Bronchial asthma at concomitant diseases various organs — features of the clinical course of bronchial asthma in various concurrent diseases.
The most common symptoms encountered in patients with bronchial asthma are allergic rhinitis, allergic rhinosinusopathy, vasomotor rhinitis, nasal and sinus polyposis, arterial hypertension, various endocrine disorders, pathology of the nervous and digestive systems.
The presence of arterial hypertension in patients with bronchial asthma is a generally accepted fact. The frequency of the combination of these diseases is increasing. The main factor in increasing systemic blood pressure is central and regional hemodynamic disorders: increased peripheral vascular resistance, decreased pulse blood supply to the brain, impaired hemodynamics in the pulmonary circulation. An increase in blood pressure is promoted by hypoxia and hypercapnia, which accompany chronic bronchial obstruction, as well as the influence of vasoactive substances (serotonin, catecholamines and their precursors). There are two forms arterial hypertension for bronchial asthma: hypertension (25% of patients), which is benign and slowly progresses, and symptomatic “pulmogenic” (the predominant form, 75% of patients). In the “pulmogenic” form, blood pressure increases mainly during severe bronchial obstruction (attack, exacerbation), and in some patients it does not reach normal and increases during exacerbation (stable phase).
Bronchial asthma is often combined with endocrine disorders. There is a known correlation between asthma symptoms and the function of the female genital organs. During puberty in girls and premenopausal women, the severity of the disease increases. In women suffering from bronchial asthma, premenstrual asthmatic syndrome often occurs: exacerbation 2-7 days before the onset of menstruation, less often - simultaneously with it; With the onset of menstruation, significant relief occurs. There are no pronounced fluctuations in bronchial reactivity. Most patients have ovarian dysfunction.
Bronchial asthma is severe when combined with hyperthyroidism, which significantly disrupts the metabolism of glucocorticosteroids. A particularly severe course of bronchial asthma is observed against the background of Addison's disease (a rare combination). Sometimes bronchial asthma is combined with myxedema and diabetes mellitus(about 0.1% of cases).
Bronchial asthma is accompanied by central nervous system disorders of various types. IN acute stage psychotic states with psychomotor agitation, psychoses, comatose states. At chronic course autonomic dystonia is formed with changes at all levels of the autonomic nervous system. Asthenoneurotic syndrome is manifested by irritability, fatigue, and sleep disturbance. Vegetative-vascular dystonia is characterized by a number of signs: hyperhidrosis of the palms and feet, red and white “dermatographism”, tremor, autonomic crises of the sympathoadrenal type (sudden shortness of breath with a respiratory rate of 34-38 per 1 mn, feeling of heat, tachycardia up to 100-120 per 1 min , rise in blood pressure to 150/80-190/100 mm Hg, frequent excessive urination, urge to defecate). Crises develop in isolation, imitating an asthmatic attack with subjective feeling suffocation, but there is no difficulty in exhaling or wheezing in the lungs. Symptoms of vegetative dystonia occur with the onset of bronchial asthma and become more frequent in parallel with its exacerbations. Autonomic dysfunction is manifested by weakness, dizziness, sweating, fainting states and contributes to prolongation of the period of coughing, asthma attacks, residual symptoms, more rapid progression of the disease and relative resistance to therapy.
Concomitant diseases can have a significant impact on the course of bronchial asthma digestive system(pancreatic dysfunction, liver and intestinal dysfunction), which are found in a third of patients, especially with long-term glucocorticosteroid therapy.
Concomitant diseases complicate the course of bronchial asthma, complicate its treatment and require appropriate correction. The treatment of arterial hypertension in bronchial asthma has certain features. “Pulmogenic” arterial hypertension, observed only during attacks of suffocation (labile phase), can normalize after eliminating bronchial obstruction without the use of antihypertensive drugs. In cases of stable arterial hypertension, complex treatment uses hydralazine drugs, ganglion blockers (arpenal, fubromegan, merpanit, temekhin, peitamine), hypothiazide, veroshpiron (has the properties of an aldosterone blocker, corrects disorders electrolyte metabolism) 100-150 mg per day for three weeks. Adrenergic α-blocking drugs, in particular pyrroxan, can be effective; calcium antagonists (Corinfar, isoptin) are used.
The neurogenic components of an attack of bronchial asthma can be influenced by ganglion blockers and anticholinergics (can be used in combination with bronchodilators: arpenal or fubromegan - 0.05 g three times a day; halidor - 0.1 g three times a day; temekhin - 0.001 g three times a day day), which are recommended for mild attacks of a reflex or conditioned reflex nature, when bronchial asthma is combined with arterial hypertension and pulmonary hypertension. These drugs must be used under blood pressure control; They are contraindicated for hypotension. For the treatment of patients with a predominance of the neurogenic component in pathogenesis, various options novocaine blockades(subject to novocaine tolerance), psychotherapy, hypnosuggestive therapy, electrosleep, reflexology, physiotherapy. These methods can eliminate the state of fear, conditioned reflex mechanisms of attacks, and anxious mood.
Treatment of concomitant diabetes is carried out according to general rules: diet, antidiabetic drugs. At the same time, it is not recommended to use biguanides to correct carbohydrate metabolism, which, due to increased anaerobic glycolysis (mechanism of glucose-lowering action), can aggravate the clinical picture of the underlying disease.
The presence of esophagitis, gastritis, stomach ulcers and duodenum creates difficulties for glucocorticosteroid therapy. In cases of acute gastrointestinal
In cases of bleeding, it is more advisable to use parenteral glucocorticosteroid drugs; an alternating treatment regimen is preferable. The optimal way to treat bronchial asthma complicated by diabetes mellitus and peptic ulcer disease is to prescribe maintenance inhaled glucocorticosteroid therapy. With hyperthyroidism, there may be a need for increased doses of glucocorticosteroid drugs, since an excess of thyroid hormones significantly increases the rate and changes the metabolic pathways of the latter. Treatment of hyperthyroidism improves the course of bronchial asthma.
In cases of concomitant arterial hypertension, angina pectoris and other cardiovascular diseases, as well as hyperthyroidism, it is necessary to use B-stimulating adrenergic drugs with great caution. For persons with dysfunction of the digestive glands, it is advisable to prescribe enzyme preparations(festal, digestin, panzinorm), which reduce the absorption of food allergens and can help reduce shortness of breath, especially in the presence of food allergies. Patients with positive results of tuberculin tests and a history of tuberculosis during long-term glucocorticosteroid therapy are prophylactically prescribed tuberculostatic drugs (isoniazid).
For elderly patients, the use of adrenergic drugs, B-stimulating drugs and methylxanthines, is undesirable due to their side effects on the cardiovascular system, especially with coronary atherosclerosis. In addition, the bronchodilating effect of adrenergic drugs decreases with age. When a significant amount of liquid sputum is produced in patients with bronchial asthma, this age group Anticholinergic drugs are useful, which in some cases are more effective than other bronchodilators. There are recommendations for the use of synthetic androgens for elderly men suffering from bronchial asthma with a sharp decrease in androgenic activity of the gonads (Sustanon-250 - 2 ml intramuscularly with an interval of 14-20 days, course - three to five injections); at the same time, remission is achieved faster and the maintenance dose of glucocorticosteroid drugs is reduced. There are instructions on the advisability of using antiplatelet agents, in particular dipyridamole (curantil) - 250-300 mg per day - and acetylsalicylic acid (in the absence of contraindications) - 1.53.0 g per day, especially for elderly patients in whom bronchial asthma is combined with pathology of cardio-vascular system. For microcirculation disorders and changes in the rheological properties of blood, heparin is used at a dose of 10-20 thousand units per day for 510 days.
Treatment is being carried out concomitant pathology upper respiratory tract.
Arterial hypertension, bronchial asthma and chronic obstructive pulmonary diseases
The drugs of choice for the treatment of arterial hypertension in bronchial asthma and chronic obstructive pulmonary diseases are calcium antagonists and A II receptor blockers.
