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in Moscow. Arterial hypertension – lifelong use of the drug? Consultations with specialists, manipulations and operations in an international multidisciplinary health clinic
Arterial hypertension – lifelong use of the drug?
Probably the majority of patients seen by a cardiologist are patients with high blood pressure – arterial hypertension (AH). Some of them suffer from high blood pressure for the first time due to a stressful situation, others take medications for a long time, but, as a rule, few have a complete understanding of their disease and, most importantly, how to live with it correctly and effectively.
Blood pressure in a healthy person changes throughout the day depending on the level of stress (physical, mental, etc.), but in general these fluctuations do not exceed the so-called physiological norm that supports the normal functioning of the body. For adults, blood pressure is considered normal and is no more than 140/90 mm Hg. art. In some cases, for example, in the presence of diabetes and kidney disease, the pressure should be lower at the level of 130/80 – 120/70 mm Hg. art. Which helps prevent the development of these diseases and the development of their complications. The state of the nervous and cardiovascular systems plays an important role in maintaining blood pressure within optimal limits. In case of high blood pressure, the heart works overtime and pumps extra blood. Over time, this leads to increased vascular resistance, which constricts under conditions of sustained overload. The walls of the arteries become thicker, harden, and lose their elasticity. With long-term hypertension, the load on blood vessels becomes unbearable, which can lead to degenerative changes in their wall, with the development of pathological narrowing or expansion, and even rupture of the blood vessel. If these complications occur in a vital organ (heart, brain), they may lead to myocardial infarction or cerebral hemorrhage (stroke). But despite this risk, the danger of high blood pressure is that it can remain completely asymptomatic for a long time.
High blood pressure is usually not diagnosed after one blood pressure measurement, unless the readings are very high, for example, more than 170-180/105-110 mm Hg. art. A series of measurements are usually made over a period of time to completely eliminate random fluctuations and inaccuracies. It is also necessary to take into account the conditions under which blood pressure measurements are performed. As a rule, blood pressure rises under stress, after drinking strong coffee or smoking a cigarette.
About one-third of the adult population has persistently high blood pressure above 140/90 mm Hg. 2/3 of those suffering from high blood pressure do not know about their disease, and those who know often do not attach due importance to it (especially if the numbers are not very high, about 160/100 mm Hg), so headache and heart pain will not occur Shortness of breath, irregular heartbeat, and swelling.
An interesting fact is that in a doctor’s office, when measuring blood pressure, the readings can be higher than while resting at home. This effect is called “white coat hypertension” and results from the patient’s fear of the disease or the doctor. In addition to measuring blood pressure, the doctor usually checks for changes in other organs, especially if the pressure readings are at high levels.
If an adult’s blood pressure does not exceed 140/90 mm. g. art. Remeasurement is then usually performed no later than one year later. In patients whose blood pressure is between 140/90 and 160/100, repeat measurements are performed after a short period of time to confirm the diagnosis.
High (lower) diastolic pressure, such as 110 or 115 mm Hg. Indicates the need for immediate treatment.
High blood pressure is one of the most common diseases. In developed countries, 10% of the adult population and about 60% of people over 65 years of age have high blood pressure. Unfortunately, more than 30% of these people do not know about their disease, receive treatment regularly and follow the doctor’s recommendations. Unlike a number of diseases that you can “overcome”, hypertension, as a rule, is a chronic, lifelong condition.
Arterial hypertension is often primary in nature and is a symptom of hypertension. In less common cases, high blood pressure is secondary and is a sign of diseases of various organs (kidneys, blood vessels, etc.). Each of these diseases requires special treatment, which is why any increase in blood pressure requires consultation with a cardiologist.
In older people, a special type of high blood pressure sometimes occurs, called “isolated systolic hypertension.” In this case, systolic pressure indicators are equal to or exceed 140 mm Hg. Diastolic pressure remains below 90 mm Hg. This type of high blood pressure is a serious risk factor for developing strokes and heart failure. Often, patients seek help only when the diastolic pressure becomes, in their opinion, too low – 50-60 mm Hg. art. Sometimes it can be a sign of heart disease, but more often it is associated with age-related changes in the wall of blood vessels, and it is very important to find medications that will reduce the gap between systolic and diastolic pressure, which in turn will reduce the risk of stroke. And heart failure.
In cases where routine and dietary measures do not allow adequate control of blood pressure, additional (not instead) medications are prescribed. Today their list is very impressive. Often, when a patient seeks help with complaints of high blood pressure despite taking prescribed medications, you can see that the medications are correctly selected and suitable for the patient for long-term use, but their doses are insufficient. In cardiology, there is the concept of an effective dose – that is, the dose that can be relied upon to produce the desired effect. And if you take the same drug in two or four halves, and not just 2, but once a day, and often not even every day, then there is no need to talk about any antihypertensive effect, let alone therapeutic effect, of the drug. When prescribing one or more medications, the cardiologist takes into account the level of blood pressure, the severity of hypertension, the daily blood pressure profile of the individual, the main risk factors or causes of arterial hypertension, the severity of damage to target organs, the presence of comorbidities, and the interaction of drugs with each other. Some and with other medications taken, and the possibility of side effects. Therefore, it is absolutely unacceptable for the patient to change the doctor’s prescriptions, medication doses, the frequency of taking it, or stop taking one or another medication on his own. If, when taking the prescribed group of antihypertensive drugs, the patient notices the occurrence of any side effects, the pressure does not decrease or, on the contrary, decreases excessively, it is necessary to discuss this with the attending physician, who, having understood the reasons, Your prescriptions will be adjusted.
The patient’s role in the treatment of arterial hypertension cannot be underestimated. The effectiveness of treatment measures largely depends on the extent of his readiness, in accordance with the doctor’s recommendations, to effectively and persistently fight risk factors and eliminate them if possible. Dealing with risk factors means quitting smoking, limiting alcohol consumption, taking recommended medications regularly and monitoring their effect on blood pressure by recording measurements in a special diary
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