Essential (primary ) hypertension - Causes, Symptoms and Treatment .MF .
In recent decades, due to the deterioration of the environment, an increase in stress, consumption of food with excessive content of chemicals, increased level of diseases of the cardiovascular system and hypertension in general.Hypertension - a disease that not only causes a subjective discomfort, but also dangerous long-term consequences and complications.
So, hypertension is considered to be a long, persistent increase in numbers of more than 140 mm Hg for systolic, "upper" pressure and 90 for diastolic, the "lower" pressure measured by cuff on the arm of the patient alone.Hypertension may be secondary or symptomatic and occur in diseases of various organs, such as the heart and the aorta, the thyroid gland, adrenal glands, kidneys, brain, renal vessels.But most (90 - 95%) developed primary or essential hypertension.This type of increase of the pressure at which the visible diseases of other organs missing.
Previously known as primary hypertension, hypertensive disease, now the terms hypertension a
In a healthy organism to maintain the dynamic equilibrium of blood pressure is provided by the tone of the vessels and their neuro-humoral regulation, circulating blood volume (CBV) and the concentration of sodium in the blood.In primary hypertension is a violation of the processes of regulation of these parameters.What reasons can cause trouble, so still do not clear.
Distribution of primary hypertension in people over 40 years old 20 - 25%, while among women the disease occurs somewhat more often.Just as symptomatic hypertension, essential degree is divided into current stage and that it is important to take into account for the purpose of treatment and determining the risk of complications and sudden cardiac death.
Depending on the maximum pressure of numbers, primary hypertension can be:
1 severity - at the level of BP 140/90 - 159/99
2 degrees - 160/100 to 179/109
3 degrees - higher than 180/110 mm.Hg.Art.
are the following stages of the disease:
I stage.Characterized not constant increase of pressure level during emotional stress, physical stress.The defeat of bodies - targets, and no complications.It can last for years.
II stage. pressure increased constantly, but good drops hypotonic drugs.Most hypertensive crises occur.The defeat of bodies - targets the most sensitive to the ever-increased blood pressure in the arteries, diagnosed clinically and instrumentally.
- myocardial hypertrophy,
- retinal angiopathy Eye (pathology of the retina), atherosclerosis of the aorta, carotid, femoral and other arteries,
- kidney disease - the presence of protein in urine, increased creatinineserum.
III stage. significant, sustained increase in pressure, currently treated only taking combinations of antihypertensive drugs.The frequent hypertensive crises.At this stage, already there are complications - stroke, heart attack, angina, heart failure, nephropathy, dissecting aortic aneurysm, bleeding in the retina.
Causes of primary hypertension
Unlike symptomatic hypertension, based on essential not lie any apparent organic lesion of other organs.This type of hypertension is more common during long-term psycho-emotional stress, especially among those engaged in strenuous mental work, and the inhabitants of large cities with lots of mental stimuli.It is also prone to primary hypertension, people with anxiety - doubtful personality type, constantly in a state of chronic stress and anxiety.This is due to increased levels of stress hormones in the blood (epinephrine, norepinephrine) produced in the adrenal glands, as well as in vascular adrenoceptor stimulation constant.Vessels constantly in an elevated tone, increasing the resistance to blood flow, thereby increasing blood pressure.Narrowing of renal arteries leading to the formation of a breach in their substance, carrying out the regulation of blood volume in the bloodstream (the renin, angiotensinogen).A vicious circle, since at this stage kidney trigger mechanism of sodium and water retention in the body, which further stimulates an increase in pressure.
addition psychogenic causes of disease, development of primary hypertension can have the following risk factors influence:
- high consumption of salt (more than 6 grams per day)
- poor diet
floor - older than 55 -60 years, though often hypertension occurs in people 35 - 40 years
- menopause women
life - improving cholesterol
blood - diabetes
- vegetative - vascular dystonia
Symptoms of primary hypertension
over the years, an increase in pressure may remain unnoticed for a man, as poor health, he connects with overwork and no control pressure.The main complaint with essential hypertension:
- headache in the occipital region, often occurring on the chime in a horizontal position, after stress or physical exertion
- general weakness
- a sense of constantfatigue and "weakness»
- feeling palpitations
with the defeat of bodies of targets appear symptoms such as:
- on the part of the eye - blurred vision,
- brain - emotional instability, anxiety, sleep disorders, hearing loss,unsteadiness of gait,
- kidney - increase or decrease in daily urinary volume, increased night urination, morning facial swelling, especially the area under the eyes
- heart - shortness of breath when walking or at rest, pain on the left side of the chest, rapid, slow, or irregular heartbeat, lower limb edema
clinical picture is complemented by appropriate clinical With the development of complications.
