X chronic obstructive pulmonary disease (COPD) is a chronic, slowly progressive disease characterized by irreversible or partially reversible (with the use of bronchodilators or other treatment) obstruction bronchial tree. Chronic obstructive pulmonary diseases are widespread among the adult population and are often combined with arterial hypertension (AH). COPD includes:
Features of the treatment of hypertension against the background of COPD are determined by several factors.
1) Some antihypertensive drugs are able to increase the tone of small and medium bronchi, thereby worsening lung ventilation and aggravating hypoxemia. The use of these drugs in COPD should be avoided.
2) In persons with a long history of COPD, the symptom complex “ pulmonary heart" The pharmacodynamics of some antihypertensive drugs changes in this case, which should be taken into account during the selection and long-term treatment of hypertension.
3) Medication COPD treatment in some cases can significantly change the effectiveness of the selected antihypertensive therapy.
During physical examination, it can be difficult to diagnose cor pulmonale, since most of the signs revealed during examination (pulsation of the jugular veins, systolic murmur over the tricuspid valve and increased 2nd heart sound over the valve pulmonary artery) are insensitive or nonspecific.
In the diagnosis of “pulmonary heart”, ECG, radiography, fluoroscopy, radioisotope ventriculography, myocardial scintigraphy with a thallium isotope are used, but the most informative, inexpensive and simple diagnostic method is echocardiography with Doppler scanning. Using this method, it is possible not only to identify structural changes in the parts of the heart and its valve apparatus, but also to quite accurately measure blood pressure in the pulmonary artery. ECG signs of cor pulmonale are listed in Table 1.
It is important to remember that in addition to COPD, the “pulmonary heart” symptom complex can be caused by a number of other reasons (sleep apnea syndrome, primary pulmonary hypertension, diseases and injuries of the spine, chest, respiratory muscles and diaphragm, repeated thromboembolism of small branches of the pulmonary artery, severe chest obesity, etc.), consideration of which is beyond the scope of this article.
The main structural and functional signs of the “pulmonary heart”:
Changes in the structural and functional properties of the myocardium in cor pulmonale syndrome often lead to “paradoxical” reactions to drugs, including those used to correct high blood pressure. In particular, one of the common signs of “pulmonary heart” is cardiac rhythm and conduction disturbances (sinoatrial and atrioventricular blockades, tachy- and bradyarrhythmias). In case of slowing of intracardiac conduction and bradycardia, the use of some calcium antagonists (verapamil and diltiazem) for antihypertensive purposes is sharply limited - due to high risk cardiac arrest.
b-blockers
Blockade of b 2 -adrenergic receptors causes spasm of the medium and small bronchi. Deterioration of pulmonary ventilation causes hypoxemia, and is clinically manifested by increased shortness of breath and increased breathing. Non-selective b -adrenergic blockers (propranolol, nadolol) block b 2 -adrenergic receptors, therefore, in COPD, they are usually contraindicated, while cardioselective drugs (bisoprolol, betaxolol, metoprolol) can in some cases (concomitant severe angina, severe tachyarrhythmia) be prescribed in small cases doses under close ECG monitoring and clinical condition(Table 2). Of the beta-blockers used in Russia, b-blockers have the greatest cardioselectivity (including in comparison with the drugs listed in Table 2). bisoprolol (Concor) . Recent studies have shown a significant advantage of Concor in terms of safety and effectiveness of use in chronic obstructive bronchitis compared to atenolol. In addition, a comparison of the effectiveness of atenolol and bisoprolol in people with hypertension and concomitant bronchial asthma, according to parameters characterizing the state of the cardiovascular system (heart rate, blood pressure) and indicators of bronchial obstruction (FEV1, VC, etc.) showed the advantage of bisoprolol. In the group of patients taking bisoprolol, in addition to a significant decrease in diastolic blood pressure, there was no effect of the drug on the condition of the airways, while in the placebo and atenolol group an increase in airway resistance was detected.
The use of b-AB with direct vasodilating properties (carvedilol) and b-AB with the properties of an inducer of endothelial nitric oxide synthesis (nebivolol) in arterial hypertension has been less studied, as has the effect of these drugs on breathing in chronic pulmonary diseases.
At the first symptoms of deterioration in breathing, any beta-blockers are canceled.
Calcium antagonists
They are the “drugs of choice” in the treatment of hypertension against the background of COPD, since, along with the ability to dilate the arteries of the systemic circle, they have the properties of bronchodilators, thereby improving pulmonary ventilation.
Bronchodilating properties have been proven for phenylalkylamines, short- and long-acting dihydropyridines, and to a lesser extent for benzodiazepine AKs (Table 3).
