What is non-drug treatment. Treatment of hypertension with modern medications according to schemes and folk remedies

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Basic pathophysiological mechanisms of hypertension

The level of blood pressure is maintained by two interrelated hemodynamic parameters: cardiac output or MOS and PSS. MOS is determined by heart rate and UOS value.

The value of PSS depends on the patency (tonus) of resistive vessels (arterioles and precapillaries) and the severity intravascular disorders MC, blood viscosity.

Thus, blood pressure reflects the relationship between arteriolar capacity and intravascular fluid volume (Kushakovsky MS, 1977).

Under physiological conditions, there is an inverse relationship between MOS and PSS, due to which a stable average hemodynamic pressure is maintained. The close relationship between the most important components of hemodynamics and sufficient stability of blood pressure is ensured by a complex, multi-stage apparatus of neurohumoral control, which operates according to the principle feedback.

There are two links in the regulation system. One of them is the sympathetic-adrenal system, which controls the tone of resistive vessels, i.e. PSS and capacitive vessels (veins), which determines the venous return of blood to the heart and, consequently, the IOC. In addition, SAS controls the production of renin by the kidneys, which through the formation of angiotensin also affects vascular tone and PSS.

The second link of regulation is the renin-angiotensin-aldosterone system. This link is purely humoral and functions depending on the level of pressure in the renal vessels: with its increase, the pressure in renal artery and the juxtaglomerular apparatus of the kidney responds compensatory with a decrease in renin production and, as a result, a decrease in the level of angiotensin-2 and aldosterone.

The RAAS system has a direct effect on the kidney, changing its function of sodium and water secretion: the higher the blood pressure, the weaker the reabsorption processes in the distal tubules. This leads to an increase in diuresis, the release of large amounts of sodium and water, i.e. IOC decreases and, accordingly, blood pressure. When blood pressure falls, reverse shifts occur. This is the so-called “pressure-diuresis” mechanism. In addition, RAAS also acts directly on vascular tone.

As arterial hypertension progresses, left ventricular remodeling occurs, which is its structural and geometric changes, including the processes of its hypertrophy and dilatation, leading to changes in geometry, sphericity, as well as violations of systolic and diastolic function (Belenkov Yu.N. et al., 2002 ; Ivanov A.P. et al., 2006).

Hypertension develops as a result of disturbances in the blood pressure regulation system that occur in individuals with a hereditary predisposition under the influence of factors external environment(psycho-emotional stress, overuse salt, obesity, age adjustment endocrine system smoking, drinking alcohol).

According to A.A. Dzizinsky (1974, 1992), S.G. Abramovich (1989, 2001) and A.A. Fedotchenko (1992), under the influence of hereditary and external factors, disturbances occur in the SAS system, which is responsible for short-term control of blood pressure regulation with the development of its hyperreactivity. In addition, hyperreactivity of the vessels themselves and the heart may occur. This is an important key link in pathogenesis, which causes not only initial manifestations arterial hypertension, but also its stabilization.

Classification of hypertension

One of its main provisions is the introduction of the term "degree of GB", reflecting the level of increase in blood pressure, which implies the progression of the patient's condition over time. In addition, it defines the stratification of patients depending on the likelihood of the risk of complications (Dzizinsky A.A., 2000).

Within the framework of the XVII Conference of the American Society for Hypertension, which was held on May 1317, 2003 in New York, new recommendations were presented by the Joint Committee on the Prevention, Detection, Evaluation and Treatment of High Blood Pressure - JNC-7 (Britov A.N. et al. , 2003; Kobalava Zh.D. et al., 2004; Chobanian A. et al., 2003).

Based on this information, at the initiative of the Section of Arterial Hypertension of the All-Russian Scientific Society of Cardiologists (Chazova I.E. et al., 2004), the main provisions of the draft of the second revision of recommendations for the prevention, diagnosis and treatment of GB were developed.

In them, along with the allocation of the degree of HD, when making a diagnosis, the stage of the disease should also be indicated, which implies the presence of possible vascular and organ lesions of target organs. Due to the commonality of therapeutic approaches, the 2nd and 3rd stages are combined.

Thus, only two stages of GB are distinguished: stage 1 - systolic blood pressure 140-159 mm Hg. and / or diastolic blood pressure 90-99 mm Hg, stage 2 - systolic blood pressure 160 mm Hg. and above and / or diastolic blood pressure of 100 mm Hg. and higher. Compared with JNC-6 (1997), a new category is distinguished - prehypertension (prehypertension).

Non-drug treatment and prevention of hypertension

Society bears significant economic losses from arterial hypertension. According to expert estimates, they amount to 34 billion rubles a year, of which the cost of treatment and rehabilitation of patients is more than 22 billion rubles, costs associated with disability and premature death population - about 12 billion rubles (Oshchepkova E.V., 2002). HD is the most expensive disease of the cardiovascular system: over the past 10 years, the cost of antihypertensive therapy has increased 4 times, which is due to both the increase in prices for modern drugs and the need to achieve lower target levels of blood pressure (Ostroumova O.D. et al., 2003).

Conducted by E.V. Frolova et al. study (2004) showed economic efficiency measures of non-drug correction of GB, which resulted in an increase in the survival of patients by 20 days for women and 8 days for men. At the same time, the cost of 1 year of saved life for women amounted to 8220 rubles. (274 US dollars), for men - 9240 rubles. ($308).

In a number of developed Western countries, large-scale measures aimed at prevention, early diagnosis and provision of regular treatment of hypertension with bringing the level of blood pressure to target values ​​have reduced the incidence of stroke by 40-50% (Skvortsova V.I. et al., 2002; N.V. Vereshchagin et al., 2004). According to Yu.A. Varakina et al. (1999), a 5-year program of therapeutic measures conducted by the Research Institute of Neurology of the Russian Academy of Medical Sciences in a population of 4049-year-old men reduced the incidence of stroke by 57%.

Timely comprehensive and adequate treatment of GB, as well as addressing the issues of preventing this disease, will increase the duration and quality of life of patients, avoid complications (Oganov R.G., 2002; Lyadov K.V. et al., 2004; Fursov A.N. s et al., 2006). However, one drug therapy cannot take the responsibility for solving the entire spectrum of complex problems.

Drug treatment with modern antihypertensive drugs is the most efficient way secondary prevention complications and decrease in mortality of the population (Shalnova S.A., 2003), but one should agree with the opinion of E.E. Gogin (2003) that "it is not easy to treat patients with GB, despite the large selection of drugs - there is no drug that is best for all patients, and the disease is not limited to an increase in blood pressure."

To not drug therapy HD clinicians are compelled to apply because of a number of problems that arise with long-term drug treatment.

