Hypertension - the pathology of the cardiovascular device developing as a result of dysfunction of the highest centers of vascular regulation, neurohumoral and renal mechanisms and leading to arterial hypertension, functional and organic changes of heart, central nervous system and kidneys.
The prevalence of a hypertension among women and men of approximately identical-10-20%, a thicket a disease develops aged after 40 years though the hypertension quite often occurs even in teenagers. The hypertension contributes to faster development and a heavy course of atherosclerosis and emergence of life-threatening complications. Along with atherosclerosis the hypertension is one of the most frequent reasons of premature mortality of young able-bodied population.
The leading manifestation of a hypertension - is permanent the high arterial blood pressure, i.e. the ABP which is not restored to normal level after situational rise as a result of psychoemotional or physical activities, and decreasing only after intake of antihypertensives. According to WHO recommendations, the arterial blood pressure which is not exceeding 140/90 mm Hg is normal. Exceeding systolic indicator over 140-160 mm Hg. and diastolic - over 90 — 95 mm Hg. recorded at rest at double measurement throughout two medical examinations are considered a hypertension.
Classification of a hypertension
Cardiologists of the whole world annually gather for a symposium on arterial hypertension. At a congress of 2003 they agreed to accept the following classification of a hypertension by degrees:
- Easy degree. Arterial blood pressure is in limits 140 — 159/90 — 99 mm Hg.;
- The second degree, or moderate. Arterial blood pressure in the range of 160 — 179/100 — 109 mm Hg.;
- Heavy, the third degree hypertension. Arterial blood pressure is higher than 180/110 mm Hg.
Now the severity of an arterial hypertension is not defined without "the aggravating factors" — so-called risk factors. The risk is always on the lips cardiologists in relation to a hypertension - it is risk of development of cardiovascular complications as a result of hypertensia. Depending on this risk also the forecast of consequences of an arterial hypertension is corrected.
Treat the risk factors aggravating a course of an arterial hypertension (hypertensia) and worsening its forecast:
- Age. At men — 55 years are more senior, at women — 65 years are more senior.
- Smoking of the patient.
- The general cholesterol is more than 6.5 mmol on liter.
- Family anamnesis of early cardiovascular diseases.
- The other risk factors worsening the forecast for a hypertensia course, such kakozhireniye, inactive lifestyle, belonging to socioeconomic group of high risk, diabetes, belonging to ethnic group of high risk , etc.
Manifestations of a hypertension
1) A headache which at further progressing of a disease remains one of the main manifestations of an arterial hypertension. The headache has no accurate communication with time of day, it can arise at any time, but as a rule at night or early in the morning, after awakening. It is felt as weight or a raspiraniye in a nape and can cover other areas of the head. Usually, patients describe a headache in an arterial hypertension as feeling of "hoop". Sometimes pain amplifies in a severe cough, a ducking, a natuzhivaniye, the century, persons can be followed by small puffiness. Improvement of venous outflow (vertical position of the patient, muscular activity, massage, etc.) usually is followed by reduction or disappearance of a headache.
The headache at increase in arterial blood pressure can be caused by the muscle tension of soft covers of the head or a tendinous helmet of the head. It arises against the background of the expressed psychoemotional or physical pressure and abates after rest and conflict resolution. In this case speak about tension headache which is also shown by feeling of compression or tightening of the head "bandage" or "hoop", can be followed by nausea and dizziness. It is long ongoing pains lead to emergence of irritability, irascibility, hypersensitivity to external irritants (loud music, noise).
2) Pains in heart in an arterial hypertension differ from typical attacks of stenocardia:
- are localized in the field of a top of heart or to the left of a breast;
- arise at rest or at emotional pressure;
- usually are not provoked by physical activity;
- last long enough (minutes, hours);
- are not stopped by nitroglycerine.
3) The asthma arising at patients with a hypertension, in the beginning at physical activity and then and at rest, can indicate considerable damage of a cardiac muscle and development of heart failure.
4) Hypostases of legs can indicate presence of heart failure. However, moderate peripheral hypostases in an arterial hypertension can be connected with a delay of sodium and water, caused by disturbance of secretory function of kidneys or intake of some medicines.
5) The disorder of vision is characteristic of patients with an arterial hypertension. Quite often at increase in arterial blood pressure the fog, a veil or flashing of "front sights" before eyes appears. These symptoms are connected, mainly, with functional disturbances of blood circulation in a retina. Rough changes of a retina (fibrinferments of vessels, hemorrhages, amotio of a retina) can be followed by considerable decrease in sight, doubling in eyes (diplopia) and even total loss of sight.