However, large doses of calcium antagonists can suppress compensatory vasoconstriction of small bronchial arterioles and in these cases can disrupt the ventilation-perfusion ratio and increase hypoxemia. Therefore, if it is necessary to enhance the hypotensive effect in a patient with COPD, it is more advisable to add an antihypertensive drug of a different class (diuretic, angiotensin receptor blocker, ACE inhibitor) to the calcium antagonist - taking into account tolerability and other individual contraindications.
Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers
To date, there is no data on the direct effect of therapeutic doses of ACE inhibitors on pulmonary perfusion and ventilation, despite the proven participation of the lungs in the synthesis of ACE. The presence of COPD is not a specific contraindication to the use of ACE inhibitors for antihypertensive purposes. Therefore, when choosing antihypertensive drug In patients with COPD, ACE inhibitors should be prescribed “on a general basis.” However, it should be remembered that one of the side effects of drugs in this group is a dry cough (up to 8% of cases), which in severe cases can significantly complicate breathing and worsen the quality of life of a patient with COPD. Very often, persistent cough in such patients serves as a compelling reason to discontinue ACE inhibitors.
To date, there is no evidence of an adverse effect on pulmonary function of angiotensin receptor blockers (Table 4). Therefore, their prescription for antihypertensive purposes should not depend on the presence of COPD in the patient.
In the long-term treatment of arterial hypertension, thiazide diuretics (hydrochlorothiazide, oxodoline) and the indole diuretic indapamide are usually used. Appearing in modern methodological recommendations « cornerstone» antihypertensive therapy with repeatedly confirmed high preventive efficacy, thiazide diuretics do not worsen or improve the ventilation-perfusion characteristics of the pulmonary circulation - since they do not directly affect the tone of the pulmonary arterioles, small and medium-sized bronchi. That's why presence of COPD does not limit the use of diuretics for the treatment of concomitant hypertension. With concomitant heart failure with congestion in the pulmonary circulation, diuretics become the treatment of choice, since they reduce elevated pressure in the pulmonary capillaries, however, in such cases, thiazide diuretics are replaced with loop diuretics (furosemide, bumetanide, ethacrynic acid)
In the long-term treatment of arterial hypertension, thiazide diuretics (hydrochlorothiazide, oxodoline) and the indole diuretic indapamide are usually used. Being in modern guidelines the “cornerstone” of antihypertensive therapy with repeatedly confirmed high preventive effectiveness, thiazide diuretics do not worsen or improve the ventilation-perfusion characteristics of the pulmonary circulation - since they do not directly affect the tone of the pulmonary arterioles, small and medium-sized bronchi. Therefore, the presence of COPD does not limit the use of diuretics for the treatment of concomitant hypertension. With concomitant heart failure with congestion in the pulmonary circulation, diuretics become the treatment of choice, since they reduce elevated pressure in the pulmonary capillaries, however, in such cases, thiazide diuretics are replaced with loop diuretics (furosemide, bumetanide, ethacrynic acid)
In case of decompensation of chronic “pulmonary heart” with the development of circulatory failure in the systemic circle (hepatomegaly, swelling of the extremities), it is preferable to prescribe not thiazide, but loop diuretics(furosemide, bumetanide, ethacrynic acid). In such cases, it is necessary to regularly determine the electrolyte composition of the plasma and, if hypokalemia occurs, as a risk factor for cardiac arrhythmias, actively prescribe potassium-sparing drugs (spironolactone).
a-adrenergic blockers and vasodilators
For hypertension, a direct vasodilator, hydralazine, or a-blockers, prazosin, doxazosin, or terazosin, are sometimes prescribed. These drugs reduce peripheral vascular resistance by directly acting on arterioles. Direct influence on respiratory function these drugs do not, and therefore, if indicated, they can be prescribed to lower blood pressure. However, a common side effect of vasodilators and α-blockers is reflex tachycardia, requiring the administration of β-blockers, which, in turn, can cause bronchospasm. In addition, in light of recent data from prospective randomized trials, the use of α-blockers for hypertension is now limited due to the risk of developing heart failure with long-term use.
Rauwolfia preparations
Although in most countries rauwolfia preparations have long been excluded from the official list of drugs for the treatment of hypertension, in Russia these drugs are still widespread - primarily because of their low cost. Drugs in this group can worsen breathing in some patients with COPD (mainly due to swelling of the mucous membrane of the upper respiratory tract).
“Central” acting drugs
Antihypertensive drugs in this group have varying effects on the respiratory tract, but in general their use in concomitant COPD is considered safe. Clonidine is an α-adrenergic agonist, but acts predominantly on α-adrenergic receptors of the vasomotor center of the brain, so its effect on small vessels of the mucous membrane of the respiratory tract is insignificant. There are currently no reports of serious deterioration in breathing in COPD during treatment of hypertension with methyldopa, guanfacine and moxonidine. It should, however, be emphasized that this group of drugs is almost never used for the treatment of hypertension in most countries due to the lack of evidence of improvement in prognosis and large quantity side effects.
