Malignant hypertension. Causes of malignant hypertension and methods of its elimination
This is a prolonged excessive increase in blood pressure of more than 170/120 mm. rt. Art. in combination with damage to targeted organs (retina, kidneys, heart and brain). May be complicated by loss of vision, stroke, heart or kidney infarction. Clinical picture often nonspecific, including dizziness, nausea, vomiting, and headaches. The diagnostic program consists of monitoring blood pressure, laboratory methods, Ultrasound and CT. The treatment is complex, based on a combination of non-drug and drug effects. If necessary, surgery is performed.
ICD-10
I10 I11 I13 I15
General information
Forecast and prevention
With timely prescribed full-fledged treatment (mainly etiotropic), good patient compliance, the prognosis is favorable. The overall effectiveness of correction measures depends on the accuracy of the diagnosis with the determination of the etiology of the underlying disease, the presence or absence of damage to target organs, and other associated clinical conditions... Malignant arterial hypertension often develops against the background of the patient's benign hypertension. To reduce the risk of worsening the condition, it is necessary to adhere to the prescribed therapy while maintaining the target numbers. blood pressure, observe a mode of sleep and rest, refuse bad habits, especially smoking.
A chronic disease of malignant hypertension most often occurs in smokers and is accompanied by high blood pressure. In medicine, it is called malignant hypertension, which leads to disruption of the cardiovascular system, kidneys and heart. Basically, men aged 40 and above suffer from this ailment. Unfortunately, it is impossible to completely recover from the disease, but you can reduce the attacks of pain and avoid complications.
The main task in treatment is to control the level of pressure and prevent the development of pathological diseases such as heart attack and angina pectoris.
The reasons
Arterial hypertension becomes malignant only with complications and exacerbations. And also with the wrong or untimely treatment. It is quite difficult to identify the cause of the onset of the disease, since it develops in adulthood.
What factors affect the development of the disease:
- pheochromothocytoma, tumor of the adrenal glands of the brain;
- vascular diseases of the kidneys;
- kidney tissue diseases;
- heredity;
- the use of drugs that contribute to weight loss;
- primary aldosteronism;
- renal failure;
- tumor of the kidneys.
The difficulty in determining the cause of the onset of the disease arises from the fact that there may be several of them. In case of renal vascular disease, blood is supplied to the organs with low blood pressure. And the kidneys perceive this as a signal of reduced pressure throughout the body. As a result, the kidneys secrete more substances to increase blood pressure.
Malignant hypertension can develop due to hormonal stress. They produce enzymes that cause vasoconstriction and high blood pressure.
Developmental symptoms
The danger lies in the fact that the disease develops quite quickly, often asymptomatic. Malignant arterial hypertension progresses within 2-4 weeks, while the patient's condition deteriorates sharply. Possibly weight loss in a short period of time and accelerated erythrocyte sedimentation.
Symptoms of a malignant arterial hypertension:
- dizziness and severe headaches, in rare cases, loss of consciousness;
- nausea, vomiting;
- cramps with high blood pressure;
- disruption of the brain: the quality of vision, memory and attention decreases;
- violation of cerebral circulation;
- swelling on the face;
- disruption of the kidneys;
- disruption of the gastrointestinal tract;
- weight loss.
While taking drugs that belong to the group of nitrates, there is a feeling of pressing pain in the area chest... It speaks of development ischemic disease heart, as well as the deposition of cholesterol above acceptable levels.
How arterial hypertension develops
Malignant hypertension progresses rather quickly, within 4 weeks. A person's blood pressure can rise several times during the day. In most cases, the cause of the development of the disease is adrenal insufficiency.
If hypertension is not promptly treated, then exacerbations and complications can lead to the appearance of other pathological diseases. For example, deterioration of the visual apparatus. If the fundus is damaged, a person can become completely blind and lose sight.
What complications and exacerbations occur during the development of the disease:
- loss of vision and eye damage;
- tumor optic nerve;
- renal failure;
- in case of disruption of the brain, fainting and coma are possible;
- kidney dysfunction;
- clouding of the mind;
- feeling of nausea and vomiting.
The results of treatment of the disease depend on the degree of damage. important organs - kidneys, heart and brain. It is impossible to recover completely, but it is possible to reduce the attacks of headaches and normalize blood pressure. Treatment is carried out for at least 4-5 years.