Diagnosis of a hypertension
With symptomatic hypertensia in the conditions of policlinic are necessary for diagnosis of a hypertension and its differentiation:
- repeated measurements of the ABP on a shoulder and a hip, in a standing position and lying;
- determination of the neurologic status;
- eyeground research;
- analysis of urine;
- X-ray inspection of heart and aorta;
- X-ray analysis of a skull and cervical spine (according to indications);
- crops of urine and consultation of the urologist (if necessary).
Causes of a hypertension
- genetic predisposition: approximately the genetic predisposition to EG caused by a mutation in genes of angiotensinogen, receptors of angiotensin II, angiotensin-converting enzyme, renin, an aldosteronsintetaza, a β-subunit of amiloridchuvstvitelny natrium channels of a renal epithelium, etc. is found in 50% of patients.
- smoking: reduces an endothelium - dependent vasodilation, increases activity of a sympathetic part of the nervous system, is risk factor of developing coronary heart disease.
- excess consumption of table salt: the excess of sodium increases the volume of the circulating blood, causes swelling of walls of arterioles, increases sensitivity of a vascular wall to vasoconstrictive factors.
- insufficient receipt with water and food of calcium and magnesium, microelements and vitamins
- alcohol abuse
- obesity, excess body weight
- low physical activity, hypodynamia
- psycho-emotional stressful situations
- appearance of arterial hypertension depends on age of the person. At young age, generally because of smoking, alcoholization, drugs, vertebrobazilyarny insufficiency, congenital anomalies of vessels, kidneys, adrenal glands, a hypophysis. In the middle age - at the expense of the excess body weight, psychological loadings or the postponed diseases with damage of heart, vessels, kidneys. And aged after 40 years is almost always the result of sclerous defeat of vessels.
Treatment of a hypertension
The psychological relaxation, daily moderate dynamic loads are useful. In a diet the major importance has restriction of table salt to 4-6 g a day, an alcohol exception. In hypertensia of heavier course the periods (2-3 days) of more considerable restriction of salt can be useful. At the persons inclined to completeness, systematic restriction of caloric content of food is necessary.
As the hypertension is the most important risk factor of developing coronary heart disease, it is reasonable to exclude other risk factors for prevention of this disease - to stop or reduce smoking, to eliminate a lipidemia usually with restriction in a diet.
The most important principle of hypotensive medicinal treatment is constant reception of minimal effective doses of drug. Such treatment is possible only when using available drugs in the form of tablets. Normalization of the ABP is not a reason for treatment cancellation. In favorable conditions, for example during good and long rest, the attempt to reduce doses of the taken medicine on condition of observance of general measures can be made.
Apply a set of drugs of various mechanism of action to treatment of arterial hypertension. In need of the combined treatment it is reasonable to use, as a rule, drugs with various mechanism of action.
Medicinal treatment of an uncomplicated hypertension is usually begun with small doses. Then the dose is slowly raised to effect that allows to find the minimal effective dose suitable for long-term treatment with the smallest risk of side effect. Rate of increase in a dose is chosen taking into account speed of action and elimination of drug, individual shipping. For the majority of drugs an optimum interval between increase in a dose - not less than 3-4 days.
In an uncomplicated hypertension a common practice is gradual strengthening of medicinal treatment that is reached by increase in a dose, increase in number of the used hypotensive drugs (from one to 2-3), accession of stronger operating drugs taking into account features of the course of the disease, associated diseases and possible complications.
Necessary condition of efficiency of hypotensive treatment is trusting relationship between the patient and the doctor.
In a hypertension of a heavy course and in hypertensive crisis the treatment essentially differs from stated. Before hospitalization the patients have to remain in a chair with the lowered legs, as far as possible, in a quiet situation. At some patients quite fast and well transferable hypotensive effect can be reached by chewing of 10-20 mg of nifedipine. In principle parenteral administration of quickly operating hypotensive drugs in effective doses is shown to this patients.
Before transportation it is reasonable to enter intramusculary or intravenously Dibazolum (in a dose of 30-40 mg, i.e. 3-4 ml of 1% solution or 6-8 ml of 0.5% solution) which is usually well transferred; at considerable excitement and fear in addition - intravenously slowly enter 5-10 mg of diazepam. At the excited patients instead of Dibazolum with diazepam it is possible to use a clonidine - 0.15 mg subcutaneously with possible repetition in 30 min. at insufficient effect.
