Bronchial asthma and arterial hypertension. Bronchial asthma and cardiovascular disease Other causes and factors of hypertension

The date: 23.06.2020

H. Ronic obstructive pulmonary disease (COPD) - chronic slowly progressive disease, characterized by irreversible or partially reversible (when using bronchodilitics or other treatment) obstruction of bronchial wood. Chronic obstructive lung diseases are widespread among the adult population and are often combined with arterial hypertension (AG). To COPD refers:

Bronchial asthma
Chronical bronchitis
Emphyms lungs
Bronchiectatic disease

Features of the treatment of AG on the background of COPD are due to several factors.

1) Some hypotensive tools are capable of increasing the tone of small and medium bronchi, thereby worsering the ventilation of the lungs and exacerbating hypoxmia. The appointment of these funds when COPD should be avoided.

2) A symptom complex of the "pulmonary heart" is formed in persons with a long history of COPD. Pharmacodynamics of some antihypertensive drugs changes, which should be taken into account during the selection and long-term treatment of AG.

3) Medical treatment of COPDs in some cases can significantly change the effectiveness of selected hypotensive therapy.

In a physical study, it is difficult to diagnose the "pulmonary heart", since most of the signs detected during the inspection (pulsation of the metering veins, systolic noise over a three-rolled valve and amplification of the 2nd cardiac tone above the pulmonary artery valve) are neglected or non-specific.

In the diagnosis of the "pulmonary heart", an ECG, radiography, radiograph, radioisotope ventriculography, myocardial scintigraphy with isotope wasotoped, however, the most informative, inexpensive and simple diagnostic method is echocardiography with Doppler scanning. With this method, it is possible not only to identify the structural changes in the departments of the heart and its valve apparatus, but also quite accurately measure the blood pressure in the pulmonary artery. ECG signs of the "pulmonary heart" are listed in Table 1.

It is important to remember that in addition to COPD, the symptom complex of the "pulmonary heart" can be caused by a number of other causes (night apnea syndrome, primary pulmonary hypertension, diseases and injuries of the spine, chest, respiratory muscles and diaphragms, repeated thromboembolism of small branches of pulmonary artery, expressed obesity chest, etc.), the consideration of which is beyond the scope of this article.

The main structural and functional signs of the "pulmonary heart":

Hypertrophy of myocardium right ventricle and right atrium
Increased volume and volumetric overload of the right heart
Increased systolic pressure in the right heads of the heart and pulmonary artery
High heart rate (in the early stages)
Atrial violations of rhythm (extrasystole, tachycardia, less often - flickering arrhythmia)
The insufficiency of the trilateral valve, in the later stages - pulmonary artery valve
Heart failure for a large circulation of blood circulation (in late stages).

The change in the structural and functional properties of myocardium in the syndrome of the "pulmonary heart" often leads to "paradoxical" reactions for drugs, including those used to correct an increased blood pressure. In particular, one of the frequent signs of the "pulmonary heart" is the violations of the heart rhythm and conductivity (synoyatrial and atrioventricular blocks, tachy and bradyrithmia). In the case of slowing the intracardiac conductivity and bradycardia, the use with the hypotensive target of some calcium antagonists (verapamil and diltiazem) is abruptly limited - due to the high risk of stopping the heart.

b -Adrenoblocators

Blocade B 2 -adrenoreceptors causes spasm of medium and small bronchi. The deterioration in the lung ventilation causes hypoxemia, and clinically manifested by the amplification of shortness of breath and breathing. Non-selective b -adrenoblocators (propranolol, supolyol) are blocked b 2 -adrenoreceptors, so when COPDs are usually contraindicated, while cardiolective preparations (bisoprolol, betaxolol, metoprolol) can in some cases (accompanying heavy angina, pronounced tachyarhythmia) are appointed in small doses under thorough control of the ECG and clinical condition (Table 2). The greatest cardooselectivity (including compared with the drugs listed in Table 2) from the B -Adrenoblocators used in Russia has bisoprolol (Concorp) . The recent studies showed a reliable advantage of the concoction on safety and efficiency of use in chronic obstructive bronchitis compared to Atenolol. In addition, a comparison of the effectiveness of atenolol and bisoprolla in individuals with agriculture and accompanying bronchial asthma, according to the parameters characterizing the state of the cardiovascular system (heart rate, blood pressure) and the indicators of bronchial obstruction (FEV 1, ZAN, etc.) showed the advantage of bisoprolol. In the group of patients who took bisoprolol, in addition to a reliable reduction in the diastolic blood pressure, there was a lack of influence of the drug on the state of the air routes, while in the placebo and atenolol group, an increase in respiratory resistance was revealed.

Inadrenoblasts with internal sympathomimetic activity (pindolol, acebotolol) less affect the tone of the bronchi, however, their hypotensive efficiency is small, and the prognostic benefits of arterial hypertension have been proven. Therefore, with a combination of AG and COPD, their appointment is justified by individual indications and under strict control.

Application with arterial hypertension B -AB with straight vazodilative properties (carvedilol) and b -AB with the properties of the inductor endothelial synthesis of nitrogen oxide (nebivolol) are studied less, as well as the influence of these drugs for breathing in chronic pulmonary diseases.

At the first symptoms of the deterioration of breathing, any b -AB is canceled.

Calcium antagonists

Are "drugs of choice" in the treatment of hypertension on the background of COPD, because along with the ability to expand the arteries of a large circle, they possess the properties of bronchodulators, thereby improving the ventilation of the lungs.

Bronching properties are proved in phenylalkylamines, short and long-term dihydropyridines, to a lesser extent - in benzodiazepine ak (Table 3).

However, large doses of calcium antagonists are able to suppress compensatory vasoconstriction of small bronchial arterioles and in these cases are capable of disturbing the ventilation and perfusion ratio and enhance hypoxemia. Therefore, if it is necessary to enhance the hypotensive effect in a patient with a COPD, it is more expedient to add a hypotensive drug of another class to the calcium antagonist (diuretik, angiotensin receptor inhibitor, an ACE inhibitor) - taking into account portability and other individual contraindications.

Inhibitors of angiotensin glittering enzymes and blockers angiotensin receptors

To date, there is no data on the direct influence of therapeutic doses of ACE inhibitors to perfusion and lung ventilation, despite the proven lungs in the synthesis of ACE. The presence of COPD is not a special contraindication to the appointment of ACE inhibitors with a hypotensive target. Therefore, when choosing a hypotensive drug, COPF inhibitors of APF should be assigned "on general reasons". Nevertheless, it should be remembered that one of the side effects of drugs of this group is a dry cough (up to 8% of cases), which in severe cases is able to significantly shrink the breath and worsen the quality of life of the patient with COPD. Very often, the thrust cough in such patients serves as a weighty reason for the abolition of ACE inhibitors.

To date, there is no data on the adverse effect on the function of light blockers angiotensin receptors (Table 4). Therefore, their appointment with a hypotensive goal should not depend on the presence of COPD in the patient.

Diuretics

In prolonged treatment of arterial hypertension, tiazide diuretics (hydrochlorostiazide, oxodoline) and indole diuretic Indapamide are used, as a rule. As a modern methodological guidelines with a "cornerstone" of hypotensive therapy with repeatedly confirmed high prophylactic efficacy, thiazide diuretics do not worsen and do not improve the ventilation and perfusion characteristics of the small circulation circle - because they do not directly affect the tone of pulmonary arterioles, small and medium bronchi. Therefore, the presence of COPD does not limit the use of diuretics for the treatment of concomitant ag. With concomitant heart failure with stagnation in a small circle of blood circulation of diuretics become a means of choice, because reduced the increased pressure in pulmonary capillaries, but in such cases, thiazide diuretics are replaced with loop (furosemide, bumetale, etcrinic acid)

When decompensating the chronic "pulmonary heart" with the development of blood circulation deficiency in a large circle (hepatomegaly, edema extremities), preferably the purpose of non-tiazide, but loop diuretics (furosemide, bumetate, ethanis acid). In such cases, it is necessary to regularly determine the electrolyte composition of the plasma and when hypokalemia appears, as the risk factor of cardiac arrhythmias actively prescribe potassium-saving drugs (spironolactone).

a -adrenoblocators and vasodilators

At hypertension, a direct vasodilator hydralazine is prescribed, or a -adrenobloclates of prazozin, doxazosin, therazozin. These drugs reduce peripheral vascular resistance, directly affecting arterioles. Direct influence on the respiratory function These drugs do not provide, and therefore, with appropriate indications, they can be prescribed to reduce blood pressure. However, the frequent side effect of vasodilators and A -adrenoblastors is reflex tachycardia, which requires the appointment of B -AB, which, in turn, are able to cause bronchospasm. In addition, in the light of the recent data of prospective randomized studies, it is now limited to the assignment of A -adrenobloclars with AG - due to the risk of heart failure during long-term reception.

Preparations Rawolfia

Although in most countries, Rauolfia preparations have long been excluded from the official list of funds for the treatment of AG, these drugs are still widespread in Russia - primarily due to low cost. Preparations of this group are able to degrade the breath in individual patients with COPD (mainly due to the edema of the mucous membrane of the upper respiratory tract).

Preparations of "Central" action

The hypotensive means of this group have a different effect on the respiratory tract, but in general their use with associated COPD is considered safe. Clonidine is a -adrenomimetic, but acts mainly on a -adrenoreceptors of the brain vesa derogatory center, so its effect on the small vessels of the mucous membrane of the respiratory tract is slightly. There are no reports of a serious impairment of breathing during the COPD against the background of the treatment of AG methyldop, Guangfatin and Moxonidine is currently not. However, it should be emphasized that this group of drugs in most countries for the treatment of high is almost not used due to the unprovenness of improving the forecast and a large number of side effects.

Effect of drugs used in COPD, on the effectiveness of hypotensive therapy

As a rule, antibiotics, mercolytic and expectorant drugs prescribed by patients with COPD, do not affect the effectiveness of hypotensive therapy. A somewhat different is the case with preparations that improve bronchial patency. Inhalation b -Adrenomimetics in large doses are able to cause hypertension in patients and provoke an increase in blood pressure - up to a hypertensive crisis.

Sometimes appointed when COPDs for the relief / prevention of bronchospasm inhalation of steroid means of influence on blood pressure, as a rule, do not provide. In cases where a long-term intake of steroid hormones is required, a fluid delay, an increase in weight and an increase in blood pressure - as part of the development of drug syndrome Cushing. In such cases, the correction of increased blood pressure is carried out, first of all, diuretics.

As is known, arterial pressure is almost in every person with age. However, for asthmatics, the presence of hypertension is a prognostically unfavorable sign. Such patients need special attention and carefully planned medication therapy.

DOCTOR / NURSE CHECING BLOOD PRESSURE.

Despite the fact that both diseases of pathogenetically are in no way connected, it was found that the blood pressure during asthma rises quite often.

Some asthmatics belong to the high risk of hypertension development, namely people:

Elderly.
With increased body weight.
With a heavy, uncontrolled asthma.
Taking medicines provoking hypertension.

Doctors separately single out the secondary hypertension. A registered such form of increased ad is often found among patients with bronchial asthma. This is due to the formation of chronic pulmonary heart patients. This pathological state develops due to hypertension in a small circulation circle, to this, in turn, leads hypoxic vasoconstriction. The latter is a compensatory mechanism mechanism, consisting in a smaller supply of blood to the hosted areas of the lungs towards those zones where gas exchange is intensively passing.

However, bronchial asthma is rarely accompanied by a resistant increase in pressure in pulmonary arteries and veins. That is why the variant of the development of secondary hypertension due to the chronic pulmonary heart in asthmatics is possible only if they have a concomitant chronic lung disease (for example, obstructive disease).

