High blood pressure

Causes of high blood pressureThe appearance of signs of increased blood pressure in the patient can occur in the context of existing chronic diseases, then we are talking about a secondary or symptomatic version of blood pressure. In the event that hypertension is primary and even after a complete examination of the patient, it is not possible to determine the cause which causes an increase in intravascular blood pressure, the term "hypertension" must be used, which is an independent nosological form.Primary high blood pressure is observed in almost 90% of cases of an increase in blood pressure, and the polyetiological development of this pathological state is currently taken into account. Thus, there are non -modified risk factors for hypertension, which is not possible to avoid (sexual and genetic determinism and age), however, these provocative factors are not dominant in the development of severe blood pressure. To a greater extent, the development of primary arterial hypertension is influenced by the human lifestyle (unsolved nutrition, bad habits, inactivity, psycho-emotional instability). Together, all the factors caused above sooner or later create favorable conditions for the pathogenetic development of high blood pressure. Currently, many pathogenetic theories of the development of essential arterial hypertension are taken into account, although these hypotheses were no effect on the patient's tactics and determining the volume of therapeutic measures. Etiopathogens of the development of secondary high blood pressure must be taken into account to a greater extent, because without the elimination of the etiological factor causing an increase in blood pressure, in this case, you should not wait for the positive results of the treatment.Thus, with the renovascular version of symptomatic high blood pressure, the main pathogenetic link is the stenosis of the renal artery which occurs with its atherosclerotic lesion or its fibrous dysplasia-muscular. An extremely rare etiological factor that affects the renal arteries is systemic vasculitis. The consequence of stenosis is the development of the ischemic lesion of one or two kidneys which cause hyperproduction of renin, which has an indirect effect on an increase in blood pressure. In the pathogenesis of the development of the endocrine etiological form of high blood pressure, there is an increase in the level of hormonal substances which have a stimulating effect on an increase in intravascular blood pressure, which occurs with Celenko-Rush syndrome, Conn syndrome and feoochromocytoma. Certain cardiovascular diseases can act as a background pathology for the development of secondary arterial hypertension, such as aorta coarcation.

High blood pressure symptomsClinical manifestations at the initial stage of high blood pressure development can be completely absent, and the diagnosis in this case is based solely on data from an objective and instrumental-laboratory examination.The complaints presented by patients with high blood pressure are quite non -specific, and therefore, in the beginnings of essential hypertension, the diagnosis is considerably difficult. In most cases, with an episode of arterial hypertension, the patient is disturbed by headache with a predominant location in the front and occipital region, net stunning, in particular during the modification of the body position in space, of pathological noise in the ears. These manifestations are not pathognomonic, it is therefore not advisable to consider them as clinical criteria for high blood pressure, because the above symptoms are periodically observed in absolutely healthy people and have nothing to do with an increase in blood pressure. Classic clinical manifestations in the form of respiratory problems, signs of dysfunction of cardiac activity are only observed in the stage of the distant reaction of high blood pressure. Certain etiopathogenetic forms of arterial hypertension are accompanied by the development of specific clinical symptoms, in relation to which an experienced specialist can establish a correct diagnosis during the initial examination and carefully collect an anamnesis. For example, with a renovascular type of high blood pressure, an acute beginning of clinical manifestations is still noted, which consists of a strong increase and a strong increase in indicators of blood pressure mainly due to the diastolic component. Renovascular hypertension is not characterized by a crisis course, however, the well-being of the patient with this pathology is extremely serious. Endocrine high blood pressure, on the contrary, is characterized by a trend during the paroxysmal of the disease with the development of conventional hypertensive crises. For this pathology, the patient has a clinical "paroxysmal triad", which consists in developing sharp headaches, pronounced perspiration and rapid palpitations, is characteristic. Patients who are in this pathological condition have extreme psycho-emotional excitability. The development of a hypertensive crisis occurs most often at night, and the duration of clinical manifestations does not exceed more than an hour, after which patients note a strong weakness and dull current headaches.

