Classification of Arterial Hypertension (AH)

To prevent disability due to grade 3 hypertension, a significant damage to the arteries, special antihypertensive drugs used in the treatment are used as monotherapy:

  • diuretics;
  • vasodilators;
  • calcium channel blockers;
  • β-blockers;
  • α-blockers;
  • ACE inhibitors;
  • AT1 antagonists.

In the primary prevention of grade 3 hypertension, it is important to achieve ideal body weight, reduce calorie and fat intake, and limit excessive sodium and alcohol consumption (gt; 30 g/day) increased physical aerobic activity. At the same time, other risk factors, such as smoking, are eliminated.

Secondary prevention of grade 3 disease consists in the early detection of existing arterial hypertension (about ⅓ patients do not know about their disease). This can be achieved by measuring blood pressure at each doctor’s visit, compiling a medical history in high-risk groups (family history of hypertension, patients with diabetes mellitus).

The prognosis of grade 3 hypertension is associated with the course of the disease itself and the development of changes in organs, vascular complications. These include:

  • heart failure;
  • myocardial infarction;
  • a stroke of thrombotic or hemorrhagic etiology;
  • renal failure (premature or accelerated atherosclerosis of the renal artery, nephrosclerosis, etc.).

Effective control of high blood pressure is the main requirement for a favorable effect on the prognosis of the disease. The main problems of successful control include, in addition to the search for vulnerable and sick people, the problems of their long-term monitoring and continuous effective treatment.

In case of hypertension, prevention is the best treatment option. There are a number of principles that must be followed to prevent disease.

a)
reception
GCS (patients with bronchial asthma,
rheumatological diseases and
other)

b)
NSAIDs (patients with rheumatologic,
nervous diseases)

at)
taking sympathomimetics (patients with
bronchial asthma when taken
anorexants to reduce appetite
for weight loss)

d)
intake of MAO inhibitors and tricyclic
antidepressants in patients with diseases
CNS

d)
taking oral contraceptives

f)
the use of alcohol, cocaine, etc.

6.
Combined arterial hypertension:
diabetic
chronic glomerulosclerosis
pyeloneuritis, aortic atherosclerosis
renal artery atherosclerosis, etc.

1)
onset before age 20 and after 50-55
years

3)
target organ damage (retinopathy
grade 2 and above serum creatinine
more than 0,15 mg/l, left hypertrophy
ventricle or cardiomegaly according to
Echo-KG)

4)
inefficiency combined (three-
or even four-component)
antihypertensive therapy

5)
exacerbation
AH, initially treatable

6)
anamnestic, physical and
laboratory data indicating
SAG (OGN;
suspicious crises
pheochromocytoma; eyeball and enlargement
thyroid gland with toxic goiter,
changes in urine tests, etc.)

1.chronic
glomerulonephritis:
young age of patients; disease link
with streptococcal or viral
infection, hypothermia; change
the color of urine such as “meat slops” in
medical history; the presence of edema; in analyzes
urine proteinuria, often 
1 g/l, erythrocyturia, cylindruria; at
the presence of chronic renal failure – an increase in
blood urea, creatinine;

2.chronic
pyelonephritis:
more often in women; the relationship of the disease with pregnancy,
gynecological diseases
hypothermia, urolithiasis,
kidney abnormalities; in the clinical picture
– fever, chills,
dysuric phenomena, turbid urine, pain
lower back pain on palpation
kidney;

3. diabetic
glomerulosclerosis:
long experience of diabetes;
inadequate treatment of diabetes; edema syndrome
hypoproteinemia, proteinuria, cylindruria;
rapid increase in chronic renal failure

4.polycystic
kidney:
average age of patients; weighed down
family history; palpation of the abdominal
cavities are determined by large tuberous
kidneys typical picture of numerous
cysts on sonogram, intravenous
urogram, angiogram

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5.
stenosis
renal artery:
young women (fibromuscular
dysplasia), older men
(atherosclerotic stenosis); heavy
often malignant hypertension; in 40% of patients
systolic murmur is heard around
the navel and in the lateral abdomen;
missing or minimal changes
in urine tests; on RWG there is a decrease
vascular segment with the affected
parties; blood flow acceleration and deceleration
reaching peak speed at
Doppler spectrography of renal blood flow
arteries on the affected side

Limitation
salt and protein intake (especially with
diabetic glomerulosclerosis and chronic renal failure)
loop diuretics (especially with chronic renal failure)

no effect 
calcium antagonists (nifedipine,
isradipine, amlodipine) 
no effect 
ACE inhibitors (especially indicated for
diabetic glomerulosclerosis, as
slow down further progression
kidney damage in diabetes;

contraindicated
with bilateral renal stenosis
arteries or renal artery stenosis
single kidney, as in these cases
lead to a sharp decrease in GFR) 
no effect 
-blocker
(prazosin) or -, -
blocker (labetalol) 
no effect 
potassium channel activator, direct
minoxidil vasodilator 10-25 mg/day
2 doses (reserve drug for treatment
severe hypertension)

1.
Renal Reconstructive Surgery
arteries (balloon angioplasty,
resection of stenosis and anastomosis
end to end, endarterioectomy,
aortic-renal bypass grafting)

2.
Unilateral wrinkling nephrectomy
one of the kidneys, impossibility
reconstructive kidney surgery
vessel with unilateral lesion

