Slide 13

Risk levels (risk of stroke or myocardial infarction) in the next 10 years:

Low risk (risk 1) – less than 15% Medium risk (risk 2) – 15-20% High risk (risk 3) – 20-30% Very high risk (risk 4) – 30% and above

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Low risk group (risk 1). This group includes men and women under 55 years of age with hypertension in the absence of other risk factors, target organ damage, and associated cardiovascular disease. Medium risk group (risk 2). This group includes patients with grade 1 or 2 hypertension. The main sign of belonging to this group is the presence of 1-2 other risk factors in the absence of target organ damage and associated cardiovascular diseases.

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High risk group (risk 3). This group includes patients with grade 1 or 2 hypertension, 3 or more other risk factors or target organ damage or diabetes. The same group includes patients with stage 3 hypertension without other risk factors, without target organ damage, without concomitant cardiovascular diseases and diabetes. Very high risk group (risk 4). This group includes patients with any degree of hypertension who have concomitant diseases CVS, as well as with grade 3 hypertension with the presence of other risk factors and/or target organ damage and/or diabetes, even in the absence of concomitant diseases.

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Classification of secondary hypertension

Secondary systolic-diastolic hypertension 1. Renal 1.1 Diseases of the kidney parenchyma Acute and chronic glomerulonephritis Hereditary nephritis Chronic pyelonephritis Interstitial nephritis Polycystic kidney disease Kidney damage in systemic diseases connective tissue and systemic vasculitis Diabetic nephropathy Hydronephrosis Renal tuberculosis Congenital renal hypoplasia Myeloma nephropathy Goodpasture's syndrome

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1.2 Renovascular hypertension Atherosclerosis of the renal arteries Fibromuscular hyperplasia of the renal arteries Thrombosis of the renal arteries and veins Aneurysms of the renal arteries Nonspecific aortoarteritis 1.3 Renin-producing kidney tumors 1.4 Primary renal sodium retention (Liddle syndrome) 1.5 Nephroptosis

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2. Endocrine Adrenal (Itsenko-Cushing’s syndrome, congenital virilizing adrenal hyperplasia, primary hyperaldosteronism, pheochromocytoma) Hypothyroidism Acromegaly Hyperparathyroidism Carcinoid 3. Coarctation of the aorta 4. Hypertension during pregnancy

Slide 20

5. Neurological disorders Increased intracranial pressure (brain tumor, encephalitis, respiratory acidosis) Quadriplegia Lead intoxication Acute porphyria Hypothalmic (diencephalic) syndrome Familial dysautonomia Guillain-Barré syndrome Sleep apnea of ​​central origin

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6. Acute stress, including postoperative Psychogenic hyperventilation Hypoglycemia Burn disease Pancreatitis Withdrawal symptoms in alcoholism Crisis in sickle cell anemia Condition after resuscitation measures

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7. Hypertension induced by drugs, as well as with exogenous intoxications Taking oral contraceptives Treatment with corticosteroids, mineralocorticoids, sympathomimetics, estrogens Treatment with monoamine oxidase inhibitors simultaneously with the intake of foods rich in tyramine Intoxication with lead, thallium, cadmium 8. Increase in BCC Excessive intravenous infusions Polycythemia vera 9. Alcohol abuse (chronic alcoholism)

Slide 23

Systolic hypertension

1. Increased cardiac output Aortic valve insufficiency Arteriovenous fistula, open aortic duct S-m thyrotoxicosis Paget's disease Hypovitaminosis B Hyperkinetic type of hemodynamics 2. Sclerotic rigid aorta

Slide 24

Examples of diagnosis formulation

Arterial hypertension 1st degree. Risk 2. Dyslipidemia. AG 2 tbsp. Risk 3. Hypertensive heart H1. Ventricular extrasystole. AG 2 tbsp. Risk 4. Diabetes, type 2, stage of clinical-metabolic subcompensation, middle stage. severity, diabetic microangiopathy of the vessels of the lower extremities. AG 3 tbsp. Risk 4. IHD: angina pectoris FC 2. Atherosclerosis of the aorta, coronary arteries. H 1. Polycystic kidney disease. Chr. pyelonephritis, without exacerbation. Secondary nephrogenic hypertension.

Slide 25

General tactics for managing people with hypertension

After establishing a diagnosis of hypertension and assessing cardiovascular risk, individual patient management tactics are developed. Important aspects of managing a patient with hypertension are: Motivating the patient for treatment and compliance with recommendations for lifestyle changes and drug therapy. The experience and knowledge of the doctor and the patient’s trust in him. Decision on the appropriateness and choice of drug therapy.

Slide 26

Diagnostics

Taking an anamnesis to determine the duration of the increase in blood pressure, its levels, the presence of hypertensive crises; factors provoking increases in blood pressure; clarify the presence of signs that allow one to suspect the secondary nature of hypertension: family history of renal diseases; a history of kidney disease, bladder, hematuria, abuse of analgesics; use of various medications or substances: OK, GSK, NSAIDs, erythropoietin, cyclosporine; long-term work with lead salts; a history of endocrine diseases; paroxysmal episodes of sweating, anxiety headaches, palpitations (pheochromocytoma); muscle weakness, paresthesia, cramps (aldosteronism)

Slide 27

identify factors aggravating the course of hypertension: the presence of dyslipidemia, diabetes, other heart and vascular diseases; aggravated medical history of hypertension, diabetes, and other CVDs in close relatives; smoking; nutritional features; level physical activity; alcohol abuse; snoring, sleep apnea; personal characteristics of the patient.

Slide 28

carefully identify the patient’s complaints indicating damage to target organs: brain, eyes - presence and nature of headache, dizziness, sensory and motor disorders, blurred vision; heart - pain in chest, their connection with increases in blood pressure, emotional and physical stress, palpitations, interruptions in heart function, shortness of breath; kidneys – thirst, polyuria, hematuria, nocturia; peripheral arteries – coldness of the extremities, intermittent claudication. evaluate possible influence on AG factors environment, marital status, nature of work; clarify medical, social and work history.

Slide 29

Physical examination

During a physical examination, the physician should identify POM and signs of secondary hypertension. Be sure to measure the patient’s height, weight, waist circumference, and calculate BMI. The secondary nature of hypertension may be indicated by the following data revealed during the examination: Symptoms of the disease or Itsenko-Cushing syndrome; Neurofibromatosis of the skin (sm pheochromocytoma); Kidney enlargement (polycystic disease, space-occupying formations); Weakened or delayed pulse in the femoral artery and reduced blood pressure on it (coarctation of the aorta, nonspecific aortoarteritis); Rough systolic murmur above the aorta, in the interscapular region (coarctation of the aorta, aortic diseases); Auscultation of the abdominal area - noises over the area of ​​the abdominal aorta, renal arteries (renal artery stenosis - vasorenal hypertension).

