The increase in cardiovascular diseases, observed in all developed countries of the world, requires close attention to the issues of prevention and effective treatment diseases of the heart and blood vessels.
Research data show that about 65 million Americans aged 18-39 and 1 billion people worldwide suffer from arterial hypertension. Arterial hypertension (AH) is a risk factor for the development and progression of atherosclerosis, coronary disease heart, chronic heart failure and acute disorders of cerebral circulation.
Changes in the vessels of the elastic type (aorta, pulmonary artery and large arteries extending from them) are an important link in the pathogenesis of AH. Normally, the elastic properties of these vessels, especially the aorta, contribute to the smoothing of periodic blood waves produced by the left ventricle during systole and their transformation into continuous peripheral blood flow. The elastic properties of the aorta modulate the function of the left ventricle, reducing the afterload on it and its final systolic and diastolic volumes. This leads to a decrease in the tension of the walls of the left ventricle, as a result of which the trophism of the most sensitive to hypoxia subendocardial layers of the myocardium improves and coronary blood flow improves.
One of the significant characteristics of the vessels of the elastic type is the stiffness, which determines the ability of the arterial wall to resist deformation. Rigidity vascular wall depends on age, the severity of atherosclerotic changes, the rate and degree of age-related involution of the most important structural proteins of elastin and fibulin, age-related increase in collagen stiffness, genetically determined features of elastin fibers and on the level of blood pressure (BP). A number of studies have highlighted the role of inflammation in the pathogenesis of large artery stiffness.
The classic marker of arterial stiffness/elasticity of large vessels is pulse wave velocity (PWV). The value of this indicator largely depends on the ratio of the thickness of the vessel wall to the radius of the vessel lumen and the elasticity of the vessel wall. The more extensible the vessel, the slower the pulse wave propagates and the faster it weakens, and vice versa - the more rigid and thicker the vessel and the smaller its radius, the higher the PWV. Normally, PWV in the aorta is 4-6 m/s, in less elastic muscle-type arteries, in particular the radial artery, it is 8-12 m/s. The "gold standard" for assessing aortic stiffness is considered to be PWV between the carotid and femoral arteries.
Central (aortic) and peripheral arterial pressure
In the normal arterial system, after the contraction of the ventricle in systole, the pulse wave is directed from the place of origin (aorta) to large, medium, and then small vessels at a certain speed. Along the way, the pulse wave encounters various obstacles (for example, bifurcations, resistive vessels, stenoses), leading to the appearance of reflected pulse waves heading towards the aorta. With sufficient elasticity of large vessels, primarily the aorta, the reflected wave is absorbed.
The sum of direct and reflected pulse waves differs in different vessels, as a result of blood pressure, primarily systolic blood pressure (SBP), differs in various main vessels and does not coincide with that measured on the shoulder. The degree of increase in SBP in peripheral arteries relative to SBP in the aorta varies greatly in different subjects and is determined by the modulus of elasticity of the studied arteries and the remoteness of the measurement site. Because of this, the cuff pressure in the brachial artery does not always correspond to the pressure in the descending aorta. A certain contribution to the increase in blood pressure in the brachial artery relative to blood pressure in the aorta is made by an increase in the rigidity of its wall, which means the need to create greater compression in the cuff. Unlike peripheral blood pressure, the level of central blood pressure is modulated by the elastic characteristics of large arteries, as well as the structural and functional state of medium-sized arteries and the microcirculatory bed, and thus is an indicator that indirectly reflects the state of the entire cardiovascular bed.
The greatest prognostic value has blood pressure in the ascending and central parts of the aorta, or central blood pressure. In the case of an increase in stiffness (decrease in elasticity) of the aorta, the reflected wave is not absorbed sufficiently and, as a rule, due to a higher PWV returns during systole, which leads to an increase in central SBP. The consequence of increased rigidity and an increase in central blood pressure is a change in the afterload on the left ventricle and impaired coronary perfusion, which leads to left ventricular hypertrophy and an increase in myocardial oxygen demand.
In recent years, special techniques have appeared (for example,) that allow fixing such determinants of pulse pressure as pulse (fluctuations of the arterial wall from the heart to resistive vessels) and reflected (fluctuations of the arterial wall from resistive vessels to the heart) waves, and with the help of computer processing when registration of fluctuations of the radial artery, calculate the values of the central pressure in the aorta (Fig. 1).