Diagnosis of essential hypertension
diagnosis of primary hypertension can be set on the basis of the survey, in which no significant changes in other organic bodies, which served the cause of high blood pressure.If during the examination of the internal organs of the disease was found, causing secondary hypertension, the doctor assumes primary hypertension in the patient.If revealed pathological changes of internal organs, the doctor should carefully interpret the results and understand this condition was the cause or consequence of hypertension.
To eliminate initial disease of the brain, kidney, heart and aorta, the endocrine system, it may take a lot of time at the level of outpatient care, so many patients are hospitalized in the therapeutic hospital for examination.Especially if there is a malignant course of hypertension in individuals younger than 30 years - a persistent, substantial rise in pressure to very high numbers.In the latter case, the doctor should think of symptomatic hypertension.
the differential diagnosis of primary and secondary hypertension, a doctor, in addition to examination of the patient and measuring the pressure on both hands, apply such methods of diagnosis:
1. Laboratory methods.
- blood and urine tests - routine investigation
- biochemical analysis of blood - cholesterol, glucose, liver enzymes, kidney function indicators - urea and creatinine.
- hormonal blood tests may be appointed for suspected hypothyroidism and hyperthyroidism, pituitary and adrenal tumors (pituitary - Cushing syndrome, pheochromocytoma)
- glycemic profile, glucose tolerance test - identify carbohydrate metabolism disorders (diabetes)
- ECG.On the 1st stage may be unremarkable.In the 11 - 111 stages show signs of hypertrophy and myocardial ischemia, myocardial infarction.
- ultrasound of the thyroid gland, kidneys, internal organs.It allows not only to detect abnormalities of the kidneys, caused the cause of hypertension (glomerulonephritis, pyelonephritis), but on the contrary, to assess the degree of damage to the kidney tissue with primary hypertension.
- Echocardiography.Can be detected heart disease and aortic hypertrophy, myocardial contractility disorders, enlargement of the heart chambers, violation of blood flow through them, decreased cardiac output, aortic atherosclerosis.
- Daily monitoring of blood pressure and ECG.Held for a more complete understanding of the build up of pressure conditions during the day, due to the exercise, rest, meals, etc.
- X-ray of the chest cavity.The auxiliary method in the diagnosis of heart defects that may cause secondary hypertension.In primary hypertension 11 - 111 stages can detect myocardial hypertrophy, dilatation of the cavities of the heart in congestive heart failure.
- Coronary angiography.It is carried out if the patient develops angina, manifested clinically and / or ECG, was moved myocardial infarction, as well as to assess the extent of coronary atherosclerosis.
- MRI of the brain may be imposed in cases of suspected neurogenic nature of secondary hypertension, such as brain tumors, skull - brain injury, meningoencephalitis.In secondary hypertension evaluated the degree of vascular encephalopathy.
- MRI of the kidneys and adrenal glands shown in suspected renin (kidney tumor of cells that produce renin), chromaffin, pheochromocytoma (adrenal gland tumor).
Treatment of primary hypertension
Hypertension Treatment begins with correcting lifestyle and non-drug therapies.Lifestyle for patients with essential hypertension consists of the following activities:
- Quitting smoking and alcohol abuse. proved that the poisons contained in cigarettes and alcohol, getting into the body, a toxic effect on the inner wall of blood vessels and cause damage to it.
- Limiting use of salt in food to 5 - 6 g per day. salt, namely sodium contained therein, promotes fluid retention, increasing the volume of blood in the vessels.
- Proper nutrition. should be excluded from the diet of "harmful" products - fast food, spicy, smoked, sharp, salty, fatty and fried foods.It is recommended to increase the amount of food in fresh fruits and vegetables, dairy products, cereals and cereal products.For proper operation of the whole organism in food should be taken at the same time, about 4 - 6 times a day.Choosing low-calorie foods without artificial additives, coupled with the power mode will also help to normalize blood cholesterol levels and reduce the overweight with obesity.
