Гіпертонічна хвороба, сучасні погляди на лікування, та антигіпертензивна терапія в корекції порушень добового профілю артеріального тиску у пацієнтів з гіпертонічною хворобою. Схеми комбінованих антигіпертензивних препаратів

Abstract

Головна мета лікування хворих на АГ – досягнення максимального зниження ризику серцевосудинних захворювань і смертності, що полягає в усуненні всіх ідентифікованих факторів ризику (зниження маси тіла, фізична активність, припинення паління, корекція ліпідного профілю, компенсація цукрового діабету, лікування асоційованих клінічних станів) та зниженні АТ до рівня цільового. Автором досліджені різні погляди вчених на запровадження різних схем лікування комбінованими антигіпертензивними препаратами, їх ефективність при лікуванні пацієнтів з гіпертонічною хворобою.

Arterial hypertension is characterized not only by elevated blood pressure, but by significant structural changes in the function and structure of the myocardium and vessels: left ventricular hypertrophy, vascular wall atherosclerosis, gradual development of cardiovascular insufficiency. Changes in the heart with hypertension are called structural remodeling of the heart. In the case of remodeling of the heart, there are changes in intramocardial vessels with accumulation in collagen adventitia, microscopic scarring in the area of necrotizing myofibrils of the heart and fibrous fibers in the left and right ventricles. According to modern ideas in the development of hypertension, multifactorial etiopathogenetic mechanisms are important. These major factors include enhancement of the renin-angiothecinoma system, in particular, an increase in the synthesis of renin and metabolism of electrolytes: calcium, magnesium, sodium, potassium. It is important to increase the activity of the sympathetic system (hyperadrenalemia, increase the sensitivity of the vessels to catecholamines) and change the function of intracellular mediators (prostaglandins, bradykinin, and others). Disturbances of metabolism in the body: energetic, protein, lipid, vascular endothelium dysfunction, microcirculation, apoptosis, lipid peroxidation, tissue hypoxia. According to the recommendations of the Ukrainian Society of Cardiologists, a “step by step” scheme for the treatment of hypertension was adopted. When soft and moderate AG treatment start with monotherapy with one of the medicines of the first row, and in severe form of hypertension – with the combined use of two or three drugs. The patient is prescribed the first-line antihypertensive medication in the middle dose. If a hypotensive effect is achieved then continue treatment. In the case of insufficient hypotensive action, if within 4 weeks of monotherapy with a hypotensive drug no therapeutic effect is achieved, then switch to a combined pharmacotherapy. AG is a pathogenetically heterogeneous disease; in different patients, elevated blood pressure is due to heterogeneous mechanisms. Determining the leading factor in increasing pressure in the patient is difficult enough. Therefore, it is more appropriate to use combined medications. The benefits of combination therapy are that a combination of two or more antihypertensive agents that affect various mechanisms of increased blood pressure, contributes to a more pronounced therapeutic effect, reduces the side effects of drugs, since the latter are used in smaller doses, it is possible to conduct long-term pharmacotherapy in the outpatient setting. In connection with the increase in the number of local military conflicts, terrorist acts and the threat of their occurrence, the problem of the development of social and stress violations received in an atmosphere of combat or close to it becomes more and more relevant. Of particular importance is the study of the influence of factors of military service on the course of hypertension in the military. A peculiarity of the present is the formation of a professional army. The professionalization of the Armed Forces of Ukraine is a complex process, which envisages, first of all, the recruitment of personnel by contract servicemen. Military service – a special type of human activity, which is characterized by an irregular working day, physical and psychological overload, limited ability to make decisions and other stressful situations. The social condition of the profession of a service man is an independent risk factor and the psychological status in them is characterized by emotional instability, an increased level of neuroticism, which should be taken into account when analyzing the causes of the onset and the clinical course of hypertension.