The risk of prescribing cardioselective beta-blockers in such cases is often exaggerated; in small to moderate doses these drugs are usually well tolerated. In cases of severe bronchospasm and the impossibility of prescribing beta-blockers, they are replaced with calcium antagonists - blockers of slow calcium channels, which in moderate doses have a bronchodilator effect. However, in severe chronic obstructive pulmonary diseases, large doses of slow calcium channel blockers can aggravate ventilation-perfusion imbalances and thereby increase hypoxemia.
Sick chronic obstructive pulmonary diseases with intolerance to acetylsalicylic acid, clopidogrel can be prescribed as an antiplatelet agent.
Literature
Arabidze G.G. Belousov Yu.B. Karpov Yu.A. Arterial hypertension. A reference guide for doctors. M. 1999.
Karpov Yu.A. Sorokin E.V. Stable coronary heart disease: strategy and tactics of treatment. M. 2003.
Preobrazhensky D.V. Batyraliev T.A. Sharoshina I.A. Chronic heart failure of the elderly and old age. Practical cardiology. - M. 2005.
Prevention, diagnosis and treatment of arterial hypertension. Russian recommendations. Developed by the GFOC Expert Committee. M. 2004.
Rehabilitation for diseases of the cardiovascular system / Ed. I.N. Makarova. M. 2010.
Related materials:
Obesity and hypertension. Time bomb
Very often those with extra pounds suffer high blood pressure blood. At all excess weight- this is a time bomb, since it contains the germ of such serious diseases as diabetes, hypertension, bronchial asthma and even cancer.
In an organism overflowing with excess products (fat), the tendency and possibility of tumor growth greatly increases, since all conditions are created for the nutrition of abnormal, aggressive cancer cells, a lot of fat and little oxygen - with obesity, tissue redox processes are disrupted! There is no need to say that extra pounds of fat cause the heart to suffer, shortness of breath, pain and deformation in the joints and spine, and swelling in the intestines and liver. Inflammation of the gallbladder and the deposition in it of all kinds of crystallized metabolic waste, called “stones,” are a common accompaniment of obesity.
From all that has been said, one thing is clear: obesity must be treated. But how? There are many “easy” and “pleasant” treatment methods - from coding, acupuncture, treatment with psychics, to pills, various “fat burners”. Alas, the action of all these methods is based on one mechanism - to influence in one way or another the hormonal system of the body, that is, the system of endocrine glands ( thyroid, pancreas, adrenal glands, gonads), which closely interact with each other and with the brain (coding). These drugs cause increased work - fat burning, with subsequent disturbances in the functioning of the endocrine glands, various malfunctions in it, ranging from diseases thyroid gland to sexual disorders (violations menstrual cycle, impotence) and even diabetes.
Having lost weight during the first months of treatment, people acquire new diseases or the excess weight soon returns, and most importantly, the diseases that accompany obesity are not cured. But, as popular wisdom says, “you can’t pull a fish out of the pond without difficulty,” and even more so you won’t get rid of excess waste that pollutes the body: fat, pus, stones, mucus, which, clogging our organs, make us sick and die prematurely.
And any disease can be cured only if obey the laws of nature and fulfill them. It is impossible to fight nature (and using any medicine is a fight against your own body), and it is also impossible to deceive nature (you can eat and lose weight at the same time by using fat burners). You can only obey nature, because it created us according to its own laws.
And the first law of nature, which we constantly follow we destroy - this is purity. The cleanliness of both the external environment, which is very much disturbed in the form of technology and chemistry, and the internal environment, that is, the body itself. By the way, the body itself constantly tries to maintain this purity. Despite the fact that we heavily pollute the body with inappropriate and excess food. And then we carefully cleanse the blood and vital organs through the liver, this gigantic filter, which deposits all poisons and toxins in fatty tissue, which is why it is said that fat is a septic tank for waste.
What does hypertension have to do with all this? The most direct: slagged kidneys begin to react with a spasm of their own blood vessels so that less unnecessary toxic metabolic products pass through them. At the same time, renin begins to be released, causing persistent spasm of blood vessels throughout the body. Here it comes: increased diastolic pressure. But in order to still push blood through these compressed vessels into all organs and not cause disruption of the blood supply in them, the heart is forced to work with double and triple load, work hard, so the systolic blood pressure increases - it reaches 200 and above (normal – 120 units). But blood pressure increases not only in obese people, but also in thin people, although less often. Yes, if the functioning of the intestines and pancreas is disrupted and thus the ability to assimilate the food taken is impaired. But the pancreas and intestines work poorly because they themselves are also contaminated with decay products of the body’s tissues. When they are cleansed of these extra, very toxic products, the work of both the intestines and kidneys is restored, and thin (as well as overweight) people acquire normal weight and normal blood pressure.
Yes, true miracles can only be done by nature, that is, natural healing.
Now a few words about those who treated themselves with us naturally, and not with drugs: patient Z.T. 62 years old, started treatment weighing 125 kg and with blood pressure 220/110. Over the course of 6 months of treatment, her weight dropped to 80 kg, and her blood pressure returned to normal completely. The attitude towards life has completely changed. Now this is not a sick, old woman who was about to die, but a young, cheerful, full of optimism, who says: “I lost 50 kg of weight and looked 30 years younger and went. to the ballroom dance group.”
Patient Barannikova O.I., 68 years old, suffered from headaches and high blood pressure for 50 years. A month after the start of treatment, the headaches stopped completely, blood pressure returned to normal after two months, and after another four months she was completely cured of psoriasis.
Smirnov A.I. weighed 138 kg, blood pressure 230/120. I regularly underwent 2-3 courses of natural treatment per year, in one year my weight dropped to 75 kg and my blood pressure became completely normal and stable.
And many similar examples can be given. Healing by nature is not healing by magic. If you have been sick for five or twenty years, you will not be cured in one week or month. You need perseverance and perseverance, as well as faith in the forces of nature.
Article update 01/30/2019
Arterial hypertension(AG) in Russian Federation(RF) remains one of the most significant medical and social problems. This is due to the widespread prevalence of this disease (about 40% of the adult population of the Russian Federation has increased level blood pressure), and also with the fact that hypertension is the most important factor risk of major cardiovascular diseases - myocardial infarction and cerebral stroke.
Constant persistent increase in blood pressure (BP) up to 140/90 mm. rt. Art. and higher- a sign of arterial hypertension (hypertension).
Risk factors contributing to the manifestation of arterial hypertension include:
- Age (men over 55, women over 65)
- Smoking
- sedentary lifestyle,
- Obesity (waist circumference more than 94 cm for men and more than 80 cm for women)
- Familial history of early cardiovascular disease (men under 55 years of age, women under 65 years of age)
- The value of pulse blood pressure in the elderly (the difference between systolic (upper) and diastolic (lower) blood pressure). Normally it is 30-50 mmHg.
- Fasting plasma glucose 5.6-6.9 mmol/l
- Dyslipidemia: total cholesterol more than 5.0 mmol/l, low-density lipoprotein cholesterol 3.0 mmol/l or more, high-density lipoprotein cholesterol 1.0 mmol/l or less for men, and 1.2 mmol/l or less for women, triglycerides more than 1.7 mmol/l
- Stressful situations
- alcohol abuse,
- Excessive salt intake (more than 5 grams per day).
The development of hypertension is also promoted by diseases and conditions such as:
- Diabetes mellitus (fasting plasma glucose 7.0 mmol/l or more with repeated measurements, as well as postprandial plasma glucose 11.0 mmol/l or more)
- Other endocrinological diseases (pheochromocytoma, primary aldosteronism)
- Diseases of the kidneys and renal arteries
- Reception medicines 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. Elderly people are at risk.