Rarely bronchial asthma leads to secondary hypertension due to disorders in the synthesis of polyunsaturated arachidonic acid. But the most common cause of hypertension in such patients is preparations that are long used to eliminate the symptoms of the underlying disease.

These medical environments include sympathomimetics and corticosteroids. Thus, phenooterol and salbutamol, which are used quite often, in high doses are able to increase the heart rate and, accordingly, increase hypoxia by increasing the need of myocardium in oxygen.

It is worth remembering that the attack of a suffocation during asthma may cause transient increase in pressure. This condition is a dangerous for the sickness of the patient, because against the background of elevated intragenuous pressure and stagnation in the upper and lower hollow veins, the swelling of the cervical veins and the clinical picture, similar to the lung artery thromboembolism, is often developing. Such a state, especially without timely provided medical care, can lead to a fatal outcome. Also bronchial asthma, which is accompanied by increased arterial pressure, is hazardous by the development of violations in brainwater and coronary circulation or cardiovascular failure.

Principles of therapy

[File # CSP8995671, License # 1702849]
Licensed Through http://www.canstockphoto.com In Accordance With the End User License Agreement (http://www.canstockphoto.com/legal.php)
(c) Can Stock Photo Inc. / Portokalis If the person suffering from bronchial asthma has become recorded by cases of increased blood pressure, it is necessary to immediately appeal for help from the doctor. It is categorically not recommended to choose pills from hypertension to independently, since many of them are contraindicated to take astmatics, because they can only worsen the state.

Deals with the tactics of treatment, the doctor for the beginning establishes whether there is a connection between the attacks of asthma and the increase in blood pressure. If both of these states are interrelated, only drugs are prescribed to relieve the symptoms of the pulmonary disease. If not - special medicines are selected, which eliminate the signs of arterial hypertension. Such drugs should:

Put antithrombotic activity.
Show antioxidant action.
Maintain potassium level at the proper level to prevent the development of pulmonary failure.
Do not cause a patient's cough attacks.
Do not interact with bronchodilies.

Preference is given to drugs that show local, and not a systematic effect on the body. As supporting therapy, in the presence of chronic hypertension, a doctor can be appointed diuretics (mainly potassium-saving - Veroshpirius, Tamiampur), potassium and magnesium preparations.

Choose a medicine from pressure at bronchial asthma should be carefully taking into account side effects. Preference in treatment is given to drugs that do not worsen the ventilation ability of the lungs.

Unwanted drugs

As already mentioned, bronchial asthma can progress against the background of some incorrectly chosen antihypertensive drugs.

These include:

Beta adrenoblockers. A group of medicines that strengthens the obstruction of the bronchi, the reactivity of the respiratory tract and reduces the therapeutic effect of sympathomimetics. Thus, the drugs aggravate the flow of bronchial asthma. Currently it is allowed to use selective beta adrenoblays (atenolol, tenoric) in small doses, but only strictly according to the testimony.
Some diuretics. At asthmatics, this group of drugs can cause hypokalemia, which leads to the progression of respiratory failure. It is worth noting that the joint reception of diuretics with beta-2 agonists and systemic glucocorticosteroids only enhances the unwanted elimination of potassium. Also, this group of drugs can enhance blood thickening, cause metabolic alkalosis, resulting in a respiratory center, and the indicators of gas exchange are worse.
iAPF. The effect of these medicines causes changes in bradykinin metabolism, increases the content of anti-inflammatory substances in the lungs parenchyma (Substance P, Neurokinin A). This leads to bronchokonstriction and cough appearance. Despite the fact that this is not an absolute contraindication to the appointment of ACE inhibitors, the preference in treatment is still given to another group of medical preparations.

Another group of drugs, with which it is necessary to be taken care, is alpha-adrenoblays (physiothens, ebrantil). According to studies, they are able to increase the sensitivity of the bronchi to histamine, as well as strengthen the shortness of breath in patients with bronchial asthma.

Preparations of choice

What antihypertensive agents are still allowed to apply with bronchial asthma?

The preparations of the first line include calcium antagonists. They are divided into non-dihydropidine. The first group includes verapamil and diltiazem, which in asthmatics are used less often in the presence of concomitant stagnant heart failure, due to their ability to increase the heart rate.

Dihydropyridine calcium antagonists (nifedipine, nipple, amlodipine) are the most effective antihypertensive drugs with bronchial asthma. They expand the clearance of the arteries, improve the function of its endothelium, impede the formation of atherosclerotic plaques in it. From the side of the respiratory system - improve the patency of the bronchi, reduce their reactivity. The best therapeutic effect was achieved when combining these drugs with thiazide diuretics.

However, in cases where the patient has concomitant severe violations by cardiac rhythm (atrioventricular blockade, pronounced bradycardia), calcium antagonists are prohibited for use.

Another frequently used group of antihypertensive drugs - angiotensin II receptor antagonists (Kozar, Lorista). In terms of its properties, they are similar to ACE inhibitors, however, unlike the latter, do not affect bradykinine metabolism and thereby do not cause such an unpleasant symptom as cough.

In patients with bronchial asthma, an increase in blood pressure is often observed (AD), hypertension occurs. To normalize the patient's condition, the doctor must be carefully selected with the asthma pills from pressure. Many drugs used in the treatment of hypertension can provoke the attacks of choking. Therapy should be carried out taking into account two diseases to avoid complications.

The reasons for the appearance of asthma and arterial hypertension are different, risk factors, features of diseases do not have common features. But often against the background of bouts of bronchial asthma, patients have an increase in pressure. According to statistics, such cases are frequent, occur regularly.

Is bronchial asthma causes the development of hypertension in patients, or are these two parallel diseases developing independently? Modern medicine has two opposite opinions regarding the question of the relationship of pathologies.

Some doctors talk about the need to establish in asthmatics with elevated pressure of a separate diagnosis - bulmonogenic hypertension.

Doctors indicate direct causal relationships between pathologies:

35% of asthmatics develop arterial hypertension;
during an asthmatic attack, hell rises sharply;
pressure normalization is accompanied by an improvement in the asthmatic state (the absence of attacks).

Adherents of this theory consider asthma by the main factor in the development of a chronic pulmonary heart, causing a stable increase in pressure. According to statistics in children having bronchial attacks, such a diagnosis occurs much more often.

The second group of doctors speaks of the absence of dependence and connection between two diseases. Diseases develop separately from another, but their presence affects the diagnosis, the effectiveness of treatment, the safety of drugs.

Regardless of whether there is an interrelation of bronchial asthma and hypertension, the presence of pathologies should be considered to select the correct course of treatment. Many pills that reduce pressure are contraindicated to astmatic patients.

The theory of pulmongenic hypertension binds the development of hypotension during bronchial asthma with a lack of oxygen (hypoxy), which occurs in asthmatics during attacks. What is the mechanism for the appearance of complications?

The lack of oxygen awakens the vascular receptors, which causes an increase in the tone of the autonomic nervous system.
Neurons increase the activity of all processes in the body.
The amount of hormone (aldosterone) produced in the adrenal glands increases.
Aldosterone causes an increased stimulation of the walls of the arteries.

This process causes a sharp increase in blood pressure. The data is confirmed by clinical studies carried out during the attacks of bronchial asthma.

With a long period of the disease, when asthma treatment is carried out by potent drugs, it becomes the cause of violations in the work of the heart. Right ventricle ceases to function normally. Such a complication is called the syndrome of a light heart and provokes the development of arterial hypertension.

Hormonal agents used in the treatment of bronchial asthma for assistance in critical condition also contribute to the increase in pressure in patients. Crimshes with glucocorticoids or oral preparations with frequent use violate the operation of the endocrine system. The consequence becomes the development of hypertension, diabetes, osteoporosis.

Bronchial asthma can cause arterial hypertension by itself. The main reason for the development of hypertension becomes drugs used by asthmatics to relocate attacks.

There are risk factors in which the pressure increases in patients with asthma is more often observed:

excess weight;
age (after 50 years);
development of asthma without effective treatment;
side effects of drugs.

Some risk factors can be eliminated by adjusting the lifestyle and following the recommendations of the attending physician at the reception of medicines.

The choice of medication from hypertension at bronchial asthma depends on what provokes the development of pathology. The doctor conducts a thorough patient survey in order to establish how often suffocations often occur and when the pressure increases.

Two events development options are possible:

Blood pressure is growing during an asthmatic attack;
the pressure does not depend on the attacks, constantly increased.

The first option does not require special treatment of hypertension. There is a need to eliminate the attack. For this, the doctor selects the anti-asthma agent, indicates the dosage and duration of its use. In most cases, the inhalation with the help of the canopy is stopped, reduced pressure.

If an increase in blood pressure does not depend on the attacks and remission of bronchial asthma, it is necessary to choose a course of treatment from hypertension. At the same time, drugs must be maximally neutral according to the availability of side effects that do not cause aggravation of the main disease of asthmatics.

There are several groups of medicines used in the treatment of arterial hypertension. The doctor chooses drugs that do not harm the patient's respiratory system in order not to complicate the heap of bronchial asthma.

After all, different groups of medicines have side effects:

Beta-adrenoblockers cause tissue spasms in bronchi, ventilation of the lungs is disturbed, shortness of breath increases.
ACE inhibitors (angiothenzine enzyme) provoke a dry cough (arises in 20% of their patients receiving), shortness of breath, aggravating the state of asthmatics.
Diuretics cause a decrease in serum potassium level (hypokalemia), an increase in carbon dioxide in the blood composition (hypercringe).
Alpha-adrenoblocators increase the sensitivity of the bronchi to histamine. With oral use, practically safe drugs.

In comprehensive treatment, it is important to take into account the influence of funds that buy an asthmatic attack on the appearance of hypertension. A group of beta-adrenomimetics (Berotek, Salbutamol) with long-term use provoke an increase in blood pressure. Doctors observe such a tendency after an increase in the dose of the inhaled aerosol. Under its impact, stimulation of myocardial muscles occurs, which causes an increase in cardiac rhythm.

The reception of hormonal drugs (methylprednisolone, prednisone) causes a circulation of blood flow, increases the thread pressure on the walls of the vessels, which causes sharp jumps. Adenosinergic agents (aminoophyllin, eufillin) lead to a violation of cardiac rhythm, causing pressure increase.

reduction of hypertension symptoms;
lack of interaction with bronchodilies;
antioxidant characteristics;
reducing the ability to form thrombov;
the absence of an antitussive effect;
the drug should not affect the level of calcium in the blood.

Preparations of calcium antagonists group meet all requirements. Studies have shown that these funds do not violate the operation of the respiratory system even with regular use. Doctors use calcium channel blockers in complex therapy.

There are two groups of drugs of this action:

dihydropyridine (Felodipine, Nagardipine, Amlodipine);
nedigidropyridine (isoptin, verapamil).

The first group medicines are used more often, they do not increase the heart rate, which is an important advantage.

In comprehensive therapy, diuretic drugs are also used (Laziks, Ugitis), cardiolective means (concor), a potassium-free group of drugs (TIAMPUR, VEROSHPIR), diuretics (thiazid).

The choice of drugs, their forms, dosages, the frequency of application and the duration of use can only be carried out by a doctor. Independent treatment threatens the development of severe complications.

Especially neatly pick up the course of treatment is necessary to asthmatics with the "Light Heart Syndrome". The doctor prescribes additional diagnostic methods in order to assess the overall condition of the body.