Diagnostic methods
To make an accurate diagnosis, an experienced doctor conducts a series of studies. First of all, he pays attention to the patient's complaints. The condition of the patient himself is also taken into account. It is important to know in what cases blood pressure rises. The color of the skin, the presence of edema and the condition of the hips and waist can determine the stage of the disease.
For an accurate diagnosis, it is necessary to undergo a series of studies:
- general blood and urine tests;
- biochemical analysis;
- Ultrasound of the cardiovascular system;
- ultrasonography;
- Ultrasound thyroid gland, kidneys and adrenal glands;
- fundus examination;
- determination of hormone levels;
- computed tomography of the urinary system;
- x-ray studies of the state of the vessels of the kidneys;
- SCT and MRI to identify tumors and areas, vasoconstriction.
In rare cases, a consultation with a nephrologist, neurologist and endocrinologist is prescribed. To identify the cause of the development of the disease, the doctor needs to study the patient's medical history. It is especially important to know what diseases have been suffered in the last 2-3 years.
Treatment and prevention
Almost all treatments are aimed at lowering blood pressure to normal levels. At the same time, it is important to prevent exacerbations and reduce the risk of developing pathological and life-threatening diseases.
The following methods of prevention and treatment are used:
- detoxifying;
- non-drug;
- medicated or conservative;
- surgical.
The non-drug method is used as a prophylaxis to improve the patient's condition. It aims to reduce excess weight, maintaining a healthy lifestyle, dieting. It is not recommended to drink and smoke, you need to limit the use of salt, fatty foods and smoked meats . You need to consume as many minerals as possible, such as magnesium, potassium and calcium.
The drug method is prescribed if the disease is actively progressing and developing rapidly. Treatment should be carried out strictly under the supervision of the attending physician. Self-medication is not recommended folk remedies... You may have a high sensitivity to the components of certain drugs. Therefore, it is recommended to seek the advice of an experienced doctor before use.
Medication treatment is carried out with the help of drugs such as diuretics, sympatholytics, ganglion blockers. It is important to take into account that a sharp decrease in pressure can lead to the development of other pathological diseases.
During treatment, you must constantly visit your doctor. If you want to be treated with folk remedies, then it is imperative to consult a doctor. In severe conditions, the patient can be hospitalized until his condition improves.
What is the danger of the disease
Complications and exacerbations can be fatal. People who have hypertension and follow the rules proper nutrition and lifestyle, can live up to 5 years. In other cases, when the disease is neglected, up to a maximum of 1 year.
Complications of hypertension lead to the development of the following pathological diseases:
- stroke;
- complete loss of vision;
- angina pectoris;
- heart attack;
- heart failure;
- violation of the heart rhythm.
Thanks to the development of innovative technologies, the treatment of the disease has become more effective. This significantly increased the lifespan of people with hypertension. However, these figures are not that high. Besides effective treatment patients must adhere to a strict diet and proper lifestyle. It is very important for this disease to give up bad habits: smoking, alcohol, overeating. Compliance with the basic rules of proper nutrition helps to avoid the development of the disease.
I10 Essential [primary] hypertension
Epidemiology
Malignant arterial hypertension, as a form of arterial hypertension, is not often observed (up to 1% of patients). Currently, primary malignant hypertension is extremely rare (0.15-0.20% among all persons with essential hypertension). Mostly males under the age of 40 fall ill, after 60 years the incidence sharply decreases, and by the age of 70, the disease is extremely rare.
Causes of malignant arterial hypertension
Arterial hypertension of any nature (hypertension or symptomatic hypertension) can acquire features of malignancy during development. Most common reasons malignant arterial hypertension:
- parenchymal kidney disease (rapidly progressive glomerulonephritis);
- end-stage renal failure;
- arterial hypertension in smokers.
In some cases, malignant arterial hypertension can develop with endocrine pathology (pheochromocytoma, Conn's syndrome, renin-secreting tumors), in women in late pregnancy and / or in early postpartum period... This evolution is predominantly observed in untreated or inadequately treated patients.