This refers not only to the numerous side effects of drugs that most patients with GB need to take for life, but also the difficulty of observing the very fundamental principle maintenance therapy, as many patients stop taking medications for various reasons.

Among them: the lack of proper information in the media for the population on the only correct tactics for the long-term use of modern antihypertensive drugs; their high cost, which is especially pronounced when it is necessary for patients with GB to achieve lower target levels of blood pressure; passion is not enough effective medicines lost in last years its value (reserpine, adelfan, clonidine, dopegyt, etc.), which leads to patients losing confidence in a positive outcome of treatment; psychological attitude of patients to short time treatment and irregularity of use (“as needed”) antihypertensive drugs.

According to V.S. Volkova et al. (2001), in the treatment of GB, only 53.3% of patients follow the doctor's recommendations for the regular intake of drugs that reduce blood pressure.

Non-drug methods of lowering blood pressure are applicable in patients with hypertension at any degree of its increase, although in the early stages of the disease, with an adequate struggle of the patient "for healthy lifestyle life ", you can achieve a decrease in blood pressure without taking medication antihypertensive drugs (Table 4).

The main non-drug methods of treatment and prevention of GB, in our opinion, are: reducing the consumption of salt and alcohol, weight loss, physical training, psychotherapeutic measures, natural physical factors and hardware physiotherapy.

It should be noted that clinicians do not include therapeutic physical factors in the group of non-drug methods of treating GB, assigning them the role of adjuvant therapy. this disease. Today it is difficult to accept this, since in recent years there have been highly effective methods of physiotherapy and evidence of real opportunity their impact on pathogenetic mechanisms diseases.

It must be frankly admitted that at present the potential of natural and preformed physical factors in the treatment of hypertension is not sufficiently realized. Meanwhile, active use physical factors will more successfully solve the problems of treatment and prevention of GB (Kotovskaya E.S., 1984; Sorokina E.I., 1989; Knyazeva T.A. et al., 2001; Bogolyubov V.M., 2002; Abramovich S. G., 2003).

Table 4. Lifestyle changes to manage hypertension (JNC - 7, 2003)

S.G. Abramovich, N.A. Kholmogorov, A.A. Fedotchenko

They are: bloodletting, cauterization, compresses, baths, massage. Non-drug methods of treatment also include methods of physical and mental training not described in detail in the "Four Tantras", such as relaxation, yantra yoga, contemplative transformation of the body-speech-thought complex.

Bloodletting.

“Diseases for which bloodletting is prescribed: widespread fever, confused fever, fever from infection, tumors and edema, surya disease, herpes zoster, lymph diseases, leprosy, and in the absence of these, diseases of the liver, spleen, mouth, eyes, head and so on. In short, bloodletting is prescribed for the most part in heat diseases arising from [based on] blood and bile. But bloodletting is not allowed with undivided blood [see. below], immature contagious diseases, empty heat, unresolved intoxication, dangerous contagious heat, depletion of bodily strength, although this is the essence of a disease with the genesis of heat. In addition, bloodletting is not allowed during pregnancy in women, after childbirth, in diseases of edema due to metabolic disorders, a decrease in the fiery warmth of the stomach, indigestion of food, in short, in diseases arising [on the basis of] mucus and wind, [but even] in the absence of such - in children under 16 years of age and in persons who have reached senile age.

Time sequence. "Dividing bloodletting must be carried out immediately in cases of swirling of blood in internal dense and hollow organs, with extensive fever, contagious diseases, and in the absence of such - with continuous bleeding from the mouth, nose, etc., classified as mature diseases ..." .

There are a number of other indications and contraindications, however, due to the complexity of preparing for bloodletting and the bloodletting procedure itself, I consider it inappropriate to present this topic in detail in this book. I just want to briefly outline the main points related to bloodletting.

First. For bloodletting, special instruments were used, the material of manufacture, the form, and the quality of which were subject to very serious requirements. The secrets of making such instruments were passed from master to master.

Second. It is necessary to learn to clearly distinguish between diseases in which bloodletting is used, and those diseases in which it is unacceptable. To do this, the doctor must be fluent in the art of diagnosis, have a good knowledge of nosology. The same requirements are also important for the third point - knowledge of the time sequence of the development of diseases, since the use of bloodletting in an immature disease is usually not allowed.

Fourth. It is necessary to properly prepare the patient's body for bloodletting. By special methods, one should bring the immature disease to maturity, with the help of special medicinal compositions, separate the bad blood from the good blood in the places of bloodletting, then, again using medicines, separate the blood and the wind. As a result, when bloodletting, a little bubbling blood comes out of the incised place at first, with large bubbles of gases, then a little black in color comes out. bad blood and then the bleeding stops. But this is the simplest case. Fifth. Necessary good knowledge bloodletting techniques, primarily practical. This technique varies depending on which vessel is being bled. Note that what is called bloodletting includes bloodletting from the veins, arteries, and also the removal of lymph from the lymphatic vessels.

Sixth. It is necessary to have a good knowledge of the topography of the body points where bloodletting is performed during specific diseases. In total, there are 77 main and 13 additional channels of blood, bile and lymph, from which diseased blood, bile and lymph are released from the body. There are also 112 main and a number of secondary channels and places in which bloodletting is unacceptable, these are "vulnerable structures of the channels of the body" .

Seventh. It is necessary to know the measure, the amount of released blood or lymph in each case.

Eighth. Knowledge and skills required to care for the patient after the procedure.

Ninth. You should be aware that excessive, insufficient and unskilled bloodletting can be harmful. The doctor must be extremely careful not to make a mistake, and if he makes one, he must be able to protect the patient from its consequences.

Tenth. The doctor should be aware of the signs of a beneficial effect on the patient's body of the bloodletting procedure.

Moxibustion.

The topic of cauterization is usually considered under seven points: indications for the use of cauterization, contraindications, cones for cauterization, places where cauterization is performed, technique of cauterization, rehabilitation, effect of cauterization or benefits of cauterization.

Indications and contraindications. Cauterization is recommended in the presence of "decrease in the warmth of the stomach, the formation of edema [tumors], gout, swirl of lymph in the bones and joints of the extremities, external edema, pain, dizziness due to wind diseases, clouding of consciousness, insanity, leading to fainting pain, disorders of the movements of the limbs due to diseases channels, lymphatic vessels and veins. In the absence of such [diseases], it is very useful in diseases of the wind and cold classes, which very often occur after boils [ulcers], empty heat and other hot diseases, and in addition - in diseases of the lymph. However, it is not cauterization should be performed in diseases of hot bile, in the heat of the blood, in [diseases] of the entrances of the sense organs, the channel of being in the perineum in men ".