The influence of drugs used for COPD on the effectiveness of antihypertensive therapy
As a rule, antibiotics, mucolytic and expectorant drugs prescribed to patients with COPD do not affect the effectiveness of antihypertensive therapy. The situation is somewhat different with drugs that improve bronchial patency. Inhalation of β-adrenergic agonists in large doses can cause tachycardia in patients with hypertension and provoke an increase in blood pressure - up to a hypertensive crisis.
Sometimes prescribed for COPD to relieve/prevent bronchospasm by inhalation steroid drugs As a rule, they have no effect on blood pressure. In cases where long-term use is required steroid hormones inside, fluid retention, weight gain and increased blood pressure are likely - as part of the development of drug-induced Cushing's syndrome. In such cases, correction of high blood pressure is carried out primarily with diuretics.
Row concomitant diseases requires correction drug therapy main pathology. Arterial hypertension in bronchial asthma is a fairly common occurrence. Therefore, it is important for the doctor and patient to know which drugs are contraindicated to take in case of the combined course of these diseases. Following simple rules will help avoid complications and save the patient’s life.
Bronchial asthma is chronic inflammation upper respiratory tract, which is accompanied by bronchospasm. Patients suffering from this disease often have autonomic dysfunctions. And the latter in some cases become the cause of arterial hypertension. That is why both diseases are pathogenetically related. In addition, increased blood pressure is a symptom of bronchial asthma, in which the body suffers from a lack of oxygen, which enters the lungs in less quantity through narrowed airways. In order to compensate for hypoxia, the cardiovascular system increases pressure in the bloodstream, trying to provide organs and systems with the necessary amount of oxygenated blood.
The reason for increased systolic and diastolic blood pressure is an increase in peripheral vascular resistance and increased pumping function of the myocardium. These are compensatory reactions to oxygen deficiency. In older people, hypertension is a disease that is provoked by the deposition of atherosclerotic plaques in the vascular walls. But in younger patients it can occur as a direct consequence of chronic asthmatic attacks. In patients suffering from asthma for a long time, the so-called “pulmonary heart” is formed. It is characterized by hypertrophy of the right ventricle - an increase in its mass and expansion of the cavities.
The “pulmonary heart” loses the ability to redistribute blood through the main vessels, as a result of which the pressure in the pulmonary circulation increases. This phenomenon is called.
A cough can be a manifestation of both pathologies at once. In the presence of a combination of these two pathologies, the following clinical symptoms develop:
Bronchial asthma and hypertension individually are dangerous to human life, let alone if they develop in parallel. In fact, this situation occurs quite often today. It is difficult to say which disease provokes another. Although doctors note that bronchial asthma is usually preceded by improper use of medications that are supposed to reduce blood pressure.
Hypertension and asthma should only be treated by a specialist. Firstly, such a doctor will be able to correctly analyze the situation and refer the patient for the necessary examinations. Secondly, based on the results, the doctor prescribes drugs to combat hypertension and bronchial asthma.
As for treatment, the following categories of drugs can be used, which have their own side effects:
These medications can cause bronchial obstruction in patients with asthma, and also provoke airway reactivity, which causes blockage therapeutic effect from inhalations and oral medications. Beta blockers are not absolutely safe medications, so even eye drops from this category can lead to exacerbation of asthma or hypertension.
Unfortunately, even despite the achievements of modern medicine, there is still no exact opinion as to why the use of this group can provoke bronchospasm. However, it is believed that in such a situation the main factor is violations in parasympathetic system body.
As for side effects, the most common occurrence is a dry cough, and this symptom usually occurs due to irritation of the upper respiratory tract. According to the observations of doctors, patients with bronchial asthma are more likely than healthy people to have such a consequence as cough.
In addition, shortness of breath, suffocation and hypertension may occur, respectively, asthma itself may worsen. Today, specialists rarely prescribe inhibitors ACE for patients for bronchitis, especially obstructive forms. But in fact, any disease of the respiratory system can be treated with this category of drugs, the main thing is that the doctor correctly selects the drug. It is the patient's responsibility to be aware of potential side effects. But it will still be better if the disease is treated with angiotensin II receptor antagonists.
This group is excellent for asthmatics, but it can provoke the development of hypokalemia. Hypercapnia may also develop, which suppresses the respiratory center, which increases hypoxemia. If, with hypertension, the patient does not have pronounced swelling of the respiratory tract, then diuretics are prescribed in very small doses to give maximum effect without side effects.
