Cardiology

Polyclinic: Modern approaches to diagnostics and treatment of arterial hypertension

Hypertension_2
Written by med

Cardiac about the disease – the main cause of disability and premature death of the inhabitants of economically developed countries in the modern world. Today, their share in the structure of mortality is 40-60%, with the continued growth of morbidity and loss of people increasingly young age makes heart disease the most important medical and social health problem.

Statistics for Eastern Europe is disappointing. The cause of 50% of the cases of death are cardiovascular disease, the leading positions are occupied by ischemic heart disease and stroke.

According to medical statistics in our country Patala anatomical dissections performed no more than 30% of the total number of deaths per year. First place is firmly occupied by diseases of the cardiovascular system. In the second place are liver disease, in particular cirrhosis – 25%. In third place – malignancies – 20%. Respiratory occupy fourth place – 5%. The greatest number of deaths occurs as a result, as a rule, not a single disease, the most common combination of three or four nosology – the so-called co-morbidity. In fact, most doctors will agree with me, as therapists and doctors narrow profile, very often come to accept patients who have not a nosological form of the disease, and two or three or even more. Usually, almost in the majority of cases it is accompanied by obesity. In his report on the issues of metabolic therapy in Cardiology, MD, a professor, a cardiologist in Moscow GKB№5 Vertkin AL He announced the sad statistics, which mainly in middle-aged men whose weight is more than 20% of their ideal weight, the risk of acute myocardial infarction, coronary artery disease, pulmonary embolism, diabetes, acute stroke, COPD, ie, the risk of various cardiovascular and vistseropaty 20 times higher than in those with normal body weight. In 40% of cases of coronary heart disease caused by smoking. Every fifth person is a comorbid disease GKB№5 cardiologist in Moscow Vertkin AL He announced the sad statistics, which mainly in middle-aged men whose weight is more than 20% of their ideal weight, the risk of acute myocardial infarction, coronary artery disease, pulmonary embolism, diabetes, acute stroke, COPD, ie, the risk of various cardiovascular and vistseropaty 20 times higher than in those with normal body weight. In 40% of cases of coronary heart disease caused by smoking. Every fifth person is a comorbid disease GKB№5 cardiologist in Moscow Vertkin AL He announced the sad statistics, which mainly in middle-aged men whose weight is more than 20% of their ideal weight, the risk of acute myocardial infarction, coronary artery disease, pulmonary embolism, diabetes, acute stroke, COPD, ie, the risk of various cardiovascular and vistseropaty 20 times higher than in those with normal body weight. In 40% of cases of coronary heart disease caused by smoking. Every fifth person is a comorbid disease acute stroke, COPD, there is a risk of various cardiovascular and vistseropaty 20 times higher than in those with normal body weight. In 40% of cases of coronary heart disease caused by smoking. Every fifth person is a comorbid disease acute stroke, COPD, there is a risk of various cardiovascular and vistseropaty 20 times higher than in those with normal body weight. In 40% of cases of coronary heart disease caused by smoking. Every fifth person is a comorbid diseasediabetes. Patients on multiple comorbid diseases, developed the so-called metabolic syndrome. Its main components include obesity, hypertension, insulin resistance. In men, decreased libido, developing hypogonadism, erectile dysfunction, in the body decreases testosterone levels. It is a chronic multiple organ dysfunction is a predictor (ie the accelerator) unfavorable outcome in surgical patients, elderly patients. And it is very important to note that statins should be required to include in the basic therapy of hypertension and coronary heart disease, as the results of Patala-anatomical autopsy in 58% of cases observed constrictive calcification in 30% of cases – constrictive atherosclerosis in 14% cases – moderate atherosclerosis.

In many developed countries, there is a clear trend towards an increase in the proportion of elderly people in the population, the most frequent cause of morbidity and mortality which is a cardiovascular disease. The prevalence of hypertension (HT) in our country among elderly persons reaches 75-80%. In treating hypertension in these patients there is a problem of influence on the systemic hypotensive therapy “swings” blood pressure (BP), it is extremely difficult tolerated by patients even with careful titration doses of drugs. In addition, there is a question about the status of the target organs and metabolic changes that occur during treatment. In this regard, optimization of treatment of patients with hypertension in this age group, despite the recommendations are still relevant. The drugs of choice in the treatment of hypertension in the elderly are diuretics and calcium channel antagonists. However, the use of diuretics may lead to unwanted side effects such as hypokalemia, hyperlipidemia and hyperuricemia. tides can arise from the use of calcium channel antagonists,tachycardia , edema of the lower extremities.