Within 10 seconds, the pressure curve in the radial artery of the upper limb is recorded using an applanation tonometer. The data is processed using software: the average shape of the curve is calculated, which is transformed into a plot of central aortic pressure (CPA) using the accepted mathematical method. Computer processing of the obtained central pressure curves makes it possible to determine the CPA parameters: the time to the first (T1) and second (T2) systolic peaks of the wave. The pressure at the first peak / break (P1) is taken as the ejection pressure, a further increase to the second peak (ΔP) means the reflected pressure, their sum (maximum pressure during systole) is the systolic CDA (CDAc)
In addition to the value of central blood pressure, there is an indicator of pressure increase, the augmentation index (gain, AIx) expressed as a percentage, which is defined as the pressure difference between the first, early peak (caused by cardiac systole) and the second, late (appearing as a result of reflection of the first pulse wave) systolic peak divided by the central pulse pressure.
Thus, the central aortic pressure is a calculated parameter of hemodynamics, depending not only on cardiac output, peripheral vascular resistance, but also on the structural and functional characteristics of the main arteries (their elastic properties). Differences between the level of central and peripheral SBP are most clearly expressed in young age and decrease in the elderly. It has been shown that central blood pressure, especially central pulse pressure, and the augmentation index correlate with the degree of remodeling of large arteries and PWV as a classic indicator of vascular wall stiffness.
Arterial stiffness as a cardiovascular risk factor
Changes in the mechanical properties of large arteries have a clear pathophysiological relationship with clinical outcomes. Research suggests that PWV, a measure of arterial stiffness, may be a better predictor of subsequent cardiovascular events compared to known risk factors such as age, BP, hypercholesterolemia, and diabetes mellitus. Studies evaluating PWV have established that an increase in arterial stiffness is a predictor of cardiovascular risk in apparently healthy individuals, patients with end-stage diabetes mellitus. kidney failure and the elderly. It has been demonstrated that arterial stiffness is a predictor of mortality in AH patients. Thus, in a population study of Copenhagen County population, it was demonstrated that an increase in PWV (>12 m/s) is associated with a 50% increase in the risk of cardiovascular events. In addition, the predictive value of PWV was found in a Japanese study with an average follow-up of 8.2 years.
It has been established that indirect indices of aortic stiffness and reflected wave, such as central aortic pressure and augmentation index, are independent predictors of cardiovascular events and mortality. Thus, in a study including 1272 normotensive and untreated hypertensive patients, it was demonstrated that central SBP was an independent predictor of cardiovascular mortality after adjusting for various cardiovascular risk factors, including left ventricular myocardial mass and determination of the thickness of the intima-media complex. at ultrasound examination carotid arteries. Moreover, patients with high aortic pressure have a worse CV prognosis than those with better central aortic pressure control..
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An increase in aortic stiffness is also an independent predictor of diastolic dysfunction in hypertensive patients (Fig. 2) and may also limit exercise tolerance in dilated cardiomyopathy. In heart failure patients with preserved left ventricular ejection fraction, systolic dysfunction and arterial stiffness appear with age and/or progression of hypertension.
Increased arterial stiffness is associated with endothelial dysfunction and decreased nitric oxide (NO) bioavailability. Endothelial dysfunction in patients at high CV risk may explain why these conditions are associated with increased arterial stiffness in the early stages before the onset of atheroma. Therefore, drugs such as nebivolol that increase NO formation can reduce the stiffness of large arteries, which in turn can lead to a decrease in cardiovascular risk.
Thus, the value of arterial stiffness, assessed by PWV, for the risk cardiovascular outcomes demonstrated in a number of prospective studies both in patients with hypertension and in the general population. Since 2007, the assessment of PWV in the carotid-femoral segment has been recommended as additional method studies to identify target organ damage in hypertension.
A.N. Belovol, Doctor of Medical Sciences, Professor, Corresponding Member of the National Academy of Medical Sciences of Ukraine;
I.I. Kknyazkova, Doctor of Medical Sciences, Associate Professor
Kharkiv National Medical University
Being in good health people don't usually think about their blood pressure readings.
It is unlikely that anyone questions how important blood pressure indicators are for the body.
An increase in blood pressure initially does not affect the patient's well-being. The first symptoms appear only in the advanced stages of the disease.
Blood pressure in the vessels does not coincide with its indicators in the atmosphere. Thanks to this fact, proper blood circulation and blood supply to all organs and systems is possible.
The highest blood pressure in the central arterial vessels: aorta, pulmonary trunk, subclavian arteries.
Many smaller vessels depart from these vessels, which carry blood throughout the body, literally to every cell.
During the contraction of the heart, or systole, blood is ejected from the heart into the bloodstream. At this point in the arteries observed the highest numbers of blood pressure. This parameter is called systolic, but for most people it is familiar as the top.