Slide 30

POM should be suspected in the following cases: brain – auscultation of noises over the carotid arteries, motor and sensory disorders; retina of the eye – changes in the vessels of the fundus; heart – increased apical impulse, rhythm disturbances, presence of symptoms of CHF (wheezing in the lungs, presence of peripheral edema, enlarged liver); peripheral arteries – absence, weakening or asymmetry of the pulse, coldness of the extremities, symptoms of skin ischemia; carotid arteries - systolic murmur over the area of ​​the arteries.

Slide 31

Standard laboratory tests

Fasting plasma glycemia Glucose tolerance test General CL LDL CL HDL TG TG Potassium Uric acid Creatinine Estimated creatinine clearance or glomerular filtration rate Hemoglobin and hematocrit Urinalysis (with determination of microalbuminuria); quantitative analysis proteinuria.

Slide 32

Standard instrumental studies

ECG Echo-CG Ultrasound of the carotid arteries Fundus examination Home blood pressure measurement 24-hour blood pressure monitoring Measurement of pulse wave velocity

Slide 33

Special research methods

To confirm secondary hypertension, the following studies are carried out: determination of the concentration of renin, aldosterone, corticosteroids, catecholamines in plasma and/or urine, angiography, ultrasound of the kidneys and adrenal glands, CT, MRI of the relevant organs, kidney biopsy.

Slide 34

Lifestyle interventions

Slide 35

General principles of drug treatment of patients with hypertension

Antihypertensive therapy should be continuous; At the beginning of treatment, monotherapy is prescribed; If the effect of the drug is insufficient, its dosage is increased or a second drug is added; It is advisable to use medications long acting to achieve a 24-hour effect with a single dose.

Slide 36

Choice of antihypertensive drugs

The effectiveness of antihypertensive therapy is assessed by the level of blood pressure reduction. As both initial and maintenance therapy, drugs of 5 main groups can be used: thiazide and thiazide-like diuretics, calcium channel blockers, ACE inhibitors, angiotensin 2 receptor blockers and beta blockers. Drugs of these classes can be used both as monotherapy and low-dose fixed combinations.

Slide 37

Indications and contraindications for prescribing the main groups of antihypertensive drugs

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Slide 40

Preferred antihypertensive drugs for target organ damage and associated clinical diseases

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Slide 42

Therapy selection strategy (monotherapy/combination therapy)

Regardless of the choice of drugs, the use of monotherapy achieves the desired level only in a limited number of patients. To achieve the target blood pressure level, most patients require the use of more than one antihypertensive drug. Initial therapy can be carried out using either monotherapy or the combined use of two drugs in low doses, followed by increasing the dose or number of drugs if necessary. The use of monotherapy as initial therapy is possible with a slight increase in blood pressure, with a low and moderate risk of developing CVD complications. Preference should be given to the combined use of two drugs in low doses in cases where the initial blood pressure level corresponds to grade 2 or 3 hypertension or the overall risk of complications is high.

Slide 43

Fixed-dose combinations of drugs are preferred because simplifying treatment has a better chance of adherence to therapy. A reduction in the risk of complications is observed with the following combinations: diuretic + ACE inhibitor or angiotensin 2 receptor antagonist or calcium antagonist or ACE inhibitor + calcium antagonist or angiotensin 2 receptor antagonist + calcium antagonist.

Slide 44

Features of antihypertensive therapy in patients with diabetes

Whenever possible, an intensive regimen of non-drug interventions should be used in patients with type 2 diabetes, with particular attention to weight loss and limiting salt intake. Target blood pressure level is 130/80 mm Hg. Antihypertensive therapy is prescribed already with stage 1 hypertension. Diuretics and beta blockers should not be used at the first stage of treatment, because they aggravate insulin resistance and cause the need to increase the dose or number of glucose-lowering drugs.

Slide 45

First-line drugs, in cases where monotherapy is sufficient, are ACE inhibitors or angiotensin 2 receptor blockers; they should also be a mandatory component of combination therapy (imidazole receptor antagonists, low-dose thiazide diuretics, beta-blockers (nebivolol) can be added to them or carvedilol), Ca channel blockers). Treatment decisions should consider the need for interventions that address all risk factors, including statins.

Slide 46

Features of antihypertensive therapy in patients with impaired renal function

Renal dysfunction is always accompanied by a high risk of developing cardiovascular complications. To prevent the progression of renal dysfunction it is necessary: ​​it is necessary to achieve a target blood pressure level of less than 130/80 mm Hg. To achieve target blood pressure, a combination of several drugs (including loop diuretics) is often required. To reduce the severity of proteinuria, it is necessary to use angiotensin 2 receptor blockers, ACE inhibitors, or a combination thereof. In addition to antihypertensive therapy, such patients are shown statins and antiplatelet drugs, because they have a very high risk of developing cardiovascular complications.

Slide 47

Features of antihypertensive therapy in patients with cerebrovascular pathology

Target blood pressure level is less than 140/90 mmHg. In such patients, all groups of antihypertensive drugs can be used. The most effective is the prescription of ACE inhibitors or angiotensin 2 receptor blockers in combination with diuretics.

Slide 48

Features of antihypertensive therapy in patients with ischemic heart disease, CHF, atrial fibrillation

In post-MI patients, early administration of beta-blockers, ACE inhibitors, or angiotensin 2 receptor blockers reduces the risk of recurrent MI and death. When a history of hypertension in patients with CHF is indicated in antihypertensive therapy, it is advisable to include thiazide and loop diuretics, beta blockers, ACE inhibitors, angiotensin 2 receptor blockers, aldosterone receptor blockers. The use of Ca channel blockers should be avoided.

Slide 49

In patients with atrial fibrillation, strict monitoring of antihypertensive therapy is necessary when treated with anticoagulants. The use of angiotensin 2 receptor blockers is considered preferable in patients with paroxysmal atrial fibrillation. With a permanent form of atrial fibrillation, beta-blockers and non-dihydropyridine calcium channel blockers (verapamil, diltiazem), which reduce the frequency of the ventricular rhythm, retain their importance.