Collection and processing of edelweiss, production of cones. Cauterization is carried out with the help of special cones of different sizes, made from edelweiss and a certain amount of nettle. At various diseases the size of the cone for cauterization varies from the size of the "upper phalanx of the thumb" to the "size of a dry pea". For the manufacture of cones, the inflorescence of edelweiss depleted and edelweiss Palibina are used.

The places where cauterization is performed are called "sanmig" (gsang dmigs) in Tibetan. They are of two types: "sanmmg", in which pain is felt, i.e. attached to the disease itself, and additionally known to the doctor as "sanmig".

The first are places of arthritic swirls of lymph in the joints of bones, external tumors, edema; places in which, when pressed, pain is felt, and when the pressure is removed, relief is felt; around edema, growths, malignant wounds.

The second are places associated with the circulation channels of wind, bile, mucus, blood, lymph.

Let's take an example. “The first vertebra is the 'sanmig of the wind'. When bending the neck, round protrusions become visible; on the first such round bone, cauterization is performed. [This is the VII cervical vertebra.] The main indications are: due to wind entering the channel of life [there are] confusion of consciousness, insanity, severe cardiac arrhythmia, trembling in the body, wind-induced dumbness, insomnia, deafness, inability to turn the neck; [cauterization of this vertebra] is also useful in other diseases of the wind group [diseases].”

cauterization technique. First, poison should be removed from the patient's body. “Poisons are a term for substances harmful to the body and life that enter [the body] with food.” Then the edelweiss cone is placed on the “sanmig” place of the back chosen by the doctor, having previously prepared this place. Rules have been developed for cauterization with one cone, several cones , the rules that determine the duration of cauterization.Moreover, "if, for example, cauterization is performed on a" sanmig ", heat should be felt in front, and vice versa. The absence of pain at the site of cauterization after the procedure is a sign that cauterization has been of great benefit.

Rehabilitation. After cauterization, the remains of the ash are not cleaned clean, but smeared on top with a mixture of butter and salt; it is not recommended to drink cold water and wine at night, etc. .

Benefits of burning. “If cauterization is performed in accordance with the method, it has a beneficial effect on the flow of wind and blood, “closing the mouth” of the channels, relieving pain, suppressing wind, strengthening memory and mind, generating heat in the stomach and body, digesting food, removing dead tissue from tumors, abscesses, chronic wounds, on the removal of edema, stretching of the lymph, draining it, etc.” .

Compresses.

There are cold and hot compresses, but doctors believe that in some cases special compresses are needed for children.

Cold compresses.

With swelling from bruises and fractures, widespread and confused heat, if they are accompanied by pain, a heating pad filled with cold water, a cloth moistened with cold water, a cold cobblestone pulled out of the water or other cold objects are applied to the sore spots. Such a compress relieves pain, eliminates heat.

In case of continuous bleeding from the nose, it is recommended to apply a bottle of cold water drawn in the early morning, when the stars have not yet gone out, or silt mixed with water from the bottom of a well or spring to the gap between the eyebrows, to the hollow on the back of the head.

In case of toothache due to the heat of the blood and to areas swollen due to wind disturbances, cold mud is also applied.

In gouty fever apply cold compress from crushed yellowish Sophora root mixed with an equal amount of cow dung.

In case of extensive heat due to disorders of the blood and bile, a cloth moistened with cold water or a cobblestone pulled out of cold water is applied under the armpits and on the forehead.

Hot compresses. For pain from indigestion or due to acute diseases of the organs abdominal cavity apply a hot compress from salt wrapped in a cloth heated in a pan or in a cast iron.

With a decrease in the warmth of the kidneys and retention of urine on the lower back, it is recommended to apply a hot compress from a dried bard preheated over a fire and wrapped in a cloth.

With postpartum pain in the lower part of the intestine, in the buttocks, kidneys, lumbar region it is recommended to apply warm compresses from earth wrapped in a cloth, thrown back by a mouse when digging a mink, after warming up the earth on a fire in good wine.

With dark red mucus, intoxication and other causing pain in stomach diseases, it is recommended to apply hot compresses from the leaves of bergenia, sorrel and Japanese medlar boiled in water and then wrapped in cloth.

In case of cold tumors of the stomach due to indigestion, it is recommended to apply hot compresses from pigeon droppings heated over a fire and wrapped in cloth.

In case of acute diseases of the abdominal organs of helminthic origin, it is recommended to apply hot compresses from the roots and leaves of angelica daurica heated on fire and wrapped in cloth.

If lymph enters the articular sheaths, it is recommended to boil the ground pebble or sand mixed with a small amount of salt in beer or water, wrap it in a cloth and apply a hot compress.

In case of retention of urine due to cold, it is recommended to apply a hot compress from the sediment of ghee and pigeon droppings to the lower abdomen.

For pain in the limbs due to diseases of the lymph, it is recommended to apply a hot compress from sheep's dung boiled in wine.

Compresses are contraindicated in diseases of mucous edema, when bile juice stains meat and skin in a dark yellow color, with leprosy, intoxication, dropsy, obesity, contagious disease "ball", smallpox, skin rashes, after eating.

Compresses applied to the liver in children are used in cases of liver enlargement. The child is undressed and laid on his back. A piece of natural silk is dipped into cold water, then placed on the child’s stomach on the right, cleaned, barringgonia leaves are placed on the liver area, a mirror, crystal, ladle, a vessel with water, an old opener or any cold, round and smooth one is placed on top of the lower part of the liver. thing and move it 10 to 15 times to the upper part of the liver, then again cleanse the stomach, moisten a piece of silk with water and place it on the liver area, tying it with ribbons, as if wrapping the stomach in silk. According to the degree of the disease - small, large, dangerous - this compress should be worn for 3 to 5 days.

baths.

There are hot baths from the waters of natural sources and artificial baths.

Baths are prescribed for gouty, rheumatoid, contraction of the limbs that appeared on the basis of edema of the legs due to coarsening of the veins and the formation of articular tumors and edema; with lameness caused by improper functioning of the white channels; with muscle flabbiness; during the formation of nodes in the channels due to a decrease in their heat; with curvature of the lumbar channels; with the disease "variegation of meat" and other diseases of the skin and lymph; with old wounds; with suppuration of wounds; with the disease "surya" of dense and hollow organs; with intoxication; with tumors and edema due to wind disorders; with deterioration of skin pigmentation, roughening of the skin; with chronic, difficult to treat diseases.

Baths are contraindicated in heat from infection, confused heat, extensive heat, pregnancy, high blood pressure, heart disease.