Folk Medicine offers a wide selection of methods that help reduce the frequency of appearance of asthmatic seizures, as well as lower blood pressure. Healing fees, tincture, rubbing reduce pain during exacerbation. The use of folk medicine funds also need to coordinate with the attending physician.

Bronchial asthma patients can avoid the development of arterial hypertension, if they follow the recommendations of the doctor regarding treatment and lifestyle:

Remove attacks by suffocation with local drugs, reducing the effects of toxins on the entire body.
Conduct regular control of the pulse frequency and hell.
When violations of cardiac rhythm appear or a stable increase in pressure to contact the doctor.
Making a cardiogram twice a year for timely detection of pathologies.
Take maintaining drugs in the event of chronic hypertension.
Avoid increased physical exertion, stress provoking pressure drops.
Refuse bad habits (smoking aggravates asthma and hypertension).

Bronchial asthma is not a sentence and direct cause of the development of arterial hypertension. A timely diagnosed diagnosis, a correct course of treatment, taking into account the symptoms, risk factors and side effects, the prevention of complications will allow patients with asthma to live for many years.

a source

elderly age;
obesity;
reception of medicines having a side effect in the form of hypertension.

The features of the course of hypertension against the background of bronchial asthma is the increased risk of developing complications in the form of violations of cerebral and coronary blood circulation, cardiovascular failure. It is especially dangerous to the fact that asthmatics are not enough pressure at night, and during the attack period, a sharp deterioration in the condition in the form of a hypertensive crisis is possible.

One of the mechanisms that explains the occurrence of hypertension of a large circle of blood circulation is the insufficient flow of oxygen due to bronchospasm, which provokes the release of thorough compounds into the blood. With long-term flow of asthma, the arterial wall is damaged. This is manifested in the form of a violation of the function of the inner shell and the increased rigidity of the vessels.

And here more on emergency care during cardiac asthma.

intense headache, spilled or limited by whiskeys and a population;
noise in ears; Signs of increased pressure
heaviness in the head;
dizziness;
feeling of constant weakness;
fast fatiguability;
nausea;
vision impairment;
insomnia;
pulse care;
sweating;
hand shakes;
numbness of the limbs;
protecting pain in the heart.

At the same time, the rhythm of abbreviations is accelerated and cardiac output increases. The systolic pressure indicator grows and the diastolic falls. High pulse blood pressure, sharp tachycardia and ejection of stress hormones during the attack period lead to a significant circulatory disruption.

a source

Tablets from hypertension during asthma. Hypertension and bronchial asthma. What products can help reduce pressure

Bronchial asthma and hypertensive disease are dangerous individually for human life, what can be said if they develop in parallel. In fact, this situation today is often found. It is difficult to say what kind of disease provokes another. Although doctors note that usually bronchial asthma is preceded by improper reception of drugs that should reduce pressure.

Hypertension and asthma should be treated only by a specialist. First, such a doctor will be able to correctly analyze the situation and send the patient to the necessary surveys. Secondly, focusing on the results, the doctor prescribes drugs to combat hypertension and bronchial asthma.

As for treatment, there may be drugs of the following categories that have their own side effects:

These drugs can cause obstruction of the bronchi in patients with asthma, as well as provoke the reactivity of the respiratory tract, which is why the therapeutic effect of inhalations and oral preparations occurs. Beta-adrenoblockers are not absolutely safe medicines, therefore even eye drops from such a category can lead to an exacerbation of asthma or hypertensive disease.

Unfortunately, even despite the achievements of modern medicine, there is no more accurate opinion, which is why the use of this group can provoke bronchospasm. Nevertheless, it is believed that in such a situation, the main factor is the violations in the parasympathetic system of the body.

angiotensin-plastic enzyme inhibitors (ACE);

As for side effects, there is most often a dry cough, while such a symptom usually arises due to irritation of the upper respiratory tract. According to the observations of doctors, patients with bronchial asthma are more often healthy, as a cough.

In addition, shortness of breath, suffocation and hypertensive disease, respectively, asthma itself can exacerbate. To date, experts rarely prescribe ACE inhibitors in patients with bronchitis, especially obstructive forms. But in fact, any respiratory disease may be treated through this category of drugs, the main thing is that the doctor competently picked up the drug. The patient must be aware of the potential side effects. But still it will be better if a disease is treated with antagonists of angiotensin receptors II.

This group is perfect for astmatics, but it can provoke the development of hypokalemia. A hypercup can also be developed, which suppresses the respiratory center, which is why hypoxemia is enhanced. If with a hypertensive disease in a patient there is no pronounced swelling of the respiratory tract, then diuretics are prescribed at all in small doses to give a maximum effect without side effects.

In arterial hypertension and asthma, nifedipine and nipples are prescribed patients, which relate to the dihydropyridine group. These medicines help to relax the muscles of the tracheobronchial tree, suppress the release of the granules into the surrounding tissues, and also enhance the browillating effect. According to numerous observations, the treatment of hypertension with calcium antagonists does not give any complications on the 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 drugs are used in the treatment of hypertension very carefully, it applies to the presence of bronchial asthma in the patient. If we take the preparations orally, then there will be no changes in bronchial passability, but instead there may be a problem with the reaction of the bronchi to histamine. Any medicine from hypertension or bronchial asthma should be discharged by a specialist. Any self-treatment can cause complications of health status, and this is already not to mention that there are many probable side effects.

It has already been noted that it is necessary to determine which problem is the main - hypertension or asthma. In the previous section, attention was paid to drug treatment of hypertension, it's time to talk about.

In order to get rid of such a disease, the following approaches apply:

means for internal use - Herbal fees (extracts), Vitaminized complexes, complexes with trace elements, chlorophyllipte, pharmaceutical preparations;
folk Medicine - Herbal Decorations and Tincture;
drops and syrups for intake - can be represented by extracts from therapeutic herbs;
funds for local exposure - ointments, rubbing, compresses, microornels, substances based on plant pigments, vitamins and essential oils, vegetable fats and herbal infusions;
treatment of asthmatic bronchitis is carried out with the help of vitamin therapy - these funds can be used orally or subcutaneously;
preparations for breast treatment, there is an impact on the skin, therefore herbal extracts, natural oils with macro, microelements and monovitamins, chlorophyllipte can be used;
as for external influence, it is still possible to use a chatter, which may include herbal infusions, minerals, medical preparations, chlorophyllipte, and it is applied not only to the chest, but also for all the body, especially on the sides;
emulsions and gels are applicable to the local impact on the chest, are created on the basis of plant pigments and fats, herbal hoods, trace elements, vitamins A and B, monovitamins;
bronchial asthma is successfully treated and with lactotherapy - it is intramuscular injections with hoods from whole milk cow, in which the juice of tree aloe is added;
appacks - a relatively new method of treatment, helps to reduce the manifestations of not only asthma, but also hypertension;
physiotherapy - this treatment implies the use of UTU, UHF, electrophoresis, external laser irradiation of blood, magnetotherapy, magnetoveser and therapy;
pharmaceutical preparations are bronchorants, antihistamines, expectorant, immunomodulatory, anti-inflammatory, antitoxic, antiviral, muscolics, antifungal and other medicines.

DOCTOR / NURSE CHECING BLOOD PRESSURE.

Despite the fact that both diseases of pathogenetically are in no way connected, it was found that the blood pressure during asthma rises quite often.

Some asthmatics belong to the high risk of hypertension development, namely people:

Elderly.
With increased body weight.
With a heavy, uncontrolled asthma.
Taking medicines provoking hypertension.

[File # 1702849] Licensed # 1702849] Licensed Through http://www.canstockphoto.com In Accordance With the End User License Agreement (http://www.canstockphoto.com/legal.php)
(c) Can Stock Photo Inc. / Portokalis If the person suffering from bronchial asthma has become recorded by cases of increased blood pressure, it is necessary to immediately appeal for help from the doctor. It is categorically not recommended to choose pills from hypertension to independently, since many of them are contraindicated to take astmatics, because they can only worsen the state.

Put antithrombotic activity.
Show antioxidant action.
Maintain potassium level at the proper level to prevent the development of pulmonary failure.
Do not cause a patient's cough attacks.
Do not interact with bronchodilies.

Choose a medicine from pressure at bronchial asthma should be carefully taking into account side effects. Preference in treatment is given to drugs that do not worsen the ventilation ability of the lungs.

As already mentioned, bronchial asthma can progress against the background of some incorrectly chosen antihypertensive drugs.

Beta adrenoblockers. A group of medicines that strengthens the obstruction of the bronchi, the reactivity of the respiratory tract and reduces the therapeutic effect of sympathomimetics. Thus, the drugs aggravate the flow of bronchial asthma. Currently it is allowed to use selective beta adrenoblays (atenolol, tenoric) in small doses, but only strictly according to the testimony.
Some diuretics. At asthmatics, this group of drugs can cause hypokalemia, which leads to the progression of respiratory failure. It is worth noting that the joint reception of diuretics with beta-2 agonists and systemic glucocorticosteroids only enhances the unwanted elimination of potassium. Also, this group of drugs can enhance blood thickening, cause metabolic alkalosis, resulting in a respiratory center, and the indicators of gas exchange are worse.
iAPF. The effect of these medicines causes changes in bradykinin metabolism, increases the content of anti-inflammatory substances in the lungs parenchyma (Substance P, Neurokinin A). This leads to bronchokonstriction and cough appearance. Despite the fact that this is not an absolute contraindication to the appointment of ACE inhibitors, the preference in treatment is still given to another group of medical preparations.

What antihypertensive agents are still allowed to apply with bronchial asthma?

However, in cases where the patient has concomitant severe violations by cardiac rhythm (atrioventricular blockade, pronounced bradycardia), calcium antagonists are prohibited for use.

Along with asthma, other diseases appear: allergies, rhinitis, diseases of the digestive tract and hypertension. Are there any special pills from pressure for asthmatics, and that patients can be drunk to not provoke respiratory problems? The answer to this question depends on many factors: how the attacks occur when they begin and that they provoke them. It is important to correctly determine all the nuances of the course of disease to assign correct treatment and choose drugs.

For this question, doctors did not find an unequivocal response. They note: people with respiratory diseases are truly often faced with the problem of increased pressure. But further opinions are divided. Some experts insist on the existence of phenomenon of bulmonogenic hypertension, which causes a pressure attack during asthmatic disease. Other specialists this fact deny, speaking that asthma and hypertension are two diseases that do not depend on each other and are not interconnected. But the connection between diseases is confirmed by the following factors:

35% of people having diseases of the respiratory tract suffer from hypertension;
under the attacks (exacerbations), the pressure rises, and during the remission, it is normalized.

There are arterial hypertension as a symptom of exacerbation, as well as hypertension, as a disease that flows parallel to asthma. Hypertension is a few species. Deals are divided by the type of origin, the flow of the disease, the level:

By the course of the disease

Secondary (symptomatic)	Appears complication against the background of other diseases.
Benign	Unnoticed and long-term development of symptoms.
Malignant	Develops rapidly.
By level of pressure	Soft (1st degree)	The disease does not require treatment with medicines. The patient can only change the lifestyle.
	Moderate (2nd degree)	Pressure over 160 per 109 indicators. Use drug methods
	Heavy (3rd degree)	Indicators above 180 to 110. Pressure is constantly at this level. Perhaps the defeat of other organs.

During the attack, an increase in blood pressure is observed.