Slide 50

Indications for hospitalization

Indications for planned hospitalization: - The need for special, often invasive, research methods to clarify the diagnosis or form of hypertension; Difficulties in selecting drug therapy in patients with frequent GCs; Refractory hypertension. Indications for emergency hospitalization: HA that cannot be controlled at the prehospital stage; GC with severe manifestations of hypertensive encephalopathy; Complications of hypertension requiring intensive care and constant medical supervision: cerebral stroke, subarachnoid hemorrhage, acute visual impairment, pulmonary edema, etc.

Slide 51

Hypertensive crisis

sudden increase in systolic and/or diastolic blood pressure to individually high values, accompanied by the appearance or intensification of cerebral, coronary and renal circulatory disorders, as well as severe disturbances in autonomic function nervous system.

Slide 52

Predisposing factors for the development of GC

Neuropsychic stressful situations Intense physical activity Prolonged hard work without rest, associated with great responsibility, taking large amounts of water and salty food the day before Marked changes in meteorological conditions Impact of “acoustic” and “light” stress, leading to overstrain of the auditory and visual analyzers Alcohol abuse Consumption large amounts of coffee Heavy smoking Sudden withdrawal of beta-blockers Sudden cessation of treatment with clonidine Excessive mental stress accompanied by lack of sleep Treatment with corticosteroids, NSAIDs, tricyclic antidepressants, sympathomimetic amines

Slide 53

Diagnostic criteria for GC

Relatively sudden onset Individually high blood pressure, with diastolic blood pressure usually exceeding 120-130 mm Hg. Presence of signs of dysfunction of the central nervous system, encephalopathy with general cerebral and focal symptoms and corresponding complaints of the patient Neurovegetative disorders Cardiac dysfunction of varying severity with subjective and objective manifestations Pronounced ophthalmological manifestations (subjective signs and changes in the fundus) New or worsened renal dysfunction

Slide 54

Classification of Civil Codes

GCs are divided into 2 large groups: complicated (life-threatening) and uncomplicated (non-life-threatening). Complicated crises are characterized by a significant increase in blood pressure, severe, rapidly progressive damage to target organs, posing a threat to the life and health of the patient. Complicated hypertensive crises include the following clinical situations:

Slide 55

Rapidly progressive or malignant hypertension with papilledema Cerebrovascular diseases: acute hypertensive encephalopathy ischemic stroke with severe hypertension hemorrhagic stroke subarachnoid hemorrhage Heart disease: acute dissection of an aortic aneurysm acute left ventricular failure acute myocardial infarction or the threat of its development unstable stenosis cardia condition after coronary artery bypass surgery Kidney diseases: acute glomerulonephritis renal crisis in systemic connective tissue diseases severe hypertension after kidney transplantation

Slide 56

Excess circulating catecholamines pheochromocytoma crisis interaction of food or drugs with MAO inhibitors use of sympathomimetic amines “rebound” hypertension after sudden cessation of treatment with antihypertensive drugs Eclampsia Surgical diseases: severe hypertension in patients requiring immediate surgical operation postoperative hypertension postoperative bleeding in the area of ​​vascular ligation severe, extensive burns of the body severe nosebleeds head injuries

Slide 57

Uncomplicated GCs

are not accompanied by acute target organ damage and do not require immediate initiation of intensive antihypertensive therapy, because Blood pressure is reduced slowly over the course of a day.

Slide 58

When medicinal treatment of GC is necessary to solve the following problems

1. Relief of increased blood pressure: determine the degree of urgency of starting treatment, select a drug and route of administration, establish the required rate of blood pressure reduction, determine the level of permissible blood pressure reduction. 2. Ensuring adequate monitoring of the patient’s condition during the period of lowering blood pressure: timely diagnosis of the occurrence of complications or excessive lowering of blood pressure is necessary. 3. Consolidation of the achieved effect: prescribe the same drug with which blood pressure was reduced, if impossible, other antihypertensive drugs, taking into account the mechanism and duration of action of the selected drugs. 4. Treatment of complications and concomitant diseases.

Slide 59

Algorithm for choosing therapy for GC

Uncomplicated GC Treatment of uncomplicated GC can be carried out in outpatient setting. In uncomplicated HA, the rate of blood pressure reduction should not exceed 25% in the first 2 hours, followed by reaching the target level within 24-48 hours. Drugs with a rapid onset of action and a short half-life should be used.

Slide 60

Choice of drugs for uncomplicated GC

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Complicated HA is accompanied by life-threatening conditions and requires lowering blood pressure, starting from the first minutes, with the help of parenterally administered drugs. Patients are treated in the emergency cardiology department or the intensive care unit of the cardiology or therapeutic department. Blood pressure should be reduced gradually to avoid deterioration of blood supply to the brain, heart and kidneys, usually by no more than 25% in the first 1-2 hours.

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Slide 2

Prevalence of hypertension

In economically developed countries, 20-25% of the population suffers from hypertension. Currently in Russia about 45 million people suffer from hypertension. only 57% of hypertensive patients know about their disease; only 17% of them receive treatment, and only 8% have adequate therapy. In Russia, the share of mortality from cardiovascular diseases in total mortality is 53.5%, with 48% due to ischemic heart disease, 35.2% due to cerebrovascular diseases. Strokes in Russia occur 4 times more often than in the USA and Western European countries.

Slide 3

Epidemiology of hypertension in Russia

According to a survey of a representative sample (1993), the age-standardized prevalence of hypertension (>140/90 mm Hg) in Russia is 39.2% among men and 41.1% among women. Women are better informed about the presence of the disease than men (58.9% versus 37.1%), are treated more often (46.7% versus 21.6%), including effectively (17.5% versus 5. 7%) In men and women, there is a clear increase in hypertension with age. Before 40 years of age, hypertension is more often observed in men, after 50 years – in women.

Slide 4

Among men under 40 years of age, only 10% of patients with hypertension receive drug therapy; in subsequent age groups, this figure increases to 40% in patients 70–79 years of age. The effectiveness of treatment for hypertension in men is practically independent of age and ranges from 4 to 7%. Among women, antihypertensive therapy is received from 30% in the age group 20–29 years to 58% in the age group 60–69 years. The effectiveness of treatment decreases with age: if every 5th woman is effectively treated before the age of 50, then subsequently the number of effectively treated women decreases to 8%, reaching a minimum of recent years life (1.5%).