Degrees and stages of high blood pressureThe determination of the severity and intensity of clinical manifestations of high blood pressure, as well as the stage of development of the disease, is a prerequisite for the selection of an adequate treatment regime. The separation of high blood pressure is based on primary and symptomatic genesis, the level of increase in the systolic and diastolic component of blood pressure is laid.Patients with 1 degree of high blood pressure do not often note a pronounced violation of their own health due to the fact that blood pressure in this situation does not exceed 159/99 mm. Rt. Art.2 degree of blood pressure is accompanied by pronounced clinical manifestations and organic changes in the target organs, and the indicators of blood pressure are around 179/109 mm. Rt. Art. 3 degree of the disease is distinguished by an extremely severe aggressive course and a tendency to develop complications from the altered brain and heart function. With the third degree, a critical increase in blood pressure exceeding 180/110 mm is noted. Rt. Art.In addition to the classification of high blood pressure in terms of severity, in practical activities, cardiologists use the separation of the stage of this pathology, the criteria of which are the presence of signs of damage to target organs.In the initial stage of high blood pressure, both the primary and secondary genesis, the patient has completely no manifestations of organic lesions sensitive to an increase in blood pressure of tissues and organs.The second step in the disease implies the development of detailed clinical symptoms, the intensity of the manifestation of which depends directly on the severity of damage to internal organs. However, in most cases, this stage of high blood pressure is established on the basis of instrumental confirmation of organ lesions in the form of hypertrophic cardiomyopathy, narrowing of the left ventricle of the heart as a function of the echocardioscopy and the ECG Creatinine levels in level plasma. The third stage of high blood pressure is terminal, in which the patient has the development of irreversible changes in all organs sensitive to the increase in blood pressure. With regard to the heart of a person who has long been suffering from an increase in blood pressure, ischemic myocardial damage is developing, manifesting itself in the formation of infarction zones. On brain structures, high blood pressure has a negative effect in the form of a provocation of transient ischemic attacks, hypertension encephalopathy and even the formation of households in ischemic stroke. The long -term systemic increase in intravascular pressure extremely negatively affects the structure of blood vessels, whose result is the formation of hemorrhages in the retina and the edema of the optical disc.The terminal stage of the development of arterial hypertension is characterized by a significant suppression of the renal function, which is reflected on the level of creatinine levels, which exceeds the indicator of 177 μmol / L.

Diagnosis of high blood pressureDuring the procedure for a clinical and instrumental-laboratory examination of patients with high blood pressure, the main objective should not be so much to establish the fact of increasing blood pressure, but to detect the cause of the development of secondary high blood pressure, signs of damage to internal organs, as well as the assessment of the presence of risk factors for the development of the profiles of the heart profile. With the initial contact with a sick key to establish the correct diagnosis and determine other processing tactics, an in -depth collection of the patient's anamnestic data is an in -depth collection. An objective examination of a patient with high blood pressure allows you to determine the etiopathogenetic form of the disease due to the detection of specific pathognomonic signs. Thus, with the existing abdominal type of obesity in a patient, combined with hypertrichosis, hirsutism and a persistent increase in the diastolic component of blood pressure, the endocrine nature of the disease (Iconko-Doll syndrome) should be supposed. With pheochromocytoma, accompanied by severe paroxysmal hypertension, an increase in skin pigmentation in the projection of axillary hollows is observed. The main clinical criterion diagnostic for renovascular blood pressure is the auscultation of vascular noise in the projection of the region close to the basin.The volume of laboratory research methods for high blood pressure consists of an analysis of the patient's lipidogram, the determination of uric acid and creatinine, as the main criteria of renal dysfunction, analysis of the patient's hormonal state. In order to determine the stage of the disease, a necessary condition is the diagnosis of the lesions of the target organs, that is to say organs in which irreversible changes develop due to an increase in blood pressure. Thus, to study the heart for altered activity and organic lesion, electrocardiographic recording and ultrasound visualization are used, which are part of a standard screening examination of all patients with high blood pressure. In order to detect retinopathy, which is observed mainly with prolonged severe high blood pressure, the patient's background should be examined. It is advisable to use radiation visualization methods as instrumental kidneys for studying kidney and brain, which are not included in the compulsory list of diagnostic measures, but considerably facilitate the early establishment of correct diagnosis (computed tomography, magnetic resonance imaging).