Water natural sources in Buryatia and in the Chita Autonomous Soviet Socialist Republic at one time lamas were investigated and distributed according to classes of diseases. Already in the 70s, the traditional doctor G.L. Lenkhoboev and candidate of philosophical sciences N.Ts. Zhambaldagbaev jointly examined a large number of natural sources in Buryatia and the Chita region. The springs were surveyed by traditional methods: water was determined by taste, by strength (priority), by the soil through which it passes, by the characteristics of the flora growing at the source, etc. At the same time, it turned out that many natural springs retained their strength, but in those places where deep wells were drilled and torpedoed for the mass use of water, these waters have largely lost their healing properties. In the same area, different sources, even those located in close proximity, could be used to treat diseases of completely different etiologies - they passed through different soils, being enriched with different microelements and, consequently, forces. When such waters are mixed, their features are lost. When using water from natural sources for baths and specially prepared water using various medicinal ingredients, it is necessary to adhere to fairly strict rules, partly varying in each case. The experience of practical balneology is not easily transferred, and this book describes the rules for applying healing baths it would be inappropriate - if they are used incorrectly, the consequences can be very deplorable.

Massage.

Under the massage Tibetan medicine understand the application of rubbing, kneading, and tapping techniques after anointing the skin with old butter, sesame oil, animal fat, and medicinal substances. This is one of the ways to treat painful foundations.

Grease.

In case of insanity, fainting, memory loss and other groups of wind diseases, a year-old butter is rubbed into the region of the 1st vertebra (this is the VII cervical vertebra) and, starting from it, VI and VII, as well as to the point between the nipples on the chest. After rubbing and kneading, these places are wiped with flour from roasted barley. Similar procedure performed in the following cases.

When itching due to lymph disorders, it is recommended to rub horse, onager, donkey fat into the skin.

When the strength of the kidneys is depleted, the expiration of the seed is recommended to rub beaver fat [or otter fat] and marmot fat into the lumbar vertebrae.

When a whitish discharge appears between the eyelid and the eyeball, resembling a paste in consistency, it is recommended to rub yak oil with cumin into the soles of the feet. Rubbing mixtures.

For abscesses, abscesses, abscesses, it is recommended to rub the mixture prepared in the form of a slurry into sore spots from yellow sulfur, salt, wine (beer) sourdough, soot in old oil and bask in the sun.

In old festering wounds and old wounds with pus that is difficult to remove, it is recommended to rub a mixture of ash from the burnt hollow stalks of astragalus or astragalus in mare's or donkey's milk.

For gouty pains, white or black sesame flour boiled in cheese whey should be rubbed.

When acne, pimples, sores from lichen appear on the face, it is recommended to rub a liquid mixture of white mustard powder, calamus powder, purified salt and dry leaves of Japanese loquat on cow urine.

For colic based on blood diseases, skin diseases, infectious edema, herpes zoster and eczema, it is recommended to rub a mixture of red sandalwood powder, large-leaved gentian flowers and Baikal skullcap roots in snow water.

For rashes on the skin with scabies, it is recommended to rub a mixture of soot, burdock Saussurea roots, sorrel, dwarf stellera roots ash, salt, wine [beer] sourdough in rancid oil (on oil that collects on the walls of a vessel with sour milk).

For diseases of "spotted skin", lichen, "cow mucus" (see) and other skin diseases, it is recommended to rub the mixture from the skin of a black snake, burned in a vessel without smoke, on pork fat.

Contraindications.

Massage is contraindicated for indigestion (indigestion of food taken), stiffness in the thighs due to wind disorders, lack of appetite, poisoning with poisons made from precious stones, dropsy, diseases of mucus and dark red stomach mucus, etc. In total, five main non-drug methods of treatment of Tibetan medicine are described.

As for the additional corrective methods available in Tibetan medicine, a special study should be devoted to their study. Let's name some of them.

Acupuncture It is considered the final corrective procedure that closes the entrances of the canals after removing diseases from them with the help of drug and non-drug therapy. Carrying out acupuncture at the very beginning of treatment is compared with the situation when, having found thieves in the house, they close the doors without expelling them.

Yoga methods. There are many yoga systems, individual elements of which can serve the cause of maintaining and restoring health. In general, it can be said that the practice of yoga includes exercises to control the mind, speech and body, aimed at achieving a balance in the functions of the body systems, energetically provided by the activity of the "lunar" wind of La-lana, the "solar" wind of Rasana and the "wind of wisdom" Avadhuti, as well as the mode of pulsations of "solar", "lunar" and "equal" origin.

Psychic therapy. Non-pharmacological mental treatment. Wide application psychopharmacotherapy in the fight against mental illness in combination with psychotherapy is currently considered as the most important path for the development of psychiatry since the appearance of the works of Sigmund Freud. But at the same time they get further development other non-drug therapies, primarily electroconvulsive therapy (ECT) and light therapy, and biofeedback.

Non-pharmacological mental treatment. Electroconvulsive therapy (ECT)

Many psychiatrists choose ECT for severe depression, psychotic and suicidal patients due to rapid offensive effect and relative safety of this method.

For non-suicidal patients with major depression or bipolar disorder, psychiatrists recommend ECT if antidepressant treatment is ineffective, side effects intolerable due to their severity or, finally, if the patient receives such a quantity of drugs that treatment with antidepressants becomes dangerous. The last of these situations is especially common in patients old age.

ECT has also been used successfully in cases of schizophrenia refractory to other treatments. The possibility of using this method in dementia is currently being studied.

Mechanism of action

In ECT, the brain is exposed to carefully selected and controlled pulses of alternating current that cause a brief seizure. Causes unknown positive action ECT in the treatment of severe depression. But many researchers believe that the therapy modifies the function of the monoamines in a manner similar to what occurs with the use of antidepressants.

Convulsive therapy, in which medications are used instead of current pulses to cause convulsive seizures, was proposed in 1934 by the Hungarian neuropsychiatrist Ladislas Meduna. He proceeded from the hypothesis that convulsive seizures can mitigate mental disorders, similar to how it is observed in epilepsy. His theory was based on the erroneous assumptions common at the time that epileptic seizures prevented the development of symptoms of schizophrenia.

In 1937, two Italian doctors began to cause convulsive seizures with electric shock, and in 1939, a well-known in colloquial speech as "electroshock therapy", ECT began to be used in the United States.

In the first years of application, the technology of the method was not yet developed in detail. In addition, in a number of cases, ECT has been highly abused. The horrifying aspects of this form of treatment have drawn a wave of harsh criticism in literature and art.

In his modern form ECT is largely safe and effective method treatment. However, because of the bad reputation attached to this method from the very beginning, it is abandoned by many patients for whom it is recommended.