Slide 5

Age-related features of headache prevalence

among 20-29 year olds - every 14th (7.1%) among 30-39 year olds - every 6th (16.3%) among 40-49 year olds - every 4th (26.9%) ) among 50-59 year olds - every 3rd (34.4%) Analysis of the prevalence of hypertension in various age groups of men showed that in Russia people suffer from hypertension

Slide 6

Conclusions

In general, the data obtained indicate: a high prevalence of hypertension in the Russian population, poor awareness of patients about the presence of the disease (especially among men), insufficient prescription of drug therapy for patients with hypertension and its catastrophically low effectiveness.

Slide 7

Risk factors

Men 55 years old; Women 65 years old Impaired lipid metabolism (total cholesterol 6.5 mmol/l) Diabetes mellitus, microalbuminuria Family history of early C-C diseases Impaired glucose tolerance Obesity Sedentary lifestyle Increased fibrinogen Stress Excessive alcohol consumption.

Slide 8

Classification of blood pressure levels in adults over 18 years of age

Slide 9

Criteria for diagnosing hypertension

Hypertension is diagnosed if systolic blood pressure is 140 mmHg. and more, diastolic – 90 mm Hg. Art. and more in persons not taking antihypertensive drugs. normal blood pressure values ​​for the waking period are 135/85 mm Hg. Art., during sleep – 120/70 mm Hg. Art. with a degree of blood pressure reduction at night by 10–20%. Hypertension is diagnosed when the average daily blood pressure is >135/85 mmHg. Art., during wakefulness >140/90 mm Hg. Art., during sleep >125/75 mm Hg. Art.

Slide 10

Rules for measuring blood pressure

It is necessary to measure the pressure on both arms. If the difference in blood pressure is equal to or greater than 10 mmHg, subsequent measurements are carried out on the arm with higher pressure. If the shoulder circumference is more than 33 cm, it is necessary to use a wider cuff, otherwise the blood pressure numbers will be overestimated. Blood pressure should be measured at least twice with an interval of 3 minutes. And calculate the average value of 2 measurements. Methodologically correct and systematic measurement of blood pressure is the key to successful treatment of hypertension!

Slide 11

Non-drug treatment methods for hypertension

Smoking cessation Decrease overweight body Reducing salt intake Adequate potassium intake (through consumption of vegetables and fruits) Healthy intake of calcium and magnesium. Reducing alcohol consumption (Patients with hypertension should be advised to reduce alcohol consumption to at least 20–30 g of pure ethanol per day for men (corresponding to 50–60 ml of vodka, 200–250 ml of dry wine, 500–600 ml of beer) and 10–20 g per day for women.) Comprehensive diet modification Increased physical activity

Slide 12

Three “pillars” that form the basis of modern CVD prevention.

Drug treatment Physical training Dietary nutrition

Slide 13

7 “golden” diet rules

1. Reduce overall fat consumption 2. Dramatically reduce consumption of saturated acids (animal fats, butter, eggs) - contribute to hyperlipedemia 3. Increase consumption of foods enriched with polyunsaturated fats fatty acids(vegetable oils, fish, poultry, seafood) - reduce blood lipid levels) 4. Increase the consumption of fiber and complex carbohydrates (vegetables, fruits) - at least 35 mg per day. 5. Replace butter with vegetable oil when cooking. 6. Drastically reduce the consumption of foods rich in cholesterol. 7. Limit the amount of table salt in food (up to 3-5 g/day). In the ancient system of Hatha Yoga, advice is given on one-day fasting on Wednesdays and Fridays ( fasting days). The same fast days are recommended in the Bible)

Slide 14

Physical training

“To go overboard does not mean to achieve the goal” (O. Balzac) “Consistency creates style, just as consistency creates strength” (G. Flaubert) “Be wise: those who are in a hurry are in danger of falling” (W. Shakespeare)

Slide 15

Mode and intensity of exercise

Aerobic exercise is the main type! - They involve large muscle groups. Can be done for a long time. Walking, jogging, swimming, tennis, cycling. Walking duration is at least 30-45 minutes. per day Regularity at least 4 days a week. Anaerobic exercises (weightlifting, bodybuilding) are CONTRAINDICATED for heart disease!

Slide 16

Refrain from exercising for 2 hours. If you feel unwell (flu, cold), stop exercising. After illness, reduce the intensity and duration of training somewhat. Do not be alarmed by muscle soreness. Knowing the symptoms of exacerbation of the underlying disease will allow you to stop training in a timely manner. Rules for safe walking

Slide 17

Prognostic values ​​of the main CVD risk factors

Slide 18

Hypertension and dyslipidemia

Impaired plasma lipid profile. The most common are hyperliproproteinemias with increased levels of total cholesterol, low-density lipoproteins and triglycerides. Increased or high levels of cholesterol in the blood - hypercholesterolemia

Slide 19

Left ventricular hypertrophy

Left ventricular hypertrophy is a strong independent risk factor for sudden death, myocardial infarction, stroke, and other cardiovascular complications. Research data indicate the possibility of reducing the mass of the left ventricular myocardium and reducing the thickness of its walls while taking antihypertensive drugs. Regression of electrocardiographic signs of left ventricular hypertrophy is associated with a reduced risk of cardiovascular complications

Slide 20

AH and ischemic heart disease

The presence of ischemic heart disease in a patient with hypertension indicates a very high risk cardiovascular complications, which is directly proportional to blood pressure levels. It has been established that beta-blockers in patients who have had a myocardial infarction reduce the risk of recurrent heart attack and cardiac death by approximately 25%.

Slide 21

Hypertension and kidney diseases

With the proven possibility of significantly reducing the incidence of strokes and coronary artery disease in the treatment of hypertension, a new problem has emerged in the form of an increase in the incidence of renal failure in patients with hypertension, including those receiving treatment. Hypertension can be both a cause and a consequence of nephropathy. However, in any case, it is the main risk factor for the progression of kidney damage. On the other hand, creatinine and proteinuria levels predict the development of not only renal failure, but also major cardiovascular complications. The risk of developing cardiovascular complications in the presence of nephropathy is comparable to that in cardiovascular diseases. It has been proven that normalization of blood pressure leads to a slowdown in the progression of kidney damage.

Slide 22

Hypertension and diabetes mellitus

Hypertension is more common in type II diabetes mellitus. Presumably, hypertension and carbohydrate metabolism disorders are pathogenetically interrelated and are a consequence of insulin resistance-hyperinsulinemia. The combination of carbohydrate metabolism disorders, hypertension, dyslipidemia and central obesity is known as metabolic syndrome. The combination of diabetes mellitus and hypertension increases the risk of developing microvascular and macrovascular disorders and, accordingly, cardiac death, coronary artery disease, heart failure, cerebral complications and peripheral vascular diseases.