In contrast to other forms of arterial hypertension, in which there is a gradual elasto-fibroplastic restructuring of arterioles, the cause of the development of malignant arterial hypertension is acute changes in renal arterioles with the development of fibrinoid necrosis. In malignant arterial hypertension, renal arterioles are often completely obliterated as a result of intimal proliferation, hyperplasia of smooth muscle cells and fibrin deposition in the necrotic vascular wall. These changes lead to disruption of local autoregulation of blood flow and the development of total ischemia. In turn, renal ischemia leads to the development renal failure.
As a factor responsible for acute vascular changes in malignant arterial hypertension, hormonal stress is considered, leading to uncontrolled synthesis of vasoconstrictor hormones and manifested by:
- a sharp increase in blood vasoconstrictor hormones (hormones of the renin-angiotensin-aldosterone system, endothelial pressor hormones, vasopressin, catecholamines, pressor fractions of prostaglandins, and so on);
- water and electrolyte disturbances with the development of hyponatremia, hypovolemia and often hypokalemia;
- the development of microangiopathies.
Malignant arterial hypertension is often accompanied by damage to erythrocytes by fibrin filaments with the development of microangiopathic hemolytic anemia... At the same time, morphological changes in blood vessels in malignant arterial hypertension are potentially reversible with adequate and constant antihypertensive treatment.
Symptoms of malignant arterial hypertension
Malignant arterial hypertension is characterized by the sudden onset and rapid progression of all symptoms of the disease. Characteristic appearance patients: the skin is pale, with an earthy tinge. Symptoms of malignant arterial hypertension often occur, such as dyspeptic complaints, rapid weight loss up to cachexia. Blood pressure is firmly held at a very high level (200-300 / 120-140 mm Hg). Reveal a tendency to increase in pulse pressure; the circadian rhythm of blood pressure changes (periods of nighttime decrease in blood pressure disappear). Hypertensive encephalopathy and transient cerebrovascular accidents often develop with an appropriate clinic.
Heart failure usually occurs as left ventricular failure, with frequent development of pulmonary edema. Echocardiographic examination reveals signs of left ventricular hypertrophy and dilatation.
An important clinical and diagnostic criterion for malignant arterial hypertension is the fundus changes manifested by hemorrhages, exudates, and edema of the optic nerve head. A sudden loss of vision in one or both eyes, which develops due to hemorrhages or other changes in the retina, is characteristic.
Forms
On the present stage malignant arterial hypertension is considered as a form of essential hypertension or symptomatic arterial hypertension, an independent nosological form of the disease, first described by Folgard and Far in 1914 and studied in detail by E.M. Tareev in the middle of the XX century.
Diagnosis of malignant arterial hypertension
Laboratory diagnostics of malignant arterial hypertension
Kidney damage is characterized by the development of proteinuria (nephrotic syndrome occurs rarely), a decrease in the relative density of urine, changes in urinary sediment (often erythrocyturia). With a decrease in blood pressure, the severity of urinary syndrome decreases. Oliguria, increasing azotemia, anemia reflect the early and rapid development of end-stage renal failure, although renal scarring is detected in only a part of patients. Often with malignant arterial hypertension, acute renal failure develops.
Diagnosis of malignant arterial hypertension involves the identification of anemia, often with elements of hemolysis, fragmentation of erythrocytes and reticulocytosis; coagulopathy of the type of disseminated vascular coagulation with the development of thrombocytopenia, the appearance of fibrin degradation products in the blood and urine; ESR is often increased. Most patients have high plasma renin activity and increased content aldosterone.
Treatment of malignant arterial hypertension
Malignant arterial hypertension is considered a medical emergency. Initial treatment malignant arterial hypertension - reduction of blood pressure within 2 days by 1/3 of the initial level, while the level of systolic blood pressure should not be reduced below 170 mm Hg, and diastolic blood pressure - below 95-110 mm Hg. Art. For this purpose, fast-acting antihypertensive drugs administered intravenously are used for several days. Further reduction of blood pressure must be carried out slowly (over the next weeks) and carefully to avoid hypoperfusion of organs and further deterioration of their functions.
Treatment of malignant arterial hypertension: drugs for intravenous administration
For intravenous administration several drugs can be used.
Sodium nitroprusside is administered for a long time (3-6 days) by drop infusion at a rate of 0.2-8 μg / kg per minute with dose titration every 5 minutes. Constant and careful monitoring of blood pressure and rate of drug administration is required.