According to the modern classification adopted by the World Health Organization (WHO), hypertension is divided into:
- 1st degree: Increased blood pressure 140-159/90-99 mmHg
- 2nd degree: Increased blood pressure 160-179/100-109 mm Hg
- 3rd degree: Increase in blood pressure to 180/110 mmHg and higher.
Blood pressure readings obtained at home can be a valuable addition to monitoring the effectiveness of treatment and are important in identifying hypertension. The patient’s task is to keep a diary of self-monitoring of blood pressure, where blood pressure and pulse values are recorded when measured at least in the morning, at lunch, and in the evening. It is possible to make comments on lifestyle (getting up, eating, physical activity, stressful situations).
Blood pressure measurement technique:
- Quickly inflate the cuff to a pressure level 20 mmHg above systolic blood pressure (SBP) when the pulse disappears
- Blood pressure is measured with an accuracy of 2 mmHg
- Reduce cuff pressure at a rate of approximately 2 mmHg per second
- The pressure level at which the 1st sound appears corresponds to SBP
- The pressure level at which sounds disappear corresponds to diastolic blood pressure (DBP)
- If the tones are very weak, you should raise your hand and perform several squeezing movements with the hand, then repeat the measurement, but do not squeeze the artery too much with the membrane of the phonendoscope
- During the initial measurement, blood pressure is recorded in both arms. In the future, the measurement is carried out on the arm on which the blood pressure is higher
- In patients with diabetes mellitus and in those receiving antihypertensive drugs, blood pressure should also be measured after 2 minutes of standing.
Patients with hypertension experience pain in the head (often in the temporal, occipital region), episodes of dizziness, rapid fatigue, poor sleep, possible pain in the heart, and blurred vision.
The disease is complicated by hypertensive crises (when blood pressure rises sharply to high numbers, frequent urination occurs, headache, dizziness, palpitations, feeling hot); impaired renal function - nephrosclerosis; strokes, intracerebral hemorrhage; myocardial infarction.
To prevent complications, patients with hypertension need to constantly monitor their blood pressure and take special antihypertensive drugs.
If a person is bothered by the above complaints, as well as blood pressure 1-2 times a month, this is a reason to contact a therapist or cardiologist, who will prescribe the necessary examinations and subsequently determine further treatment tactics. Only after carrying out the necessary set of examinations can we talk about prescribing drug therapy.
Self-prescription of medications may result in the development of undesirable side effects, complications and may have fatal outcome! Independent use is prohibited medicines according to the principle “it helped friends” or resort to the recommendations of pharmacists in pharmacy chains!!! The use of antihypertensive drugs is possible only as prescribed by a doctor!
The main goal of treating patients with hypertension is to maximum reduction risk of developing cardiovascular complications and death from them!
1. Lifestyle change measures:
- To give up smoking
- Normalization of body weight
- Consumption of alcoholic beverages less than 30 g/day of alcohol for men and 20 g/day for women
- Increasing physical activity - regular aerobic (dynamic) exercise for 30-40 minutes at least 4 times a week
- Reducing table salt consumption to 3-5 g/day
- Changing your diet with an increase in the consumption of plant foods, an increase in the diet of potassium, calcium (found in vegetables, fruits, grains) and magnesium (found in dairy products), as well as a decrease in the consumption of animal fats.
These measures are prescribed to all patients with arterial hypertension, including those receiving antihypertensive drugs. They allow you to: lower blood pressure, reduce the need for antihypertensive drugs, and have a beneficial effect on existing risk factors.
2. Drug therapy
Today we will talk about these drugs - modern means for the treatment of arterial hypertension.
Arterial hypertension - chronic illness, requiring not only constant monitoring of blood pressure, but also constant use of medications. There is no course of antihypertensive therapy; all drugs are taken indefinitely. If monotherapy is ineffective, drugs are selected from various groups, often combining several medications.
As a rule, the desire of a patient with hypertension is to purchase the strongest, but not expensive, drug. However, it is necessary to understand that this does not exist.
What medications are offered for this purpose to patients suffering from high blood pressure?
Every antihypertensive drug has its own mechanism of action, i.e. influence one or another "mechanisms" of increased blood pressure :
a) Renin-angiotensin system— the kidneys produce the substance prorenin (with a decrease in pressure), which passes into renin in the blood. Renin (a proteolytic enzyme) interacts with the blood plasma protein angiotensinogen, resulting in the formation of active substance angiotensin I. Angiotensin, when interacting with angiotensin-converting enzyme (ACE), is converted into the active substance angiotensin II. This substance increases blood pressure, constricts blood vessels, increases the frequency and strength of heart contractions, excites the sympathetic nervous system (which also leads to increased blood pressure), and increases the production of aldosterone. Aldosterone promotes sodium and water retention, which also increases blood pressure. Angiotensin II is one of the most powerful vasoconstrictor substances in the body.
b) Calcium channels of the cells of our body- calcium in the body is found in bound state. When calcium enters the cell through special channels, a contractile protein, actomyosin, is formed. Under its influence, the blood vessels narrow, the heart begins to contract more strongly, 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. These receptors include alpha-adrenergic receptors (α1 and α2) and beta-adrenergic receptors (β1 and β2). Stimulation of α1-adrenergic receptors leads to an increase in blood pressure, α2-adrenergic receptors - to a decrease in blood pressure. α-adrenergic receptors are located in arterioles. β1-adrenergic receptors are localized in the heart, in the kidneys, their stimulation leads to an increase in heart rate, an increase in myocardial oxygen demand and an increase in blood pressure. Stimulation of β2-adrenergic receptors located in the bronchioles causes dilation of the bronchioles and relief of bronchospasm.
d) Urinary system- as a result of excess water in the body, blood pressure increases.
e) Central nervous system- stimulation of the central nervous system increases blood pressure. The brain contains vasomotor centers that regulate blood pressure levels.
So, we have examined the main mechanisms of increasing blood pressure in the human body. It's time to move on to blood pressure lowering agents (antihypertensives), which affect these same mechanisms.
Classification of drugs for arterial hypertension
- Diuretics (diuretics)
- Calcium channel blockers
- Beta blockers
- Agents acting on the renin-angiotensin system
- Angiotensin receptor blockers (antagonists) (sartans)
- Neurotropic agents central action
- Drugs acting on the central nervous system (CNS)
- Alpha blockers
1. Diuretics (diuretics)
As a result of the removal of excess fluid from the body, blood pressure decreases. Diuretics prevent the reabsorption of sodium ions, which as a result are excreted and carry water with them. In addition to sodium ions, diuretics flush out potassium ions from the body, which are necessary for the functioning of the cardiovascular system. There are potassium-sparing diuretics.
Representatives:
- Hydrochlorothiazide (Hypothiazide) - 25 mg, 100 mg, included in combination preparations; Long-term use at a dosage above 12.5 mg is not recommended, due to the possible development of type 2 diabetes!
- Indapamide (Arifonretard, Ravel SR, Indapamide MV, Indap, Ionic retard, Acripamidretard) - most often the dosage is 1.5 mg.
- Triampur (a combined diuretic containing potassium-sparing triamterene and hydrochlorothiazide);
- Spironolactone (Veroshpiron, Aldactone). It has a significant side effect (in men it causes the development of gynecomastia and mastodynia).
- Eplerenone (Inspra) - often used in patients with chronic heart failure, does not cause the development of gynecomastia and mastodynia.
- Furosemide 20 mg, 40 mg. The drug is short, but fast action. Inhibits the reabsorption of sodium ions in the ascending limb of the loop of Henle, proximal and distal tubules. Increases the excretion of bicarbonates, phosphates, calcium, magnesium.
- Torsemide (Diuver) - 5 mg, 10 mg, is a loop diuretic. The main mechanism of action of the drug is due to the reversible binding of torasemide to the sodium/chlorine/potassium ion contransporter located in the apical membrane of the thick segment of the ascending limb of the loop of Henle, as a result of which the reabsorption of sodium ions is reduced or completely inhibited and the osmotic pressure of intracellular fluid and water reabsorption are reduced. Blocks myocardial aldosterone receptors, reduces fibrosis and improves myocardial diastolic function. Torasemide causes hypokalemia to a lesser extent than furosemide, but it is more active and its action is longer lasting.