For arterial hypertension and asthma, patients are often prescribed nifedipine and nicardipine, which belong to the dihydropyridine group. These medications help relax the muscles of the tracheobronchial tree, suppress the release of granules into surrounding tissues, and also enhance the bronchodilator effect. According to numerous observations, treatment of hypertension with calcium antagonists does not produce any complications on respiratory function in patients with asthma. The optimal solution to the problem of hypertension is the use of monotherapy or dilution of calcium antagonists with diuretics.
These medications are used very carefully in the treatment of hypertension, especially when the patient has bronchial asthma. If you take the drugs orally, then no changes in bronchial patency will be observed, but instead there may be a problem with the reaction of the bronchi to histamine. Any medicine for hypertension or bronchial asthma must be prescribed by a specialist. Any self-medication can cause health complications, and this is not to mention the fact that there are many possible side effects.
It was already noted above that it is necessary to determine which problem is the main one - hypertension or asthma. The previous section focused on drug treatment of hypertension, now it’s time to talk about asthmatic bronchitis.
In order to get rid of such a disease, the following approaches are used:
Basically, the effect on bronchial asthma is from the inside, so that all therapeutic components can interact as much as possible with the entire respiratory system, starting from the airways and ending with the internal organs.
But to fully cope with hypertension and asthma, you will need integrated approach, that is, methods of traditional and alternative medicine, as well as physical therapy.
Depending on the stage of development of hypertension and bronchial asthma, the patient can be treated on an outpatient basis or hospitalized. If there is no threat to life and health, then the person is simply observed by a specialist, and attends consultations at the appointed time.
His speedy recovery will depend on how responsibly the patient treats all the doctor’s instructions. The main thing is not to self-medicate, since hypertension and bronchial asthma can only be treated by a specialist.
The answer to this question depends on many factors: how the attacks occur, when they begin and what provokes them. It is important to correctly determine all the nuances of the course of the disease in order to prescribe the correct treatment and choose medications.
Doctors did not find a clear answer to this question. They note: people with respiratory diseases often face the problem of high blood pressure. But then opinions are divided. Some experts insist on the existence of the phenomenon of pulmonary hypertension, which causes an attack of pressure in asthmatic disease. Other experts deny this fact, saying that asthma and hypertension are two diseases that do not depend on each other and are not related to each other. But the connection between diseases is confirmed by the following factors:
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A distinction is made between arterial hypertension as a symptom of exacerbation, and hypertension as a disease that runs parallel to asthma. There are several types of hypertension. The disease is divided according to the type of origin, course of the disease, level:
Arterial hypertension in bronchial asthma is treated depending on what causes it. Therefore, it is important to understand the course of the disease and what triggers it. Blood pressure may rise during an asthma attack. In this case, an inhaler will help relieve both symptoms, which will stop an attack of suffocation and relieve pressure. The situation is different if the patient’s hypertension is not associated with asthmatic attacks. In this case, treatment of hypertension should take place as part of a comprehensive course of therapy. Course of the disease
The doctor selects a suitable medicine for blood pressure, taking into account the possibility of the patient developing cor pulmonale syndrome, a disease in which the right ventricle of the heart cannot function normally. Hypertension can be triggered by taking hormonal medications for asthma. The doctor must monitor the course of the disease and prescribe the correct treatment.
Bronchial asthma and high blood pressure should be treated under the supervision of a specialist. Only a doctor can prescribe the right medications for both diseases. After all, every medicine can have side effects:
Therefore, it is so important for patients with asthma and hypertension to undergo examination by a specialist to select medications and ensure correct treatment. Any drug used when self-medicated can complicate not only current illnesses, but also worsen general condition health. The patient can independently ease the course of bronchial disease, so as not to provoke attacks of suffocation, with the help traditional methods: herbal mixtures, tinctures and decoctions, ointments and rubs. But their choice should also be agreed with the doctor.
Blood pressure may rise unexpectedly and quickly. Getting rid of the disease must be prompt - it is dangerous for humans. There are many options for lowering blood pressure: from medical supplies to herbs, foods and other manipulations.
For an adult, the normal blood pressure is 120/80. If the readings deviate upward or downward by 10 mmHg, there is no need to worry. This is also considered a variant of the norm, and many people live with such numbers all the time.
If they rise to 140/90 or more, then hypertension occurs. The condition of the body deteriorates, this causes discomfort to the person. He may experience the following symptoms:
The best way to find out if your blood pressure has increased is to buy a tonometer and learn how to use it. If you often experience this type of pathology, this is a reason to immediately consult a doctor. There are many modern drugs that effectively fight hypertension. When this happens rarely, you should know how to lower your blood pressure yourself.
If high blood pressure occurs, there are general recommendations on what to do in such situations. First you need to make sure whether the indicators are really inflated. Measure and evaluate the results. If the increase is insignificant, you can use people's councils. To normalize the condition, a decoction of herbs is suitable.