Nitroglycerin (administered at a rate of 5-200 μg / min) is the drug of choice for the treatment of arterial hypertension in conditions of myocardial infarction, unstable angina, with severe coronary and left ventricular failure.
Diazoxide is administered at 50-150 mg intravenously in a stream, the total dose should not exceed 600 mg / day. The action of the drug lasts for 4-12 hours. The drug should not be used if malignant arterial hypertension is complicated by myocardial infarction or dissecting aortic aneurysm.
Perhaps intravenous use of the ACE inhibitor enalapril at a dose of 0.625-1.25 mg every 6 hours The dose is halved when the drug is combined with a diuretic or in severe renal failure. The drug is indicated for symptoms of severe heart failure; it should not be used in patients with bilateral renal artery stenosis.
Labetolol, which has both alpha and beta adrenergic blocking activity, is administered as a bolus of 20-40 mg every 20-30 minutes for 2-6 hours. The total dose of the drug should be 200-300 mg / day. During the introduction, bronchospasm or orthostatic hypotension may develop.
Sometimes verapamil is effective with intravenous jet injection in a dose of 5-10 mg. As a natriuretic, furosemide is used orally or intravenously. Additionally, you can use plasmapheresis and ultrafiltration.
Treatment of malignant arterial hypertension: oral medications
If the specified intensive treatment of malignant arterial hypertension, carried out within 3-4 days, achieves the desired result, an attempt can be made to switch to treatment with oral medications, usually with the use of at least three antihypertensive drugs of different groups, adjusting the doses in order to further slowly lower the blood pressure.
When prescribing antihypertensive drugs, it is necessary to clearly establish the cause of the development of malignant arterial hypertension (renoparenchymal, renovascular, malignant arterial hypertension due to endocrine pathology, ischemic kidney disease, and so on), the state of renal functions, concomitant diseases, in order to take into account the advantages and disadvantages of each group of antihypertensives and determine the possibility of their combined use.
], , , ,Malignant hypertension is the most severe stage of hypertension, in which blood pressure is 180/120 mm Hg. Art, and in some cases even higher. Very often this high pressure can end with severe hemorrhages, disruption of all organs and systems, changes in the vascular walls, and others. Most often, malignant hypertension occurs after primary arterial hypertension, which is observed more often than the secondary form. The malignant form of the disease is often found in men at a young age, after 60 years, the percentage of its occurrence decreases significantly.
All diseases have latent or pronounced symptoms, and malignant hypertension is no exception. All manifestations of the disease can be considered only during the development of the pathological process, because on initial stages this ailment may not manifest itself at all. The first sign of unpleasant changes in the body is a deterioration in well-being, frequent headaches that make themselves felt immediately after a change in the usual climate or weather conditions. Most often, headaches are felt in the morning.
Malignant arterial hypertension is characterized by the following symptoms:
Regular increase in pressure, deviations from the norm even in a calm state. Dizziness, vomiting, nausea, loss of consciousness. Impaired cerebral circulation, impaired memory and attention. Rapid rise in blood pressure with minimal physical activity. Rapid deterioration of vision, which can develop into blindness. General weakness of the body, edema on the face, a sharp decrease in body weight. Strong pressing pains in the chest area, which confirm the presence of coronary heart disease. Convulsions, shortness of breath, pale skin.
For each patient, the symptoms may be different, but it is the above listed manifestations that are most often observed. A patient with malignant hypertension has sleep problems. General weakness, lethargy and apathy for physical activity is present in almost all people who are faced with this problem.
It is important to know!
Vessels get dirty very quickly, especially in older people. You don't have to eat burgers or fries all day long. It is enough to eat one sausage or scrambled eggs for some amount of cholesterol to be deposited in the vessels. Over time, pollution builds up ...
It is possible to identify the cause of the appearance of malignant hypertension, despite the fact that there are a lot of them. Only 2% of diseases remain unreasonable, in all other cases, the causes are identified with the help of professional specialists. If you can determine the cause of the onset of the disease, then it will not be difficult to cure it. Among the main causes of malignant hypertension, the following diseases can be noted:
Renovascular arterial hypertension is a kidney disease during which the kidneys do not receive the right amount of blood, as a result of which their functioning is impaired. In the event that the kidneys do not receive the amount of blood they need, they regard this factor as a sharp decrease in blood pressure, which is why they begin to secrete much more substances that will increase pressure. Pheochromocytoma is a tumor of the adrenal medulla, which occurs in almost 50% of patients. Primary aldosteronism is a tumor of the adrenal cortex that secretes the hormone aldosterone. As a result, there is a sharp increase in pressure, which can occur in 10% of people. Diseases of the parenchyma. Renal vascular lesions. Renal etiology. Endocrine diseases.