Diuretics are prescribed in combination with other antihypertensive drugs. The drug indapamide is the only diuretic used independently for hypertension.
Rapid-acting diuretics (furosemide) are not advisable to use systematically for hypertension; they are taken in emergency conditions.
When using diuretics, it is important to take potassium supplements in courses of up to 1 month.
2. Calcium channel blockers
Calcium channel blockers (calcium antagonists) are a heterogeneous group of drugs that have the same mechanism of action, but differ in a number of properties, including pharmacokinetics, tissue selectivity, and effect on heart rate.
Another name for this group is calcium ion antagonists.
There are three main subgroups of AKs: dihydropyridine (the main representative is nifedipine), phenylalkylamines (the main representative is verapamil) and benzothiazepines (the main representative is diltiazem).
Recently they have been divided into two large groups depending on the effect on heart rate. Diltiazem and verapamil are classified as so-called “rhythm-slowing” calcium antagonists (non-dihydropyridine). The other group (dihydropyridine) includes amlodipine, nifedipine and all other dihydropyridine derivatives that increase or do not change the heart rate.
Calcium channel blockers are used for arterial hypertension, coronary heart disease (contraindicated for acute forms!) and arrhythmias. For arrhythmias, not all calcium channel blockers are used, but only pulse-lowering ones.
Representatives:
Pulse reducers (non-dihydropyridine):
- Verapamil 40 mg, 80 mg (extended: Isoptin SR, Verogalid EP) - dosage 240 mg;
- Diltiazem 90 mg (Altiazem RR) - dosage 180 mg;
The following representatives (dihydropyridine derivatives) are not used for arrhythmia: Contraindicated in acute myocardial infarction and unstable angina!!!
- Nifedipine (Adalat, Cordaflex, Cordafen, Cordipin, Corinfar, Nifecard, Phenigidine) - dosage 10 mg, 20 mg; NifecardXL 30mg, 60mg.
- Amlodipine (Norvasc, Normodipin, Tenox, Cordi Cor, Es Cordi Cor, Cardilopin, Kalchek,
- Amlotop, Omelarcardio, Amlovas) - dosage 5 mg, 10 mg;
- Felodipine (Plendil, Felodip) - 2.5 mg, 5 mg, 10 mg;
- Nimodipine (Nimotop) - 30 mg;
- Lacidipine (Latsipil, Sakur) - 2 mg, 4 mg;
- Lercanidipine (Lerkamen) - 20 mg.
From side effects dihydropyridine derivatives can indicate swelling, mainly lower extremities, headache, redness of the face, increased heart rate, increased urination. If swelling persists, it is necessary to replace the drug.
Lerkamen, which is a representative of the third generation of calcium antagonists, due to its higher selectivity to slow calcium channels, causes edema to a lesser extent compared to other representatives of this group.
3. Beta blockers
There are drugs that do not selectively block receptors - non-selective action, they are contraindicated in bronchial asthma, chronic obstructive pulmonary disease (COPD). Other drugs selectively block only the beta receptors of the heart - selective action. All beta blockers interfere with the synthesis of prorenin in the kidneys, thereby blocking the renin-angiotensin system. In this regard, the vessels dilate, blood pressure decreases.
Representatives:
- Metoprolol (Betalok ZOK 25 mg, 50 mg, 100 mg, Egilok retard 25 mg, 50 mg, 100 mg, 200 mg, Egilok S, Vasocardin retard 200 mg, Metocard retard 100 mg);
- Bisoprolol (Concor, Coronal, Biol, Bisogamma, Cordinorm, Niperten, Biprol, Bidop, Aritel) - most often the dosage is 5 mg, 10 mg;
- Nebivolol (Nebilet, Binelol) - 5 mg, 10 mg;
- Betaxolol (Locren) - 20 mg;
- Carvedilol (Carvetrend, Coriol, Talliton, Dilatrend, Acridiol) - mainly dosage 6.25 mg, 12.5 mg, 25 mg.
Drugs in this group are used for hypertension combined with coronary heart disease and arrhythmias.
Short-acting drugs, the use of which is not rational for hypertension: anaprilin (obzidan), atenolol, propranolol.
Main contraindications to beta blockers:
- bronchial asthma;
- low pressure;
- sick sinus syndrome;
- pathology of peripheral arteries;
- bradycardia;
- cardiogenic shock;
- atrioventricular block of the second or third degree.
4. Drugs acting on the renin-angiotensin system
The drugs act on different stages of angiotensin II formation. Some inhibit (suppress) angiotensin-converting enzyme, others block the receptors on which angiotensin II acts. The third group inhibits renin and is represented by only one drug (aliskiren).
Angiotensin-converting enzyme (ACE) inhibitors
These drugs prevent the conversion of angiotensin I to active angiotensin II. As a result, the concentration of angiotensin II in the blood decreases, blood vessels dilate, and pressure decreases.
Representatives (synonyms are indicated in brackets - substances with the same chemical composition):
- Captopril (Capoten) - dosage 25 mg, 50 mg;
- Enalapril (Renitek, Berlipril, Renipril, Ednit, Enap, Enarenal, Enam) - dosage is most often 5 mg, 10 mg, 20 mg;
- Lisinopril (Diroton, Dapril, Lysigamma, Lisinoton) - dosage is most often 5 mg, 10 mg, 20 mg;
- Perindopril (Prestarium A, Perineva) - Perindopril - dosage 2.5 mg, 5 mg, 10 mg. Perineva - dosage 4 mg, 8 mg;
- Ramipril (Tritace, Amprilan, Hartil, Pyramil) - dosage 2.5 mg, 5 mg, 10 mg;
- Quinapril (Accupro) - 5mg, 10mg, 20mg, 40mg;
- Fosinopril (Fosicard, Monopril) - in a dosage of 10 mg, 20 mg;
- Trandolapril (Hopten) - 2 mg;
- Zofenopril (Zocardis) - dosage 7.5 mg, 30 mg.
The drugs are available in different dosages for therapy with varying degrees increased blood pressure.
A feature of the drug Captopril (Capoten) is that, due to its short duration of action, it is rational only for hypertensive crises.
A prominent representative of the group, Enalapril and its synonyms are used very often. This drug does not have a long duration of action, so it is taken 2 times a day. In general, the full effect of ACE inhibitors can be observed after 1-2 weeks of drug use. In pharmacies you can find a variety of generics (analogues) of enalapril, i.e. Cheaper enalapril-containing drugs produced by small manufacturers. We discussed the quality of generics in another article, but here it is worth noting that generic enalapril is suitable for some, but does not work for others.
ACE inhibitors cause a side effect - dry cough. In cases of cough development ACE inhibitors replaced with drugs from another group.
This group of drugs is contraindicated during pregnancy and has a teratogenic effect in the fetus!
Angiotensin receptor blockers (antagonists) (sartans)
These drugs block angiotensin receptors. As a result, angiotensin II does not interact with them, the vessels dilate, and blood pressure decreases
Representatives:
- Losartan (Cozaar 50 mg, 100 mg; Lozap 12.5 mg, 50 mg, 100 mg; Lorista 12.5 mg, 25 mg, 50 mg, 100 mg; Vasotens 50 mg, 100 mg);
- Eprosartan (Teveten) - 400 mg, 600 mg;
- Valsartan (Diovan 40mg, 80mg, 160mg, 320mg; Valsacor 80mg, 160mg, 320mg, Valz 40mg, 80mg, 160mg; Nortivan 40mg, 80mg, 160mg; Valsafors 80mg, 160mg);
- Irbesartan (Aprovel) - 150 mg, 300 mg;
Candesartan (Atacand) - 8 mg, 16 mg, 32 mg;
Telmisartan (Micardis) - 40 mg, 80 mg;
Olmesartan (Cardosal) - 10 mg, 20 mg, 40 mg.
