Enap trade names, Renipril, Renitec)
- fosinopril (Fozinap, Fozikard)
- perindopril (Prestarium, Perineva)
- ramipril (Amprilan Hart) et al.
Sartana (Or angiotensin receptor blockers II) by a mechanism similar to the action of ACE inhibitors:
- losartan (Lazap, Lorista)
- valsartan (Valz)
- irbesartan (Aprovel)
- telmisartan (Telmista).
Beta-blockers. The currently used highly selective drugs with minimal side effects:
- bisoprolol (Konkor, Niperten)
- metoprolol (Egilok, Betalok)
- Nebivolol (Nebilet, considered the most selective of the current beta-blockers), and others.
calcium antagonists the mechanism of action are divided into 2 main groups, which is of great practical importance:
- dihydropyridine (amlodipine, felodipine, nifedipine, nitrendipine etc.).
- nondihydropyridine (verapamil, diltiazem).
other drugs for the treatment of hypertension are used strictly for indications and the ineffectiveness of the above classes of drugs:
- moxonidine (trade name Fiziotenz, Tenzotran).
- doxazosin / prazosin (cardura / Prazosin).
Also in the treatment of hypertension it is important to correct risk factors
- antiplatelet - acetylsalicylic acid (e.g., Cardiomagnyl, Thrombotic-ACC) used according to indications,
- statins in the presence of atherosclerosis - also in the absence of contraindications;
- drugs that reduce blood glucose levels in the presence of diabetes.
With insufficient effects, may require the addition of a second or third medicament. Rational combination:
- diuretic + beta-blocker
- diuretic + ACEI (or Sartan)
- calcium antagonist, diuretic +
- dihydropyridine calcium antagonist + beta-blocker
- calcium antagonist, ACE inhibitor + (or Sartan)
Illegal combinations:
- non-dihydropyridine calcium antagonist + beta-blocker (may develop heart block until death)
- ACEI + Sartan
Currently, the sale of a large number of so-called fixed combinations (two or three active substances in one tablet, well matching with each other). Using a combination of drugs increases the adherence to treatment and facilitates the control of blood pressure. These include the following:
- Lorista H Losap plus (+ lazartan hydrochlorothiazide)
- Valz H (valsartan + hydrochlorothiazide)
- Prestancia, Dalnevost (amlodipine + perindopril in various dosages)
- Exforge (amlodipine + valsartan) and Co-Exforge (amlodipine + valsartan + hydrochlorothiazide), and others.
For treatment and examination for hypertension should see a doctor. Only a specialist after a full examination and analysis of the survey results will be able to diagnose correctly and to appoint competent treatment.
Forecast
Prognosis essentially depends on the adequacy of the appointed treatment and patient compliance with medical recommendations.
sources:
- Global summary of hypertension. - The World Health Organization, 2013.
- Hypertension. - Clinical Guidelines, 2016.