There are often cases when malignant hypertension occurs due to several diseases at the same time, in which case its treatment will be much more difficult and lengthy. Only a specialist will be able to determine the causes of the appearance after a preliminary full examination of the patient, determining the main nuances of the disease. If you find the cause of malignant hypertension in time, you can quickly find suitable remedies for treatment and save the patient from such an unpleasant ailment that can make life incomplete.
IT IS IMPORTANT TO KNOW!
In 90-95% of people, high blood pressure develops regardless of lifestyle, being a risk factor for diseases of the brain, kidneys, heart, vision, AND ALSO INFARCTIONS AND STROKE! In 2017, scientists discovered a relationship between the mechanisms of increasing pressure and blood clotting factor.
To get rid of such a terrible disease as malignant hypertension, you must definitely apply for emergency care medical staff... As a rule, the treatment process takes place in the intensive care unit. Initially, a general examination of the patient is carried out, the causes of the onset of the disease are determined, and only then the treatment of malignant hypertension is prescribed, which is aimed at a rapid decrease in blood pressure and the restoration of all lost body functions.
Treatment must necessarily begin immediately after certain symptoms have been identified, an examination has been carried out and a diagnosis has been made. Only an experienced doctor will be able to quickly navigate the selection of the necessary medicines, as well as in carrying out the necessary events. Together with inpatient treatment the doctor can prescribe suitable medications for better result... In order for the drugs to have the most positive effect on the body, it is necessary:
For the duration of treatment, and in the future, completely stop smoking. Follow a certain diet, which involves taking salt no more than 3-4 grams per day. Physical activity (daily walking in the fresh air, if possible, jogging at a slow pace, swimming). Avoiding alcohol.
At the first stage of treatment, in order to reduce blood pressure with a sharp increase in it, drugs for internal administration can also be used, among them the following can be noted:
Preparations of a group of peripheral vasodilators, which are administered only by the attending physician. Drugs that block the entry of calcium into the blood. They are used when you need to quickly stop a hypertensive crisis. Beta blockers - normalize the heart rate, and also significantly lower blood pressure, bringing it back to normal. Drugs central action - they lower blood pressure, having a direct effect on the brain.
Treatment with one or two drugs will be ineffective, in which case it is necessary to use several drugs at once, which will complement each other as much as possible and increase the positive effect on the body. Only a professional doctor knows all the nuances of prescribing and using medications. To increase the recovery process, save time and money for treatment, only drugs are used long actingwho are actively fighting the disease for 24 hours. To ensure proper and regular control of your blood pressure, these drugs can only be used once a day.
The syndrome of malignant arterial hypertension is treated individually for each patient. There is no one standard treatment method or one drug that will have a positive effect on the body of every patient. All groups of medicines are selected strictly individually, among them the following can be noted:
In order for these or those drugs to have a positive effect on the sick organism, their dose is calculated strictly individually. Regularly taking prescribed medications, you can quickly reduce diastolic blood pressure to 100-110 mm Hg. Art. There is no need to abuse the prescribed drugs and increase the dose in order to reduce the pressure even more. Remember that an excessively sharp decrease in pressure artificially can lead to such a manifestation as ischemic stroke. Only during the correct and consistent treatment can you really achieve the desired result and get rid of your problem.
Complications with the wrong treatment
It is strictly forbidden to treat diseases such as malignant hypertension on your own. Only an experienced specialist will be able to prescribe the desired course of treatment, select medications for each patient individually, which will have an extremely positive effect on the body. If the disease is treated incorrectly or if the required dosages are not observed, you may encounter the occurrence of such additional diseases:
Is not full list diseases that can arise as a result of improper treatment of hypertension. In order not to expose yourself once again to danger and not to provoke the occurrence of other concomitant diseases that can be fatal, you must:
If symptoms of the disease are detected, consult a doctor immediately. Perform all prescribed actions and take the necessary drugs. Follow the diet prescribed by your doctor. Completely give up bad habits, especially during treatment. Improve physical activity.