Just like its predecessors, it allows you to evaluate the full effect 1-2 weeks after the start of administration. Does not cause dry cough. Should not be used during pregnancy! If pregnancy is detected during treatment, antihypertensive therapy with drugs of this group should be discontinued!
5. Centrally acting neurotropic agents
Centrally acting neurotropic drugs affect the vasomotor center in the brain, reducing its tone.
- Moxonidine (Physiotens, Moxonitex, Moxogamma) - 0.2 mg, 0.4 mg;
- Rilmenidine (Albarel (1 mg) - 1 mg;
- Methyldopa (Dopegit) - 250 mg.
The first representative of this group is clonidine, which was previously widely used for hypertension. This drug is now available strictly by prescription.
Currently, moxonidine is used both for emergency assistance at hypertensive crisis, and for planned therapy. Dosage 0.2 mg, 0.4 mg. The maximum daily dosage is 0.6 mg/day.
6. Drugs acting on the central nervous system
If hypertension is caused by prolonged stress, then drugs that act on the central nervous system are used (sedatives (Novopassit, Persen, Valerian, Motherwort, tranquilizers, sleeping pills).
7. Alpha blockers
These agents attach to alpha adrenergic receptors and block them from the irritating effects of norepinephrine. As a result, blood pressure decreases.
The representative used - Doxazosin (Cardura, Tonocardin) - is often available in dosages of 1 mg, 2 mg. It is used to relieve attacks and long-term therapy. Many alpha blocker drugs have been discontinued.
Why do you take several medications at once for arterial hypertension?
IN initial stage disease, the doctor prescribes one drug, based on some research and taking into account the patient’s existing diseases. If one drug is ineffective, other drugs are often added, creating a combination of blood pressure-lowering drugs that target different mechanisms of blood pressure lowering. Combination therapy for refractory (stable) arterial hypertension can combine up to 5-6 drugs!
Drugs are selected from different groups. For example:
- ACE inhibitor/diuretic;
- angiotensin receptor blocker/diuretic;
- ACE inhibitor/calcium channel blocker;
- ACE inhibitor/calcium channel blocker/beta blocker;
- angiotensin receptor blocker/calcium channel blocker/beta blocker;
- ACE inhibitor/calcium channel blocker/diuretic and other combinations.
There are combinations of drugs that are irrational, for example: beta blockers/calcium channel blockers, pulse-lowering drugs, beta blockers/central acting drugs and other combinations. It is dangerous to self-medicate!!!
Exist combination drugs, combining in 1 tablet components of substances from different groups of antihypertensive drugs.
For example:
- ACE inhibitor/diuretic
- Enalapril/Hydrochlorothiazide (Co-Renitec, Enap NL, Enap N,
- Enap NL 20, Renipril GT)
- Enalapril/Indapamide (Enzix duo, Enzix duo forte)
- Lisinopril/Hydrochlorothiazide (Iruzid, Lisinoton, Liten N)
- Perindopril/Indapamide (NoliprelA and NoliprelAforte)
- Quinapril/Hydrochlorothiazide (Accusid)
- Fosinopril/Hydrochlorothiazide (Fosicard N)
- angiotensin receptor blocker/diuretic
- Losartan/Hydrochlorothiazide (Gizaar, Lozap plus, Lorista N,
- Lorista ND)
- Eprosartan/Hydrochlorothiazide (Teveten plus)
- Valsartan/Hydrochlorothiazide (Co-diovan)
- Irbesartan/Hydrochlorothiazide (Co-aprovel)
- Candesartan/Hydrochlorothiazide (Atacand Plus)
- Telmisartan / HCTZ (Micardis Plus)
- ACE inhibitor/calcium channel blocker
- Trandolapril/Verapamil (Tarka)
- Lisinopril/Amlodipine (Equator)
- angiotensin receptor blocker/calcium channel blocker
- Valsartan/Amlodipine (Exforge)
- calcium channel blocker dihydropyridine/beta blocker
- Felodipine/metoprolol (Logimax)
- beta blocker/diuretic (not recommended for diabetes and obesity)
- Bisoprolol/Hydrochlorothiazide (Lodoz, Aritel plus)
All drugs are available in different dosages of one and another component; the dose must be selected for the patient by the doctor.
Achieving and maintaining target blood pressure levels requires long-term medical supervision with regular monitoring of the patient’s compliance with recommendations for lifestyle changes and adherence to the regimen of prescribed antihypertensive drugs, as well as adjustment of therapy depending on the effectiveness, safety and tolerability of treatment. During dynamic monitoring, the establishment of personal contact between the doctor and the patient and patient education in schools for patients with hypertension, which increases the patient’s adherence to treatment, are crucial.
X rhonic obstructive disease lung (COPD) is a chronic, slowly progressive disease characterized by irreversible or partially reversible (with the use of bronchodilators or other treatment) obstruction bronchial tree. Chronic obstructive pulmonary diseases are widespread among the adult population and are often combined with arterial hypertension (AH). COPD includes:
- Bronchial asthma
- Chronical bronchitis
- Emphysema
- Bronchiectasis
Features of the treatment of hypertension against the background of COPD are determined by several factors.
1) Some antihypertensive drugs are able to increase the tone of small and medium bronchi, thereby worsening lung ventilation and aggravating hypoxemia. The use of these drugs in COPD should be avoided.
2) In persons with a long history of COPD, a symptom complex of “pulmonary heart” is formed. The pharmacodynamics of some antihypertensive drugs changes in this case, which should be taken into account during the selection and long-term treatment of hypertension.
3) Drug treatment COPD in some cases can significantly change the effectiveness of selected antihypertensive therapy.
During physical examination, it can be difficult to diagnose “pulmonary heart”, since most of the signs revealed during examination (pulsation of the jugular veins, systolic murmur over the tricuspid valve and increased 2nd heart sound over the pulmonary valve) are insensitive or nonspecific.
In the diagnosis of “pulmonary heart”, ECG, radiography, fluoroscopy, radioisotope ventriculography, myocardial scintigraphy with a thallium isotope are used, but the most informative, inexpensive and simple diagnostic method is echocardiography with Doppler scanning. Using this method, you can not only identify structural changes in the parts of the heart and its valve apparatus, but also quite accurately measure blood pressure in the pulmonary artery. ECG signs of cor pulmonale are listed in Table 1.
It is important to remember that in addition to COPD, the “cor pulmonale” symptom complex can be caused by a number of other reasons (sleep apnea syndrome, primary pulmonary hypertension, diseases and injuries of the spine, chest, respiratory muscles and diaphragm, repeated thromboembolism of small branches of the pulmonary artery, severe chest obesity, etc.), consideration of which is beyond the scope of this article.
The main structural and functional signs of the “pulmonary heart”:
- Myocardial hypertrophy of the right ventricle and right atrium
- Increased volume and volume overload of the right heart
- Increased systolic pressure in the right heart and pulmonary artery
- High cardiac output (per early stages)
- Atrial rhythm disturbances (extrasystole, tachycardia, less commonly - atrial fibrillation)
- Tricuspid valve insufficiency, late stages- pulmonary valve
- Heart failure by big circle blood circulation (in later stages).