Slide 23

Hypertensive crisis

Clinical manifestations Sudden increase in systolic and diastolic blood pressure Fear, headaches Pain in the heart area Nausea, dizziness Sometimes convulsions, vomiting, agitation Necessary measures before the doctor arrives Rest, reclining position. Clonidine-0.075-0.15 mg. Under the tongue. Or Captopril 25-50 mg under the tongue. Or Cordaflex 10-20 mg sublingually

Slide 24

The goal of treatment for patients with hypertension is to maximally reduce the overall risk of cardiovascular morbidity and mortality, which involves not only lowering blood pressure, but also correcting all identified risk factors. The goal of treatment is to achieve optimal or normal indicators blood pressure (

Slide 25

Combinations with proven effectiveness for the treatment of arterial hypertension

diuretic + beta-blocker diuretic + ACE inhibitor diuretic + angiotensin II receptor antagonist calcium antagonist of the nifedipine group + beta-blocker calcium antagonist + ACE inhibitor alpha1-blocker + beta-blocker An effective combination of drugs involves the use of drugs from different classes with different mechanisms of action for the purpose obtaining additional hypotensive effect and reducing adverse events.

Slide 26

Choice of antihypertensive drug

Completed randomized trials have not revealed any benefit of any class of antihypertensive drugs in terms of the degree of blood pressure reduction. The main criterion for choosing a drug is its ability to reduce cardiovascular morbidity and mortality while maintaining a good quality of life. Controlled clinical trials– basis evidence-based medicine- testify in this regard to the undeniable advantages of b-blockers and diuretics.

Slide 27

Advantages of using BB in the treatment of hypertension

In patients with hypertension, BB therapy leads to a significant reduction in the risk of stroke (29%) and congestive heart failure (42%)

Slide 28

The main mechanisms of the hypotensive effect of beta blockers

Decreased cardiac output as a result of decreased heart rate and myocardial contractility Antirenin action (blockade of beta-1 receptors of the juxtaglomerular apparatus of the kidneys) Changes in the sensitivity of the baroreceptors of the aortic arch and carotid sinus Inhibition of the release of norepinephrine from the endings of postganglionic sympathetic nerve fibers Effects on the vasomotor centers in the brain Decreased peripheral vascular resistance

Slide 29

Requirements for a modern cardiovascular drug

High efficiency, influence on end points Modernity, compliance with international standards Safety during long-term use Impact on the quality of life - patient adherence to therapy Ease of use Accessibility for patients

Slide 30

Concor for doctors

Efficiency Reliability Safety Cost-effectiveness Convenience Availability PARAMETERS

Slide 31

EFFICIENCY OF CONCOR.

Concor (5-10 mg once a day) also provides a long-term dose-dependent reduction in blood pressure (Kirsten R, et al, 1986). Even 40 hours after taking 10 mg of Concor on the 4th week of treatment, when monitoring blood pressure, a significant decrease in blood pressure and heart rate was observed (Asmar R., 1987). A smooth decrease in blood pressure throughout the day, including in the early morning hours: the final effect/peak effect coefficient for Concor is 91.2, which indicates a pronounced and uniform hypotensive effect (Keim HJ, 1988; Metelitsa V.I., 1995) . Concor can be used for a long time without reducing effectiveness: in a study by Giesecke HG et al (1990), 102 patients with arterial hypertension were observed for 3 years. In 85% of patients, blood pressure was adequately controlled when taking 5-10 mg of Concor. The antihypertensive effectiveness of Concor does not depend on age: a study conducted by Hoffler D et al (1990) included 2012 patients. After 8 weeks of treatment, 94.9% of patients under 60 years of age and 90.6% of patients over 60 years of age responded to Concor therapy at a dose of 5-10 mg. Concor causes regression of myocardial hypertrophy (Gosse P., 1990)

Slide 32

Concor safety

High selectivity ensures the safety of Concor in patients with diabetes mellitus peripheral circulatory disorders lipid metabolism disorders smokers patients with broncho-obstruction Long half-life causes the absence of withdrawal syndrome Safe in patients with impaired liver and kidney function

Slide 33

Old age

Although it is believed that the risk of complications during therapy with b-blockers increases with age, formally advanced age is not an obstacle to their use; b-blockers remain effective in patients even of the most advanced age. Thus, in the CCP study, the mortality rate of patients over 80 years of age who received b-blockers in the post-infarction period was 32% less than in patients of the same age who did not receive this therapy

Slide 34

Reliability

determined by a high percentage of patients “responding” to Concor therapy.

Slide 35

Double-blind crossover placebo-controlled study on the effect of Concor (bisoprolol) on sexual function in men 26 patients with hypertension aged 25-70 years, divided into 2 groups Absence of any pathology that impairs sexual function Blood pressure control Questionnaire assessing quality and quantitative indicators of sexual life (including sexual history, satisfaction with sexual function, erectile dysfunction) Broekman C.P., et al., 1990 Concor and arterial hypertension: impact on sexual function in men

Slide 36

Convenient use of Concor for patients The long half-life allows the drug to be used once a day. Used regardless of food intake. Does not require special storage conditions. The tablet can be divided into parts, which facilitates the dosing regimen. The memorable shape of the tablet is in the shape of a heart.

Slide 37

Ease of use of Concor for doctors No dosage adjustment required for elderly patients No dosage adjustment required for impaired liver and kidney function Combined with most antihypertensive drugs Prescribed to a wide group of patients: smokers with concomitant diabetes mellitus, dyslipidemia, peripheral circulatory disorders, broncho-obstruction concor

Slide 38

Economical

Average price in Moscow pharmacies Concor 5 mg No. 30 180 rubles (up to 230 rubles) Concor 10 mg No. 30 280 rubles (up to 320 rubles) Of the popular beta blockers, the price is comparable to the original drugs: Betaloc and Lokren; The cost of treatment with Dilatrend is much more expensive.

Slide 39

Concor saves lives and reduces hospitalization costs 20 patients must be treated with Concor to save one life Concor prevented 60 hospitalizations per 1000 patients per 1000 patients with CHF treated with Concor, 50 lives were saved In the CIBIS II study

Slide 40

Concor Diet Physical Education + Collaboration with a doctor! Recommended: 1.Hypertension Diagnosis and what does “COMMONWEALTH” mean? Doctor,

Slide 41

Main Objectives of the school Teaching patients methods of self-control Changing behavioral habits that affect the course of the disease Acquiring skills for patients to manage drug therapy Forming a new attitude towards the disease in the patient, transferring part of the responsibility for treatment to themselves Creating partnerships between the patient and medical staff that increase the patient’s level of trust in doctor’s recommendations and motivation to implement them

Slide 42

School equipment Class room Tables and chairs, for a group of 6-8 people Blackboard A set of visual aids (posters, dummies, means of administering drugs, etc.) Monitoring equipment for each disease (pressure measuring devices) Teaching materials for patients ( diaries, memos, etc.)

