Патогенетичне обгрунтування лікування та фізичної реабілітації при гіпертонічній хворобі, ускладненій фібриляцією передсердь (огляд літератури)

Abstract

В огляді сучасної наукової літератури представлено основні питання медикаментозного лікування та фізичної реабілітації хворих з поєднаною патологією – гіпертонічна хвороба та фібриляція передсердь.

В обзоре современной научной литературы представлены основные вопросы медикаментозного лечения и физической реабилитации больных с сочетанной патологией – гипертоническая болезнь и фибрилляция предсердий.

This review of current scientific literature presents the main aspects of medical treatment and physical rehabilitation of patients with combined pathology – hypertension and atrial fibrillation. The main medical and social problems in Ukraine at the present stage are an increase in the incidence and prevalence of the most socially significant diseases – arterial hypertension and coronary heart disease. The development and progression of arterial hypertension and coronary heart disease have many identical risk factors (smoking, hypodynamia, obesity) and mechanisms. Thus, one of the leading links in pathogenesis is endothelial dysfunction. In addition, arterial hypertension may be associated with coronary heart disease due to other risk factors for cardiovascular complications. So, it is known that both dyslipidemia and the level of arterial hypertension are closely related to the body mass index, which also contributes to the remodeling of the myocardium. Today, atrial fibrillation is the most common arrhythmia that is recognized as heterogeneous nosology with different mechanisms, substrates of the onset and support of this arrhythmia, which requires different approaches to additional methods of diagnosis, prevention and treatment, since its complications significantly increase mortality. Thus, the interest in the association of atrial fibrillation with endothelial dysfunction as one of the determinants of this arrhythmia is of interest, which, in turn, can also be provoked by the presence of arterial hypertension. In modern medicine, more and more attention is paid to the hereditary factors of the risk of hypertension and coronary heart disease. In modern medicine, the influence of polymorphism of genes controlling the key neuronalhumoral systems of blood pressure regulation, on the development and clinical features of the course of arterial hypertension is actively studied. According to the results of the research, genes have been identified that can be involved in the pathogenesis of arterial hypertension. Among the mediators, which also affect the renin-angiotensinaldosterone system, taking part in the pathogenesis of hypertension and coronary heart disease, in recent years considerable attention has been paid to the study of apеlin. Treatment of patients with both hypertension and coronary heart disease requires an integrated podhoda, that simultaneous exposure to both states. Pershostupnevym objective of treatment and rehabilitation is the maximum reduction in the overall risk of cardiovascular disease and mortality by preventing myocardial infarction, cerebral stroke and chronic renal failure, regression of lesions of target organs. As tasks of the second row should consider the reduction of clinical manifestations and improve the quality of life. When developing a therapeutic strategy, one should not forget about the need for non-pharmacological measures. The latter involves such activities as smoking cessation, reducing excess body weight, maintain regular physical activity, diet low in fat and salt, limit alcohol consumption. The choice of medical therapy should be based on evidence of evidence. The drugs of the first line are: diuretics, ACE inhibitors, long-acting calcium antagonists, angiotensin II receptor antagonists, beta-blockers. Drugs of the second line are alpha adrenoblockers, alkaloids of rawolfia, central a2-agonists, imidazoline receptor agonists, direct inhibitors of renin. Exercise hypertension complicated by atrial fibrillation, as a stimulant biological regulatory systems provide active mobilization mechanisms adapted and increase adaptation abilities of the patient and tolerance to stress. Very important is the fact that physical exercise is accompanied, as a rule, of certain emotions that positively affect the flow of basic nervous processes in the cerebral cortex of the brain. Thus, there is need to develop a strategy of differentiated approaches to treatment and rehabilitation of physical comorbidity in outpatient and inpatient stages of treatment and rehabilitation.