Changes in the structural and functional properties of the myocardium in cor pulmonale syndrome often lead to “paradoxical” reactions to drugs, including those used to correct high blood pressure. In particular, one of common signs“pulmonary heart” are disturbances of heart rhythm and conduction (sinoatrial and atrioventricular blockades, tachy- and bradyarrhythmias). In case of slowing of intracardiac conduction and bradycardia, the use of some calcium antagonists (verapamil and diltiazem) for antihypertensive purposes is sharply limited - due to high risk cardiac arrest.
b-blockers
Blockade of b 2 -adrenergic receptors causes spasm of the medium and small bronchi. Deterioration of pulmonary ventilation causes hypoxemia, and is clinically manifested by increased shortness of breath and increased breathing. Non-selective b -adrenergic blockers (propranolol, nadolol) block b 2 -adrenergic receptors, therefore, in COPD, they are usually contraindicated, while cardioselective drugs (bisoprolol, betaxolol, metoprolol) can in some cases (concomitant severe angina, severe tachyarrhythmia) be prescribed in small cases doses under careful monitoring of ECG and clinical condition (Table 2). Among the beta-blockers used in Russia, b-blockers have the greatest cardioselectivity (including in comparison with the drugs listed in Table 2). bisoprolol (Concor) . Recent studies have shown a significant advantage of Concor in terms of safety and effectiveness of use in chronic obstructive bronchitis compared to atenolol. In addition, a comparison of the effectiveness of atenolol and bisoprolol in people with hypertension and concomitant bronchial asthma, according to parameters characterizing the state of the cardiovascular system (heart rate, blood pressure) and indicators of bronchial obstruction (FEV1, VC, etc.) showed the advantage of bisoprolol. In the group of patients taking bisoprolol, in addition to a significant decrease in diastolic blood pressure, there was no effect of the drug on the condition of the airways, while in the placebo and atenolol group an increase in airway resistance was detected.
The use of b-AB with direct vasodilating properties (carvedilol) and b-AB with the properties of an inducer of endothelial nitric oxide synthesis (nebivolol) in arterial hypertension has been less studied, as has the effect of these drugs on breathing in chronic pulmonary diseases.
At the first symptoms of deterioration in breathing, any beta-blockers are canceled.
Calcium antagonists
They are the “drugs of choice” in the treatment of hypertension due to COPD, since, along with the ability to dilate the arteries of the systemic circle, they have the properties of bronchodilators, thereby improving pulmonary ventilation.
Bronchodilating properties have been proven for phenylalkylamines, short-term dihydropyridines and long acting, to a lesser extent - for benzodiazepine AKs (Table 3).
However, large doses of calcium antagonists can suppress compensatory vasoconstriction of small bronchial arterioles and in these cases can disrupt the ventilation-perfusion ratio and increase hypoxemia. Therefore, if it is necessary to enhance the hypotensive effect in a patient with COPD, it is more advisable to add an antihypertensive drug of a different class (diuretic, angiotensin receptor blocker, ACE inhibitor) to the calcium antagonist - taking into account tolerability and other individual contraindications.
Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers
To date, there is no data on the direct effect of therapeutic doses of ACE inhibitors on pulmonary perfusion and ventilation, despite the proven participation of the lungs in the synthesis of ACE. The presence of COPD is not a specific contraindication to the use of ACE inhibitors for antihypertensive purposes. Therefore, when choosing an antihypertensive drug for patients with COPD, ACE inhibitors should be prescribed “on a general basis.” However, it should be remembered that one of the side effects of drugs in this group is a dry cough (up to 8% of cases), which in severe cases can significantly complicate breathing and worsen the quality of life of a patient with COPD. Very often, persistent cough in such patients serves as a compelling reason to discontinue ACE inhibitors.
To date, there is no evidence of an adverse effect on pulmonary function of angiotensin receptor blockers (Table 4). Therefore, their prescription for antihypertensive purposes should not depend on the presence of COPD in the patient.
IN long-term treatment Arterial hypertension is usually treated with thiazide diuretics (hydrochlorothiazide, oxodoline) and the indole diuretic indapamide. Appearing in modern methodological recommendations « cornerstone» antihypertensive therapy with repeatedly confirmed high preventive efficacy, thiazide diuretics do not worsen or improve the ventilation-perfusion characteristics of the pulmonary circulation - since they do not directly affect the tone of the pulmonary arterioles, small and medium bronchi. Therefore, the presence of COPD does not limit the use of diuretics for the treatment of concomitant hypertension. With concomitant heart failure with congestion in the pulmonary circulation, diuretics become the treatment of choice, since they reduce elevated pressure in the pulmonary capillaries, however, in such cases, thiazide diuretics are replaced with loop diuretics (furosemide, bumetanide, ethacrynic acid)
In the long-term treatment of arterial hypertension, thiazide diuretics (hydrochlorothiazide, oxodoline) and the indole diuretic indapamide are usually used. Being in modern guidelines the “cornerstone” of antihypertensive therapy with repeatedly confirmed high preventive effectiveness, thiazide diuretics do not worsen or improve the ventilation-perfusion characteristics of the pulmonary circulation - since they do not directly affect the tone of the pulmonary arterioles, small and medium-sized bronchi. Therefore, the presence of COPD does not limit the use of diuretics for the treatment of concomitant hypertension. With concomitant heart failure with congestion in the pulmonary circulation, diuretics become the treatment of choice, since they reduce elevated pressure in the pulmonary capillaries, however, in such cases, thiazide diuretics are replaced with loop diuretics (furosemide, bumetanide, ethacrynic acid)
In case of decompensation of chronic “pulmonary heart” with the development of circulatory failure in a large circle (hepatomegaly, swelling of the extremities), it is preferable to prescribe not thiazide, but loop diuretics (furosemide, bumetanide, ethacrynic acid). In such cases, it is necessary to regularly determine the electrolyte composition of the plasma and, if hypokalemia occurs, as a risk factor for cardiac arrhythmias, actively prescribe potassium-sparing drugs (spironolactone).
a-adrenergic blockers and vasodilators
For hypertension, a direct vasodilator, hydralazine, or a-blockers, prazosin, doxazosin, or terazosin, are sometimes prescribed. These drugs reduce peripheral vascular resistance by directly acting on arterioles. Direct influence on respiratory function these drugs do not, and therefore, if indicated, they can be prescribed to lower blood pressure. However, a common side effect of vasodilators and α-blockers is reflex tachycardia, requiring the administration of β-blockers, which, in turn, can cause bronchospasm. In addition, in light of recent data from prospective randomized trials, the use of α-blockers for hypertension is now limited due to the risk of developing heart failure with long-term use.
Rauwolfia preparations
Although in most countries rauwolfia preparations have long been excluded from the official list of drugs for the treatment of hypertension, in Russia these drugs are still widespread - primarily because of their low cost. Drugs in this group can worsen breathing in some patients with COPD (mainly due to swelling of the mucous membrane of the upper respiratory tract).
“Central” acting drugs
Antihypertensive drugs of this group have different action on the respiratory tract, but in general their use in concomitant COPD is considered safe. Clonidine is an α-adrenergic agonist, but acts predominantly on α-adrenergic receptors of the vasomotor center of the brain, so its effect on small vessels of the mucous membrane of the respiratory tract is insignificant. There are currently no reports of serious deterioration in breathing in COPD during treatment of hypertension with methyldopa, guanfacine and moxonidine. It should, however, be emphasized that this group of drugs is almost never used for the treatment of hypertension in most countries due to the lack of evidence of improvement in prognosis and the large number of side effects.
The influence of drugs used for COPD on the effectiveness of antihypertensive therapy
As a rule, antibiotics, mucolytic and expectorant drugs prescribed to patients with COPD do not affect the effectiveness of antihypertensive therapy. The situation is somewhat different with drugs that improve bronchial patency. Inhalation of β-adrenergic agonists in large doses can cause tachycardia in patients with hypertension and provoke an increase in blood pressure - up to a hypertensive crisis.
Sometimes prescribed for COPD to relieve/prevent bronchospasm, inhaled steroids, as a rule, do not have an effect on blood pressure. In cases where long-term oral administration of steroid hormones is required, fluid retention, weight gain and increased blood pressure are likely - as part of the development of drug-induced Cushing's syndrome. In such cases, correction of high blood pressure is carried out primarily with diuretics.