Arterial hypertension at bronchial asthma is treated depending on what it causes it. Therefore, it is important to understand the course of the disease and that it provokes it. Pressure can rise at the time of an asthmatic attack. In this case, to remove both symptoms will help the inhaler who stops the attack of the suffocation and removes the pressure. Other situation, if hypertension in the patient is not tied to asthmatic bosses. In this case, the treatment of hypertension should be held within a comprehensive course of therapy. Course of the disease

The appropriate medicine from pressure is selected by the doctor, given the possibility of forming a "pulmonary heart" syndrome in a patient, the disease in which the right heart ventricle cannot function normally. Hypertension can provoke a reception at asthma hormonal drugs. The doctor must track the nature of the course of the disease and appoint correct treatment.

Bronchial asthma and high pressure should be treated under the supervision of a specialist. Only a doctor can prescribe the right drugs from both diseases. After all, each drug may have side effects:

The beta-adrenoblocator can cause the obstruction of bronchi or bronchospasm in astmatics, block the effect of using anti-asthma drugs and inhalations.
APE drug provokes a dry cough, shortness of breath.
The diuretic may cause hypokalemia or hypercap.
Calcium antagonists. According to research, drugs do not complicate the respiratory function.
Alpha adrenoblocator. When taking can provoke an incorrect reaction of the body into histamine.

Bronchial asthma is often accompanied by increased arterial pressure. Such a combination refers to an unfavorable prognostic sign of the flow of both diseases. Most medications for the treatment of asthma worsen the flow of hypertension, there are also reverse reactions that need to be considered when conducting therapy.

Bronchial asthma and hypertension have no general prerequisites for occurrence - different risk factors, contingent of patients, development mechanisms. A frequent joint course of diseases has become a reason for studying the patterns of this phenomenon. Conditions were found in which the pressure from asthmatics often increases:

elderly age;
obesity;
decompensated asthma current;
reception of medicines having a side effect in the form.

The features of the course of hypertension against the background of bronchial asthma is the increased risk of developing complications in the form of violations of cerebral and coronary blood circulation, cardiovascular failure. It is especially dangerous to the fact that asthmatics do not sufficiently decrease in the pressure at night, and during the attack period there is a sharp deterioration in the form in the form.

One of the mechanisms that explains the occurrence of hypertension of a large circle of blood circulation is due to bronchospasm, which provokes the release of vasoconstrictor compounds into the blood. With long-term flow of asthma, the arterial wall is damaged. This is manifested in the form of a violation of the function of the inner shell and the increased rigidity of the vessels.

To suspect the increase in blood pressure at bronchial asthma in such clinical manifestations:

In the hardest cases against the background of an attack of asthma and the crisis, convulsive syndrome is observed, loss of consciousness. This condition can grow into brain swells with fatal consequences for the patient. The second complication group is associated with the possibility of the development of edema of the lungs both due to cardiac and pulmonary decompensation.

The complexity of the treatment of patients with a combination of hypertension and bronchial asthma is that the majority of medicines for their therapy have side effects, worsening the flow of these pathologies.

The long-term use of beta adrenomimetics during asthma causes a steady increase in blood pressure. For example, Berretk and Salbutamol, which are very often used asthmatics, only in low doses have an electoral action on BTR hook-receptors. With increasing dose or frequency of inhalation of these aerosols, the receptors located in the heart muscle are stimulated.

At the same time, the rhythm of abbreviations is accelerated and cardiac output increases. Growing and drops diastolic. High pulse blood pressure, sharp and emissions of stress hormones during the attack period lead to a significant circulatory disruption.

Hormonal preparations from the group of corticosteroids are negative on hemodynamics, which are prescribed with the severe flow of bronchial asthma, as well as eufillin, leading to violations of the heart rhythm.

Therefore, for therapy of hypertension in the presence of bronchial asthma, drugs of certain groups are prescribed.

The use of diuretic drugs is preferable from the loop group - Laziks, yard, as well as potassium-saving - Veroshpirirov and Triampur.

When prescribing hypotensive funds, it is necessary to take into account that beta blockers lead to the bronchial spasm. This worsens the pulmonary ventilation and manifests itself difficult breathing, increasing shortness of breath. This is especially characteristic of drugs with indiscriminate effect.

Cardooselective agents in small doses in concomitant tachycardia and can be used in patients with asthma. The most secure for this category of patients is its analogues.

A frequent complication of the intake of angiotensin surgery enzyme inhibitors becomes thrust dry. Therefore, although these medicines do not affect the bronchial tone, but the attacks of shortness of breath, passing in the sufferet, respiratory disorder significantly deteriorates the well-being of patients with asthma.

Formation of the "pulmonary heart"

With severe flow, asthmatics are formed a symptom complex called a pulmonary heart . Such patients have a tendency to severe reduction in the rhythm of abbreviations - and, they can not use calcium antagonists that slow down the frequency of heart abbreviations.

In this regard, all patients who take hormonal drugs and use aerosols to remove the attack of choking, it is recommended to control the pulse frequency and level of blood pressure daily. With a steady increase or decrease, they need to contact the doctor to correct therapy.

Dry cough is a side effect of antihypertensive agents from a group of angiotensin-shutting enzyme inhibitors. It especially often occurs when applying tablets:

first generation - ENAP, captopril;
constantly and in a big dose;
in patients with increased sensitivity to allergens;
in old age;
against the background of chronic bronchitis, bronchial asthma;
in smokers.

Hereditary predisposition to such a reaction is established. Cough does not cause complications, but significantly worsens the quality of the life of the patients, forces the preparations for its suppression. They usually practically do not help, and drug change is necessary to deliver. At the same time, it will be best to go to another group.

It has been proven that there are practically no cough drugs from pressure related to sartans, trade names of medicines:

Tablets for asthmatics to reduce blood pressure should not escap the lumen of the bronchi, for this choose from such groups:

a source

For many years, are unsuccessful fighting hypertension?

Chapter Institute: "You will be amazed how easy you can cure hypertension taking every day.

Hypertension is a common distributed disease. This ailment today is suffering not only by people of old age, but also the youth. This trend is explained quite simple: a large number of chronic diseases, late treatment, minimal motor activity, improper power - all this direct causes of high pressure. What pills from high pressure should be taken? What threatens for each self-treatment or uncontrolled reception of drugs?

Principles of therapy

As already mentioned, bronchial asthma can progress against the background of some incorrectly chosen antihypertensive drugs.

These include:

Beta adrenoblockers. A group of medicines that strengthens the obstruction of the bronchi, the reactivity of the respiratory tract and reduces the therapeutic effect of sympathomimetics. Thus, the drugs aggravate the flow of bronchial asthma. Currently it is allowed to use selective beta adrenoblays (atenolol, tenoric) in small doses, but only strictly according to the testimony.
Some diuretics. At asthmatics, this group of drugs can cause hypokalemia, which leads to the progression of respiratory failure. It is worth noting that the joint reception of diuretics with beta-2 agonists and systemic glucocorticosteroids only enhances the unwanted elimination of potassium. Also, this group of drugs can enhance blood thickening, cause metabolic alkalosis, resulting in a respiratory center, and the indicators of gas exchange are worse.
iAPF. The effect of these medicines causes changes in bradykinin metabolism, increases the content of anti-inflammatory substances in the lungs parenchyma (Substance P, Neurokinin A). This leads to bronchokonstriction and cough appearance. Despite the fact that this is not an absolute contraindication to the appointment of ACE inhibitors, the preference in treatment is still given to another group of medical preparations.

Another group of drugs, with which it is necessary to be taken care, is alpha-adrenoblays (physiothens, ebrantil). According to studies, they are able to increase the sensitivity of the bronchi to histamine, as well as strengthen the shortness of breath in patients with bronchial asthma.

What antihypertensive agents are still allowed to apply with bronchial asthma?

However, in cases where the patient has concomitant severe violations by cardiac rhythm (atrioventricular blockade, pronounced bradycardia), calcium antagonists are prohibited for use.

Another frequently used group of antihypertensive drugs - angiotensin II receptor antagonists (Kozar, Lorista). In terms of its properties, they are similar to ACE inhibitors, however, unlike the latter, do not affect bradykinine metabolism and thereby do not cause such an unpleasant symptom as cough.

Bronchial asthma is a chronic disease of the respiratory system of infectious allergic nature, which manifests itself in obstructive violations of the lumen of the bronchi (that is, it is easier to expressing - in the narrowing of the breathing tracks) and take part in this process many cellular elements of the most different nature, throwing a large number of all kinds of all sorts of Mediators - biologically active substances that are the root cause of all these phenomena and, as a result, seizures of suffocation.

Chronic pulmonary heart is a pathological condition, which is characterized by a number of changes from the heart itself and vessels (the most basic is hypertrophy of the right ventricle and vascular changes). This is all, mainly hypertension of a small circle of blood circulation. Also, after some time, the arterial hypertension of a secondary nature is developing (that is, the increase in pressure, the cause of which is reliably known). The question regarding the pressure at bronchial asthma, the reasons for its occurrence and the consequences of this phenomenon were relevant.

Bronchial asthma and hypertension

A number of concomitant diseases require the correction of drug therapy of the main pathology. Arterial hypertension at bronchial asthma is a rather frequent phenomenon. Therefore, the doctor and patient is important to know which drugs are contraindicated with the combined flow of these diseases. Compliance with simple rules will help avoid complications and will retain a sick life.

Preparations for the treatment of arterial hypertension at bronchial asthma and chronic obstructive diseases of the lungs are calcium antagonists and receptor blockers A II.

The risk of assignments in such cases of cardiolective beta adrenobloclars is often exaggerated; In small and medium doses, these drugs are usually transported well. With pronounced bronchospasm and the impossibility of prescribing beta-adrenobloclockers, they are replaced with calcium antagonists - blockers of slow calcium channels, which in moderate doses have a bright effect.

Sick chronic obstructive diseases of the lungs with intolerance of acetylsalicylic acid as an antiagregative can be assigned clopidogrel.

Literature

Arabidze G.G. Belousov Yu.B. Karpov Yu.A. Arterial hypertension. Reference guide for doctors. M. 1999.

Karpov Yu.A. Sorokin E.V. Stable ischemic heart disease: strategy and tactics of treatment. M. 2003.

Preobrazhensky D.V. Batyraliev T.A. Sharushina I.A. Chronic heart failure streets of elderly and senile age. Practical cardiology. - M. 2005.

Prevention, diagnosis and treatment of arterial hypertension. Russian recommendations. Developed by the Committee of Experts of the Obnok. M. 2004.

Rehabilitation for diseases of the cardiovascular system / ed. I.N. Makarova. M. 2010.

The lack of oxygen awakens the vascular receptors, which causes an increase in the tone of the autonomic nervous system.
Neurons increase the activity of all processes in the body.
The amount of hormone (aldosterone) produced in the adrenal glands increases.
Aldosterone causes an increased stimulation of the walls of the arteries.

This process causes a sharp increase in blood pressure. The data is confirmed by clinical studies carried out during the attacks of bronchial asthma.

With a long period of the disease, when asthma treatment is carried out by potent drugs, it becomes the cause of violations in the work of the heart. Right ventricle ceases to function normally. Such a complication is called the syndrome of a light heart and provokes the development of arterial hypertension.

Bronchial asthma can cause arterial hypertension by itself. The main reason for the development of hypertension becomes drugs used by asthmatics to relocate attacks.

There are risk factors in which the pressure increases in patients with asthma is more often observed:

excess weight;
age (after 50 years);
development of asthma without effective treatment;
side effects of drugs.

Some risk factors can be eliminated by adjusting the lifestyle and following the recommendations of the attending physician at the reception of medicines.

In order to start the treatment of hypertension on time, asthmatics should be aware of the symptoms of increased blood pressure:

Strong headache.
Heaviness in the head.
Noise in ears.
Nausea.
Total weakness.
Frequent pulse.
Heartbeat.
Sweating.
Numbness of arms and legs.
Tremor.
Pain in the chest.