If there are no symptoms of dehydration and a hyponatremia, it is necessary to enter intravenously 20-40 mg of lasixum which, in particular, will counteract a fluid lungs, a brain.
At certain patients the additional intravenous administration of propranolol (5 ml, i.e. 5 mg of 0.1% solution) is useful, especially in the considerable tachycardia which is not connected with heart failure or sharp decrease in the ABP. The sufficient, but short-term hypotensive effect can be reached by slow intravenous administration of verapamil (5-10 mg, i.e. 2-4 ml of 0.25% solution). Verapamil intravenously cannot be entered sick, treated beta blocker. At threat or edematization of lungs in addition enter intravenously nitroglycerine. Active antihypertensives are diazoxide (150-300 mg intravenously struyno) and especially Sodium nitroprussidum (intravenously by drop infusion on 0.5-3.5 mkg/kg in 1 min.) which at the correct use practically always allows to manage the ABP in desirable limits. At various sharply arising complications of a hypertension it is necessary to consider restrictions for separate drugs and possible side effects. After decrease and stabilization of the ABP pass to treatment with tablets, as a rule, in more intensive mode at once, in comparison with that which was used before aggravation of symptoms.
Folk remedies for treatment of a hypertension
Phytotherapy has important value in a complex of GB remedies. First of all it is sedative herbs and collecting. They can be used in finished form (extracts, tinctures and tablets). Generally it is drugs of a valerian, motherwort, hawthorn. Carry to number of the plants having the calming effect also a camomile pharmaceutical, a melissa medicinal, a peppermint, cones of hop and many others. Traditional medicine advises sick GB to eat honey, a chokeberry (200 — 300 g a day), a citrus and a dogrose in the form of drink, green tea. All these products reduce supertension and are rich with the vitamin C necessary for the weakened cardiac muscle.
It is required: on 10 g of flowers of an adonis spring, flowers of a buckwheat of a sowing campaign, roots of a lily of the valley, the crushed valerian roots, 1 glass of vodka.
Way of preparation.
To fill in the crushed collecting with 1 glass of vodka. To insist in the dark place in glasswares with a cover of 20 days.
Route of administration.
To accept 3 times a day on 25 drops on 1 tablespoon of water in 30 min. prior to food.
It is required: 60 g of dry grape wine, 20 drops of fresh juice of a yarrow, 20 drops of juice of a rue, 10 g of a grass of a buckwheat of a sowing campaign.
Way of preparation.
Ingredients to mix, insist within a day in a dark glass vessel in the warm place.
Route of administration.
To accept once a day in the morning, in 30 — 40 min. prior to food.
It is required: 5 g of bark of a willow water, 1 g of a grass of a wormwood of bitter, 15 g of a grass of a yarrow, 10 g of a ground linen seed, 150 ml of abrupt boiled water.
Way of preparation.
To fill up with 1 tablespoon of collecting in the enameled ware, to fill in with boiled water, to cover, leave for 30 min. To filter the received infusion, to wring out raw materials.
Route of administration.
To accept 2 times a day in 30 min. prior to food within a month.
It is required: 10 g of leaves of a melissa of medicinal, 20 g of corn snouts, juice of 1 lemon, 0.5 l of abrupt boiled water.
Way of preparation.
To wring out juice from a lemon. To pour out the received collecting in the enameled ware, to fill in with boiled water. To hold on the water bath of 20 min. To insist before cooling. To merge infusion, to wring out raw materials. To add lemon juice to the received infusion.
Route of administration.
To accept 1/2 glasses 3 times a day in 30 min. after a meal. To conduct 3 courses for 7 days with a week interval.
It is required: on 20 g of a grass of a rue, corn snouts, on 10 g of a root of a valerian, peppermint leaves, 1 glass of abrupt boiled water.
Way of preparation.
To mix all ingredients, to place 2 tablespoons of collecting in the enameled ware, to fill in with boiled water. To boil on the water bath of 20 min.
To insist before cooling. To filter, to wring out raw materials.
Route of administration.
To accept 2 — 3 times a day at meal time within a month.
It is required: on 30 g of roots of a valerian, herbs of an anise ordinary, herbs of a motherwort cordial, on 20 g of dried petals of sunflower, yarrow herbs, 1 glass of boiled water.
