Drug treatment of arterial hypertension

Drug treatment of arterial hypertension

How do I know if I need to start medication for hypertension?

We invite you to answer our questionnaire, which is based on the recommendations of experts of the world Health Organization (who).

Note if You have migrated:

• stroke

• heart attack

Check this box if You have identified:

• angina

• diabetes

  • vascular disease of the legs (“intermittent lameness»)

• aortic aneurysm

  • impaired renal function

Check with your doctor if You have:

  • hypertrophy of the left ventricle of the heart

• changes of the fundus

  • protein in urine and / or increased creatinine levels in blood
  • systolic blood PRESSURE above 180 mmHg. art. and / or diastolic blood PRESSURE above 110 mm Hg. st.

If you have noted at least one item in this section, then You are at high risk of cardiovascular complications. Treatment should begin IMMEDIATELY!

Filling out the questionnaire you can not continue.

Note your risk factors:

• age over 55 for men and over 65 for women

• smoking

  • elevated cholesterol (above 6.5 mmol / l)
  • cardiovascular disease in relatives

• obesity

  • low physical activity
  • excessive alcohol consumption

Count the number of noted risk factors.

If you are in a low-risk group, there is no need to start medication immediately. Within 6-12 months. blood PRESSURE should be measured regularly. If systolic blood PRESSURE still exceeds 150 mmHg. art., and diastolic blood pressure – 95 mm Hg. therefore, it is recommended to start drug therapy.

For patients of the middle risk group, observation (i.e. blood PRESSURE control) and non-drug correction of risk factors within 3-6 months are acceptable. If after 6 months. observations systolic blood PRESSURE exceeds 140 mm Hg. art. and / or diastolic blood PRESSURE exceeds 90 mm Hg. therefore, it is recommended to start drug treatment.

In the high-risk group, treatment should begin IMMEDIATELY!

In addition, drug treatment is started if the patient does not tolerate even moderately elevated blood PRESSURE.

Do I need to treat hypertension if I tolerate high blood PRESSURE well?

The most common misconception – refusal to take drugs with good tolerability of high blood PRESSURE. It should be remembered that the risk of complications of hypertension (stroke, myocardial infarction, renal failure, decreased vision) is equally high in patients who feel high blood PRESSURE (headaches, dizziness, pain in the heart), and in those who have increased blood PRESSURE is not accompanied by the appearance of any complaints. World statistics show that more than 50 % of people with high blood PRESSURE, do not even know about it. Often high, and sometimes very high blood PRESSURE, become a random “find” during a planned visit to the doctor about another disease, during medical examination, preparation for surgery, etc.

Forget about the fact that there is a “working pressure”!

We often see patients who have blood PRESSURE of 200/110 mm Hg. they feel quite satisfactory, and when increased to 250/130 mm Hg. the article they have a little bit of a headache. Such patients are very difficult to convince to start treatment, as they firmly believe that for them 200/110 mm Hg. art. – “working pressure”. However, and such patients need to reduce blood PRESSURE to normal values, in which there is no risk of damage to the heart, brain and kidneys.

Good tolerability of high blood PRESSURE is not a reason to refuse treatment!

World statistics show that patients with untreated hypertension have a much higher risk of premature death than those who are treated regularly.

Untreated hypertension shortens life!

Do I need to constantly take drugs that reduce blood pressure?

Hypertension is a chronic disease that requires regular treatment. Just as patients with diabetes need constant injections of insulin or taking hypoglycemic drugs, do not leave the house without inhalers, hypertensive patients should constantly take drugs that normalize blood PRESSURE. The exception is a very small group of patients with mild hypertension (blood PRESSURE is not higher than 160/95 mmHg), whose blood PRESSURE is normalized after a course of hypotensive therapy, normalization of lifestyle and thorough non-drug treatment.

For most patients, normalization of blood PRESSURE under the influence of treatment does not become a reason for its termination. It should be clearly understood that blood PRESSURE becomes normal due to the reception of drugs. The task of treatment is not to reduce blood PRESSURE to normal levels, and prevent its further increase.

In modern medical literature, the term “hypotensive drugs” (drugs that reduce blood PRESSURE) is increasingly replaced by the concept of “antihypertensive drugs” (drugs that do not allow an increase in blood PRESSURE).

It scares me to think that for the rest of my life I will have to take medication!

Millions of people around the world take daily medications that reduce blood PRESSURE, while maintaining the ability to work and leading an active lifestyle.

  • Include tablets in your daily routine, let it become the same integral procedure as the morning toilet, Breakfast, makeup, etc. Modern drugs are designed for one or two times during the day, which greatly facilitates the implementation of medical recommendations.
  • Take your medication at the same time.

This will help you not forget to drink medication, and will also help to maintain an even concentration of the drug in the body.

Is it possible to take breaks from medication?

Sometimes against the background of regular treatment with a normal lifestyle, especially on vacation, on vacation, blood PRESSURE spontaneously decreases. During this period, the dose of drugs can be reduced. However, we caution against attempts to self-correction of treatment.

It is better in this situation to consult a doctor.

Only for” experienced ” patients who are able to control their blood PRESSURE well, an independent change in therapy is possible. In most cases, in the future you will have to return to the previous dose of drugs.

Is it possible to stop treatment when normal blood PRESSURE is reached?