Karpov Yu.A. Sorokin E.V.

RKNPK MZ RF, Moscow

X Ronic obstructive pulmonary disease (COPD) is chronic slowly progressive disease. Characterized irreversible or partially reversible (with the use of bronchodilics or other treatment) obstruction of the bronchial tree. Chronic constructive diseases are widespread among the adult population and are often combined with arterialitytones (AG). To COPD refers:

Bronchial asthma
Chronical bronchitis
Emphyms lungs
Bronchiectatic disease

Features of the treatment of AG on the background of COPD are due to several factors.

3) Medical treatment of COPDs in some cases can significantly change the effectiveness of selected hypotensive therapy.

It is important to remember that in addition to COPD, the symptom complex of the "pulmonary heart" can be caused by a number of other causes (night apnea syndrome, primary pulmonary hypertension. Diseases and spinal injuries, chest, respiratory muscles and diaphragms, repeated thromboembolism of small branches of pulmonary artery, expressed obesity chest, etc.), the consideration of which is beyond the scope of this article.

The main structural and functional signs of the "pulmonary heart":

Hypertrophy of myocardium right ventricle and right atrium
Increased volume and volumetric overload of the right heart
Increased systolic pressure in the right heads of the heart and pulmonary artery
High heart rate (in the early stages)
Atrial violations of rhythm (extrasystole, tachycardia, less often - flickering arrhythmia)
The insufficiency of the trilateral valve, in the later stages - pulmonary artery valve
Heart failure for a large circulation of blood circulation (in late stages).

The change in the structural and functional properties of myocardium in the syndrome of the "pulmonary heart" often leads to "paradoxical" reactions for drugs, including those used to correct an increased blood pressure. In particular, one of the frequent signs of the "pulmonary heart" is the violations of the heart rhythm and conductivity (synoyatrial and atrioventricular blocks, tachy and bradyrithmia).

b -Adrenoblocators

The greatest cardooselectivity (including compared to the drugs listed in Table 2) from the Bisoprolol (Concord) is provided in Russia. The recent studies showed a reliable advantage of the concoction on the safety and efficiency of use in chronic protective bronchitis compared to Atenolol.

In addition, a comparison of the effectiveness of atenolol and bisoprolla in individuals with AG and the accompanying bronchial asthma, according to the parameters characterizing the state of the cardiovascular system (heart rate, blood pressure) and the indicators of bronchial obstruction (FEV1. Racks, etc.) showed the advantage of bisoprolol. In the group of patients who took bisoprolol, in addition to a reliable reduction in the diastolic blood pressure, there was a lack of influence of the drug on the state of the air routes, while in the placebo and atenolol group, an increase in respiratory resistance was revealed.

b -Adrenoblays with internal sympathomimetic activity (pindolol, acebouterol) less affect the tone of the bronchi, but their hypotensive efficacy is small, and prognostic benefits are not proven with arteriality. Therefore, with a combination of AG and COPD, their appointment is justified by individual indications and under strict control.

Application with arterialgypertension B -AB with direct vazodilative properties (carvedilol) and b -AB with the properties of the inductor endothelial synthesis of nitrogen oxide (nebivolol) are studied less as the influence of these respiration drugs in chronic pulmonary diseases.

Where is the connection between pathologies?

Bronchial asthma is chronic inflammation of the upper respiratory tract, which is accompanied by a bronchi spasm. Patients suffering from this disease often have vegetative dysfunctions. And the last in some cases becomes the cause of arterial hypertension. That is why both diseases are associated pathogenetically.

In addition, an increase in blood pressure is a symptom of bronchial asthma, in which the body suffers from the deficiency of oxygen, in a smaller number of incoming respiratory tract. In order to compensate for hypoxia, the cardiovascular system increases the pressure in the bloodstream, trying to provide organs and systems with the necessary amount of oxygenated blood.

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35% of people having diseases of the respiratory tract suffer from hypertension;
under the attacks (exacerbations), the pressure rises, and during the remission, it is normalized.

Some doctors talk about the need to establish in asthmatics with elevated pressure of a separate diagnosis - bulmonogenic hypertension.

Doctors indicate direct causal relationships between pathologies:

35% of asthmatics develop arterial hypertension;
during an asthmatic attack, hell rises sharply;
pressure normalization is accompanied by an improvement in the asthmatic state (the absence of attacks).

Adherents of this theory consider asthma by the main factor in the development of a chronic pulmonary heart, causing a stable increase in pressure. According to statistics in children having bronchial attacks, such a diagnosis occurs much more often.

Regardless of whether there is an interrelation of bronchial asthma and hypertension, the presence of pathologies should be considered to select the correct course of treatment. Many pills that reduce pressure are contraindicated to astmatic patients.

After all, different groups of medicines have side effects:

Beta-adrenoblockers cause tissue spasms in bronchi, ventilation of the lungs is disturbed, shortness of breath increases.
ACE inhibitors (angiothenzine enzyme) provoke a dry cough (arises in 20% of their patients receiving), shortness of breath, aggravating the state of asthmatics.
Diuretics cause a decrease in serum potassium level (hypokalemia), an increase in carbon dioxide in the blood composition (hypercringe).
Alpha-adrenoblocators increase the sensitivity of the bronchi to histamine. With oral use, practically safe drugs.

reduction of hypertension symptoms;
lack of interaction with bronchodilies;
antioxidant characteristics;
reducing the ability to form thrombov;
the absence of an antitussive effect;
the drug should not affect the level of calcium in the blood.

There are two groups of drugs of this action:

dihydropyridine (Felodipine, Nagardipine, Amlodipine);
nedigidropyridine (isoptin, verapamil).

The first group medicines are used more often, they do not increase the heart rate, which is an important advantage.

In comprehensive therapy, diuretic drugs are also used (Laziks, Ugitis), cardiolective means (concor), a potassium-free group of drugs (TIAMPUR, VEROSHPIR), diuretics (thiazid).

Principles of therapy

Two events development options are possible:

Blood pressure is growing during an asthmatic attack;
the pressure does not depend on the attacks, constantly increased.

The role of educational programs in tactics of patients with combined pathology (bronchial asthma and arterial hypertension) Text of a scientific article in the specialty "Medicine and Health"

The cause of elevated systolic and diastolic blood pressure is to increase the resistance of peripheral vessels and amplifying the pump function of myocardium. These are compensatory reactions to oxygen deficiency. In older people, hypertension is a disease that provokes deposition in the vascular walls of atherosclerotic plaques.

News Science

Astmatic and hypertensive symptoms

If there are a combination of these two pathologies, such clinical symptoms develops:

Dyspnea. More often it is expiratory character. The patient is harder to exhale than to breathe. The act of breathing is happening with the presence of a specific whistle - Vinga.
Cyanosis of the nasolabial triangle and fingertips. This symptom appears as a result of insufficient blood supply to distal parts of the body.
Cough with highlighting a small amount of transparent sputum. If the layering of a bacterial infection is observed, separated by yellow or green color.
Headache. It often occurs against the background of increased pressure and is accompanied by light neurological deviations.
Graceful feeling in the chest. It is angularity and provoked by the bronchi spasm.
Strengthening symptoms in response to external factors - physical exertion, weather change.
Total weakness. The cause of it becomes oxygen starvation of organs and tissues.
Ringing in the ears and flickering of flies in front of the eyes. These phenomena also cause a deficiency of oxygenation.

Cough can be a manifestation of both pathologies at once.

Features of the treatment of hypertension during asthma

Bronchial asthma and high pressure should be treated under the supervision of a specialist. Only a doctor can prescribe the right drugs from both diseases. After all, each drug may have side effects:

The beta-adrenoblocator can cause the obstruction of bronchi or bronchospasm in astmatics, block the effect of using anti-asthma drugs and inhalations.
APE drug provokes a dry cough, shortness of breath.
The diuretic may cause hypokalemia or hypercap.
Calcium antagonists. According to research, drugs do not complicate the respiratory function.
Alpha adrenoblocator. When taking can provoke an incorrect reaction of the body into histamine.

Therefore, patients with asthma and hypertension are so important to undergo a survey from a specialist to select drugs and ensure correct treatment. Any medication during self-medication may complicate not only current diseases, but also worsen the overall health. Self-patient can alleviate the flow of bronchial disease, so as not to provoke the attacks of suffocation, with the help of folk methods: herbal fees, tinctures and decoctions, ointments and rubry. But their choice should also be agreed with the doctor.

It is necessary to very carefully select pills from pressure for asthmatics, as some antihypertensive drugs are able to exacerbate their condition. Such dangerous drugs includes beta-adrenoblays and the IAPF. The listed drugs are able to strengthen the content of the bronchial wood and increase the formation in the upper respiratory tract of the secrecy of the secret.

The last side effect prevents the therapeutic influence of inhalation sympathomimetics, which is austmatical attack. Treatment of hypertension in patients with bronchial asthma is produced using calcium channel blockers. These medicines are optimally suitable for hypertensive, the state of which is burdened by asthmatic attacks. Among this group of medicines, preference gives "Nifedipine" and "Naitardipin". Also in the drug diagram are introduced diuretic.

RKNPK MZ RF, Moscow

b -Adrenoblocators

Calcium antagonists

Bronching properties are proved in phenylalkylamines, short and long-term dihydropyridines, to a lesser extent - in benzodiazepine ak (Table 3).

Inhibitors of angiotensin glittering enzymes and blockers angiotensin receptors

Nevertheless, it should be remembered that one of the side effects of drugs of this group is a dry cough (up to 8% of cases), which in severe cases is able to significantly shrink the breath and worsen the quality of life of the patient with COPD. Very often, the thrust cough in such patients serves as a weighty reason for the abolition of ACE inhibitors.

Diuretics

In long-term treatment of arterial blood flows are used, as a rule, tiazide diuretics (hydrochlorostiazide, oxodoline) and an indole diuretic indapamide. As a modern methodological guidelines with a "cornerstone" of hypotensive therapy with repeatedly confirmed high prophylactic efficacy, thiazide diuretics do not worsen and do not improve the ventilation and perfusion characteristics of the small circulation circle - because they do not directly affect the tone of pulmonary arterioles, small and medium bronchi.

Therefore, the presence of COPD does not limit the use of diuretics for the treatment of concomitant ag. With concomitant heart failure with stagnation in a small circle of blood circulation of diuretics become a means of choice, because reduced the increased pressure in pulmonary capillaries, but in such cases, thiazide diuretics are replaced with loop (furosemide, bumetale, etcrinic acid)

When decompensating a chronic "pulmonary heart" with the development of blood circulation deficiency in a large circle (hepatomegaly, extremity swelling), preferably the purpose of non-tiazide. And loop diuretics (furosemide, bumetale, etcrinic acid). In such cases, it is necessary to regularly determine the electrolyte composition of the plasma and when hypokalemia appears, as the risk factor of cardiac arrhythmias actively prescribe potassium-saving drugs (spironolactone).

a -adrenoblocators and vasodilators

At hypertension, a direct vasodilator hydralazine is prescribed, or a -adrenobloclates of prazozin, doxazosin, therazozin. These drugs reduce peripheral vascular resistance, directly affecting arterioles. Direct influence on the respiratory function These drugs do not provide, and therefore, with appropriate indications, they can be prescribed to reduce blood pressure.

However, the frequent side effect of vasodilators and A -adrenoblastors is reflex tachycardia, which requires the appointment of B -AB, which, in turn, are able to cause bronchospasm. In addition, in the light of the recent data of prospective randomized studies, it is now limited to the assignment of A -adrenobloclars with AG - due to the risk of heart failure during long-term reception.

