Arterial hypotension – lowered for some reason, blood pressure. Below are considered the types of this condition, manifestations and treatment. Neurocirculatory dystonia and transient arterial hypotension are described separately.
Essential arterial hypotension
Essential (primary) arterial hypotension is a disease that is manifested by stable arterial hypotension accompanied by a characteristic clinical picture (symptomatology).
Risk factors
The disease is most often found in young women. In such cases, the patient is typical of an asthenic constitution, family predisposition, dysplasia of connective tissue (in particular, mitral valve prolapse), low body weight. The specific features of professional activity are also classified as risk factors. This kind of arterial hypotension is exposed to bank employees, accountants, office workers.
Pathogenesis
To date, the pathogenesis to the end has not been studied. The thought prevails that this disease is caused by peculiar violations of the neurohumoral regulation of blood circulation.
Symptoms
Symptoms and manifestations can be different. Almost in all cases, fix headaches, excessive fatigue, dizziness. These manifestations become weaker if the human blood pressure is increased, for example, with coffee. In 50% of cases, the following symptoms are recorded:
- noise in the head
- sleep disorders
- memory impairment
- unsteadiness
- difficulties in learning the information
Patients with this diagnosis do not tolerate transport, staying at a height, stuffiness and heat, moving down the escalator or upwards. Often patients complain of a neuropsychiatric discomfort; describe the symptoms of anxiety and depression. Typical complaints related to violations of the autonomic nervous system:
- numbness of hands and/or feet;
- unreasonable feeling of heat or cold;
- paresthesia;
- disturbances of thermoregulation and sweating;
- erectile dysfunction (fixed in about 1/3 of men).
Fifteen percent of patients have syncope and orthostatic failure, as well as attacks similar to pathetic attacks. And one-third note postprandial hypotension. With the disease under consideration, people complain to doctors about heartbeat, cardialgia, dyspnea, which come after fatigue and during excitement. However, in the physical examination by the CAS, violations are usually not recorded. ECG does not show abnormalities, but in some cases benign rhythm disturbances are recorded.
Ultrasound shows a decrease in the size of the heart, the aorta and its branches, and the thickness of the part of the wall of the arteries. For diagnostic purposes, the examination of the fundus is performed, which shows the hypotonic angiopathy of the retina. Arterial pressure in the majority of patients varies greatly: alternating decreases and ups. The course of primary arterial hypotension in most cases passes through waves. Exacerbations occur with a change in vital rhythm, meteorological factors, intensity of loads.
With age, primary arterial hypotension can pass, replaced by arterial hypertension, which is tolerated by a person badly, even if the pressure increases are not critical. In most cases, doctors say a favorable prognosis. It is necessary to be afraid only if the disease has started to progress, there are repeated syncope, there are concomitant risk factors, an elderly patient.
Treatment
First, you need to exclude or limit the effect of drugs aimed at lowering blood pressure. With symptomatic arterial hypotension, therapy should focus primarily on the treatment of the underlying disease that caused it, if possible. Treatment of patients with primary arterial hypotension doctors almost always recommend starting with the use of non-pharmacological methods.
Non-drug treatment
They transfer a person to a sparing regime of loads. The patient should have enough time to rest, including during the day. When lying in bed, you need to raise the head of the bed to activate the RAAS. Long lying is harmful, because physical inactivity is a risk factor for orthostatic failure. Doctors prescribe physical therapy, orthostatic training. If the patient is in a satisfactory condition, he can be engaged in swimming.
People with severe orthostatic hypotension should be taught to get up and stay in an upright position with crossed legs and strain while musculature of the legs, abdominal press. It is necessary to choose the right chair so that it is low enough that the knees will approach the chest. Gives an effect wearing elastic pantyhose, belts, etc.
Patients with postprandial hypotension recommend frequent meals in small portions to prevent postprandial reactions. At the same time, a hot, low-calorie or rich in easily assimilated carbohydrates can provoke hypotension. It is advised to increase the intake of table salt (up to 10-20 g per day) and liquids (up to 2-2.5 liters). People’s addiction to tea and coffee is not limited. It is best to stop using any alcohol-containing beverages.