Usually, treatment is carried out in a special room where the medical team works. First, a drug is injected intravenously into the patient for complete anesthesia and muscle relaxation, then an oxygen mask is applied, and only after that a current discharge is applied to the electrodes. The patient does not feel the current, and the only noticeable reaction is, as a rule, "tightening" of the toes and slight movements of the fingers. The entire procedure, from preparation to awakening after anesthesia, usually lasts from 20 to 40 minutes.

Currently, scientists continue to study which electrode placement is most beneficial. For unilateral ECT, both electrodes are placed 3 to 7 cm apart, on the same side of the head. They choose the side on which the dominant hand is located (i.e. for "right-handers" this is Right side heads). Supporters of this strategy claim that the least memory loss is achieved in this way and there is less confusion after the procedure. With a bilateral method of treatment, the electrodes are applied symmetrically to both temples. Supporters of this traditional method it is believed that impaired memory is restored within about two weeks and to the same extent as with unilateral therapy.

ECT consists of a series of treatments that are given 2 to 3 times a week. The course of treatment for depression is from 6 to 12, and for schizophrenia from 25 to 30 sessions. However, the number of treatments depends on the patient's individual response to therapy.

Side effects

The most frequent and dangerous phenomenon in modern ECT is memory loss, which is attributed to medical procedures, but which is still not the rule. When the patient wakes up after the procedure, he looks somewhat stunned and confused for about an hour. It also happens that the patient does not remember the procedure, and sometimes the few days preceding it. Most memories are restored within a few weeks. During this period, patients may find it difficult to perceive new information.

Another danger of ECT concerns the heart, as directly related to seizure, and in connection with those medicines that are used during treatment - anesthetics and muscle relaxants.

To the number side effects include headaches, slight skin burns at electrode sites, minor muscle pain, or general malaise. IN rare cases Difficulties in speech, violations of the semantic use of words and impaired coordination were noted. All these phenomena noticeably weaken upon completion of the procedures and completely disappear within six months.

Non-pharmacological mental treatment. Light therapy (phototherapy)

Light therapy is used to treat depression, which is associated with seasonal fluctuations in affective disorders. These disorders are currently attracting the attention of many researchers and clinicians.

Mechanism of action

The patient is placed in close proximity to special lamps, which give a much brighter light than normal room lighting.

The use of bright light seems to work best in the early hours of the morning or in the evening when it is dark outside. This suggests that light therapy misleads the patient's internal clock and instills in him a sense of extended day. A half-hour irradiation with the latest and strongest lamps with a power of up to 10 thousand Lux ​​is equivalent to more than a two-hour treatment session with light installations with a power of 2500 - 3500 Lux. This method has some similarities with irradiation in a solarium, with the only difference that the lamps used in light therapy do not cause skin burns.

Patients who have undergone a course of light therapy note a decrease in depression associated with seasonal fluctuations after two to three days of treatment.

Side effects

Light therapy has no well-established side effects. Excessive exposure to powerful lamps can cause burns and damage to the eyes if they are not properly protected during the session. Frequent sunbathing over a number of years are known to pose a risk of developing severe wrinkles and certain types of skin cancer. Studies conducted in the field of light therapy have not yet received confirmation of this danger.

Biofeedback (Biofeedback)

Biofeedback is a method that expresses the desire of the patient to control his voluntarily controlled and partially uncontrolled physiological reactions. Along with the application of this method in various somatic disorders, biofeedback finds its niche especially in the psychotherapeutic treatment of anxiety and stress disorders, as well as those difficulties that increase due to anxiety or psychosocial stress, such as insomnia.

Biofeedback is particularly suitable for helping people with tension headaches. By teaching them how to relax certain muscle groups that cause headaches, some success can be achieved.

Mechanism of action

Biofeedback is rooted in learning theory, psychology, psychophysiology, and meditation. From time immemorial, yoga masters have been able to control certain physiological functions, which are considered completely independent of consciousness, such as heart rate and blood pressure. Such results can only be achieved by many years of intensive training and appropriate special exercises. Yogis are also able to plunge into a state of complete relaxation. Many of their techniques can be developed through the process of biofeedback.

In order to acquaint the patient with the methods included in Biofeedbeck, he is connected to devices that display his heart rate, blood pressure, temperature on the screen. skin, the degree of muscle tension and / or brain biocurrents. The patient is then taught how to use different methods, which will allow him to slow down the heart rate or lower blood pressure, increase body temperature, relax muscles, and in the future, possibly change the biocurrents of the brain. Depending on certain arbitrarily achieved somatic changes, the devices send signals that serve as proof to the patient that he has achieved the desired results. physiological changes. Hence the name of the method - biofeedback.

Already within a few days of exercise, the patient can achieve self-correction and take some physiological processes under control. As soon as this control becomes automatic, there will be no need for feedback from the confirming apparatus. With the achieved effect of treatment, the patient can independently relax at any time.

dangers

Biofeedbeck is not associated with any danger, except for very long exhausting workouts. In addition, there are no firmly established criteria for assessing the qualifications of a doctor in this field. Usually certified psychologists are methodically prepared better than other professionals.

Power restructuring

Some researchers are of the opinion that changing / supplementing nutrition as a form of somatic therapy may be useful in psychiatry. They suggest that nutrition can affect brain function in some way, while its unwanted side effects are minimal compared to those that accompany drug treatment. For example, megavitamin therapy, also known as "orthomolecular therapy", has been proposed for the treatment of an acute attack of schizophrenia.

Although nutritional adjustments may help some people with psychiatric symptoms, efficacy or adequacy of diet therapy in severe mental disorders research should confirm. Until proven by methodically flawless research, it must be considered highly dubious and cannot be recommended as a substitute for any of the established treatments.

Non-drug treatment of hypertension is reduced to the impact on modifiable risk factors, which helps to reduce blood pressure, increases the effectiveness of drug therapy, and reduces the degree of complications.

Weight loss

• Weight loss begins with its stabilization;
• Diet should be combined with exercise- the main goal is to burn more calories than to consume;
• It is necessary to reduce body weight gradually, no more than 1 kg per week, because. a sharp decrease in mass will cause more harm than good;
• Nutrition should be balanced and contain all the elements necessary for the body;
• After reaching the desired body weight, the diet must be followed further;
• The entire treatment process must be accompanied by positive emotions and good mood.

Balanced diet

Food should contain the required amount of proteins, fats, carbohydrates, trace elements. Moreover, both the excess of a component and its deficiency are harmful. Let's start with micronutrients.