Preparations Rawolfia

Preparations of "Central" action

There are no reports of a serious impairment of breathing during the COPD against the background of the treatment of AG methyldop, Guangfatin and Moxonidine is currently not. However, it should be emphasized that this group of drugs in most countries for the treatment of high is almost not used due to the unprovenness of improving the forecast and a large number of side effects.

Effect of drugs used in COPD, on the effectiveness of hypotensive therapy

Thus, the treatment of AG on the background of COPD has a number of features. Knowledge of which is important both for a pulmonico doctor and for cardiologists and therapists, since it will significantly improve not only the quality, but also the forecast of life in patients with combined cardiovascular and pulmonary pathology.

1. Diamond V.A. Arabidze G.G.// Prevention, diagnosis and treatment of primary arterial hypertension in the Russian Federation - Russian Medical Journal. 2000 g, T.8, №8 -С.318-342

2. Arabidze G.G. Belousov Yu.B. Karpov Yu.A. "Arterial hypertension. Reference guide for doctors. " M. "Rememid", 1999

3. Report of the WHO Expert Committee // Fighting Arterial Hypertension - Geneva, 1996, p.862

4. Makolkin V.I. "Features of the treatment of arterial hypertension in various clinical situations." RMW, 2002; 10 (17) 12-17

5. Makolkin V.I. Podzoldov V.I.// Hypertensive disease. M: Russian doctor. 2000; 96.

6. Chronic obstructive lung diseases. Federal program

Pathogenetic mechanisms

Regarding whether these two diseases are interrelated with each other - there are two diametrically opposite points of views. One group of honored academics and professors adheres to the opinion that one thing at all never influenced at all, and it will not affect, another group of no less respected people, adheres to the point of view that necessarily bronchial asthma is the main causal factor in the development of chronic pulmonary Hearts, as a result - secondary arterial hypertension. That is, according to this theory - all asthmatics in the future hypertensive.

What is the most interesting, purely statistical data confirm the theory of those scientists who see the source of secondary arterial hypertension in bronchial asthma - with age in people who have bronchial asthma, an increase in blood pressure is observed. It is possible to argue - hypertensive disease (it is essential hypertension) is observed with the age of each first.

An important argument in favor of precisely this concept will also be the fact that the chronic pulmonary heart, and, as a result, the secondary arterial hypertension is developing in children and adolescents suffering from bronchial asthma. But is statistics at the level of physiology confirm? The question is very serious, since establishing true etiology, pathogenesis and the relationship of this process with the surrounding factors, you can develop an optimized treatment scheme.

The most intelligible answer on this occasion gave Professor V.K. Gavrisyuk from the National Institute of Phthisiology and Pulmonology named after F.G. Yanovsky. It is important that this scientist is also a practitioner doctor, and therefore his opinion, which is confirmed by numerous studies, may well qualify not only on the hypothesis, but also on the theory. The essence of this teaching is set out below.

In order to understand the entire problem, it is necessary to deeper the pathogenesis of the entire process. Chronic pulmonary heart is developing only against the background of the right-hand deficiency, which, in turn, is formed due to the increase in pressure in a small circulation circle. The hypertension of the small circle is caused by hypoxic vasoconstriction - the compensatory mechanism, the essence of which is to reduce the provision of blood flow in the styles of lungs and the direction of the blood current to where gas exchange is intensively running (the so-called velve sections).

Causes and consequences

It should be noted that for the formation of right-hand deficiency with its hypertrophy and the subsequent formation of a chronic pulmonary heart, it is necessary to preserve arterial hypertension. With bronchial asthma, even in the hardest form, there is no constant increase in pressure in the pulmonary vein and the artery, and therefore it is incorrectly incorrectly considered this pathological mechanism.

In addition, there are some more very important points. With the manifestation of transient arterial hypertension caused by the attack of choking at bronchial asthma, an increase in intragenuous pressure is crucial. This is a prognostically unfavorable phenomenon, since after some time the patient can observe a pronounced swelling of the cervical veins, with all the adverse effects of this state (by and large, the symptoms of this state will have a very much similar to the thromboembolism of the pulmonary artery, because the mechanisms for the development of these pathological States are very similar to each other).

The scheme for the formation of a vicious circle.

Due to the increase in intragenic pressure and reduce the venous return of blood to the heart, it occurs in the pool of both the lower and the upper hollow vein. The only adequate help in this state will be the relief spasm of the bronchi by those methods that are used for bronchial asthma (beta2-agonists, glucocorticoids, methylxantins) and massive hemodilution (infusion therapy).

Of all the above, it becomes clear that hypertension is not a consequence of bronchial asthma as such, for the simple reason that the emerging increase in pressure in a small circle is of a non-permanent character and does not lead to the development of a chronic pulmonary heart.

Another question is other chronic diseases of the respiratory system, which cause resistant hypertension in a small circle circle. First of all, they include chronic obstructive lung disease (COP), many other diseases affecting the lungs parenchyma, according to sclerodermia or sarcoidosis. In this case, yes, their participation in the occurrence of arterial hypertension is quite substantiated.

An important point is the damage to the tissues of the heart due to oxygen starvation, which occurs when the bronchial asthma attacks. In the future, this can play a role in the increase in pressure (persistent), however, the contribution of this process is very and very insignificant.

In a minor amount of bronchial asthma (about twelve percent), a secondary increase in blood pressure arises, which, one way or another, is interconnected with a violation of the formation of polyunsaturated arachidonic acid, conjugate with excessive emissions to blood thromboxane-A2, some prostaglandins and leukotrienes.

Caused by this phenomenon, again, by reducing the flow of oxygen into the blood to the patient. However, a more significant reason is the long use of sympathomimetics and corticosteroids. Extremely negative impact on the state of the cardiovascular system at bronchial asthma have phenoterol and salbutamol, because in large dosages they significantly affect not only beta2-adrenoreceptors, but also able to stimulate beta1 adrenoreceptors, significantly increasing the frequency of heart abbreviations (cause resistant tachycardia) Thereby increasing the need of myocardium in oxygen, increasing the already pronounced hypoxia.

Also, methylxantins (theophylline) are also negative for the functioning of the cardiovascular system. With constant use, these drugs can lead to pronounced arrhythmia, and as a result, to violate the work of the heart and the next of this arterial hypertension.

It is extremely bad on the state of vessels and systematically used glucocorticoids (especially those that are used systemically) - due to its side effect, vasoconstrictions.

Tactics of conducting patients with bronchial asthma, which will reduce the risk of developing such complications in the future.

The most important thing is to consistently adhere to the course of treatment assigned by a pulmonologist against bronchial asthma and not allow contact with the allergen. After all, the treatment of bronchial asthma is carried out according to the protocol of Gina, developed by the leading world pulmonologists. It is in it that the rational stepped therapy of this disease is proposed.

That is, at the first stage of this process, the attacks are observed very rarely, no more than once a week, and they are stopped with a unite reception of Ventoline (Salbutamola). By and large, with the condition that the patient will adhere to the course of treatment and lead a healthy lifestyle, will exclude contact with the allergen, there will be no progress.

From such doses of Ventoline, no hypertension will dismiss. But our patients, for the most part, people are irresponsible, treatments do not adhere to the need to increase the dosage of drugs, the need to access the treatment of other groups of drugs with much more pronounced side effects due to the progression of the disease. It is all then and goes into an increase in pressure, even in children and adolescents.

It is worth noting the fact that treatment of this kind of arterial hypertension takes place at times more complicated than the therapy of classical essential hypertension, in view of what very many effective drugs cannot be applied. The same beta blockers (take the latest - nebivolol, metoprolol) - despite all their high-selectivity, they still affect the receptors located in the lungs and may well lead to asthmatic status (sulk light), in which Ventoline is not exactly It will help, in the absence of sensitivity to it.

The radiograph of the patient with a pronounced hypertension of a small circle. The numbers indicate the foci of ischemia.

From all of the above, you can draw the following conclusions:

Bronchial asthma itself can cause arterial hypertension, but this happens in a small number of patients, as a rule, with improper treatment, accompanied by a large number of attacks of broncho-construction. And that, it will be mediated effect, through trophic disorders of myocardium.
A more serious reason for the occurrence of secondary hypertension will be other chronic diseases of the respiratory tract (chronic obstructive lung disease (CHOOL), many other diseases affecting the parenchyma of the lungs, by type of sclerodermia or sarcoidosis).
The main cause of the upcoming hypertension in asthmatics is drugs that are treated by the bronchial asthma.
Systematic execution of patients with prescribed treatment schemes and other recommendations of the attending physician is a guarantee (but not one hundred percent) that the process will not be progress, and if it is, it will be much slower. This will keep therapy at that level, which was appointed initially, not to prescribe more strong drugs whose side effects will not lead to the formation of arterial hypertension.

Signs of improving hell

To suspect the increase in blood pressure at bronchial asthma in such clinical manifestations:

Update Article 30.01.2019

Arterial hypertension (AG) In the Russian Federation (RF) remains one of the most significant medical and social problems. This is due to the widespread dissemination of this disease (about 40% of the adult population of the Russian Federation has an increased level of blood pressure), as well as the fact that the AH is the most important risk factor of the main cardiovascular diseases - myocardial infarction and brain stroke.

Permanent persistent increase in blood pressure (blood pressure) up to 140/90 mm. RT. Art. and higher - Sign of arterial hypertension (hypertension).

The risk factors contributing to the manifestation of arterial hypertension include:

Age (men older than 55 years old, women over 65)
Smoking
sedentary lifestyle,
Obesity (waist amount of more than 94 cm for men and more than 80 cm for women)
Family cases of early cardiovascular diseases (men under 55 years old, women under the age of 65)
The magnitude of the pulse arterial pressure in the elderly (the difference between systolic (upper) and diastolic (lower) arterial pressure). Normally, it is 30-50 mm RT Art.
Plasma glucose an empty stomach 5.6-6.9 mmol / l
Dyslipidemia: total cholesterol more than 5.0 mmol / l, low-density lipoprotein cholesterol 3.0 mmol / l and more, high density lipoprotein cholesterol 1.0 mmol / l and less for men, and 1.2 mmol / l and less for Women, triglycerides more than 1.7 mmol / l
Stressful situations
alcohol abuse
Excessive salt use (more than 5 grams per day).

Also, the development of AG contributes to diseases and conditions as:

Sugar diabetes (glucose in plasma on an empty stomach 7.0 mmol / l and more during repeated measurements, as well as glucose in blood plasma after eating 11.0 mmol / l and more)
Other Endocrinological Diseases (Feochromocytoma, Primary Aldosteronism)
Diseases of the kidneys and renal arteries
Reception of drugs and substances (glucocorticosteroids, non-steroidal anti-inflammatory drugs, hormonal contraceptives, erythropoietin, cocaine, cyclosporine).

Knowing the causes of the disease, you can prevent the development of complications. In the risk group are the elderly.

According to the modern classification adopted by the World Health Organization (WHO), AG is divided into:

1 degree: Increased blood pressure 140-159 / 90-99 mm RTCT
2 degree: Increased blood pressure 160-179 / 100-109 mm RTC
3 degree: Increased blood pressure up to 180/110 mm RTTC and higher.

The blood pressure indicators obtained at home can become a valuable addition when monitoring the effectiveness of treatment and are important when the AG is detected. The task of the patient is to conduct the blood pressure self-control diary, where the indicators of the blood pressure and pulse are recorded when measuring, at least in the morning, at lunch, in the evening. It is possible to comment on the lifestyle (lifting, eating, physical activity, stressful situations).