Way of preparation.
To place 2 tablespoons of collecting in the enameled ware, to cover. To insist on the water bath of 20 min. After cooling to filter, to wring out raw materials.
Route of administration.
To accept 1/3 glasses 2 — 3 times a day at meal time.
Prevention of a hypertension
Prevention of a hypertension is possible, despite its mass character, fatal risks and genetic predisposition. It is known that this disease develops aged from 30 up to 60 years, that is in the most active vital period, and the greatest number of the diseased – aged after 40 years. To be engaged in prevention, it is necessary to know the causes of a hypertension. Thanks to efforts of doctors and mass media these reasons are well-known: stress, smoking, food (atherosclerosis), obesity. To eliminate or at least any adult can reduce negative action of each of them.
It is much told about fight against a stress, about ability to resist to it. Our life is full of stresses, to us not to exclude them, we are that by nature. The stress is a normal reaction of an organism to some irritants, and it is not dangerous. The danger consists in the injuring influence of a stress when it exceeds the normal level of responses. To help the organism, it is necessary to work over itself. By the way, it is not so difficult as it seems.
Many notice that the stress arises as chain reaction when we give in to emotions during the skirmish. If shout at us and offend, we want to answer too, and then begins to shake. If to restrain and not to shout in reply, and to speak quietly and peaceful – you not only you will save yourself from a stress, the storm of emotions of your opponent will quickly run low also it (but not you!) will remain in dejectedness. Use also various methods strengthening nervous system: release at the same time, sound sleep, alternating douche, active holiday in the fresh air.
Using tonic and excitants, you have to remember that they excite an emotional background and wear out nervous system. It is about addictions (smoking, alcohol, drugs) and distortions in food. The food role in forming of diseases is really huge, we – what we eat. The diet in a hypertension is a part of treatment, quite often with its help for several days it is possible to lower arterial blood pressure considerably. Improper feeding leads to obesity, increase in cholesterol, prematurity of atherosclerosis, and everything listed – to a hypertension.
We will receive powerful prophylactic, having only slightly changed habits in food. For example, if to reduce half usual amount of butter, saturated fats, margarine, mayonnaise, we will not impoverish in any way the diet but only we will win. When cooking use vegetable oils. It is easy to reduce consumption of meat, buying it less. Instead of meat cook more often vegetables dishes, bean and rice. Fill various pies, casseroles, pastes with vegetable, fruit and groat stuffings instead of mincemeat.
If you love fish and seafood, leave them in the menu, but except shrimps (pure cholesterol). Limit consumption of eggs, confectionery, ice cream. As having a snack and instead of a dessert use fruit in a fresh and dried look, in compotes, in syrup, preserved, candied, with nuts and yogurt. Learn to eat products from whole grain: grain bread, whole grain, cereal flakes. In your diet fermented milk products are necessary. Instead of coffee and black tea it is possible to have green or flower tea (like hibiscus tea), compote, kissel, fruit drink, milk. To support a tone of vessels, blood saturation by oxygen, good blood supply of fabrics helps active holiday in the fresh air. It is just necessary to develop a habit to regularly allow time for departures for the nature, visit of parks, stadiums, beaches. Your organism will be grateful to you for care and will answer with improvement of health.
The hypertension which in time is not stopped is dangerous by the complications among which there is an exacerbation of coronary heart disease, hypertensive encephalopathy, heart failure and hypertensive crisis. Hypertension complications: in a long-term hypertension functions of kidneys, hearts, a brain are broken. The circulatory unefficiency causes stagnation of blood in lungs and decrease in bronchial passability that is expressed by paroxysmal cough, especially at daybreak, the whistling rattles, etc.
Hypertension at pregnancy
The combination of a hypertension and pregnancy is observed quite often. According to domestic and foreign authors, the hypertension is observed in 1-3.8% is accidental and makes from 11 to 25% among all pregnant women with an arterial hypertension. Most of authors consider an upper limit of normal arterial blood pressure 135/85 mm Hg. Exceeding this level should be regarded as hypertensia. It is necessary to remember a possibility of regional hypertensia at which increase only in temporal pressure is noted.
The diagnosis of a hypertension during pregnancy can present the known difficulties because an arterial hypertension - the main symptom of late toxicosis - can be observed in chronic nephrites, some endocrine and other disorders.