Salt necessary for normal life organism. Her daily rate is 4-6 g. However, the actual salt intake for most people is much more - up to 20 g per day. It is not scientifically proven, but experimentally confirmed that reducing salt intake leads to a decrease in pressure. Unfortunately, a person in a developed society can clearly control only a fifth of salt intake. The bulk of the salt consumed enters the body with food products containing various baking powder, dyes, preservatives. Therefore, to control the intake of salt in the body, preference should be given to fresh products that do not contain various food additives.

Potassium. The main source of potassium is plant foods, meat, fish. daily requirement body in potassium is 2-4 g.

Calcium. They are rich in dairy products. The daily requirement for calcium is only 0.8 g. Calcium absorption depends on the concentration of phosphorus. The ratio of 1:1 is considered optimal - in this case, calcium is absorbed by the body as efficiently as possible. In ratios close to ideal, calcium and phosphorus are found in carrots, cottage cheese, cabbage, apples, and beef. Calcium is poorly absorbed with excess or lack of fat and vitamin D deficiency in food.

Magnesium. I'm rich herbal products. Magnesium is poorly absorbed with excessive intake of fats and calcium. The optimal ratio of calcium and magnesium in food should be 2:1. The daily requirement for magnesium for adults is 0.4 g.

Diet DASH

Diet DASH(Dietary Approach to Stop Hypertension) is recommended for all hypertensive patients. The idea behind the DASH diet came from observations of vegetarians. It turned out that they have lower blood pressure and a lower risk of heart and brain diseases, primarily heart attack and stroke. A vegetarian diet consists of fruits and vegetables, and the absence of animal products reduces the intake of cholesterol and saturated fats in the body.

Fruits and vegetables provide the body with enough potassium, which lowers blood pressure. The higher the potassium content, the lower the blood pressure. Fruits and vegetables also contain calcium and magnesium. important trace elements. However, studies have shown that these minerals do not have a significant effect on blood pressure levels.

Studies have shown that eating the DASH diet helps lower blood levels of cholesterol and low-density lipoprotein. There is also a decrease in the content of homocysteine, a substance elevated level which in the body leads to coronary disease hearts.

The DASH diet lowers blood pressure by an average of 8-14 mmHg. BP begins to decline 2 weeks after the start of the DASH diet. The maximum decrease in blood pressure is observed after 8 weeks. The researchers believe that the use of the DASH diet may be an effective alternative to drug therapy for people with grade 1 hypertension and may preclude or delay the initiation of drug therapy in people with BP levels on the verge of starting such therapy.

The DASH diet calls for 2,000 calories per day. The daily diet of the DASH diet includes the following foods:

• 7-8 servings of bread and cereal products;
• 4-5 servings of vegetables;
• 4-5 servings of fruit;
• 2-3 servings of low-fat or low-fat dairy products;
• 2 servings of meat or fish products;
• 2.5 servings of fat;
• 4-5 servings of nuts, seeds, or legumes
• 5 servings of sweets per week.

The most beneficial foods for the DASH diet are:

1. Cereal and bread products: wholemeal bread or with the addition of bran, pita bread, cereals enriched with fiber (oatmeal).
2. Vegetables: Tomatoes, potatoes, carrots, peas, pumpkin, broccoli, turnip leaves, collard greens, kale, spinach, artichokes, green beans, sweet potatoes.
3. Fruits: apples, apricots, bananas, dates, grapes, oranges, Orange juice, grapefruit, grapefruit juice, mangoes, lemons, peaches, pineapples, prunes, raisins, strawberries, tangerines.
4. Dairy products: low fat or skimmed milk, low-fat or low-fat buttermilk, low-fat or low-fat kefir or yogurt, low-fat mozzarella cheese, and low-fat hard cheeses.

   How to cure hypertension without drugs in 3 weeks

5. Meat and fish: lean meat and poultry without skin, boiled, stewed, baked.
6. Nuts, seeds, legumes: almonds, mixed nuts, peanuts, peanut butter, Walnut, sesame seeds, sunflower seeds, common beans, pinto beans, lentils.

Basic principles of the DASH diet:

• change in eating habits should occur gradually;
• the main diet should be plant foods;
• as little meat as possible;
• most fats in the body should come from food in the form of polyunsaturated (omega-3 fats) and monounsaturated fatty acids;
• food should be tasty and appetizingly prepared;
• the diet should consist of affordable and familiar foods;
• to cope with the feeling of hunger, fruits, vegetables and products with low content fat and low calories.

Sample menu for 2000 kcal DASH diet:

• Breakfast: 2 slices of bread; 1 dairy product; 2 fruits; 1 cereal product; 1 fatty product.
  For example: 1 portion corn flakes; 1 glass of low-fat milk; 1 banana; 1 toast; 1 st. a spoonful of jam; 170 g apple juice, 1 tbsp. a spoonful of margarine
• Dinner: 1 meat product; 1 dairy product; 1 cereal product; 1 fatty product; 1 vegetable; 1 fruit.
  For example: 50 g of chicken; 15 g cheddar cheese; 1 slice of lavash; 1 teaspoon margarine; 1 glass raw carrots; 1 orange.
• Dinner:1 meat product; 3 cereal products; 2 vegetables; 1 fruit; 1.5 servings from the fat group.
  For example: 80 g salmon; 1 glass of rice; 1 glass of pumpkin; 1 cup spinach; 1 st. a spoonful of light seasoning; 40 g low-fat cheese.
• Snacks:1 fruit; 1 cereal product; 1 serving of nuts.
  For example: Medium apple, 1 slice wheat bread, a third of a glass of nuts.

Smoking, alcohol, physical activity

We will not be original if we say that patients with hypertension should completely stop smoking; reduce alcohol intake to a minimum (50 ml of strong drink or its equivalent: 200 ml of dry wine, or 500 ml of beer - for men; for women - the dose is halved). Physical activity should be regular and moderate: ideally, it is necessary to devote 30-40 minutes to physical education daily.

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  Purpose of treatment arterial hypertension- prevention of long-term consequences of this pathological condition. Most patients require lifelong antihypertensive therapy, but first it is advisable to monitor the pressure for 4 to 6 months to assess the possibility of its spontaneous decrease, except in cases where immediate medical treatment is necessary (in case of damage to target organs: kidneys, brain, heart , vessels, as well as with the ineffectiveness of non-drug treatment).

  Non-drug treatment means lifestyle change. The main measures of non-drug effects in arterial hypertension are diet, reduction of excess body weight, sufficient physical activity, and the rejection of bad habits. In 40 - 60% of patients with the initial stage of arterial hypertension with low numbers of blood pressure, it is possible to achieve its reduction with the help of non-drug treatment alone.

