Internal illnesses. Hyperfolic disease (diagnosis, treatment, prognosis, prevention) (most important)

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Internal illnesses. Hyperfolic disease (diagnosis, treatment, prognosis, prevention) (most important)

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5. HYPERFOLIC DISEASE (DIAGNOSIS, TREATMENT, PROGNOSIS, PREVENTION)

Diagnostic research. The examination includes 2 stages: a mandatory study and a study to assess the damage to target organs.

Mandatory studies: general blood and urine analysis, determination of potassium, fasting glucose, creatinine, total blood cholesterol, electrocardiography, chest x-ray, fundus examination, ultrasound examination of the abdominal organs.

Additional studies: echocardiography, ultrasound examination of peripheral vessels, determination of the lipid spectrum and triglyceride levels.

Complications. Hemorrhagic stroke, heart failure, III-IV degree retinopathy, nephrosclerosis, angina pectoris, myocardial infarction, atherosclerotic cardiosclerosis.

Differential diagnosis. Secondary hypertension: diseases of the kidneys, adrenal glands (Itsenko-Cushing syndrome, Conn syndrome), pheochromocytoma, Itsenko-Cushing disease, organic lesions of the nervous system, hemodynamic arterial hypertension (coarctation of the aorta, aortic valve insufficiency, sleep-disordered breathing syndrome), iatrogenic arterial hypertension .

Treatment. At high and very high risk levels, immediate medication is prescribed. If the patient is classified as a medium risk group, the question of treatment is taken by the doctor. It is possible to observe with control over blood pressure from several weeks to 3-6 months. Drug therapy should be initiated while maintaining blood pressure levels above 140/90 mm Hg. Art. In the low-risk group, longer follow-up is possible - up to 6-12 months. Drug therapy is prescribed while maintaining blood pressure levels of more than 150/95 mm Hg. Art.

Non-drug treatments include smoking cessation, weight loss, alcohol restriction, increased physical activity, and reduced salt intake to 5 g per day. Effective drug combinations:

1) diuretic and b-blocker;

2) a diuretic and an ACE inhibitor or an angiotensin II receptor antagonist;

3) a calcium antagonist from the group of dihydropyridones and a β-blocker;

4) calcium antagonist and ACE inhibitor;

5) a-blocker and b-blocker;

6) a drug of central action and a diuretic.

In case of uncomplicated hypertensive crisis, treatment can be carried out on an outpatient basis, b-blockers, calcium antagonists (nifedipine), short-acting ACE inhibitors, loop diuretics, prazosin are prescribed orally.

With a complicated hypertensive crisis, vasodilators (sodium nitroprusside, nitroglycerin, enaprilat), antiadrenergic drugs (phentolamine), diuretics (furosemide), ganglioblockers (pentamine), antipsychotics (droperidol) are administered parenterally.

Flow. Long-term, with periods of remission.

Forecast. At stage I - favorable, at stages - serious.

Prevention. Treatment of patients with neurocirculatory dystonia, monitoring of persons at risk, use of active recreation. When a diagnosis of hypertension is made, continuous comprehensive treatment is carried out.

Author: Myshkina A.K.

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