Often, patients who have received regular therapy with good effect for several months or years, in the future, for some reason, cease to be treated. The reasons for the unauthorized termination of treatment were the imaginary “cure for hypertension” (i.e. long-term stable normalization of blood PRESSURE under the influence of treatment), the high cost of drugs, and sometimes the recommendations of friends or even doctors (!).

We are often approached by patients who “treat hypertension” only in the hospital, and at home do not take drugs until the next crisis. Hypertensive crisis, as a rule, does not take long to wait and again leads them to a hospital bed. These patients sincerely believed that hypertension can be “treated” with a course of droppers and tablets, and the doctor did not tell them that the treatment selected in the hospital should be continued in full after discharge.

In most patients, after discontinuation of medication, blood PRESSURE returns to the initial level gradually. However, the abrupt discontinuation of some drugs (clonidine, anaprilin, atenolol, etc.) causes the so-called withdrawal syndrome. In this case, blood PRESSURE increases within 24-48 hours, which may remain asymptomatic or be accompanied by a significant deterioration. In some cases, the blood pressure rises to a level significantly higher than the previous ONE.

Pay attention!

The most serious complications of withdrawal syndrome include encephalopathy (intense headache, dizziness, consciousness disorders), cerebrovascular accident (stroke), myocardial infarction and sudden death.

Treatment of withdrawal syndrome sometimes presents great difficulties for doctors, since not always a return to the previous treatment regimen immediately leads to stabilization of blood PRESSURE.

Taking drugs that normalize blood PRESSURE should be constant!

Unauthorized termination of treatment can be dangerous for health!

To what level should blood pressure be lowered?

Currently, drug treatment of arterial hypertension is based on two cardinal principles: drugs should be highly effective and safe. In order for a modern drug to appear in a pharmacy, it takes time for long-term tests on laboratory animals, and then-on volunteers and in clinical trials on patients. With proven efficacy in studies (proven in comparison with known drugs decrease in blood PRESSURE) and safety, the drug enters the Arsenal of the practitioner. In the treatment of hypertension, international and Russian recommendations clearly define the numbers to which it is necessary to reduce blood PRESSURE. It is for the majority of hypertensive patients the figures below 140/90 mm Hg. all these numbers are called target AD. In patients with diabetes, it is desirable to reduce blood PRESSURE to 140/85 mm Hg. this allows to prevent the defeat of the heart, kidneys, brain and, most importantly, to deal with vascular lesions (micro-and macroangiopathy).

Normalization of blood PRESSURE not only prevents the defeat of “target organs”, which naturally occurs in hypertension, but also prevents the development of a hypertensive crisis with dangerous complications.

In patients with initially high blood PRESSURE, especially in the elderly, the decrease in blood PRESSURE should be gradual. Do not seek immediate reduction of blood PRESSURE to normal levels, as this can lead to deterioration of blood supply to vital organs.

The transition to normal BP values in these cases takes up to several weeks.

The aim of hypotensive therapy is to reduce blood PRESSURE to 140/90 mmHg. above and below.

Can blood PRESSURE drop too much on the background of treatment?

As a rule, the treatment of hypertension begins with small doses of the drug, if necessary, gradually increasing it and bringing it to the necessary. However, with individual hypersensitivity to the drug or with initially low blood PRESSURE values, in some cases, excessive pressure reduction (hypotension) may develop. In this case, the HELL is 100/70-90/ 60 mmHg. it is known that sometimes accompanied by unpleasant sensations (weakness, dizziness, pain in the heart). In these cases, it is necessary to immediately consult a doctor to reduce the dose of the drug or replace it. Enjoy a Cup of strong tea or coffee.

Pay attention!

Excessive reduction of blood PRESSURE (hypotension) in the elderly is dangerous because of the possibility of deterioration of blood supply to vital organs (brain, heart, kidneys).

I didn’t feel much improvement after I started taking my medication!

Many patients believe that starting treatment will quickly lead to better health. Indeed, often headaches, pain in the heart associated with increased blood PRESSURE, stop a few days after the start of medication. However, in some cases, especially if the increase in blood PRESSURE is not accompanied by obvious symptoms, the condition improves gradually, within a few months of regular treatment, as the disturbed functions of the body normalize.

After the start of treatment, I began to feel worse than before!

With the normalization of blood PRESSURE under the influence of treatment, the patient often notes a deterioration in health – there are headaches, weakness, dizziness, which previously were not. Sometimes it even serves as a reason for refusing to continue treatment. Such phenomena occur more often in the elderly, long-term suffering from hypertension and previously untreated, and is due to the fact that the brain, blood vessels are “accustomed” to high blood PRESSURE. Nevertheless, blood PRESSURE needs to be reduced.

After some time after the normalization of blood PRESSURE, these phenomena will disappear, the body will rebuild and adapt to low pressure.

If discomfort persists for a long time, consult a doctor. He will probably change the dose or pick up another drug.

Is it true that HELL should be reduced only to the level at which you feel good?

Here it is necessary to return to the concept of “working pressure”, which is widespread among patients, and often among doctors. The “working pressure” refers to those relatively (!) low BP values, which the patient tolerates well. For many patients, these values are considered a boundary to which to strive, and below which the blood PRESSURE should not be reduced. This opinion is absolutely wrong, since patients with “working pressure” 180/100 mm Hg. however, the risk of complications is as great as in those who have such BP values accompanied by unpleasant symptoms.

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