Among the many concepts of pathogenesis of hypertension there is an assumption that the AG is a way to compensate the reduced tissue perfusion. A series of experiments was conducted on modeling of cerebrovascular ischemic forms of hypertension, and the mechanism of pathogenesis has been proven. It is especially clearly manifested in the cerebral blood supply limits (in particular, atherosclerosis) with the breakdown of autoregulation. Reduced cerebral blood flow leads to deficiency macroergs such as phosphocreatine, adenosine triphosphate (ATP), the inhibition of anaerobic glycolysis and aerobic activation. For correction of such disorders have been proposed for inclusion in the circuit of antihypertensive therapy Meksidol (Meksifin) (3-hydroxy-6-methyl-2-etilperidina succinate) – Direct preparation antihypoxic and antioxidant effect. Meksidol (Meksifin) causes increased activation of compensatory aerobic glycolysis and reduces the degree of inhibition of oxidative processes in the Krebs cycle under hypoxic conditions with an increase in the content of ATP and creatine phosphate, activates energosinteziruyuschie mitochondrial function and stabilizes cellular membranes. Described as anti-atherogenic effect Mexidol (Meksifin), which accounts for the ability to inhibit lipid peroxidation and have a protective effect on the local vascular mechanisms of atherogenesis.

Daily monitoring (SM) blood pressure is an important method to control hypertension, as well as assess the variability of blood pressure, hypertension and nocturnal identify adequate purpose of antihypertensive treatment. Data SM undoubtedly more accurately reflect the level of blood pressure, as measurement takes place in a normal patient activity. Average BP values ​​obtained by the CM, rather than the results of the “office” of measurements correlate with end-organ damage and have a predictive value for the development of complications. Elevated blood pressure causes changes in the cardiovascular system such as hypertrophy of left ventricular (LVH), impaired systolic and diastolic functions, remodeling of the vascular wall to increase its rigidity. In the last decade, studies conclusively proven that LVH is a significant and independent risk factor for morbidity and mortality from cardiovascular disease. However LVH prevalence increases progressively with age, irrespective of the level of blood pressure and body weight. Also with age in connection with the death of cardiomyocytes and development miokardiofibroza disturbed blood supply of the heart, which is regarded as diastolic dysfunction.

Successful prevention and treatment of hypertension and coronary heart disease are not possible without reducing the action of so-called risk factors. The concept of them was formed in the 60 years of the twentieth century. According to statistics, if the person does not smoke or high blood pressure, and it does not have hyperlipidemia, the death risk is low: 24 per 10,000 for 5 years. 7 times higher mortality in those who smoke, suffer from hypertension and hyperlipidemia is. It does not need to smoke of cigarette packs in the 5 day and do not have a pressure of 200 mm Hg and cholesterol 8 mmol / l. the fact of smoking itself, the presence of high blood pressure, hypercholesterolemia already significantly increases the risk.

Given the situation at the beginning of the twenty-first century, there have been famous the INTERHEART study, which was attended by Russian experts. EG Volkov led group working in Russia. It was identified 5 risk factors for myocardial infarction for the people living in the XXI century:

1. dyslipidemia (low density and high density and the ratio of apolipoprotein b and cholesterol or a so-called atherogenic factor)
2. The smoking
3. obesity
4. diabetes
5. hypertension

That’s five main risk factors.

In Russia smokes 58% of the population (according to the WHO – is one of the highest rates in the world). The average per capita accounted for 15 packs per month. How dangerous is it? If a person smokes 5 cigarettes a day – a 40% increase in risk of death if 1 pack – 400%, 2 packs – 900%. That is likely to die 10 times. A conventional smoking with us – it packs a day, hence 400% increased risk. Smoking – is so powerful risk factor for myocardial infarction, which, even by smoking 1-5 cigarettes a day, a person can neutralize up to 75% profit, which is obtained from statin treatment. That is, patients who took a statin while smoking kills? the effect of treatment.

Why is smoking so dangerous? Because even one cigarette increases the blood pressure for 15 minutes. When smoking a constant pressure increase continues, smokers and patients greatly reduced efficacy of antihypertensive treatment. The most interesting is that the function of the coronary vascular endothelium significantly impressed by smoking. Smokers sick vascular reaction is completely different, it is twice as worse than non-smokers. When coronary artery non-smoker rasshiryaetya to increase krvotoka, smoking vessel contrary, spazmiruyutsya, leading to myocardial ischemia. And most importantly, increased thrombogenicity of plaque, that is, respectively, there is a blood clot adhesion to the surface of the plaque and blood clots increases. In atherosclerosis expression of platelet factor in patients increased more than three times.

With the combination of these two situations – smoking and atherosclerosis – plaque thrombogenicity and AMI risk tremendously increases.

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