Technique measuring hell:

Quickly pump air into the cuff to the pressure level, by 20 mm RTTC, exceeding systolic blood pressure (garden), on the disappearance of the pulse
Hell is measured with an accuracy of up to 2 mm RTCT
Reduce the pressure in the cuff at a speed of about 2 mm RTTC in 1 second
The pressure level in which the 1st tone appears, the garden corresponds to
The pressure level at which the disappearance of the tones corresponds to the diastolic arterial pressure (DDA)
If the tones are very weak, you should raise your hand and perform several compressive movements with a brush, then the measurement is repeated, and it should not be very comprehended by the artery of the membrane of the Phondoscope
In the primary measurement, the hell is fixed on both hands. In the future, the measurement is carried out on the hand on which hell is higher
In patients with diabetes and in persons receiving antihypertensive agents, the hell should also be measured after 2 minutes of stay in the standing position.

Patients with ag are pain in the head (often in the temporal, occipital region), episodes of dizziness, rapid fatigue, poor sleep, may occur pain in the heart, violation of vision.
The disease is complicated by hypertensive crises (when the hell is sharply increased to high digits, rapid urination, headache, dizziness, heartbeat, feeling of heat); impaired kidney function - nephrosclerosis; strokes, intracerebral hemorrhage; Myocardial infarction.

For the prevention of complications of patients with AG, it is necessary to constantly monitor its blood pressure and take special antihypertensive drugs.
If a person is worried about the above complaints, as well as pressure 1-2 times a month - this is a reason to refer to the therapist or cardiologist, which will appoint the necessary surveys, and subsequently determine the further tactics of treatment. Only after the necessary survey complex it is possible to talk about the appointment of drug therapy.

An independent purpose of drugs may threaten the development of undesirable side effects, complications and may have a fatal outcome! It is prohibited to the independent use of medicines according to the principle "helped familiar" or resort to the recommendations of pharmacists in pharmacy chains !!! The use of antihypertensive drugs is possible only by appointment of a doctor!

The main purpose of the treatment of patients with AG consists in maximizing the risk of developing cardiovascular complications and death from them!

1. Activities for lifestyle change:

To give up smoking
Normalization of body weight
Consumption of alcoholic beverages less than 30 g / day alcohol for men and 20 g / day for women
Increased exercise - regular aerobic (dynamic) load of 30-40 minutes at least 4 times a week
Reducing the consumption of the table salt up to 3-5 g / day
Changing the power mode with an increase in plant food consumption, increasing in potassium diet, calcium (contained in vegetables, fruits, grain) and magnesium (contained in dairy products), as well as a decrease in animal consumption of fats.

These activities are prescribed to all patients with arterial hypertension, including those receiving antihypertensive drugs. They allow: reduce blood pressure, reduce the need for antihypertensive preparations, favorably affects the available risk factors.

2. Medical therapy

Today we will talk exactly about these drugs - modern means for the treatment of arterial hypertension.
Arterial hypertension is a chronic disease that requires not only constant control of blood pressure, but also a permanent reception of drugs. There is no course of antihypertensive therapy, all drugs are accepted indefinitely. With the inefficiency of monotherapy, the selection of drugs from various groups is carried out, often combining several drugs.
As a rule, the patient's desire with AG is the strongest, but not expensive drug. However, it is necessary to understand that this does not exist.
What drugs for this offer patients suffering from high pressure?

Each antihypertensive drug has its own mechanism of action, i.e. affect those or other "Mechanisms" raising blood pressure :

a) renin angiotensin system - A substance is produced in the kidneys (with a decrease in pressure), which goes into the blood in Renin. The renin (proteolytic enzyme) interacts with the blood plasma protein - angiotensinogen, as a result, an inactive substance of angiotensin I is formed. Angiotensin when interacting with an angiothesin-plating enzyme (ACE) enters the active substance angiotensin II. This substance contributes to an increase in blood pressure, narrowing the vessels, an increase in the frequency and force of heart rate, the excitation of the sympathetic nervous system (which also leads to an increase in blood pressure), strengthening the production of aldosterone. Aldosterone promotes sodium and water delay, which also enhances hell. Angiotenzine II is one of the strongest vessels in the body.

b) Calcium Channels of our organism - Calcium in the body is in the associated state. When calciding is admitted through special channels into the cell, the formation of a contractile protein - actomyosis. Under his action, the vessels are narrowed, the heart begins to shrink more, the pressure rises and the heart rate increases.

c) adrenoreceptors - In our body in some organs there are receptors, the irritation of which affects blood pressure. Such receptors include alpha-adrenoreceptors (α1 and α2) and beta-adrenoreceptors (β1 and β2). The focusing of α1-adrenoreceptors leads to an increase in blood pressure, α2-adrenoreceptors to decrease the blood pressure .α-adrenoreceptors are arranged in the arteries. β1 adrenoreceptors are localized in the heart, in the kidneys, their stimulation leads to an increase in the heart rate, increasing the need of myocardium in oxygen and increase blood pressure. Stimulation of β2-adrenoreceptors located in bronchioles causes the expansion of bronchiol and removal of bronchospasm.

d) urinary system- As a result of an excessive amount of water in the body, hell rises.

e) central nervous system- The excitation of the central nervous system increases blood pressure. In the brain there are vascular centers governing the level of blood pressure.

So, we considered the basic mechanisms of improving blood pressure in the human body. It's time to move to the means to reduce pressure (antihypertensive) that affect these very mechanisms.

Classification of funds for arterial hypertension

Diuretics (diuretic)
Calcium channel blockers
Beta adrenoblocators
Means acting on a renin angiotensive system
1. Blockers (antagonists) angiotensive receptors (sartans)
Neurotropic means of central action
Tools acting on the central nervous system (CNS)
Alpha adrenoblocators

1. Diolets (Diuretics)

As a result of the elimination of excessive fluid from the body, blood pressure is reduced. A diuretic tools prevent the reverse absorption of sodium ions, which are derived from the outside and carries out water. In addition to sodium ions, diuretics are flushed out of the body of potassium ions, which are necessary for the work of the cardiovascular system. There are diuretic products saving potassium.

Representatives:

Hydrochlorothiazide (hypothiazide) - 25mg, 100mg, is part of the combined drugs; Long-term use in the dosage above 12.5 mg is not recommended, due to the possible development of type 2 diabetes mellitus!
Indapamide (Arifonredard, Rowed Wed, Indapamide MV, Indap, Ionik Retard, Acrypamidredard) - more often Dosage 1,5mg.
Triampur (combination diuretik, containing potassium-saving triamtener and hydrochlorostiazide);
Spironolactone (Veroshpiron, Aldakton). It has a significant side effect (men causes the development of gynecomastia, median).
Eplerenone (Inspra) - is often used in patients with chronic heart failure, it does not cause the development of gynecomastia and medodinia.
Furosemide 20mg, 40mg. Preparation of short but quick action. It slows down the reabsorption of sodium ions in the rising knee of the loop of Genlen, proximal and distal tubules. Increases bicarbonate, phosphates, calcium, magnesium.
Toramsemid (Diiouver) - 5mg, 10mg, is a loop diuretic. The main mechanism of the drug is due to the reversible binding of the thoracemide with the cable carrier of sodium / chlorine / chlorine ions / potassium, located in the apical membrane of the thick segment of the rising part of the loop of the loop of Genla, as a result of which the reabsorption of sodium ions is reduced or fully inhibited and the osmotic pressure of the intracellular fluid and the reabsorption of water decreases. Blocks aldosterone myocardial receptors, reduces fibrosis and improves myocardial diastolic function. Thoraraside to a lesser extent than furosemide causes hypocalemia, while it exhibits greater activity, and its action is longer.

Diuretics are prescribed in a complex with other antihypertensive drugs. The drug Indapamide is the only diuretic applied at AG on their own.
A diuretic rapid action (furosemide) is undesirable to apply systematically with hypertension, they are taken in case of emergency states.
When applying diuretics, it is important to take potassium preparations by courses up to 1 month.

2. Calcium channel blockers

Calcium channel blockers (calcium antagonists) is a heterogeneous group of drugs having the same mechanism of action, but differing in a number of properties, including according to pharmacokinetics, tissue selectivity, effect on the frequency of heart abbreviations.
Another name of this group is calcium ion antagonists.
There are three main subgroups of AK: dihydropyridine (the main representative - nifedipine), phenylalkylamin (the main representative - verapamil) and benzothiazepines (the main representative - Diltiazem).
Recently, they began to divide into two large groups, depending on the impact on the frequency of heart abbreviations. Diltiazene and Verapamil refer to the so-called "rejuvenating rhythm" calcium antagonists (NEDIGIDROPIRODINOVY). The other group (dihydropyridine) includes amlodipine, nifedipine and all other Dihydropyrididin derivatives, increasing or non-changing heart rate.
Calcium channel blockers are used in arterial hypertension, coronary heart disease (contraindicated with sharp forms!) And arrhythmias. At arrhythmias, not all calcium channel blockers are used, but only pulserizing.

Representatives:

Pulsusuring (NEDIGIDROPIRODINOVY):

Verapamil 40mg, 80mg (prolonged: Isopin CP, Veroralide EP) - dosage 240mg;
Diltiakeeze 90mg (altiazem pp) - dosage 180mg;

The following representatives (dihydropyridine derivatives) do not apply during arrhythmias: Contraindicated in acute myocardial infarction and unstable angina !!!

Nifedipine (Adalat, Cordaflex, Cordafen, Cordypin, Corinthar, Nyfekard, Penigidine) - Dosage 10 mg, 20 mg; Nyfekardxl 30mg, 60mg.
Amlodipine (Norvask, Normodipin, Tenox, Cordin Cord, Es Cordic, Cardopin, Kalkhek,
Amlotop, Omeloarkardio, Amlovas) - Dosage 5mg, 10mg;
Felodipine (Captionil, Felodip) - 2,5mg, 5mg, 10mg;
Nimodipine (Nimotop) - 30mg;
Lazidipin (Lazipil, Sakur) - 2mg, 4mg;
Lercanidipine (Lercomen) - 20mg.

From side effects of dihydropyridine derivatives, you can specify swelling, mainly lower extremities. Headache, redness of the face, the increase in the pulse, the increase in urination. If the edema is saved, it is necessary to replace the drug.
Lercamen, which is a representative of the third generation of calcium antagonists, due to higher selectivity for slow calcium channels, causes edema to a lesser extent compared to other representatives of this group.

3. beta adrenoblocators

There are funds that do not selectively block receptors - non-selective action, they are contraindicated in bronchial asthma, chronic obstructive pulmonary disease (COPD). Other funds selectively block only the beta-receptors of the heart - selective action. All beta blockers prevent the synthesis of prophene in the kidneys, thereby blocking the renin-angiotensin system. In this regard, the vessels expand, hell decreases.

Representatives:

Metoprolol (Betalk Zok 25mg, 50mg, 100mg, Egyot Retard 25mg, 50mg, 100mg, 200mg, Egyptions C, VaseCardinerell 200 mg, metabardard 100 mg) ;;
Bisoprolol (Concorp, Coronal, Biol, Bisogamma, Cordinorm, Niperthen, Biprol, Bidop, Aritel) - Most often Dosage 5mg, 10mg;
Nebivolol (non-binelol) - 5 mg, 10 mg;
Betaxolol (Locase) - 20 mg;
Carvedilol (Karvendrend, Coriol, Talliton, Dilatrend, Acrediol) - mostly dosage 6.25mg, 12,5mg, 25mg.

Preparations of this group are used in hypertension combined with ischemic heart disease and arrhythmias.
Short-breathing drugs whose use is not rational with hypertension: anaprilin (indisimated), atenolol, propranolol.