If the reason for the jump is a stressful situation you have experienced, you need to calm down, lie down and remain in this position in silence.
With a strong increase, only drug treatment will help. For such cases, the drugs “Anaprilin”, “Nifedipine”, “Verapamil” are suitable. It is good to put in a drip with magnesium (magnesium sulfate), if possible.
The pill may not work right away. There is no need to increase the dose or try a different drug. The effect will appear within an hour, you need to lie down and wait quietly. An overabundance of medications will only worsen the situation.
After returning to normal indicators eliminate provoking factors - do not smoke at least at first, do not drink coffee, strong tea and alcohol. If you are unable to reduce your high blood pressure, call an ambulance.
The list of medications that can quickly reduce high blood pressure includes the following drugs:
They are not suitable for frequent use. If you have any chronic disease that causes hypertensive crises, you need to get a doctor's prescription and undergo a course of treatment. A specialist will also tell you how to reduce the pressure of a one-time nature in this case. Constantly reducing pressure without addressing the cause is dangerous to health.
"Dibazol". Active ingredient- Bendazole. Available in the form of tablets with a dosage of 20 mg and a solution for injection of 5 or 10 mg. There is also an option for children - 4 mg tablets.
The drug blocks cation channels in the muscles of the vessel walls. The action provided is one of the main ways to relieve pressure.
In parallel with this, the active component affects other parts of the body. It increases the production of interferon and antibodies, with which we fight infections, and also increases the excitation of neural connections in the spinal cord.
Take 1 tablet 2 hours before or after meals. The course of treatment is prescribed by the doctor based on individual indications. Use is prohibited in case of hypersensitivity to the components.
"Pentamine." Belongs to the group of ganglion blockers. Release form: 5% solution for injection. Indicated for hypertensive crisis, vasospasm, renal colic, bronchial asthma, cerebral and pulmonary edema.
Do not use for hypotension, glaucoma, after myocardial infarction, thrombophlebitis, renal or liver failure, lesions of the central nervous system.
It can be used in two ways - intravenously (for hypertensive crisis and other emergency situations) and intramuscularly (for vascular spasm). The initial dosage is 1 ml. solution. The maximum single dose is 3 ml. After administering the drug, the patient should lie down for at least 2 hours, as the pressure may drop too quickly and worsen the condition.
"Furosemide". This is a diuretic drug. By removing excess fluid from the body, the load on the walls of blood vessels is reduced, which helps lower blood pressure.
Release form: tablets of 40 mg of active substance. Indications: edema in diseases of internal organs (liver, kidneys, heart) and arterial hypertension.
Blood pressure-lowering tablets for hypertension have contraindications:
High blood pressure suggests a dosage of mg. This drug is usually used in combination with other drugs for hypertension. When used together, the dose of another medicine is halved.
"Anaprilin." Active ingredient: Propranolol. Available in the form of tablets of 10 and 40 mg. Belongs to the group of beta-blockers - these lower blood pressure and antiarrhythmic drugs. It has accompanying effects on the body - contraction of the uterus, increased bronchial tone, decreased intraocular pressure.
Use 40 mg 2 times a day. The maximum dose per day is 320 mg.
"Nifedipine". Dosage form- 10 mg tablets. Purpose: angina pectoris and hypertension. It belongs to the group of calcium channel blockers. Take 1 tablet 2 or 3 times a day during or after meals. The daily maximum is 40 mg.
"Verapamil." It is also a calcium channel blocker. They produce tablets of 40 and 80 mg. Indications: angina pectoris, disturbances of normal heart rhythm, arterial hypertension.
Single dose – mg. Can be used 3-4 times a day. But usually the number of doses and dosage are calculated individually by the attending physician.
How to relieve high blood pressure without resorting to medications? You can use folk recipes, namely herbal decoctions. For these purposes, medicinal plants are used, which also have a sedative effect:
All these herbs can be found in any pharmacy. The package indicates the dosage and the correct method of preparation. Do not overdose - in large quantities, decoctions from medicinal plants can be harmful to health. The manufacturer's recommendations on how to deal with high blood pressure must be strictly followed.
You can brew the herb not only for oral administration. Add the decoction to a bath of warm water and soak in it for half an hour. This procedure will calm you down and help reduce your blood pressure.
An unusual way to lower blood pressure is to use food products. Natural healers include nuts, milk, bananas, and garlic. To improve the condition of the body, it is useful to eat berries.
Kefir will help cope with the disease. Pour it into a glass, add a spoonful of cinnamon, stir and drink quickly.
Another food that can lower blood pressure is beets. IN folk medicine the recipe for the mixture is known beet juice and honey. It will help reset the blood pressure monitor a little. The products must be mixed in equal quantities. There are recommendations for course intake of this natural medicine. Take ½ teaspoon 3 times a day. Duration of treatment – 1 month.