High blood pressure treatmentThe fundamental modern approach to hypertension therapy is to achieve maximum elimination of the risk of developing complications from the heart profile and the level of mortality. In this regard, the priority of the attending physician is to completely eliminate the reversible risk factors (modified) available to the patient with a new cessation of hypertension of high blood pressure and concomitant clinical manifestations. There is a certain standard, which consists in reaching the target limit of blood pressure, whose indicators should not exceed 140/90 mm HGIn which cases should antihypertense therapy be used for high blood pressure? Cardiologists of their practice use the developed classification, which implies an evaluation of the "risk of the patient to develop cardiovascular complications". According to this classification, combined treatment using a modification of the lifestyle and the correction of drugs is subject to people at high risk of complications of the cardiac profile in combination with a critical increase in the number of hypertension. Patients belonging to the category of moderate and low risks are subject to dynamic observation for at least three months, and it is only in the absence of the effect of the use of non -drug correction methods should be used for drug antihypertensive treatment.The principles of correction of arterial hypertension are a gradual decrease in blood pressure to target numbers by the method of using the minimum therapeutic dose of one or more hypotensive drugs. In certain situations, low -dose monotherapy of a hypotensive drug may have a long positive effect in terms of high blood pressure relief. Currently, the pharmaceutical market is filled with a wide range of antihypertensive drugs, however, combined groups of drugs with prolonged hypotensive effects (up to 24 hours) are the most popular. As drugs of choice compared to the first episode of high blood pressure, the preference must be given to diuretic agents which have a wide range of positive effects in the form of prevention of the development of cardiovascular complications, reduction of mortality, as well as the prevention of the progression of hypertrophic changes in the left ventricle of the heart. The pharmacological effect, accompanied by a slight decrease in blood pressure, is determined by a decrease in the reabsorption of water and sodium and a decrease in vascular resistance.The choice of a diuretic drug depends on existing concomitant diseases in the patient. Thus, with high blood pressure, combined with signs of heart and kidney failure, it should be given the preference to move diuretic drugs. Tiazide diuretic agents for prolonged use can cause the development of hypokalemic syndrome, and therefore, it is preferable to use them in combination with aldosterone antagonists.In a situation where the patient has signs of high blood pressure combined with tachyarhythmia, angina attacks and symptoms of chronic cardiovascular insufficiency of a stagnant nature, it is advisable to use a group of water blocks as drugs of the first row. The mechanism of the antihypertensive effect of these drugs is to reduce heart release and inhibition of renin products. It should be kept in mind that the non-compliance of the dose of the drug in this group can cause a pronounced decrease in the heart rate and the bronchoconstrictor frequency, which is an absolute indication of the cancellation of the reception of the Ba-blocker. It is advisable for patients with high blood pressure in the context of proteinuria. An absolute contraindication for the use of ECA inhibitory group drugs is a two-lane renal stenosis in the patient. The medicines of the antagonists of receptor receptor receptors II of angiotensin II have a similar hypotensive effect with the only difference being that they do not cause the development of cough and sapling of anhioneurotic nature, which considerably widens the scope of their application.The group's groups of the group of calcium channel blockers have a pronounced hypotensive effect, making it possible to stop high blood pressure due to a decrease in the calcium content in the vascular wall. The prescription category of drugs in this group is mainly older patients who, simultaneously with high blood pressure, observe signs of ischemic myocardial damage, manifesting themselves in the development of angina attacks. In cardiological practice, exclusively prolonged forms of calcium channel blockers are used due to the fact that short -acting calcium antagonists considerably increase the risk of provoking an acute myocardial infarction. In a situation where hypertension in the patient is combined with a violation of the pace of cardiac activity, it is advisable to use the category of calcium of phenylaclamines and derivatives of benzotiazepine. An absolute contraindication to the use of this category of drugs is the patient's heart failure, accompanied by a decrease in the emission fraction of less than 45%.In addition, the relief of the drug crisis should be taken into account, in which there is a critical increase in the number of intravascular pressure and the acute price of high blood pressure. In this situation, a preference should be given to drugs with a pronounced antihypertensive effect, because with a prolonged hypertension crisis course, the risk of fatal results increases sharply. With the signs of the patient of complicated hypertension crisis, the parenteral path of the administration of drugs with a hypotensive effect is preferable. Most groups of hypotensive agents are produced in parenteral forms. As a rule, the hypotensive effect occurs no later than 5 minutes after administration of the medication.In the case of a simple hypertensive crisis, it is not necessary to use parenteral forms of antihypertensive drugs, because in this pathological condition, there is no critical increase in blood pressure. The oral intake of antihypertensive agents to an adequate dosage allows you to reduce pressure in several hours and maintain target numbers in the future. Of course, at present, there are however many methods of medication when you stop a hypertension crisis to exclude the development of complications, the planned antihypertension treatment plan should be regularly applied. In the event that hypertension in the patient is secondary in nature and develops following the stenosis of the renal arteries, the fundamental treatment method is the operational correction of stenosis and revealing by angioplasty. Operational manuals of renovascular high blood pressure (Shunt bypass, endartritomy) are only used for existing contraindications to the use of transluminal angioplasty. If the patient has signs of an aggressive high blood pressure course due to severe unilateral nephrosclerosis, the only treatment is nephrectomy.With endocrine secondary arterial hypertension, a combination of surgical treatment (radical excision of the tumor substrate) and antihypertension therapy of drug (Spironolactone at a daily dose of 200 mg with the primary aldosterron, pcentolamine at a 25 -hour dose with theochromocytome) is used.

High blood pressure preventionCompliance with preventive measures, the action of which aims to prevent episodes of increasing intravascular blood pressure, as well as the reduction in the risk of complications of high blood pressure, is shown not only to patients who have long suffered from this pathology, but also to healthy people whose signs of increased pressure may occur.A scientifically proven fact is a dependence on the direct correlation of an increase in blood pressure in human body weight, and consequently, the normalization of the weight of a person with high blood pressure is the main priority preventive event. In addition, compliance with the eating behavior correction rules help prevent the progression of atherosclerotic vascular lesions, which is one of the main causes of high blood pressure.Recent studies in the field of pharmacology have proven the beneficial effects of omega-3 fatty acids on the restoration of blood vessels, which can also be considered as an effective method for the prevention of high blood pressure. Given these conclusions, you should use olive oil in sufficient quantities daily and strongly limit animal fat.Of course, if you want to get rid of the manifestations of high blood pressure, you should abandon bad habits in the form of smoking and drink alcoholic drinks, because nicotine and alcohol particles can increase intravascular blood pressure even in microdoses.People who have already noted episodes of high blood pressure as secondary preventive measures should be measured daily by blood pressure, to hold a special newspaper reflecting the efficiency of used drug therapy, and if new clinical manifestations aggravate, without taking up the doctor on this subject.Hypertension - Which doctor will help? In the presence or suspicion of the development of high blood pressure, you must immediately seek advice from doctors as a cardiologist, endocrinologist and nephrologist.