In patients with bronchial asthma, an increase in blood pressure (BP) is often observed, and hypertension occurs. To normalize the patient’s condition, the doctor must carefully select blood pressure pills for asthma. Many drugs used to treat hypertension can cause asthma attacks. Therapy should be carried out taking into account two diseases to avoid complications.
The causes of asthma and arterial hypertension are different, the risk factors, and the specific course of the diseases do not have common features. But often, against the background of bronchial asthma attacks, patients experience an increase in blood pressure. According to statistics, such cases are frequent and occur regularly.
Does bronchial asthma cause the development of hypertension in patients, or are these two parallel diseases that develop independently? Modern medicine has two opposing opinions regarding the issue of the relationship between pathologies.
Some doctors talk about the need to establish a separate diagnosis for asthmatics with high blood pressure - pulmonary hypertension.
Doctors point to direct cause-and-effect relationships between pathologies:
- 35% of asthmatics develop arterial hypertension;
- during an asthma attack, blood pressure rises sharply;
- normalization of pressure is accompanied by an improvement in the asthmatic condition (no attacks).
Proponents of this theory consider asthma to be the main factor in the development of chronic pulmonary heart disease, which causes a stable increase in pressure. According to statistics, children with bronchial attacks, such a diagnosis occurs much more often.
The second group of doctors speaks of the absence of dependence and connection between the two diseases. Diseases develop separately from one another, but their presence affects the diagnosis, the effectiveness of treatment, and the safety of drugs.
Regardless of whether there is a relationship between bronchial asthma and hypertension, the presence of pathologies should be taken into account to choose the right course of treatment. Many blood pressure-lowering pills are contraindicated in asthmatic patients.
The theory of pulmonary hypertension links the development of hypotension in bronchial asthma with a lack of oxygen (hypoxia), which occurs in asthmatics during attacks. What is the mechanism of complications?
- Lack of oxygen awakens 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 produced in the adrenal glands (aldosterone) increases.
- Aldosterone causes increased stimulation of arterial walls.
This process causes a sharp increase in blood pressure. The data is confirmed by clinical studies conducted during attacks of bronchial asthma.
At long period diseases, when asthma is treated with potent drugs, this causes disturbances in the functioning of the heart. The right ventricle stops functioning normally. This complication is called cor pulmonale syndrome and provokes the development of arterial hypertension.
Hormonal drugs used in the treatment of bronchial asthma to help in critical condition also contribute to increased blood pressure in patients. Injections with glucocorticoids or oral medications, when used frequently, disrupt the functioning of the endocrine system. The consequence is the development of hypertension, diabetes, and osteoporosis.
Bronchial asthma can cause hypertension on its own. The main cause of hypertension is the drugs used by asthmatics to relieve attacks.
There are risk factors in which increased blood pressure is more likely to occur in patients with asthma:
- excess weight;
- age (after 50 years);
- development of asthma without effective treatment;
- side effects of drugs.
Some risk factors can be eliminated by adjusting your lifestyle and following your doctor's recommendations for taking medications.
In order to begin treatment for hypertension in a timely manner, asthmatics should know the symptoms of high blood pressure:- Strong headache.
- Heaviness in the head.
- Noise in ears.
- Nausea.
- General weakness.
- Frequent pulse.
- Heartbeat.
- Sweating.
- Numbness of arms and legs.
- Tremor.
- Chest pain.
A particularly severe course of the disease is complicated by convulsive syndrome during an attack of suffocation. The patient loses consciousness, and cerebral edema may develop, which can be fatal.
The choice of medication for hypertension in bronchial asthma depends on what provokes the development of the pathology. The doctor conducts a thorough interview with the patient in order to determine how often asthma attacks occur and when an increase in pressure is observed.
- Blood pressure rises during an asthmatic attack;
- The pressure does not depend on attacks, it is constantly elevated.
The first option does not require special treatment for hypertension. There is a need to eliminate the attack. To do this, the doctor selects an anti-asthma drug, indicates the dosage and duration of its use. In most cases, inhalation using a spray can stop an attack and reduce blood pressure.
If the increase in blood pressure does not depend on attacks and remission of bronchial asthma, it is necessary to select a course of treatment for hypertension. In this case, the drugs should be as neutral as possible in terms of the presence of side effects, not causing exacerbation main disease of asthmatics.
There are several groups of drugs used in the treatment of arterial hypertension. The doctor chooses drugs that do not harm the patient’s respiratory system, so as not to complicate the course of bronchial asthma.
- Beta-blockers cause tissue spasm in the bronchi, pulmonary ventilation is disrupted, and shortness of breath increases.
- ACE inhibitors (angiotensin-converting enzyme) provoke a dry cough (occurs in 20% of patients taking them), shortness of breath, aggravating the condition of asthmatics.
- Diuretics cause a decrease in potassium levels in the blood serum (hypokalemia) and an increase in carbon dioxide in the blood (hypercapnia).
- Alpha blockers increase the sensitivity of the bronchi to histamine. When taken orally, the drugs are practically safe.
In complex treatment, it is important to take into account the influence of drugs that relieve an asthmatic attack on the appearance of hypertension. A group of beta-adrenergic agonists (Berotec, Salbutamol) for long-term use provoke an increase in blood pressure. Doctors observe this trend after increasing the dose of inhaled aerosol. Under its influence, the myocardial muscles are stimulated, which causes an increase in heart rate.
Taking hormonal drugs (Methylprednisolone, Prednisolone) causes disruption of blood flow, increases the flow pressure on the walls of blood vessels, which causes sharp jumps in blood pressure. Adenosinergic drugs (Aminophylline, Eufillin) lead to heart rhythm disturbances, causing increased blood pressure.
It is important that drugs treating hypertension do not aggravate the course of bronchial asthma, and drugs to eliminate an attack do not cause an increase in blood pressure. A complex approach will provide effective treatment.
Criteria by which the doctor selects drugs for asthma from pressure:
- reduction of symptoms of hypertension;
- lack of interaction with bronchodilators;
- antioxidant characteristics;
- decreased ability to form blood clots;
- lack of antitussive effect;
- the drug should not affect the level of calcium in the blood.
Drugs from the calcium antagonist group meet all the requirements. Studies have shown that these drugs do not interfere with the functioning of the respiratory system even with regular use. Doctors use calcium channel blockers to complex therapy.
There are two groups of drugs with this effect:- dihydropyridine (Felodipine, Nicardipine, Amlodipine);
- non-dihydropyridine (Isoptin, Verapamil).
Medicines of the first group are used more often; they do not increase the heart rate, which is an important advantage.
Diuretics (Lasix, Uregit), cardioselective drugs (Concor), potassium-sparing group of drugs (Triampur, Veroshpiron), diuretics (Thiazide) are also used in complex therapy.
Choice medications, their form, dosage, frequency of use and duration of use can only be administered by a doctor. Self-treatment risks developing severe complications.
Particularly careful selection of the course of treatment is necessary for asthmatics with “pulmonary heart syndrome.” The doctor prescribes additional diagnostic methods, in order to evaluate general state body.
Traditional medicine offers a wide range of methods that help reduce the frequency of asthmatic attacks, as well as lower blood pressure. Healing fees herbs, tinctures, rubbing reduce pain during an exacerbation. Use of funds traditional medicine It is also necessary to agree with your doctor.
Patients with bronchial asthma can avoid the development of arterial hypertension if they follow the doctor’s recommendations regarding treatment and lifestyle:
- Relieve asthma attacks with local medications, reducing the impact of toxins on the entire body.
- Carry out regular monitoring of heart rate and blood pressure.
- If heart rhythm disturbances or persistent increases in blood pressure occur, consult a doctor.
- Do a cardiogram twice a year for timely detection of pathologies.
- Take maintenance medications if chronic hypertension develops.
- Avoid enlarged physical activity, stress, causing pressure changes.
- Refuse bad habits(Smoking aggravates asthma and hypertension).