- Proper organization of physical activity. To maintain good condition of cardio - vascular system is not necessary to engage in weight training, extreme sports or to spend every night in the gym.It is enough to charge the morning and evening with a simple set of exercises, if the patient is currently no contraindications to this, and the doctor is not recommended to comply with strict bed rest.
For non-drug treatments include:
- auditory training
- phytotherapy (valerian, St. John's wort, sage, Motherwort, mint, lemon balm and other herbs.)
These methods can help with initial hypertension stagewhen there are no organ damage - the targets and complications.Otherwise prescriber one or a combination of:
- ACE (angiotensin converting enzyme) and ARA II (receptor antagonists to angiotensin II), not only are the primary mechanism of sodium retention and body fluids, but also protect the organs - targetfrom further harmful effects of high pressure.Drugs - lizigamma, Prestancia, fozikard, zokardis Hart;lorista, valsartan and other
-. beta - blockers and calcium antagonists reduce peripheral vascular tone by reducing vascular resistance.Drugs - betalok, rekardium, nebilet;amlodipine, felodipine, etc.
-. Diuretics derive the excess fluid from the body.Drugs - diuver, arifon, indapamide, veroshpiron, hydrochlorothiazide and other
-. Other groups of drugs for angina, heart failure, heart attack and other complications - nitrates, antiplatelet agents, statins.
Preferably, treatment start with a non-drug methods (stage I), with no effect to appoint any one drug with a low dose.At the stage of organ - targets in the development of complications, when persistent increase pressure until significant digits recommend taking a combination of drugs.Combination products - Exforge (valsartan and amlodipine), Losap plus (+ hydrochlorothiazide losartan), Aritel plus (+ hydrochlorothiazide, bisoprolol) and many others.
Complications of hypertension
Uncontrolled high blood pressure without treatment can lead to a hypertensive crisis.This status lasting from a few hours to several days, characterized by increasing pressure resistant to significant digits, sometimes higher than 220 mm.Hg.Art.For patients who suffer badly, even a slight rise in pressure, crisis can be considered as an increase in blood pressure up to 150/100 or higher, accompanied by a pronounced deterioration in health.
for crisis characterized by very sharp headache, not cropped painkillers, migraine character, nausea, vomiting, not bringing relief, dizziness, inability to remain upright, redness of the skin, pain in the heart, a sense of breathlessness or shortness of breath.
First aid in hypertonic crisis is taking sublingual tablets of captopril or nifedipine.Hospitalization is indicated for myocardial ischemia, diabetes, myocardial or stroke.
During the crisis may develop other complications of essential hypertension:
- acute myocardial infarction
- transient ischemic attack
- acute hemorrhagic or ischemic stroke
- dissecting aortic aneurysm
- retinal hemorrhage with loss of vision
- acute heart failure
- acute renal failure
Each of these states require emergency hospitalization or therapeutic cardiology department.Prevention of complications is regular, continuous reception of prescription drugs.The dosage should be reduced gradually to a complete withdrawal of the drug.
To assess the prognosis of patients with hypertension developed a risk assessment scale (Framingham model).It uses five groups of risk of complications and death from cardio - vascular causes during the next 10 years.
1. Slight risk - less than 5%
2. Low Risk - 5 - 15%
3. Moderate risk - 15 - 20%
4. High Risk - 20 - 30%
5. Very high risk - more than 30%.
risk group, which is a particular patient is determined by the following criteria:
- the absence or presence of risk factors
- the degree of increase in blood pressure
- the presence of organ damage - target and associated clinical conditions (heart attack, stroke, nephropathy, angina, andetc.).
For example, a patient with no risk factors, without the involvement of other organs and without complications, with a slight increase of unstable blood pressure falls into the low risk group, ie a favorable prognosis.A patient with multiple risk factors, with the defeat of bodies, myocardial or stroke, with a constant increase in blood pressure more than 180/100 mm.Hg.Art.It has a very high risk of cardiac death, that is, poor prognosis.
therapists Sazykina OJ