The lower value when measuring pressure is called diastolic or lower.
The difference between these two indicators is also an important indicator. This is pulse blood pressure, changes in which are also a sign of the development of pathologies.
There is a special table of the European Union of Cardiologists, according to which doctors are guided by assessing the blood pressure of patients.
The magnitude of blood pressure depends on many factors: on the fraction of cardiac output, the diameter of the vascular lumen, on the work of the myocardium and the resistance of the vascular wall.
Measurement of blood pressure norms
Since ancient times, healers have understood that many ailments of people depend on the state of their vessels.
Thus, an invasive method for measuring blood pressure was invented.
A special needle was inserted into the blood vessel, which measured the tension of the fluid circulating in the vessels.
Today, a gentle method of measuring blood pressure is used. It is important to measure and bring minimal risk to the health of the patient.
The modern measurement method is the Korotkov method.
For execution this method a tonometer is required, which includes a sphygmomanometer and a stethophonendoscope.
Measurements should be taken at regular hours, with a certain frequency. Don't forget to keep a BP diary.
Measurement is usually carried out three times, with a break between measurements. It is important to measure blood pressure in both arms, as the values may vary.
Before the proposed measurement, you should not smoke, drink coffee and tea, alcohol. Do not use decongestant nasal drops (Nazivin, Naphthyzin, Farmazolin, etc.). This group drugs have a vasoconstrictive effect, and leads to vasoconstriction.
Before starting the procedure, the patient is offered to rest for a quarter of an hour.
During this event, a person sits, leaning on the back of a chair (armchair), relaxing the upper and lower limbs.
The examined hand is on the same level with the probable projection of the heart. It is recommended to place a support under the arm, such as a pillow.
The hand must be bare. The cuff is applied a couple of centimeters above the elbow crease. It is necessary to leave a distance between the surface of the arm and the cuff.
The head of the phonendoscope is applied in the projection of the brachial artery.
Blood pressure and its norms in adults
Normal blood pressure in adults fluctuates in several divisions.
IN this case it depends on the constitution, features of physiology and metabolic exchange.
The norm by age sometimes depends on gender.
Many people think that only 110 over 80 is normal, while at the same time 110 over 70 is normal, and high 120 over low 70 is also normal. Patients often worry about such jumps, but all of the numbers listed are within the age norm.
There are the following blood pressure standards:
- upper norm, or systolic;
- lower rate, or diastolic;
- pulse rate.
The pressure of 120 over 70, what does this mean, is of interest to every patient suffering from disorders in the work of the heart vascular system.
Systolic blood pressure should not exceed a value of more than 139 millimeters of mercury.
If the numbers exceed this value, arterial hypertension is diagnosed.
If the pressure drops beyond the normal range, then the reverse diagnosis is made - hypotension.
There are many reasons for changes in blood pressure. The list includes age indicators (older vessels react poorly to pressure), gender, lifestyle.
With changes in blood pressure norms, appropriate therapy is prescribed:
- With small fluctuations, the patient's lifestyle should be considered and taken into account. Normal enough is just changing habits. Should quit smoking, increase uniform motor activity proper rest and sleep. It has long been proven that there is a relationship between lifestyle and the state of the vessels of patients.
- When the values rise above, special pharmacological therapy is prescribed. Antihypertensive drugs for pressure are used. Upon reaching the numbers 110-130 for the systolic state, the optimal dose is set.
- With a sharp jump or hypertensive crisis, emergency antihypertensive treatment is used, which, ideally, is carried out by an emergency physician.
- Concomitant treatment of additional pathology is also used to lower blood pressure, as any heart disease, diabetes mellitus, circulatory failure, kidney failure, problems thyroid gland entails an increase in systemic, intracranial and intraocular blood pressure.
You should carefully monitor and understand what the norm of blood pressure is, so misinterpretation and treatment can lead to complications.
The most common complications include:
- acute coronary syndrome, also known as myocardial infarction of varying severity;
- strokes of various origins;
- hypertensive crises;
- violations of the blood supply to various organs;
- dilatation of the heart chambers;
- cardiac hypertrophy;
- hypertensive angiopathy;
- visual impairment.
As a complication, the patient may develop renal failure.
Lower limits of blood pressure indicators and pressure indicators during pregnancy
Not only the increase in the upper level of blood pressure is a danger to the patient.
In this regard, the patient must know the norm of the lower limit and what pressure is normal for him.
The scale of the lower limits ends at 70 millimeters.
Anything lower can lead to a collapsed state.