3.
Bilateral nephrectomy with bilateral
defeat with a terminal stage of chronic renal failure
and malignant course of hypertension followed by
hemodialysis and donor transplantation
kidneys

1.
disease
(pituitary adenoma, excessively producing
ACTH causing adrenal hyperplasia
and the release of an increased amount of corticosteroids in
blood) and syndrome
(corticosteroma, corticoblastoma –
tumors of the adrenal cortex causing
increased secretion of corticosteroids into the blood)
Itsenko-Cushing:
obesity of the upper half of the body,
moon face;

striae on the stomach
hips hirsutism, dry skin,
multiple acne; dystrophy of the nail
phalanx; steroid ulcers; polycythemia;
bone pain due to osteoporosis;
secondary diabetes; sexual dysfunction
systems; daily excretion of free
urinary cortisol 
100 mcg; CT imaging
brain or adrenal gland

Treatment:
surgical (transfenoidal
pituitary adenoma removal, adrenalectomy,
adrenal destruction
ethanol); gamma irradiation of the pituitary gland;
adjuvant therapy therapy: parlodel
and peritol (reduce the secretion of corticotropic
hormones); chloditan, aminoglutethimide and
ketoconazole (block steroidogenesis
in the adrenal glands).

2. pheochromocytoma
(hormone tumor from mature
cells of the chromaffin tissue of the brain
layer of the adrenal gland causing excessive
secretion of adrenaline, norepinephrine and
dopamine, less often – a paraganglia tumor
aorta, sympathetic nerve nodes and
plexuses) – periodic emission
catecholamines in the blood 
sudden, in a few minutes,
increase in blood pressure over 300 mm Hg

,
accompanied by pronounced
autonomic disorders
(palpitations, trembling, sweating, fear,
anxiety, skin manifestations,
increased blood glucose
with thirst during the crisis, polyuria after
him, a tendency to orthostatic
pressure drop); body weight reduction
(due to the strengthening of the main exchange);

excretion of adrenaline and norepinephrine
above 100 mcg/day in daily urine; test with
alpha-blockers: phentolamine
0,5% – 1 ml iv or oil 
decrease in arterial pressure by more than 80 mmHg,
and DA blood pressure of 60 mm Hg after 1-2 minutes –
a positive test for pheochromocytoma;
CT adrenal glands; hyperglycemia and
leukocytosis during a crisis

Treatment:
surgical – removal of the tumor,
conservative treatment for crisis and
resistant AG – -blockers
(phentolamine, prazosin)

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3. Primary
hyperaldosteronism
(Cohn syndrome, due to
aldosterone-producing adenoma
adrenal cortex or bilateral
hyperplasia of the adrenal cortex)

Clinical diagnostic
features:
stable and steady increase in hypertension,
resistant to conventional hypotensive
means other than veroshpiron/spironolactone
– an aldosterone antagonist; signs
severe hypokalemia: muscle
disorders (muscle weakness, adynamia,
parasthesia, there may be paresis,
functional paralysis);

changes from
sides of the CCC (tachycardia, extrasystole,
other rhythm disturbances); TANK: increased
sodium, reduced potassium; OAM: isohypostenuria,
alkaline urine reaction; ECG: electrolyte
disorders (arrhythmias, ST-segment depression,
T wave inversion, pathological tooth
U,
elongation of the electric systole,
increased QT interval); visualization
tumors with CT and ultrasound

Treatment:
surgical – resection of the adrenal gland,
conservative – aldosterone antagonists
(spironolactone), salt restriction, diet,
potassium-rich potassium preparations
(panangin); in the absence of effect –
calcium channel blockers or
ACE inhibitors.

4.
toxic goiter
– a hereditary autoimmune disease,
leading to the appearance of IgG,
which stimulate the thyroid gland,
causing increased release of T3 into the blood
и
T4

more frequent
and increased contractions of the heart and hypertension:
increased mental irritability
and irritability; thickening of the neck; weight loss;
sweating, feeling hot;

heartbeat
extrasystole, atrial fibrillation;
hand tremor, muscle weakness, shortness of breath;
effervescence, typical eye symptoms;
increase in T3 content
and T4
in blood; thyroid enlargement
and decreased echogenicity of the parenchyma with
sonography; increase in absorption
radioactive iodine with isotopic
examination of the thyroid gland.

Treatment:
thyreostatics (merkazolil, potassium
perchlorate, lithium carbonate, preparations
microiod) -blockers;
radioactive iodine treatment; surgical
– subtotal thyroid resection
glands

1.
coarctation of the aorta
– congenital narrowing of the aorta below the site
left subclavian artery,
leading to a sharp increase
blood flow resistance in the area
constriction and circulatory disorders
kidneys, as renal arteries depart
distal to the site of narrowing: predominant
upper body development over
bottom;

Arterial pressure on the arms is higher than on the legs
(normally vice versa); cooling feet and
intermittent claudication; systolic
trembling over the notch of the sternum; systolic
noise heard better on the back
chest on the left; lack of pulse
on the femoral artery; on the review
chest x-ray:
ribs due to increased collateral
blood flow through the intercostal arteries,
deformation of the aortic arch in the form of the number “3”;
visualization of stenosis with echocardiography and
angiography

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Svetlana Borszavich

General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.

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