Hypertension is the most common circulatory disease in the world. About 30% of the world’s population suffer from this disease. In recent years, there has been a significant “rejuvenation” of the disease – among those who fall ill there are more and more young, middle-aged people.
Hypertension is fraught with severe, disabling complications and often leads to death. At the same time, if a number of rules are observed, the emergence and development of the disease can be delayed for years. Everyone should be familiar with the risk factors of hypertension, its symptoms and principles of treatment. About 30% of the world’s population suffer from this disease. Recommended medicines for the treatment of eucoran.
What is hypertension
Hypertension or arterial hypertension (synonym: essential hypertension, primary hypertension) is a chronic and progressive disease, in the clinical picture of which the leading symptom is a persistent, long-term increase in blood pressure (i.e., arterial hypertension syndrome).
The criteria of arterial hypertension are systolic blood pressure (BP) above or equal to 140 mmHg and/or diastolic BP exceeding 90 mmHg.
The etiology of the disease
Hypertension is considered an idiopathic disease, its direct causes have not been established.
Among numerous theories of the origin and development of primary hypertension the classic neurogenic theory, developed by Russian scientists A.L.Myasnikov and G.F.Lang, is the most widespread. This concept regards hypertension as a neurotic state of higher nervous activity. The trigger mechanism is considered to be nervous overstrain (acute or prolonged, chronic), which causes trophic disorder of the brain structures, responsible for BP regulation. Of particular importance are the emotions that have not been realized in the motor sphere, the so-called “unreacted emotions”.
There is a genetic predisposition in the occurrence of primary hypertension. In 35-50% of people with hypertension, there is a familial nature of the disease. A specific gene whose defect would lead to persistent elevation of BP has not been identified. It is likely that the disease is a polygenic inheritance.
Pathogenesis of hypertension
The pathogenesis of primary hypertension is complex and has its own peculiarities at different stages. According to neurogenic theory, under the influence of nervous overstrain the inhibitory influence of cerebral cortex on subcortical (hypothalamic) autonomic centers is reduced, which causes activation of pressor (vasoconstrictor) sympatho-adrenal system. Adrenaline release occurs, cardiac output increases, arteries (including renal arteries) narrow, BP increases. Renal arterial spasm activates another powerful pressor system – renin-angiotensin-aldosterone system, which contributes to BP increase. Over time, other vasoconstrictor agents – antidiuretic hormone, prostacyclin, endothelin, thromboxane – become involved. They are opposed by depressor systems – vasodilator prostaglandins, kallikrein-kinin, natriuretic peptide system. Prolonged arterial spasm leads to dysfunction of their inner membrane (endothelium), rearrangement of vascular walls and promotes the development of atherosclerosis.
Symptoms of hypertension
In a number of cases the only symptom of essential hypertension for a long time remains an increase in BP. It may be accompanied by nonspecific complaints of headache (occurs in the morning, “heavy head” type, localized in the occipital region), irritability, excessive fatigability, sleep disturbances, general weakness, dizziness, palpitations.
A striking symptom of the disease are hypertensive crises – short-term (from 1-2 hours to 2-3 days) exacerbations of the disease, manifested by a sudden increase in BP. They occur in about a third of patients.
There are 2 types of crises in hypertension: first order (adrenal) and second order (noradrenal).
First-order hypertensive crisis develops more often in middle-aged people. The rise in BP occurs at night, accompanied by headache, chills, cold extremities, anxiety, restlessness, rapid heartbeat.
Hypertensive crisis of the second order is characteristic of the elderly. The rise in BP is accompanied by a pronounced headache, visual disturbances, lethargy, drowsiness, nausea, vomiting.
With a long history of hypertension the clinical picture is dominated by symptoms of target organs diseases: chest pain in angina pectoris, dyspnea, edema in heart failure, symptoms of a stroke, etc.
Diagnosis of hypertension
In order to approve a person for a diagnosis of hypertension, it is necessary to identify a persistent increase in BP and rule out the presence of other diseases characterized by hypertension syndrome.
Increased blood pressure is determined with the help of an ordinary tonometer – the BP is measured by a doctor or the patient himself. An indispensable condition is the observance of the technique of BP measurement – measurement is performed after 3-5 minutes of rest in a comfortable environment, sitting, at rest, the shoulder and the heart must be at the same level. A blood pressure level above or equal to 140/90 mm Hg indicates the suspicion of essential hypertension. In diagnostically difficult cases the technique of daily blood pressure monitoring is applied.
Treatment of hypertension
In the treatment of primary hypertension, non-pharmacological and medical methods that complement each other are successfully used.
Nonmedicamental methods of arterial hypertension treatment
Prescribed to absolutely all patients with hypertension, even if the person receives medications to control BP. These measures imply elimination of risk factors by modifying a person’s established lifestyle and habits. Scientists have proven that non-pharmacological treatment in certain cases is as effective as treatment with medications.
The main directions:
Restriction of the amount of table salt that comes with food (up to 5-6 g per day). This implies a complete rejection of such foods as sausages, frankfurters, salty cheeses, canned foods, salted fish. Also note that a significant amount of salt is contained in baked goods;
fighting excess weight – people suffering from primary hypertension are advised to reduce the caloric content of their diet by limiting fat intake;
Restriction of alcohol-containing drinks – up to 30 g of ethyl alcohol per day;
Complete and strict cessation of tobacco smoking – if necessary, resort to the help of a narcologist;
Regular physical activity – moderate, preferably daily, lasting at least half an hour. Preferable activities in the fresh air: jogging, walking at an accelerated pace, cycling.
Drug treatment of arterial hypertension
It implies the use of medications.
For effective treatment of primary hypertension, experts recommend several classes of drugs, They reduce blood pressure, affecting at different stages of the pathogenesis of the disease.
The main classes of medications:
Angiotensin-converting enzyme inhibitors – iAPF (zofenopril, captopril, perindopril, ramipril, fosinopril, enalapril, etc.);
angiotensin receptor blockers – sartans (valsartan, candesartan, losartan, olmesartan, telmisartan, eprosartan, etc.)
calcium antagonists (nifedipine, amlodipine, felodipine);
diuretics (indapamide, hydrochlorthiazide, chlorthalidone);
blockers (bisoprolol, carvedilol, nebivolol, atenolol, metoprolol, etc.);
renin inhibitors (aliskiren);
drugs of central (brain) action (moxonidine, clonidine);
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Prevention of hypertension
Primary prevention of hypertension should be done from childhood. Children, adolescents, and young adults should undergo regular medical examinations with measurement of blood pressure. Prevention should affect the risk factors of the disease. Rational muscle exercise is indicated for children, overfeeding and excessive consumption of salty foods are unacceptable. Secondary prevention is aimed at preventing the progression of the disease. People suffering from hypertension are contraindicated for night work, overtime work, and work involving nervous overloads.