Slide 1

Hypertension and its complications from the perspective of a general practitioner

Scientific supervisor: I.N. Bobrovsky Compiled by: Yu.N. Fefelova, I.A. Cherkasov, O.R. Hasanli

State General Educational Institution of Higher Professional Education Stavropol State Medical Academy of the Ministry of Health and Social Development of Russia Department of Public Health, Health Care Management, Economics and Social Work

Slide 2

Hypertension is a disease the main symptom of which is an increase in blood pressure caused by dysregulation of vascular tone and heart function. There are two types of this disease: -primary -secondary Primary essential or arterial hypertension is an increase in blood pressure only with hypertension. Secondary arterial hypertension is often a symptom of latent inflammation of the kidneys or damage to the renal vessels.

Slide 3

The main complications that arise from hypertension: -Cerebral stroke -Myocardial infarction -Ischemic heart disease -Angina pectoris -Arrhythmia -Arterial hypertension -Hypertensive crisis -Atherosclerosis -Atrioventricular block -Heart failure -Spinal stroke

Slide 4

The main risk factors are: - high levels of cholesterol in the blood - obesity - smoking - degree of increase in blood pressure - stress - physical inactivity - alcohol - diabetes mellitus - overweight - harmful occupational factors

Slide 5

The first symptoms: - weakness - headache - fatigue - sleep disturbance

Symptoms of complications: - dizziness - nausea - vomiting - heart pain - shortness of breath

Slide 6

Stages of the disease, symptoms During hypertension, three stages are distinguished: I - stage of functional changes. During this period, patients are worried about weakness, headache, fatigue, and sleep disturbances. High blood pressure does not remain constant and normalizes under the influence of rest and sedatives. No changes in internal organs were detected. II - stage of initial organic changes. Blood pressure is elevated; to reduce it, the use of special hypothetical drugs is required. Hypertensive crises may occur. The course of atherosclerosis worsens, coronary disease heart, damage to the kidneys, eyes and other organs appears. The left ventricle of the heart enlarges. III - stage of pronounced organic changes. Blood pressure is persistently elevated. Complications may occur, such as myocardial infarction, cerebral stroke, heart failure, and blindness.

Slide 7

Diagnostics: - medical history - objective examination - laboratory and instrumental studies Treatment is based on various methods: - Medication - Surgical

Slide 3.

The term"arterial hypertension" or "arterial hypertension" called an increase in blood pressure compared to generally accepted norms. Arterial hypertension is a syndrome characteristic of hypertension and symptomatic arterial hypertension accompanying other diseases.

Hypertension is a primary independent disease characterized by increased blood pressure (essential hypertension).

So-called symptomatic hypertension should be distinguished from hypertension, when hypertension is only a symptom of some other disease, for example, inflammation of the kidneys, certain diseases of the endocrine glands, etc.

Hypertension (essential or primary arterial hypertension) is a disease the leading symptom of which is a tendency to increase blood pressure, not associated with any known disease of the internal organs. Hypertension accounts for 90-95% of all cases of arterial hypertension in humans, while secondary (symptomatic) arterial hypertension accounts for only 5-10%.

Arterial hypertension (AH, Hypertension) - a persistent increase in blood pressure from 140/90 mm Hg. and higher.

The word “hypertension” refers to persistently elevated blood pressure. An increase in blood pressure occurs when there is a narrowing of the arteries and/or their smaller branches, the arterioles. Arteries are the main transport routes through which blood is delivered to all tissues of the body. In some people, the arterioles often narrow, first due to spasm, and later their lumen remains constantly narrowed due to thickening of the wall, and then, in order for the blood flow to overcome these narrowings, the work of the heart increases and more blood is released into the vascular bed. Such people, as a rule, develop hypertension.

Slide 4.

Manifestations of hypertension do not have specific symptoms. Complaints with hypertension arise when the so-called target organs are affected; these are the organs that are most sensitive to increases in blood pressure. The patient experiences dizziness, headaches, noise in the head, decreased memory and performance indicate initial changes in cerebral circulation. This is then followed by double vision, flickering spots, weakness, numbness of the limbs, and difficulty speaking.

Slide 5.

An advanced stage of arterial hypertension can be complicated by cerebral infarction or cerebral hemorrhage. The earliest and most permanent sign of constantly elevated blood pressure is an increase, or hypertrophy, of the left ventricle of the heart, with an increase in its mass due to the thickening of heart cells, cardiomyocytes.

Slide 6.

The appearance of left ventricular hypertrophy significantly increases the risk of sudden death, coronary artery disease, heart failure, and ventricular arrhythmias. Progressive dysfunction of the left ventricle leads to the appearance of symptoms such as: shortness of breath on exertion, paroxysmal nocturnal shortness of breath (cardiac asthma), pulmonary edema (often during crises), chronic (congestive) heart failure. Against this background, myocardial infarction and ventricular fibrillation develop more often.

Slide 7.

Manifestations:

1. Headache. It feels like heaviness or fullness in the back of the head and can affect other areas of the head. Typically, patients describe headaches due to arterial hypertension as a feeling of a “hoop.” Sometimes the pain intensifies with a strong cough, tilting the head, straining, and may be accompanied by slight swelling of the eyelids and face.

2. Pain in the heart area with arterial hypertension differs from typical angina attacks:

localized in the area of ​​the apex of the heart or to the left of the sternum;

occur at rest or during emotional stress;

usually not provoked by physical activity;

last long enough (minutes, hours);

are not relieved by nitroglycerin.

3. Shortness of breath.

4. Swelling of the legs.

5. Visual impairment. Often, when blood pressure rises, fog, a veil or flickering “flies” appear before the eyes. These symptoms are mainly associated with functional circulatory disorders in the retina. Severe changes in the retina (vascular thrombosis, hemorrhages, retinal detachment) can be accompanied by a significant decrease in vision, double vision (diplopia) and even complete loss of vision.

Slide 8.

Risk factors for arterial hypertension.

1. Non-modifiable (unchangeable) risk factors include:

Heredity - people who have relatives with hypertension are most predisposed to developing this pathology.