Do not drink freshly squeezed beet juice. Let it brew for 24 hours. Otherwise, its effect will be the opposite - it will damage the blood vessels.
Lovers folk recipes know how to lower blood pressure - with the help of watermelon seeds. They are dried and ground in a blender to a powder. In this form, take it ½ teaspoon 3 times a day for 3-4 weeks.
There is a recipe for older people that will help not only relieve blood pressure, but also strengthen the body as a whole. Cut the lemon and orange into pieces and crush them into porridge along with the zest. One dose of citrus mixture per day will be enough for positive result. Before meals, eat one teaspoon of this remedy.
If you sometimes feel unwell and your tonometer readings are much higher than normal, you need to remember a few rules on how to lower your blood pressure without using medications. Here are the main recommendations:
If there is an option to lower your blood pressure without medications, take it. When such a pressure surge is not associated with internal disease, but provoked external factors(stress, weather), alternative methods really help. And they are much healthier and safer than drugs.
There are many possible answers to the question “how to reduce high blood pressure”. The most common one is medicines. But there are many others effective ways. If there is no effect from self-treatment call a doctor - long time the development of pathology can be dangerous. Try to protect yourself from stressful situations. Spend more time in the fresh air, exercise your lungs physical exercise, eat right, get rid of excess weight and bad habits - hypertension will bypass you.
Drug treatment of hypertension is necessary, as this will normalize blood pressure and prevent the development of a number of complications, such as heart attack and stroke.
However, medications for hypertension can only be taken after a doctor's prescription. After all, there are different groups of drugs that have different effects and have a number of side effects, such as dizziness, increased urination, cough, etc.
It is impossible to do without drug therapy, because high blood pressure has a slow destructive effect on the entire body. But most often the kidneys, heart and brain are affected by hypertension.
What should you do to prevent the development of complications? Antihypertensive medications should be taken regularly, because this is the only way to control blood pressure.
All drugs for high blood pressure are divided into groups. They can be used as monotherapy or combined with each other to enhance the effect and reduce side effects.
Diuretics. Diuretic medications can quickly reduce blood pressure by removing salts and excess fluid from the body. To quickly normalize blood pressure, the use of potassium-sparing diuretics and saluretics (Dicarb, Hypothiazide, Furosemide and others) is recommended.
These diuretic drugs remove not only water from the body, but also calcium and sodium salts. However, a deficiency of potassium salts negatively affects the functioning of muscles, including the myocardium.
But what to do if you need to lower your blood pressure? For these reasons, along with saluretics, you should take drugs containing potassium salts - Asparkam or Panangin.
Potassium-sparing diuretics for hypertension, such as Triamterene, do not remove potassium. But if they are used incorrectly, they can accumulate in the blood, which also has an adverse effect on the body.
It is worth noting that diuretics do not cause a cough, but they can provoke a disorder water-salt balance, as a result of which side effects develop such as:
Popular diuretics are Hydrochlorothiazide, Spironolactone, Indapamide, Triampur, Diuver and others.
Beta blockers. Used to lower high pressure, arising against the background of heart problems, for example, ischemic heart disease. The drugs affect cardiovascular system adrenaline, they block the beta receptors of adrenaline, which is sensitive to this substance.
In this case, the vessels, including the coronary ones, dilate, as a result of which the heart rate and blood pressure levels decrease. As a rule, beta-blockers such as Bisoprolol, Metoprolol, Celiprolol are prescribed to young patients with heart problems.
Due to the narrowing of peripheral blood vessels, beta blockers should not be taken by patients with poor circulation in the extremities.
Calcium channel blockers. In addition to lowering blood pressure, such medications are used for heart diseases. CCBs block the flow of calcium into muscle cells, inhibiting their contraction.
For calcium deficiency smooth muscle the walls of blood vessels do not contract as necessary. As a result, the vessels relax, blood flow inside them is facilitated and pressure decreases.
Prominent representatives of BCC are the following drugs:
ACE inhibitors. Such tablets expand blood vessels. ACE is an enzyme involved in the synthesis of a substance that has a strong vasoconstrictor effect - angiotensin II.
Basically, ACE inhibitors are indicated for hypertension that develops against the background of heart and kidney diseases. Also, drugs belonging to this group are indicated for high diastolic pressure and in case of increased load on the heart muscle.
However, with regular use of ACE inhibitors, a dry cough appears. What to do in this case? Often, the doctor prescribes antihypertensive drugs belonging to a different group.
Popular drugs from this group are Ramipril, Perindopril, Enalapril.
Angiotensin II receptor blockers. These drugs monitor blood pressure for 24 hours. However, in order to achieve a sustainable decrease in blood pressure, you need to drink them for at least 3 months.