The main difference of a hypertension from late toxicosis - supertension before pregnancy or from its first loops. On the woman could not measure pressure before pregnancy. Besides, thanks to hypotensive action of the pregnancy, the arterial blood pressure before increased in early pregnancy could be normal. Therefore new increase in this pressure in the second half of pregnancy will create a picture of late toxicosis.
For the correct diagnosis in these cases the characteristic changes from a cardiovascular system demonstrating long increase in blood pressure in a big circle of blood circulation - a hypertrophy of a left ventricle, shift of a cardiac impulse, emphasis of the II top on an aorta matter, bifurcation of the I top and even a cantering rhythm is frequent with a metal shade, the phenomena of insufficiency of a myocardium. At an electrocardiographic research the levogramma, dystrophic changes of a myocardium is often noted.
Also the age of pregnant women is a little various: younger in late toxicoses and more elderly in a hypertension (30 years are usually more senior). Sometimes the correct diagnosis can be made after the termination of a beremenpost when blood pressure continues to remain high. The course and the result of pregnancy are defined by the stage of a hypertension and various complications characteristic of it. Distinguish three stages of this disease.
The unstable increase in pressure at its tranzitorny phase which is replaced by the periods of normal pressure is characteristic of the I stage of a disease (neurogenetic - according to G.F. Lang, functional - according to I.D. Strazhesko). Changes from a cardiovascular system and kidneys usually are absent, but at most of patients the vasoconstriction of an eyeground is noted.
At the II stage of a disease (transitional - according to G.F. Lang, organic - according to N.D. Strazhesko) already resistant is observed it is raised arterial blood pressure though its considerable fluctuations can be also in this stage, however pressure decrease does not reach normal level. A.L. Myasnikov divides this stage into two phases: And - unstable, or labile, and In - stable. In a transition phase the significant changes usually are defined from a cardiovascular system, up to disturbance of blood circulation, stenocardia, myocardial infarctions. Changes from kidneys can be observed - a small amount of protein in urine, a microhematuria. The daily urine is usually not changed. Changes of an eyeground are more significant: there are Gvist's symptoms, Salyus I and II, a symptom of a copper wire. Pregnant women often complain of some disorders of vision, "flashing of front sights" before eyes. Head bolp, weight in the head and dizzinesses have more resistant character. These changes are especially significant in phase B.
At the III stage (nephrogenic - according to G.F. Lang, dystrophic - on II. D. Strazhesko) blood pressure, especially diastolic, with firmness keeps on high figures, the phenomena of a renal failure and heavy changes are expressed from a number of bodies and systems (heart, the central nervous system, kidneys, a liver). This stage of a hypertension is an unconditional contraindication for pregnancy continuation.
Pregnancy at the I stage of a hypertension can be usually brought to the safe end, though in this stage heavy complications in connection with accession of late toxicosis can be observed. The question of a possibility of preservation of pregnancy at the II stage of a disease, especially in phase B, has to be discussed in each case separately after preliminary hospitalization of the pregnant woman for a research of a functional condition of kidneys, a cardiovascular system, capillaries.
The most frequent complication of pregnancy at women with a hypertension - late toxicosis. According to O.F. Matveeva, it develops more than at a half of pregnant women. According to the Kiev research institute of pediatrics, obstetrics and gynecology, at the II stage of a hypertension the toxicosis of pregnancy is noted at 85% of pregnant women. Accession of late toxicosis is demonstrated emergence of protein in urine, by hypostases, deterioration in a picture of an eyeground and further increase in arterial blood pressure. Accession of late toxicosis in rather early pregnancy poses a big threat for mother and a fruit and if it is not possible to reduce the toxicosis phenomena, it is necessary to interrupt pregnancy.
As indications for early termination of pregnancy in its late terms, besides heavy toxicosis and threat for fruit life, heavy complications of a hypertension from which the greatest danger is constituted by hypertensive crises, the acute hypertensive encephalopathy arising in connection with increase in intracranial pressure can serve. Hypertensive encephalopathy is shown strong head bolyo, and can end with a disorder of vision, substantial increase of pressure with appearance of the spasms reminding eclampsia attacks and a cerebral hemorrhage.
Nevertheless the vast majority of pregnant women with a hypertension well adapt to the available increase in pressure, sometimes even show few complaints and in the absence of complications safely transfer childbed.
Except encephalopathy, the menacing symptoms are hemorrhages on an eyeground, amotio of a retina and premature placental detachment. In these cases the immediate delivery is also shown.