Reasons for changing the norm of lower blood pressure:
- Shocks of various origins - infectious-allergic, toxic, cardiogenic, anaphylactic.
- Bleeding.
- Adrenal insufficiency.
- Violation of brain activity.
These conditions are very dangerous because of their detrimental effect on the renal glomeruli. If systemic blood pressure falls below 50, the kidneys refuse to work properly and acute renal failure develops.
A feature of the pregnant body is the blood supply not only to itself, but also to the developing fetus.
A dangerous condition for mother and child is eclampsia. It is characterized by high jumps in blood pressure, as a result of which the mother may experience cardiovascular insufficiency, placental abruption and fetal death.
The first signs of gestational hypertension are functional noise in the ears, dizziness, a sharp deterioration in well-being, increased heart rate, increased heart rate. Often, pregnant women develop vomiting and nausea.
Many note that before the onset of an attack, everything begins to spin before their eyes.
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Cardiologists and therapists take into account the indicators of upper and lower blood pressure. To make a diagnosis of essential hypertension or essential hypertension requires a simultaneous increase in both indicators. Treatment of hypertension is carried out with the help of drugs that regulate not only upper, but also increased lower pressure.
What is lower blood pressure?
To understand the pressure indicators, you need to know how both numbers are formed:
- top pressure or systolic illustrates the pumping function of the heart. The indicator is formed at the moment of expulsion of blood from the left ventricle, so it is higher than the lower pressure;
- lower pressure or diastolic is fixed by the device at the time of diastole, or relaxation of the heart muscle. It is formed at the time of closing aortic valve and illustrates the state of vascular elasticity, their tone and response to cardiac ejection fraction.
The lower pressure is normally at the level of 60 - 89 mm. rt. Art. It can rise or fall, which characterizes different pathologies. For example, lower pressure is reduced in renal artery stenosis. It is often called "renal", since the condition of this indicator is often associated with kidney pathologies. And the upper pressure is called cardiac.
Blood pressure is determined by indicators of systolic (upper) and diastolic pressure (lower)
High lower pressure: what is the danger of the condition?
The danger of increased lower pressure lies in the pathogenetic mechanisms of the process. Gradually, the state of the body changes:
- The heart pumps blood in an enhanced mode, then both indicators of pressure rise or the heart pumps blood in a normal mode, then the lower pressure rises.
- Normal functioning of the heart and an increase or decrease in lower pressure indicate that changes in the walls have occurred in the aorta and other blood vessels. The circulatory system is in a state of tension, which leads to wear of the vessels.
- The wear of the vascular wall leads to the fact that it breaks and becomes the cause of a stroke or heart attack.
- A gradual change in the wall causes the deposition on it atherosclerotic plaques which also leads to strokes and heart attacks. Atherosclerosis also becomes an impetus for the development of senile dementia, a decrease in intelligence and cognitive abilities, the appearance diabetes second type.
- Over time, along with atherosclerotic plaques, calcifications and blood clots are deposited on the vessels. Thrombosis and thromboembolism are possible.
- In the kidneys, stenosis of the artery develops over time, which provokes a gradual wrinkling of the tissue or atrophy of the parenchyma of the organ. The kidneys do not remove metabolic products in the same volume, which is characterized by the development of chronic renal failure and intoxication of the body.
Diastolic pressure measures the level of blood flow pressure on the vascular membrane when the heart muscle is relaxed, when the volume of blood in the vessels decreases.
How to recognize high blood pressure?
If the lower pressure is increased, then the patient will not complain about the direct manifestations of this condition. An isolated increase in lower pressure will not manifest itself in the form of a headache or asthma attacks. Such symptoms are typical only for increased upper and lower pressure.
Elevated diastolic pressure can be detected incidentally during the examination of the patient.
It is also possible, over time, to complain about comorbidities and the consequences of increased lower indicators in the form of:
- memory and cognitive impairments;
- frequent urination in small volumes (pollakiuria);
- thromboembolism or thrombosis.
The loss of vascular elasticity is accompanied by a violation of the blood supply to organs, namely, it becomes difficult for oxygen in the composition of erythrocytes to penetrate through the vascular wall. Organ ischemia develops. This can cause the development of coronary artery disease, which in the future will provoke a heart attack against the background of constant stress in the work of the myocardium.
An increase in normal values indicates a constant stress state of the vessels
Why does high blood pressure develop?
An essential increase in lower pressure occurs no more than in 25% of cases. If only the lower indicators increase, then the reason is more often in secondary diseases. An increase in lower pressure will provoke an increase in the systolic parameter in the future.