Bronchial asthma is not a death sentence and is a direct cause of the development of arterial hypertension. Timely diagnosis, correct course of treatment, taking into account symptoms, risk factors and side effects, prevention of complications will allow patients with asthma to live for many years.
Bronchial asthma with concomitant diseases of various organs- features of the clinical course of bronchial asthma in various concurrent diseases.
The most common symptoms encountered in patients with bronchial asthma are allergic rhinitis, allergic rhinosinusopathy, vasomotor rhinitis, nasal and sinus polyposis, arterial hypertension, various endocrine disorders, pathology of the nervous and digestive systems.
The presence of arterial hypertension in patients with bronchial asthma is a generally accepted fact. The frequency of the combination of these diseases is increasing. The main factor in increasing systemic blood pressure is central and regional hemodynamic disorders: increased peripheral vascular resistance, decreased pulse blood supply to the brain, impaired hemodynamics in the pulmonary circulation. An increase in blood pressure is promoted by hypoxia and hypercapnia, which accompany chronic bronchial obstruction, as well as the influence of vasoactive substances (serotonin, catecholamines and their precursors). There are two forms of arterial hypertension in bronchial asthma: hypertension (25% of patients), which is benign and slowly progresses, and symptomatic “pulmogenic” (the predominant form, 75% of patients). In the “pulmogenic” form, blood pressure increases mainly during severe bronchial obstruction (attack, exacerbation), and in some patients it does not reach normal and increases during exacerbation (stable phase).
Bronchial asthma is often combined with endocrine disorders. There is a known correlation between asthma symptoms and the function of the female genital organs. During puberty in girls and premenopausal women, the severity of the disease increases. In women suffering from bronchial asthma, premenstrual asthmatic syndrome often occurs: exacerbation 2-7 days before the onset of menstruation, less often - simultaneously with it; With the onset of menstruation, significant relief occurs. There are no pronounced fluctuations in bronchial reactivity. Most patients have ovarian dysfunction.
Bronchial asthma is severe when combined with hyperthyroidism, which significantly disrupts the metabolism of glucocorticosteroids. A particularly severe course of bronchial asthma is observed against the background of Addison's disease (a rare combination). Sometimes bronchial asthma is combined with myxedema and diabetes mellitus (about 0.1% of cases).
Bronchial asthma is accompanied by central nervous system disorders of various types. In the acute stage, psychotic states with psychomotor agitation, psychoses, and comatose states are observed. In the chronic course, autonomic dystonia is formed with changes at all levels of the autonomic nervous system. Asthenoneurotic syndrome is manifested by irritability, fatigue, and sleep disturbance. Vegetative-vascular dystonia is characterized by a number of signs: hyperhidrosis of the palms and feet, red and white “dermatographism”, tremor, autonomic crises of the sympathoadrenal type (sudden shortness of breath with a respiratory rate of 34-38 per 1 mn, feeling of heat, tachycardia up to 100-120 per 1 min , rise in blood pressure to 150/80-190/100 mm Hg, frequent excessive urination, urge to defecate). Crises develop in isolation, imitating an asthmatic attack with a subjective feeling of suffocation, but there is no difficulty in exhaling or wheezing in the lungs. Symptoms of vegetative dystonia occur with the onset of bronchial asthma and become more frequent in parallel with its exacerbations. Autonomic dysfunction is manifested by weakness, dizziness, sweating, fainting and contributes to prolongation of the period of coughing, asthma attacks, residual symptoms, more rapid progression of the disease and relative resistance to therapy.
Concomitant diseases of the digestive system (pancreatic dysfunction, liver and intestinal dysfunction), which are found in a third of patients, especially with long-term glucocorticosteroid therapy, can have a significant impact on the course of bronchial asthma.
Concomitant diseases complicate the course of bronchial asthma, complicate its treatment and require appropriate correction. The treatment of arterial hypertension in bronchial asthma has certain features. “Pulmogenic” arterial hypertension, observed only during attacks of suffocation (labile phase), can normalize after eliminating bronchial obstruction without the use of antihypertensive drugs. In cases of stable arterial hypertension, complex treatment uses hydralazine drugs, ganglion blockers (arpenal, fubromegan, merpanit, temekhin, peitamine), hypothiazide, veroshpiron (has the properties of an aldosterone blocker, corrects electrolyte metabolism disorders) 100-150 mg per day for three weeks . Adrenergic α-blocking drugs, in particular pyrroxan, can be effective; calcium antagonists (Corinfar, isoptin) are used.
The neurogenic components of an attack of bronchial asthma can be influenced by ganglion blockers and anticholinergics (can be used in combination with bronchodilators: arpenal or fubromegan - 0.05 g three times a day; halidor - 0.1 g three times a day; temekhin - 0.001 g three times a day day), which are recommended for mild attacks of a reflex or conditioned reflex nature, when bronchial asthma is combined with arterial hypertension and pulmonary hypertension. These drugs must be used under blood pressure control; They are contraindicated for hypotension. To treat patients with a predominance of the neurogenic component in pathogenesis, various variants of novocaine blockades are used (provided novocaine is tolerated), psychotherapy, hypnosuggestive therapy, electrosleep, reflexology, and physiotherapy. These methods can eliminate the state of fear, conditioned reflex mechanisms of attacks, and anxious mood.
Treatment of concomitant diabetes is carried out according to general rules: diet, antidiabetic drugs. At the same time, it is not recommended to use biguanides to correct carbohydrate metabolism, which, due to increased anaerobic glycolysis (mechanism of glucose-lowering action), can aggravate the clinical picture of the underlying disease.
The presence of esophagitis, gastritis, gastric and duodenal ulcers creates difficulties for glucocorticosteroid therapy. In cases of acute gastrointestinal
In cases of bleeding, it is more advisable to use parenteral glucocorticosteroid drugs; an alternating treatment regimen is preferable. The optimal way to treat bronchial asthma complicated by diabetes mellitus and peptic ulcer disease is to prescribe maintenance inhaled glucocorticosteroid therapy. With hyperthyroidism, there may be a need for increased doses of glucocorticosteroid drugs, since an excess of thyroid hormones significantly increases the rate and changes the metabolic pathways of the latter. Treatment of hyperthyroidism improves the course of bronchial asthma.
In cases of concomitant arterial hypertension, angina pectoris and other cardiovascular diseases, as well as hyperthyroidism, it is necessary to use B-stimulating adrenergic drugs with great caution. For persons with dysfunction of the digestive glands, it is advisable to prescribe enzyme preparations (festal, digestin, panzinorm), which reduce the absorption of food allergens and can help reduce shortness of breath, especially in the presence of food allergies. Patients with positive results of tuberculin tests and a history of tuberculosis during long-term glucocorticosteroid therapy are prophylactically prescribed tuberculostatic drugs (isoniazid).
For elderly patients, the use of adrenergic B-stimulating drugs and methylxanthines is undesirable due to their side effects on the cardiovascular system, especially in coronary atherosclerosis. In addition, the bronchodilating effect of adrenergic drugs decreases with age. When a significant amount of liquid sputum is produced in patients with bronchial asthma in this age group, anticholinergic drugs are useful, which in some cases are more effective than other bronchodilators. There are recommendations for the use of synthetic androgens for elderly men suffering from bronchial asthma with a sharp decrease in androgenic activity of the gonads (Sustanon-250 - 2 ml intramuscularly with an interval of 14-20 days, course - three to five injections); at the same time, remission is achieved faster and the maintenance dose of glucocorticosteroid drugs is reduced. There are instructions on the advisability of using antiplatelet agents, in particular dipyridamole (curantyl) - 250-300 mg per day - and acetylsalicylic acid (in the absence of contraindications) - 1.53.0 g per day, especially for elderly patients in whom bronchial asthma is combined with cardiac pathology -vascular system. For microcirculation disorders and changes in the rheological properties of blood, heparin is used at a dose of 10-20 thousand units per day for 510 days.
Concomitant pathology of the upper respiratory tract is treated.