Male gender – it has been established that the incidence of arterial hypertension in men is significantly higher than the incidence in women. Female sex hormones, estrogens, prevent the development of hypertension. But when menopause arrives, the saving effect of estrogens ends and women become equal in morbidity to men and often overtake them.

Age – men over 55 years old, women over 65 years old.

Slide 9.

2. Modifiable (changeable) risk factors include:

Increased body weight

Sedentary lifestyle

Alcohol consumption

Eating a lot of salt for food – you can consume 4.5 g or a level teaspoon per day.

An unbalanced diet with an excess of atherogenic lipids (creating atherosclerosis - found in large quantities in all animal fats, meat, especially pork and lamb), excess calories, leading to obesity and contributing to the progression of type II diabetes.

Smoking– nicotine creates a spasm of the arteries, which, when consolidated, leads to stiffness of the arteries, which entails an increase in pressure in the vessels.

Stress– lead to activation of the sympathetic nervous system, which functions as an instant activator of all body systems, including the cardiovascular system. In addition, pressor hormones, i.e., those that cause spasm of the arteries, are released into the blood.

Severe sleep disturbances such as sleep apnea syndrome, or snoring. Snoring causes increased pressure in the chest and abdominal cavity. All this is reflected in the blood vessels, leading to their spasm. Arterial hypertension develops.

Diabetes mellitus.

Arterial hypertension in combination with diseases of the adrenal glands, thyroid gland, kidneys, diabetes mellitus, atherosclerosis, obesity, chronic infections (tonsillitis) contribute to the development of hypertension and mutually support each other.

The cause of the disease remains unknown in 90-95% of patients - it is essential (that is, primary) arterial hypertension. In 5-10% of cases, increased blood pressure has an established cause - it is symptomatic (or secondary) hypertension.

Causes of symptomatic (secondary) arterial hypertension:

primary kidney damage (glomerulonephritis) - the most common reason secondary arterial hypertension.

unilateral or bilateral narrowing (stenosis) of the renal arteries.

coarctation (congenital narrowing) of the aorta.

pheochromocytoma (tumor of the adrenal glands that produces adrenaline and norepinephrine).

hyperaldosteronism (tumor of the adrenal gland that produces aldosterone).

thyrotoxicosis (increased thyroid function).

consumption of ethanol (wine alcohol) more than 60 ml per day.

medications: hormonal drugs (including oral contraceptives), antidepressants, cocaine and others.

Slide 10.

Determination of the stage of hypertension according to the degree of target organ damage

GB I stages: assumes no changes in target organs.

Occurs with signs of hyperadrenergy. This is juvenile hypertension, with a predominance of the sympatho-adrenal mechanism (unpleasant sensations in the heart, irradiation to the shoulder and forearm, palpitations, hyperemia of the face and sclera, pulsation in the head, sweating, chills, feelings of fear and internal tension). There are no objective signs of organic organ damage - there is no hypertrophy of the left ventricle of the heart, changes in the fundus (or they are minimal and inconsistent), kidney function is normal, hypertensive crises are rare. Diastolic pressure at rest ranges from 95 to 104 mm Hg, systolic pressure - from 160 to 179 mm Hg. Art., the pressure is labile, changes during the day, normalization is possible during rest.

GB II stages: suggests the presence of one or more changes in target organs.

Characterized by fluid retention, kidney damage (swelling of the eyelids, puffiness of the face, numbness of the fingers, headaches in the occipital and frontal areas, nosebleeds, rare urination). Left ventricular hypertrophy (proven by physical, radiological, echocardiographic, ECG examination), changes in the fundus from type 1-2 to type 3; urine tests without significant changes, renal blood flow and glomerular filtration rate are reduced, radioisotope renograms reveal signs of a diffuse bilateral decrease in renal function. From the central nervous system - various manifestations of vascular insufficiency, transient ischemia. Diastolic pressure at rest ranges from 10-114 mmHg. Art., systolic reaches 180-200 mm Hg. Art. Outside the treatment period, hypertension is quite stable, hypertensive crises are typical.

GB III stages: signs of target organ damage appear due to the damaging effects of hypertension.

Characterized by a sustained increase in blood pressure. Systolic blood pressure reaches 200-230 mm Hg. Art., diastolic – 115-129. However, at this stage, blood pressure may spontaneously decrease, in some cases quite significantly, reaching a lower level than inIIstages. The condition of a sharp decrease in systolic blood pressure in combination with increased diastolic blood pressure is called “decapitated” hypertension. It is caused by a decrease in the contractile function of the myocardium. If atherosclerosis of large vessels is added to this, then the level of diastolic blood pressure decreases.

OnIIIstage of hypertension, hypertensive crises often occur, accompanied by cerebrovascular accident, paresis and paralysis. But the vessels of the kidneys undergo especially significant changes, resulting in the development of arteriolohyalinosis, aretriolosclerosis and, as a consequence, the formation of a primary wrinkled kidney, which leads to chronic renal failure.

More often inIIIstage, cardiac or cerebral pathology predominates, which leads to death before chronic renal failure develops.

The clinical picture of heart damage is angina pectoris, myocardial infarction, arrhythmia, circulatory failure.

Cerebral lesions - ischemic and hemorrhagic infarctions, encephalopathy.

As for changes in the fundus of the eye, its examination reveals the “silver wire” symptom, sometimes acute retinal ischemia with loss of vision (this severe complication can occur as a result of vasospasm, thrombosis, embolism), swelling of the optic nerve nipples, retinal edema and its detachment, hemorrhages

Slide 13.

Degree of arterial hypertension.

Classification of blood pressure levels (mmHg)

Slide 14.

Consequences of arterial hypertension.

Many people have asymptomatic hypertension. However, if arterial hypertension is not treated, it is fraught with serious complications. One of the most important manifestations of hypertension is damage to target organs, which include:

Heart(left ventricular myocardial hypertrophy, myocardial infarction, development of heart failure);

brain(dyscirculatory encephalopathy, hemorrhagic and ischemic strokes, transient ischemic attack);

kidneys(nephrosclerosis, renal failure);

vessels(dissecting aortic aneurysm, etc.)$

retina of the eye.

The most significant complications of arterial hypertension include

hypertensive crises (sudden increase in blood pressure, accompanied by a significant deterioration in cerebral, coronary, and renal circulation, which significantly increases the risk of severe cardiovascular complications: stroke, myocardial infarction, subarachnoid hemorrhage, dissection of the aortic wall, pulmonary edema, acute renal failure)

cerebrovascular accidents (hemorrhagic or ischemic strokes),

myocardial infarction,

nephrosclerosis (primarily shriveled kidney),

heart failure,

dissecting aortic aneurysm.