Not every person knows what malignant hypertension is, which is why in many cases the problem is not immediately recognized. If you have any of the symptoms described above, you should immediately seek help from a doctor who can identify this disease. Remember, the sooner the problem is identified, the faster and more effectively you can get rid of it and enjoy life in a healthy body.
Most often, the disease initially proceeds in a latent form (asymptomatic). Then the symptoms arise:
- sudden headaches, dizziness, visual disturbances, nausea and vomiting, convulsions, loss of consciousness, arising at the peak of an increase in blood pressure;
- persistent increase in blood pressure and the absence of periods of its normalization, which is noted from the very onset of the disease;
- no decrease in blood pressure at night. Moreover, at night, blood pressure may even rise above daytime values \u200b\u200b(determined by daily blood pressure monitoring);
- rapid rise in blood pressure indicators and increasing damage internal organsoccurring in a short time, within a few days, less often weeks;
- memory and attention disorders, transient disorders of cerebral circulation, strokes (nutritional disorders of a certain part of the brain due to cessation of blood flow in this area) develop when the vessels of the brain are damaged;
- visual impairment up to blindness occurs when the fundus is damaged;
- pressing pains behind the sternum during exertion, passing after taking drugs from the nitrate group (drugs that expand narrowed blood vessels of the heart), indicate ischemic heart disease (a disease in which the vessels of the heart are narrowed by atherosclerotic plaques - deposits of cholesterol (fat-like substance) in the vascular wall) as complications of malignant arterial hypertension;
- growing general weakness, the appearance of edema on the face, a decrease in temperature and body weight, which may indicate the development of renal failure (impaired renal function due to the death of some of their cells) as a complication of malignant arterial hypertension.
The reasons
- Only in 2 out of 100 patients it is not possible to identify the cause of malignant arterial hypertension. Then the diagnosis of essential hypertension is established ( hereditary disease, in which, mainly in adulthood, the patient's blood pressure begins to rise, followed by damage to target organs - the heart, blood vessels and kidneys).
- In most cases, the cause of a malignant increase in blood pressure can be found out and, therefore, influenced. Then a diagnosis of symptomatic arterial hypertension is established (that is, an increase in blood pressure due to any disease). Such diseases include:
- pheochromocytoma (tumor of the adrenal medulla, secreting catecholamines - substances that increase blood pressure) - is detected in almost half of the cases;
- renovascular arterial hypertension is detected in one third of patients. This is a vascular disease of the kidneys, in which the amount of blood flowing to the kidneys is sharply reduced. The kidneys, sensing the low pressure of blood flowing to them, perceive this as low blood pressure throughout the body and secrete more and more substances to increase it;
- diseases of the parenchyma (tissue) of the kidneys (for example, polycystic kidney disease - the presence of multiple cavities in the tissue of the kidneys) - cause malignant arterial hypertension in every tenth patient;
- primary aldosteronism (a tumor of the adrenal cortex that secretes the hormone aldosterone - an indicator of water-salt metabolism in the body, which also increases blood pressure) - is also detected in every tenth;
- kidney tumors - rarely detected.
Treatment of malignant arterial hypertension
- Treatment of malignant arterial hypertension should begin as early as possible. This can prevent the development of serious complications.
- Elimination of the cause of malignant arterial hypertension, if this cause is identified, is the basis of treatment. For example, in case of a tumor of the kidney or adrenal gland, its removal is performed; when the renal vessel narrows, the narrowed area is replaced with an artificial vascular prosthesis or the vessel is expanded by inserting a stent (a special mesh frame) into it.
- Drug-free treatment begins at the same time as medication. Its principles:
- normalization of body weight;
- limiting alcohol consumption;
- to give up smoking;
- adherence to a diet low in salt (3-4 g per day) and animal fats and an adequate intake of potassium, magnesium, calcium (for example, bananas, dairy products);
- increased physical activity (walking, running, swimming, cycling). It is desirable to conduct physical activity no more than 2 times a day, but not less than 3 times a week. The load should be dosed, that is, equal to ¾ of the activity that causes discomfort. As your body becomes more trained, you can increase the intensity of your training.
- At the first visit of the patient to reduce the risk of complications, the diastolic blood pressure should be reduced (the second digit in the measurement) to 100-110 mm Hg. in 24 hours.