Basic contraindications to beta blockers:

bronchial asthma;
low pressure;
sinus node weakness syndrome;
pathologies of peripheral arteries;
bradycardia;
cardiogenic shock;
atrioventricular blockade of the second or third degree.

4. Means acting on a renin angiotensin system

Preparations operate at different stages of the formation of angiotensin II. Some inhibit (suppress) an angiotensification enzyme, others block the receptors to which angiotensin II act. The third group inhibits renin, is represented by only one drug (alianis).

Angiotenzine Enzyme Enzyme Inhibitors (ACE)

These drugs prevent the transition of angiotensin I to active angiotensin II. As a result, the concentration of angiotensin II decreases in the blood, the vessels are expanding, the pressure is reduced.
Representatives (in brackets indicated synonyms - substances with the same chemical composition):

Captive (Kopoten) - Dosage 25mg, 50mg;
Enalapril (ReniPril, Berlipril, Renipril, Ednit, Anap, Enaren, Enam) - Dosage most often 5mg, 10mg, 20mg;
Lysinopril (Dotroton, Dapril, Lizigamma, Leisioton) - Dosage most often 5mg, 10mg, 20mg;
Perindopril (Preshaum A, Perines) - Perindopril - 2,5mg dosage, 5mg, 10mg. Perines - dosage 4mg, 8mg.;
Ramipril (Tritacea, Amprilan, Kartil, Pyramil) - 2,5mg dosage, 5mg, 10mg;
Hinapril (Akkiro) - 5mg, 10mg, 20mg, 40mg;
Fozinopril (Fozicard, Monophil) - Dosage 10mg, 20mg;
Transdolapril (gopten) - 2mg;
Zofensoid (Zocardis) - Dosage 7,5mg, 30mg.

Preparations are available in different dosages for therapy with varying degrees of enhancement of blood pressure.

The peculiarity of the preparation of Captopril (Kopoten) is that he is due to its short-term action is rational only with hypertensive crises.

The bright representative of the Enalapril group and its synonyms are used very often. This drug does not differ in the duration of action, so take 2 times a day. In general, the full effect of APF Igraphs can be observed after 1-2 weeks of use of drugs. In pharmacies you can meet a variety of generics (analogs) of Enalapril, i.e. Cheaper, containing enalapril preparations that produce small manufacturers. We reasoned about the quality of generics in another article, it is worth noting that someone enalapril is suitable for someone, they do not work for someone.

ACE inhibitors cause a side effect - dry cough. In cases of cough development, the ACE inhibitors are replaced by the drugs of another group.
This group of drugs is contraindicated during pregnancy, has a teratogenic effect of the fetus!

Blockers (antagonists) angiotensin receptors (sartans)

These funds block angiotensin receptors. As a result, angiotensin II does not interact with them, the vessels are expanding, hell decreases

Representatives:

Lozartan (Kozar 50mg, 100mg; Lozec 12.5mg, 50mg, 100mg; Lorist 12,5mg, 25mg, 50mg, 100mg; vasotenz 50mg, 100mg);
Eprosartan (Teveten) - 400mg, 600mg;
Walssartan (40mg, 80mg, 160mg, 320mg; Waltacor 80mg, 160mg, 320mg, Vals 40mg, 80mg, 160mg; Nortivan 40mg, 80mg, 160mg; valsafors 80mg, 160mg);
Irbesartan (Approvnel) - 150mg, 300mg;
Kandesartan (atacand) - 8mg, 16mg, 32mg;
Telmisartan (Macardis) - 40mg, 80 mg;
Olmertan (Cardosal) - 10mg, 20mg, 40mg.

Just as predecessors, allow us to estimate the full action after 1-2 weeks after the start of reception. Do not cause dry cough. Do not apply during pregnancy! When pregnaning pregnancy during the treatment period, hypotensive therapy with drugs of this group should be discontinued!

5. Neurotropic means of central action

Neurotropic drugs of central action affect the vessels center in the brain, reducing its tone.

Moxonidine (Physiotense, Moksonitex, Moksogamma) - 0.2 mg, 0.4 mg;
Rilmenidin (Albarel (1MG) - 1MG;
Metyldop (operated) - 250 mg.

The first representative of this group is clofelin, which has been widely used earlier with AG. Now this drug is released strictly by recipe.
Currently, Moxonidine is used both for emergency assistance in hypertensive crisis, as well as for planned therapy. Dosage 0.2 mg, 0.4 mg. Maximum daily dosage 0,6mg / day.

6. Means operating on the central nervous

If the AG is caused by prolonged stress, then drugs acting on the central nervous system are used (sedatives (novative, perrsen, valerian, dyeing, tranquilizers, sleeping pills).

7. Alpha Adrenoblocators

These funds are attached to alpha-adrenoreceptors and block them for irritant effects of norepinephrine. As a result, hell is reduced.
The used representative - doxazosin (Cardura, Tonokardin) - more often produced in dosages 1 mg, 2 mg. It is used to relieve attacks and long-term therapy. Many drugs of alpha blockers are removed from production.

Why are few drugs at once with arterial hypertension

In the initial stage of the disease, the doctor prescribes one drug, on the basis of some studies and, taking into account the diseases of the patient. If one drug is ineffective, other drugs are often added, creating a combination of drugs to reduce blood pressure, affecting various mechanisms to reduce blood pressure. Combined therapy for refractory (sustainable) arterial hypertension can combine up to 5-6 drugs!

Preparations are selected from different groups. For instance:

aPF / diuretic inhibitor;
angiotensin / diuretic receptor blocker;
aFF inhibitor / calcium channel blocker;
aCF / Calcium Channels / Beta-Adrenoblocator;
an angiotensin receptor block / calcium channel blocker / beta-adrenoblocator;
aFF inhibitor / calcium channel blocker / diuretic and other combinations.

There are combinations of drugs that are irrational, for example: beta blockers / calcium channel blockers pulserizing, beta blockers / central action preparations and other combinations. It is dangerous to engage in self-medication !!!

There are combined drugs combining in 1 tablet components of substances from different groups of antihypertensive drugs.

For instance:

aCF / diuretic inhibitor
- Enalapril / Hydrochlorothiazide (Ko-Renatez, ENAP NL, ENAP N,
- ENAP NL 20, Renipril GT)
- Enalapril / Indapamide (Enzyx Duo, Enzyme Duo Forte)
- Lysinopril / Hydrochlorothiazide (Iruzide, Leisioton, Lithan H)
- Perindopril / Indapamide (Noliprelai Nolipreforte)
- Hinapril / hydrochlorothiazide (accumulated)
- Fozinopil / Hydrochlorothiazide (Fozicard N)
angiotensin receptor blocker / diuretic
- Lozartan / Hydrochlorothiazide (Gizar, Lozap Plus, Lorista N,
- Lorist ND)
- Eprosartan / Hydrochlorothiazide (Teveten Plus)
- Valsartan / Hydrochlorothiazide (co-doda)
- Irbesartan / Hydrochlorothiazide (Co-Approvnel)
- Candesartan / Hydrochlorothiazide (Ataanda Plus)
- Telmisartan / HCHT (McCardis Plus)
aCF / Calcium Channel Ingiber
- Transdolapril / Verapamil (Tarka)
- Lysinopril / Amlodipine (Equator)
angiotensin receptor blocker / calcium channel blocker
- Valsartan / Amlodipine (Exeffer)
dihydropyridine calcium channel blocker / beta blocker
- Felodipine / metoprolol (logism)
beta blocker / diuretic (it is impossible in diabetes and obesity)
- Bisoprolol / hydrochlorothiazide (Lodoz, Aritel Plus)

All drugs are produced in different dosages of one and another component, the dose must be selected for the patient.

The achievement and maintenance of target levels of blood pressure require long-term medical observation with regular control of the patient's implementation of recommendations on how to modify the lifestyle and compliance with the admission mode of appointed antihypertensive agents, as well as correction of therapy, depending on the effectiveness, safety and tolerance of treatment. With a dynamic observation, the establishment of personal contact between the doctor and the patient, training of patients in schools for patients with hypertension, which increases the commitment of the patient to treatment is crucial.

Hydrostatic (cardiogenic or heart) swelling of the lungs
It happens during diseases that peculate the pressure (hydrostatic) inside the capillaries and further penetration of plasma from them into pulmonary alveoli. The causes of such a form are: defects of vessels, hearts; myocardial infarction; acute lack of left ventricle, myocarditis; blood stagnation with hypertension, cardiosclerosis; heart defects with the presence of hardness of heart abbreviations; emphysema, bronchial asthma.
Negrotogenic pulmonary swelling, to which:
Yatrogenic	Arises: with the increased velocity of drip administration into the vein of large volumes of physiological solution or plasma without active forcing urine release; with a low amount of protein in the blood, which is often detected in cirrhosis of the liver, nephrotic kidney syndrome; in a period of long-term increase in temperature to high numbers; under starvation; with the eclampsia of pregnant women (second half toxicosis).
Allergic, toxic (membrane)	It is provoked by the action of poisons, toxins that violate the permeability of the walls of the alveoli, when the liquid penetrates in them instead of air, filling almost the entire volume. Causes of toxic edema of the lungs in humans: inhalation of toxic substances - glue, gasoline; an overdose of heroin, methadone, cocaine; alcohol poisoning, arsenic, barbiturates; overdose of medicines (fentanyl, apresin); entering the cells of nitrogen oxide, heavy metals, poisons; extensive deep lung fabric burns, Uremia, Diabetic, hepatic coma food allergy, medicinal; radiation damage to the region of the sternum; poisoning of acetylsalicylic acid with long-term admission of aspirin in large doses (more often in adulthood); metal carbonate poisoning. Often passes without characteristic signs. The picture becomes clear only when conducting radiography.
Infectious	Develops: if you get into the bloodstream infection, causing pneumonia, sepsis; in chronic diseases of the respiratory organs - emphysema, bronchial asthma, pulmonary thromboembolism (blocking the artery of clocks of platelets - embolomes).
Aspiration	It occurs when penetrating into light foreign bodies, the contents of the stomach.
Traumatic	It happens with penetrating chest injuries.
Cancer	It occurs due to the failure of the functions of the pulmonary lymphatic system with the difficulty of lymph outflow.
Neurogenic	Main reasons: intracranial hemorrhage; intensive convulsions; the accumulation of exudate in alveoli after the operation on the brain.

Severity	The severity of symptoms
1 - on the border of development	Revealed: non-sniff; heart rate impairment; often there is bronchospasm (a sharp narrowing of the walls of the bronchi, which causes difficulties with the flow of oxygen); anxiety; whistling, individual wheezing; dry skin.
2 - average	Observed: wheezing, which are heard at a short distance; pronounced shortness of breath, in which the patient is forced to sit, leaning forward, leaning on the elongated hands; throwing, signs of neurological stress; spirin appears on the forehead; strong pallor, lip, fingers.
3 - hard	Indeptly pronounced symptoms: kinders are heard, raging wheezing; there is a strong pronounced inspiratory shortness of breath with a difficult sigh; dry bakery cough; the opportunity just to sit (since the cough increases in a lying position); compressive grace of breast pain caused by oxygen deficiency; skin coats on the chest are covered with abundant later; pulse alone reaches 200 shots per minute; strong anxiety, fear.
4 Degree - Critical	Classic manifestation of critical condition: severe shortness of breath; cough with abundant pink foamy wet; severe weakness; far heard rough bubbles; painful attacks of suffocation; swollen cervical veins; shiny, cold limbs; fear of death; abundant sweat on the skin of the abdomen, chest, loss of consciousness, comatose state.