Non-drug treatments for hypertension

  Treatment of hypertension should be accompanied by a decisive change in lifestyle: first of all, the mandatory introduction of regular feasible physical activity (this can be walking, jogging, calm swimming, cycling and other activities that you like). And of course, you can't do without a special diet.

  In many patients with hypertension of I and even II degree, with the help of therapeutic nutrition, it is possible to achieve a significant decrease in blood pressure, while simultaneously reducing the dose of drugs, which will increase the effectiveness of drug treatment and prevent its complications. Limiting the intake of salt to 4-5 g per day allows you to reduce blood pressure in a week, first by 4-6 mm Hg. Art., and then, as such a diet is followed for 2-3 weeks or more, sometimes to the norm. Salt restriction is especially effective in the elderly and in obesity. To improve the taste of food, you can use dried sea ​​kale, greens, onions, garlic, spices, tomato juice, citric acid, vinegar, as well as various salt substitutes.

  However, the measure should be observed in everything, since the sodium and chlorine that are part of table salt are trace elements indispensable for our body. Therefore, if symptoms of their deficiency occur (muscle weakness, loss of taste, suppression of appetite, and others), it is necessary to increase the intake of table salt. How to ensure that it does not linger in the body?
  There is a way out: the use of foods rich in potassium, which helps to remove fluid from the body!

For your information

Healthy laughter relieves stress and relaxes muscles, as well as boosting immunity, which helps to treat hypertension. According to studies conducted in the USA, each explosion of laughter relieves the stress of the cardiovascular system for 45 minutes. This improves the elasticity of blood vessels and blood circulation.

  Be sure to include cucumbers, dried fruits, nuts, beans, seaweed, peas, potatoes in your diet. Sufficient potassium intake is also important to prevent potassium deficiency, which occurs with the use of certain diuretic drugs (eg, furosemide).

AH: non-drug and drug treatment

  You should take these medicines Strictly according to the doctor's prescription! Usually they are prescribed accompanied by potassium preparations (panangin, asparkam and others). And be sure to get tested! After all, if the increase in blood pressure is secondary and associated with kidney disease, you can harm yourself by eating potassium-containing foods.

  It is desirable to enrich the diet with multivitamin preparations - no more than 1-2 tablets per day, especially in the winter-spring period. A decrease in body weight of at least 4-5 kg ​​almost always contributes to a decrease in blood pressure. Therefore, with hypertension and obesity, it is recommended first of all to adhere to low-calorie diets.

Medical treatment of hypertension

  Treatment of arterial hypertension is carried out taking into account the stage of the disease, its clinical manifestations and complications. At complex therapy Hypertensive patients use antihypertensive, sedative, diuretic and other drugs.

  As a starting therapy for stages I and II of hypertension (mild and moderate hypertension), one of the first-line drugs (diuretic, an angiotensin-converting enzyme inhibitor, beta-blocker, calcium antagonist, angiotensin II receptor antagonist or alpha-adrenoblocker) is usually prescribed ) with a subsequent increase in dose with insufficient effect.
  However, today there is no doubt that essential hypertension is a heterogeneous disease due to the presence of a large number factors contributing to their development of vasoconstriction and maintenance of elevated blood pressure. And monsiatherapy, aimed at correcting only one of the numerous pathogenetic links, does not allow achieving the desired level of blood pressure reduction: despite the increase in dose, the effectiveness of treatment with one drug is only 50-60%.
  And therefore, more and more often, experts recommend for adequate correction of blood pressure combination therapy- a combination of antihypertensive drugs of different groups. Combination therapy with diuretics and ACE inhibitors has notable advantages, since with complex application drugs of these groups often achieve a decrease in blood pressure due to complementary effects.

  It is also desirable to use light sedatives that relieve increased excitability (valerian, motherwort, corvalol). In the early stages of GB, they resort to drugs that expand the lumen of blood vessels (papaverine, no-shpa, dibazol).

For your information!

  If you are taking antihypertensive and diuretic drugs, you must remember: when you quickly change the horizontal position of the body to vertical, blood pressure drops rapidly; it is fraught with loss of consciousness.
  Therefore, one should not abruptly rise and sit in bed, and even more so - abruptly get up after a night's sleep or a long lying down. This should be done slowly, in stages, so that the heart and blood vessels can compensate for the change in position.

  If a patient suffering from hypertension does not have coronary heart disease, as a result of the above measures, it is possible to bring the pressure back to normal. However, in the presence of coronary disease, it is impossible to significantly reduce the indicators so as not to cause a deterioration in blood circulation in the heart muscle.

  At the same time, for the prevention of a heart attack and other complications, lower pressure is of fundamental importance: we must strive to reduce it to normal, that is, to 80 mm Hg. Art.
The rate at which blood pressure falls is very important.. In the absence of emergency indications (worsening of the course of cardiac asthma, an attack of angina pectoris, a pre-stroke state), the decrease in pressure to the desired level must be carried out gradually, over several weeks.

  And even if the above are true emergency conditions, all the same, it is better to reduce the pressure not immediately, but during the day. A sudden drop in blood pressure can cause acute disorders blood circulation in the brain and heart, which creates the risk of developing an ischemic stroke or heart attack.

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Goal of treatment for hypertension

The main goal of treating a patient with hypertension is to achieve the maximum degree of reduction general risk cardiovascular complications. This involves not only correcting elevated BP, but also addressing all identified reversible risk factors such as smoking, high cholesterol, physical inactivity, Not balanced diet, obesity, and appropriate treatment of comorbidities (eg, diabetes mellitus).

Target blood pressure is the amount of blood pressure that should be achieved during treatment.

In the treatment of patients with hypertension, the value of blood pressure should be less than 140/90 mm Hg, which is the target level. With good tolerability of the prescribed therapy, it is useful to lower blood pressure to lower values. When combining hypertension with diabetes mellitus or kidney damage, it is recommended to reduce blood pressure to less than 130/80 mm Hg. With antihypertensive therapy, it should be borne in mind that it is difficult to achieve a decrease in systolic blood pressure below 140 mm Hg. in elderly patients. When target levels of blood pressure are reached, it is necessary to take into account the lower limit of blood pressure reduction - up to 110 mm Hg.

Non-drug treatment of arterial hypertension

Art. systolic blood pressure and 70 mm Hg. Art. diastolic blood pressure.

Achieving target BP should be gradual and well tolerated by the patient. The rate of decrease in blood pressure to the recommended normal figures is determined by the doctor, taking into account the characteristics of the course and duration of the disease, the presence of damage to target organs, concomitant diseases. If any reactions from the brain or heart appear, a further decrease in blood pressure should not be achieved. With regard to concomitant other risk factors, it is also recommended to achieve their effective control.