- At the first stage of treatment with extremely high blood pressure figures or hypertensive crisis (a sharp increase in blood pressure, accompanied by a deterioration in the patient's well-being), you can use short-acting medications, including for intravenous administration:
- short-acting calcium antagonist drugs (drugs that block the entry of calcium into cells) are preferred for the treatment of hypertensive crises;
- beta-blockers (a group of drugs that lower blood pressure and heart rate) - can be used both intravenously and in pills;
- drugs from the group of peripheral vasodilators (drugs that reduce pressure by expanding blood vessels) - are administered intravenously, subject to constant monitoring by a doctor;
- centrally acting drugs (lowering blood pressure by affecting the brain) or ganglion blockers (lowering blood pressure by blocking autonomic ganglia - nerve thickenings) - are used intravenously if the previous measures are ineffective.
- Treatment with one or two antihypertensive (pressure lowering) drugs in such patients is ineffective. It is necessary to immediately use three antihypertensive drugs. It is important that only long-acting drugs (12-24 hours) should be prescribed for continuous use. This provides smoother control of blood pressure, allows you to take medications 1-2 times a day, and reduces the risk of missed doses due to forgetfulness.
- A combination of drugs is selected individually, which may include representatives of the following drug groups:
- angiotensin-converting enzyme (ACE) inhibitors - drugs that suppress the angiotensin-converting enzyme, which triggers a cascade of reactions to increase blood pressure;
- angiotensin-converting enzyme receptor antagonists (also called sartans, act like aCE inhibitors, rarely cause allergic reactions);
- beta-blockers (drugs that lower blood pressure and heart rate);
- calcium antagonists (drugs that lower blood pressure by preventing calcium from entering the cells) of the nifedipine, verapamil, diltiazem group;
- diuretics (diuretics);
- agonists of imidazoline receptors (drugs that lower blood pressure by acting on its central mechanisms, that is, through the brain);
- combined alpha and beta blockers (drugs that lower blood pressure, slow down (make it rare) the heartbeat and dilate peripheral vessels), which are preferable for patients with heart failure (decreased pumping function of the heart) and with some symptomatic hypertension.
A more dramatic decrease in pressure can provoke the development of ischemic stroke (death of a part of the brain due to the cessation of blood flow to it).
Complications and consequences
Complications of malignant arterial hypertension are as follows.
- Stroke is the most frequent complication malignant arterial hypertension. It can lead to death or disability of patients.
- Blindness (can occur due to damage to the optic nerve and retinal hemorrhages with its detachment).
- Ischemic heart disease (a disease that develops due to insufficient blood supply to the muscle of the heart).
- Exertional angina is a disease in which the heart's own arteries narrow. The patient feels pressing or constricting pain behind the sternum during physical or emotional stress.
- Myocardial infarction is the death of a portion of the heart muscle due to the cessation of blood flow through the vessel feeding it.
- Heart failure - a decrease in the contractile function of the heart with the development of blood stasis.
- Heart rhythm disturbances (disturbances in the frequency, regularity, and sequence of heartbeats).
- Ischemic kidney disease (impaired blood supply to the kidneys), kidney necrosis and infarction (death of a portion of kidney tissue due to direct exposure to it or the closure of the feeding vessel) lead to renal failure (a condition in which the kidneys' ability to excrete urine is completely or partially impaired, which causes accumulation in the body of water and harmful metabolic products).
- nowadays, the emergence of highly effective methods of treating hypertension and its complications has significantly increased the life of patients. Most patients now live at least a year from the date of diagnosis, three quarters of them live more than 5 years;
- the main cause of death is a stroke (death of a part of the brain due to the cessation of blood supply to it), less often patients die from coronary heart disease and from renal failure.
Prevention of malignant arterial hypertension
Malignant arterial hypertension can develop suddenly against the background of existing benign arterial hypertension. There are several reasons for this:
- improper treatment - insufficient, not taking into account the characteristics of the body, with interruptions;
- smoking. In smokers due to vasoconstriction, malignant arterial hypertension occurs 5 times more often than in non-smokers;
- blood clotting disorders.
Additionally
At the end of the 20th century, every fourth patient with malignant arterial hypertension lived for less than a year from the moment of diagnosis. Only every hundredth could live more than 5 years.