Forblood pressure measurements The following conditions apply:

Patient position:

Sitting in a comfortable position; hand on the table;

The cuff is placed on the shoulder heart level, its lower edge is 2 cm above the elbow.

Circumstances:

Avoid drinking coffee and strong tea within 1 hour before the test;

do not smoke for 30 minutes before measuring blood pressure;

discontinuation of sympathomimetics (medicines that increase blood pressure), including nasal and eye drops;

Blood pressure is measured at rest after a 5-minute rest. If the procedure for measuring blood pressure was preceded by significant physical or emotional stress, the rest period should be increased to 15-30 minutes.

Equipment:

The size of the cuff must correspond to the size of the arm: the rubber inflated part of the cuff must cover at least 80% of the circumference of the arm; for adults, a cuff 12-13 cm wide and 30-35 cm long (average size) is used;

The mercury column or tonometer needle must be at zero before starting the measurement.

Measurement ratio:

to assess the blood pressure level in each arm, at least two measurements should be taken, with an interval of at least a minute; with a difference ≥ 5 mm Hg. make 1 additional measurement; the final (recorded) value is taken to be the average of the last two measurements;

To diagnose the disease, at least 2 measurements must be taken with a difference of at least a week.

Measuring technique:

quickly inflate the cuff to a pressure level of 20 mm Hg. exceeding systolic (upper) blood pressure (by disappearance of the pulse);

blood pressure is measured with an accuracy of 2 mm Hg. Art.

reduce the pressure in the cuff by 2 mm Hg. per second.

the pressure level at which the first sound appears corresponds to systolic (upper) blood pressure;

the pressure level at which sounds disappear - diastolic blood pressure;

if the tones are very weak, then you should raise your hand and perform several squeezing movements with the brush; then the measurement is repeated; you should not strongly compress the artery with the membrane of the phonendoscope;

The first time you should measure the pressure on both arms. Subsequent measurements are made on the arm where the blood pressure level is higher;

It is advisable to measure pressure in the legs, especially in patients< 30 лет; измерять артериальное давление на ногах желательно с помощью широкой манжеты (той же, что и у лиц с ожирением); фонендоскоп располагается в подколенной ямке.

Slide 15.

Factors influencing the prognosis of hypertension The risk of developing cardiovascular complications in patients with hypertension depends not only on blood pressure levels, but also on existing concomitant risk factors, target organ damage, and the presence of associated clinical conditions. Blood pressure level has lost its dominant role in choosing treatment tactics.

Stratification of patients according to risk level makes it possible to qualitatively assess the individual prognosis (the higher the risk, the worse the prognosis) and to identify groups for preferential socio-medical support.

Clinical manifestations of cardiovascular disease and end-organ damage are considered stronger prognostic factors than traditional risk factors.

Slide 20.

Determining the degree of risk.

The diagnosis made to the patient reflects the degree, stage and risk group for developing life-threatening complications. For example: AGIIIdegreesIIstage, risk 2, stage 2.

Slide 22.

Renin-angiotensin system(renin-angiotensin-aldosterone system) is a hormonal system that regulates blood pressure and blood volume in the body.

Sodium deficiency + decreased blood supply; decrease in blood pressure release of renin from the juxtaglomerular apparatus angiotensinogen

AngiotensinI

AngiotensinII

Vasospasm, water retention, vasoconstriction (narrowing of blood vessels)

AndNa + , increases blood pressure, synthesis

aldosterone, vasopressin

catecholamines

Slide 23.

Examination of patients with suspected hypertension has the following goals: to confirm a stable increase in blood pressure, exclude secondary arterial hypertension, identify the presence and degree of damage to target organs, assess the stage of arterial hypertension and the degree of risk of complications.

When collecting anamnesis, special attention is paid to the patient’s exposure to risk factors for hypertension, complaints, level of increase in blood pressure, the presence of hypertensive crises and concomitant diseases.

Slide 24.

The following studies should be performed in all patients with arterial hypertension:

general blood and urine analysis;

blood creatinine level(to exclude kidney damage);

blood potassium level without taking diuretics(a sharp decrease in potassium levels is suspicious for the presence of an adrenal tumor or renal artery stenosis);

electrocardiogram(signs of left ventricular hypertrophy are evidence of a long course of arterial hypertension);

determination of blood glucose levels(on an empty stomach);

echocardiography(determining the degree of left ventricular myocardial hypertrophy and the state of cardiac contractility)

fundus examination.

chest x-ray;

Ultrasound of the kidneys and adrenal glands;

Ultrasound of the brachiocephalic and renal arteries;

Serum C-reactive protein;

urine analysis for the presence of bacteria (bacteriuria), quantitative assessment of protein in the urine (proteinuria);

determination of microalbumin in urine (required in the presence of diabetes mellitus).

Slide 27.

Treatment of arterial hypertension.

The main goal of treating patients with arterial hypertension is to minimize the risk of developing cardiovascular complications and death from them. This is achieved through long-term lifelong therapy aimed at:

reducing blood pressure to normal levels(below 140/90 mmHg). When arterial hypertension is combined with diabetes mellitus or kidney damage, it is recommended to lower blood pressure< 130/80 мм рт.ст. (но не ниже 110/70 мм рт.ст.);

“protection” of target organs (brain, heart, kidneys), preventing their further damage;

active influence on unfavorable risk factors (obesity, hyperlipidemia, carbohydrate metabolism disorders, excess salt intake, physical inactivity) that contribute to the progression of arterial hypertension and the development of its complications.

Slide 28.

Basic principles drug therapy arterial hypertension:

Drug treatment should begin with minimal doses of any class of antihypertensive drugs and gradually increase the dose; the drug should provide a stable effect throughout the day and be well tolerated by the patient; it is most advisable to use long-acting drugs to achieve a 24-hour effect with a single dose; if monotherapy is ineffective, it is advisable to use optimal combinations of drugs; long-term (almost lifelong) use should be carried out medicines to maintain optimal blood pressure levels and prevent complications of arterial hypertension.

Currently, seven classes of drugs are recommended for the treatment of arterial hypertension:

1. diuretics;

2. b-blockers;

3. calcium antagonists;

4. angiotensin-converting enzyme inhibitors;

5. angiotensin receptor blockers;

6. imidazoline receptor agonists;

7. α-blockers.