It is noteworthy that angiotensin 2 receptor blockers have virtually no side effects, including that they do not cause coughing.
Centrally acting agents. Popular representatives of this drug group Moxonidine, Methyldopa and Albarel. Such drugs bind to receptors in nerve cells, regulating the activity of the SNS and reducing the intensity of vasoconstrictor signals. As a result, vascular spasm is eliminated, and pressure numbers drop.
It is worth noting that centrally acting tablets of the previous generation (Clonidine) are now practically not used in the treatment of hypertension.
Most often, a dry cough develops after taking ACE inhibitors. As a rule, it is precisely this side effect that forces treatment to be discontinued.
It is worth noting that cough can occur as a result of therapy with any medications from this group. But most often, such a negative symptom develops during treatment with Enalapril and Captopril. Moreover, cough occurs twice as often after taking Enalapril.
It is worth noting that after taking ACE inhibitors in patients with CHF, such side effect appears much more often than in hypertensive patients (26% and 15%). The reasons for its occurrence include an increase in the concentration of bradykinin, which collects in the upper respiratory tract, causing a cough.
In addition, a hereditary predisposition to the development of cough after taking ACE inhibitors is assumed. In this case, the patient feels an unpleasant tickling in the back wall of the throat.
Basically, the cough is paroxysmal, dry, prolonged and intermittent. It often gets worse when the patient is lying down, which can lead to hoarseness and even urinary incontinence and vomiting.
Moreover, these phenomena are not accompanied by hypersensitivity, symptoms of bronchial obstruction or changes in kidney function. What to do to eliminate cough after taking ACEI? According to some studies, to eliminate cough it is enough to reduce the dosage of the drug.
Time from the start of therapy with ACE inhibitors until the onset of unpleasant symptom can range from 1 day to 1 year. But on average it appears 14.5 weeks after regular use of the drug.
It is worth noting that the cough reflex that develops while taking ACE inhibitors is generally not dangerous to the patient’s health; it often simply causes discomfort. But it was found that patients with this symptom have a worse quality of life and are more susceptible to depression.
To determine whether the cough is caused by the use of ACE inhibitors, their use must be discontinued for 4 days. Typically, the symptom disappears after 1-14 days. But if treatment is resumed, it may develop again.
What to do and what medications can be used to suppress the cough reflex after taking ACE inhibitors? The following medications are used to relieve cough:
In addition to ACE inhibitors, cough can develop against the background of lowering blood pressure with beta blockers. Such drugs affect sensitive receptors located in the blood vessels, heart and bronchi.
When the blood vessels narrow, dry skin appears nonproductive cough. It can also occur during physical activity and changes in body position.
Today, calcium channel blockers are increasingly used in the treatment of hypertension. They have a specific effect on organs and a minimal amount adverse reactions.
New tablets from this group can bind to calcium channels in cell membranes located in the vascular walls and myocardium.
When calcium enters a cell, the following happens:
However, some modern tablets from this group infringe on such processes. These include the following drugs:
Calcium channel blockers have a number of advantages. So, in addition to lowering blood pressure, they improve the general well-being of hypertensive patients and are well tolerated in old age. And modern CCBs reduce hypertrophy in the left ventricle and do not suppress physical and mental activity.
In addition, calcium channel blockers do not cause depression and do not increase bronchial tone, which cannot be said about adrenergic blockers. Therefore, such medications are recommended if hypertension is combined with broncho-obstructive diseases.
CCBs also improve renal excretory function and have a positive effect on carbohydrate metabolism uric acid and lipids. Thanks to this property, they are superior to thiazide diuretics and adrenergic blockers.
In addition to CCBs, diuretics are increasingly used for hypertension, which remove salts and fluid from the body, reducing blood volume, thereby lowering blood pressure. Modern safe diuretics are:
Also, in case of hypertension, it is customary to combine antihypertensive drugs to enhance the effect and reduce adverse reactions, including cough.
It is worth noting that with the right combination, some drugs neutralize each other's side effects. Therefore, every patient suffering from high blood pressure should know the combination of drugs used in the treatment of arterial hypertension.
During treatment with combination drugs, the incidence of hypertensive complications is significantly reduced. Often 2 or 3 agents are combined. The most effective combinations of 2 drugs are:
Such combinations are the optimal solution for the treatment of hypertension. Effective combinations of three drugs are:
In addition, there are combination drugs that combine two active ingredients in one tablet. These include Enzix duo forte (enalapril and indapamide), Lodoz, Aritel plus (hydrochlorothiazide and bisoprolol), Co-diovan (hydrochlorothiazide and valsartan) and Logimax (metoprolol and felodipine).