What determines the effectiveness of the treatment of arterial hypertension?

The main principles of treatment of arterial hypertension are as follows.

Carrying out continuous self-monitoring of blood pressure at home, keeping a blood pressure diary.

The ability to eliminate adverse factors, provoking an increase in blood pressure and complicating treatment.

Continuity of treatment, it is necessary to constantly take medications and be under the supervision of a doctor, which will reduce the risk of cardiovascular complications.

An integrated approach consisting of a combination of non-pharmacological measures and medical treatment.

Ability to provide emergency first aid.

Compliance with the principle of gradual withdrawal of the drug, since an abrupt cessation can lead to a jump in blood pressure.

Observe precautions when taking antihypertensive drugs, in particular, do not drink alcoholic beverages.

Non-drug treatment of arterial hypertension

After the doctor has assessed your condition, he develops an individual management strategy and decides on the appropriateness and choice of drug therapy. In some cases, the doctor immediately prescribes the drug, in other situations, only non-drug treatment, regular blood pressure monitoring and observation may be sufficient.

Non-pharmacological methods of treatment are recommended for all patients with hypertension, regardless of the degree of hypertension and the use of medications. Weight loss, rational nutrition, restriction of dietary salt and alcohol consumption, smoking cessation, as well as physical activity contribute to a significant decrease in blood pressure. The contribution of these interventions to lowering blood pressure levels is shown in the table (see below in the materials for patients). Therefore, with low blood pressure figures, it can be normalized only by non-drug methods of treatment.

Smoking cessation- one of the most important factors from the point of view of the prevention of diseases of the cardiovascular system, primarily coronary artery disease and strokes.

Reducing excess body weight. Reducing excess body weight is accompanied by a decrease in blood pressure, and also favorably affects other risk factors ( diabetes, elevated cholesterol levels, hypertrophy, that is, an increase in myocardial mass).

Reducing the intake of table salt. The results of studies have shown that a decrease in salt intake from 10 to 5 g / day leads to a decrease in systolic blood pressure by an average of 4–6 mm Hg. The most pronounced effect is observed in overweight patients and the elderly. Salt restriction leads to a significant reduction in the need for antihypertensive drugs.

Cessation of alcohol consumption helps to reduce blood pressure by 2-4 mm Hg. Art. and improve the effectiveness of drugs.

Comprehensive dietary modification. Diet, rich in vegetables and fruit, low in fat leads to a decrease in blood pressure by 8-14 mm Hg. Art.

Increased physical activity. Maintaining regular dynamic (walking, swimming) physical activity for at least 30 minutes a day helps to reduce blood pressure by 4–9 mm Hg. Art.

Thus, against the background of the use of non-drug methods, it is possible to achieve a significant hypotensive effect, which makes it possible to reduce the doses of antihypertensive drugs, i.e., to treat with smaller doses of drugs, and, consequently, to reduce the likelihood of side effects.

Principles of drug therapy

It is recommended to start treatment with a low dose of the drug in order to avoid the development of adverse side effects and sharp decline HELL. If, when taking a low dose of this drug, blood pressure has decreased, but not yet enough, then, provided that it is well tolerated, it is advisable to increase the dosage of this drug. It usually takes about 3-4 weeks for the drug to show maximum effectiveness. Thus, before increasing the dose of the drug, you should wait for some time. Before increasing the dose, you should consult your doctor.

If you do not tolerate the medicine well or do not notice a special effect from it, you should consult a doctor. In such situations, the drug is either canceled and replaced with another, or a second is added to the first drug.

It is very important to understand that the selection of antihypertensive therapy is a gradual, long and difficult process. You need to tune in to it and work closely with your doctor. In this case, it is better not to rush to ensure a smooth decrease in blood pressure, avoiding sudden drops. It is not always possible to immediately find the drug you need in the right dose. It takes time and observation of you. Individual reactions in different hypertensive patients for the same drug are very diverse and sometimes unpredictable. Before you are successful in lowering your blood pressure, your doctor may change doses, drugs, and quantities. Be patient, follow all the recommendations, this will help the doctor and yourself to cope with hypertension more effectively.

To date, to reduce blood pressure, there are drugs that contain two drugs at once. Therefore, if the doctor has prescribed two drugs for you, then they can be taken both separately, and some of them in the form of a fixed combination in one tablet. If it is more convenient for you to take one tablet instead of two, then consult your doctor if it is possible to switch to this form of medication.

It is advisable to use drugs long-acting providing effective reduction BP within 24 hours with a single daily dose. This reduces the variability of blood pressure during the day due to a milder and more lasting effect. In addition, a single dose regimen is much easier to follow than a two- or three-dose regimen.

Drug treatment improves the prognosis of a patient with hypertension only in cases where medicinal product, taken regularly, provides a uniform decrease in blood pressure throughout the day. The highest frequency of acute cardiovascular complications (stroke, myocardial infarction) is observed in the morning hours - "morning rise in blood pressure". During these hours, there is a sharp rise in blood pressure, which is considered as a trigger for the development of these complications. During these hours, blood clotting and the tone of the arteries, including those of the brain and heart, increase. In light of this, one of the principles of antihypertensive therapy should be the impact on the morning rise in blood pressure in order to prevent complications in the early morning hours. Successful prevention of the morning rise in blood pressure is a well-chosen antihypertensive therapy that reduces the average daily blood pressure, but if the morning rise in blood pressure persists, it is necessary to select drugs in such a way as to reduce the severity morning rises HELL, dangerous development complications, especially strokes.

After reaching the target level of blood pressure, it is advisable to continue regular monitoring with a doctor and undergo an annual examination.

Treatment of hypertension is carried out continuously or, in fact, for the majority for life, since its cancellation is accompanied by an increase in blood pressure. However, with persistent normalization of blood pressure for 1 year and adherence to lifestyle measures, in some patients, a gradual reduction in the number and / or dose of antihypertensive drugs taken is possible. Such a decision should come only from the doctor. Reducing the dose and/or reducing the number of medications used requires an increase in the frequency of visits to the doctor and self-monitoring of blood pressure at home, in order to make sure that there are no recurrent increases in blood pressure.

Often high blood pressure is underestimated due to the lack of pain. Patients stop coming to the doctor and taking prescribed medication. Forget quickly helpful tips doctor. It should be remembered that arterial hypertension, regardless of the presence or absence of clinical manifestations, is fraught with terrible complications. Therefore, it is important to maintain a constant intake of medications and regular monitoring of blood pressure. You need to keep track of how much of the drug you have left in order to buy the medicine on time and avoid skipping it.