Medication
The drug of choice for essential hypotension is midodrin. It is available in tablets and drops. The initial dose is 5 mg per day, if necessary, increase the dose to 15 mg per day in 2 divided doses – morning and afternoon. This medicine increases the venous return to the heart, increases the level of both systolic and diastolic blood pressure. The heart rate is almost not affected. The patient’s state of health is improving, he is more tolerant of physical activities and eating habits. Side effects are observed in rare cases.
In the case of essential hypotension, other adrenomimetics are effective:
- ephedrine
- phenylephrine
- caffeine
Fludrocortisone is a hormonal mineralocorticoid agent, it somewhat increases blood pressure by increasing the volume of circulating blood by delaying sodium and water. But with long courses there are many side effects.
Fainting
Fainting – syncope – a short-term, self-passing loss of consciousness and posture. At fainting the pose is lost due to loss of muscle tone. Approximately every 3-4th adult person suffered during his life at least 1 syncope.
Etiology and pathogenesis
Fainting can occur due to cardiovascular factors, blood flow disorders in the brain, rhythm disturbances and conduction of the heart. As a rule, the basis for syncope is a pronounced transient arterial hypotension and associated hypoperfusion of the brain, which last at least a few seconds. Loss of consciousness in hypoglycemia, hyperventilation, hysteria, migraine, hypoxia, epilepsy is due to other mechanisms and is called pseudosyncope.
Diagnostics
While the cause of syncope is unknown, and also with the frequent renewal of syncope, the situation is considered as very serious. It is important to find out what is the cause of fainting to make an adequate prognosis. The worse is the prognosis with fainting, which is caused by organic diseases of the heart and blood vessels. Mortality varies from 20 to 30%.
Diagnosis includes a close physical examination. The doctor finds out an anamnesis, measures blood pressure in the position of a person lying down and sitting, doing an ECG. If they suspect a certain cause, they can perform instrumental diagnostics to verify the diagnosis. If the cause is unclear, it is necessary to perform Echocardiography, daily monitoring of the ECG and ECG in conditions of physical activity. Because the causes of syncope can be hidden in the organic lesions of the heart.
Diagnostic methods can include ECL of the heart, visualization of carotid arteries and brain, electroencephalography. In some cases, they resort to the help of a psychiatrist. Neurogenic called syncope, which is based on sudden transient circulatory disorders caused by a violation of neurogenic regulation and leading to acute arterial hypotension due to weakened vascular tone and / or slow heart rate.
Neurogenic syncope
The cause of neurogenic syncope is usually unclear. Before syncope, the tone of the sympathetic nervous system rises, followed by a paralytic weakening and intensification of parasympathetic influence directed toward the heart and / or vessels.
Classification
Depending on the specific features of the circulatory deficit causing neurogenic syncope, the following are distinguished:
- cardioinhibitory syncope (65% of cases);
- vasodepressor syncope.
Symptoms and Diagnosis
Neurogenic fainting is more common in young and middle-aged people. Rarely can patients be children or elderly people. The state of health can worsen after a plentiful meal. The development of arterial hypotension with cardioinhibitory syncope can be preceded by AV blockade, sinus bradycardia, asystole, stopping the sinus node. With vasodepressor syncope there is no bradycardia, but blood pressure is lowered. For diagnosis, a test is conducted, based on the movement of a person from a horizontal position to a vertical position. The test with passive orthostasis lasts from 20 to 45 minutes. If the results are shorter, the results may be false (negative).
Treatment
For many people with benign neurogenic syncope active therapy is not needed. It is important only to follow preventive measures. It is necessary to avoid staying in stuffy rooms, prolonged orthostatic position, the impact of any other factors provoking fainting. If there are harbingers of fainting, you need to sit down or take a reclining position.
People who have fainting need to salt food and dishes and drink plenty of fluids. A full-value sleep and rest is important. In recent years, specialists have been actively working on special orthostatic training. For today, there is no information that drugs with this type of fainting give the desired effect.
The use of ECS is not relevant for everyone who has neurogenic syncope. They are used in patients with a certain type of malignant cardioinhibitory syncope. If there is a pause of more than 3 seconds in the operation of the heart, which is caused by the caused by the stopping of the sinus node and / or the AV blockade.