Also popular combined means are Gizaar, Lorista N/ND, Lozap plus (hydrochlorothiazide and losartan), Exforge (amlodipine and valsartan), Atacand plus (hydrochlorothiazide and candesartan) and Tarka (verapamil and trandolapril).
However, absolutely safe means, which do not cause any adverse reactions, do not exist. But there are modern antihypertensive drugs that have a number of advantages over other drugs. This allows them to have a minimum number of adverse reactions, because new components make such tablets less dangerous.
Some of the best modern antihypertensive drugs are selective imidazoline receptor agonists. Such drugs rarely provoke the appearance of adverse reactions, quickly normalize blood pressure and have practically no contraindications. Popular drugs from this group are Monoxidine or Rilmenidine.
In addition, it is worth choosing drugs that provide fast action and a prolonged effect, which allows you to minimize the risk of adverse reactions. Therefore, it is preferable to choose complex drugs that have virtually no side effects, which makes them the optimal choice in the fight against hypertension.
One of the most safe drugs The third generation is Physiotens. After taking it there is practically no noticeable increased sleepiness, cough and dry mouth.
This is a new remedy for high blood pressure without side effects and does not have an adverse effect on respiratory function, so Physiotens can be taken even with bronchial asthma. In addition, the medicine increases insulin sensitivity, which is important for insulin-dependent patients suffering from diabetes mellitus. The patients themselves will tell you more about the types of tablets in the video in this article.
The electrical axis of the heart is a concept that reflects the total vector of the electrodynamic force of the heart, or its electrical activity, and practically coincides with the anatomical axis. Normally, this organ has a cone-shaped shape, with its narrow end directed downward, forward and to the left, and electric axle has a semi-vertical position, that is, it is also directed down and to the left, and when projected onto a coordinate system it can be in the range from +0 to +90 0.
An ECG conclusion is considered normal if it indicates any of the following positions of the heart axis: not deviated, semi-vertical, semi-horizontal, vertical or horizontal. The axis is closer to the vertical position in thin people tall people asthenic physique, and to the horizontal - in strong stocky persons of hypersthenic physique.
For example, in the conclusion of an ECG, the patient may see the following phrase: “sinus rhythm, EOS is not deviated...”, or “the axis of the heart is in a vertical position,” this means that the heart is working correctly.
In the case of heart disease, the electrical axis of the heart, along with the heart rhythm, is one of the first ECG criteria that the doctor pays attention to, and in case of ECG decoding The attending physician must determine the direction of the electrical axis.
Determination of the position of the heart axis is carried out by a doctor functional diagnostics, deciphering the ECG, using special tables and diagrams, according to the angle α (“alpha”).
The second way to determine the position of the electrical axis is to compare the QRS complexes responsible for the excitation and contraction of the ventricles. So, if the R wave has a large amplitude in I chest lead than in III, then there is a leftogram, or deviation of the axis to the left. If there is more in III than in I, then it is a legal grammar. Normally, the R wave is higher in lead II.
Axial deviation to the right or left is not considered an independent disease, but it can indicate diseases that lead to disruption of the heart.
Deviation of the heart axis to the left often develops with left ventricular hypertrophy
Deviation of the heart axis to the left can occur normally in healthy individuals who are professionally involved in sports, but more often develops with left ventricular hypertrophy. This is an increase in the mass of the heart muscle with a violation of its contraction and relaxation necessary for normal operation with all my heart. Hypertrophy can be caused by the following diseases:
In adults, such a deviation is usually a sign of right ventricular hypertrophy, which develops in the following diseases:
The greater the degree of ventricular hypertrophy, the more the electrical axis is deflected, respectively, sharply to the left and sharply to the right.
The electrical axis of the heart itself does not cause any symptoms in the patient. The patient feels unwell if myocardial hypertrophy leads to pronounced violations hemodynamics and heart failure.
The disease is characterized by pain in the heart area
Signs of diseases accompanied by deviation of the heart axis to the left or right include headaches, pain in the heart area, swelling of the lower extremities and face, shortness of breath, asthma attacks, etc.
If any unpleasant cardiac symptoms appear, you should consult a doctor for an ECG, and if an abnormal position of the electrical axis is detected on the cardiogram, further examination must be performed to determine the cause of this condition, especially if it is detected in a child.
To determine the cause of an ECG deviation of the heart axis to the left or right, a cardiologist or therapist may prescribe additional methods research:
Direct deviation of the electrical axis does not require treatment, since it is not a disease, but a criterion by which one can assume that the patient has one or another cardiac pathology. If, after additional examination, some disease is identified, it is necessary to begin its treatment as soon as possible.
In conclusion, it should be noted that if the patient sees in the ECG conclusion a phrase that the electrical axis of the heart is not in a normal position, this should alert him and prompt him to consult a doctor to find out the cause of such an ECG sign, even if there are no symptoms does not arise.