The doctor should suspect changes and examine body structures such as:
- adrenal glands and kidneys;
- organs of the endocrine system;
- pituitary;
- heart and malformations of its development;
- neoplasms in the body that produce hormones.
It is important to determine the level of hormones, namely:
- aldosterone;
- cortisol;
- thyroxine;
- vasopressin;
- renin.
More often, the increase occurs due to a decrease in the lumen of the renal artery, and the main function of the kidney is to maintain blood balance in the vessels and arteries.
An increase in systolic and diastolic pressure requires drug treatment. More specifically, about the pathologies that cause pressure surges:
- Diseases of the kidneys, adrenal glands.
The kidneys contain receptors that affect the body's blood pressure. In the organs, the renin-angiotensin-aldosterone system (RAAS) is activated with the help of electrolytes and hormones, which ensures the interaction of renin, angiotensin and aldosterone. Due to them, the amount of urine excreted varies, the level of fluid and BCC in the body is regulated. Some substances are produced by the adrenal glands, for example, cortisol, corticosteroids. Mineralocorticoids of the aldosterone type have a hypertensive effect and remove potassium from the body, increasing the amount of sodium. To investigate the function of these structures, CT, excretory urography is prescribed.
- Pathology of the thyroid gland.
Thyroid diseases are characterized not only by the influence on pressure, but also by changes in the central nervous system. Pathologies with an excess of thyroid hormones can increase lower pressure. Substances have a hypertensive effect, and also affect the state of the heart, changing the structure of the myocardium. They increase both upper and lower pressure. Influence on tonometer indicators is one of the first symptoms of thyroid damage, it appears before other signs.
- Diseases associated with the musculoskeletal system.
An increase in upper and lower blood pressure can be explained not only by vascular pathologies. If the holes in the spine, through which the arteries pass, narrow due to pathology or injury, then the indicators on the tonometer increase, and the elasticity of the vascular wall is lost due to squeezing of the structures.
In medicine, such factors of increase are distinguished: improper functioning of the thyroid gland
- Excessive amount of fluid in the body.
This condition is explained by the intake of excess water or the restriction of excretion of fluid associated with the kidneys. The increase in lower pressure is affected by aldosterone and the amount of sodium ions. Water is retained in the tissues of the body if you eat salty foods. Water helps dilute excess salt in the body and is not excreted in the urine. To reduce lower pressure, you can remove water through physical activity, the use of diuretic decoctions and drugs.
- Atherosclerosis.
Pathology in which the elasticity of blood vessels decreases due to the deposition of lipid plaques on the vascular wall, which eventually turn into calcifications. Pathology develops over the years and does not manifest itself in the early stages. Increased lower pressure is detected when there are changes on the aortic wall and hypertension joins the pathology with an increase in systolic pressure.
Changes in the vascular wall and an increase in lower pressure indicators can be provoked by autoimmune vasculitis, systemic lupus erythematosus. Diseases manifest more often in girls aged 20-25 years.
Ways to lower high diastolic pressure
If the patient is not worried about the symptoms of increased diastolic pressure, but only cares about the indicators of the tonometer, then metabolic drugs, as well as angioprotectors, can be taken. Effective for cardiac and vascular activity such means as "Asparkam", "Panangin", ATP, "Tonginal". Potassium preparations nourish the myocardium and prevent it from depleting. It is important to take these drugs according to the instructions, with interruptions in the courses. Potassium in excessive amounts can cause fibrillation of the heart chambers and even stop them in systole.
Medicines are prescribed exclusively by the attending physician after a comprehensive examination
Together with potassium preparations, diuretics can be used. They are prescribed if the patient is concerned about swelling. You can make your own diuretic teas based on:
- field horsetail;
- bearberry;
- raspberries and currants;
- lingonberry leaves.
Pharmacies sell diuretic decoctions with instructions for brewing teas and how to use them. Such funds will reduce both lower and upper pressure. As diuretic medications, aldosterone antagonists are most often prescribed - Spironolactone, aka Veroshpiron. The drug begins to act after three to four days of regular use.
Often used drugs "Hypochlorothiazide", "Sidnokarb", "Torsid". They are potent, so the dosage is calculated strictly by a specialist. Means such as Triamteren, which saves potassium, increases the amount of the mineral in the body, therefore, it also requires a doctor's consultation and testing for electrolytes. Diuretics are not prescribed during pregnancy.
High blood pressure therapy
If there is an isolated or combined elevated lower pressure (from 95 mm Hg and above), then doctors prescribe centrally acting antihypertensive drugs:
- Moxonidine is an alpha2 blocker and imidazoline receptor antagonist.
Medications are taken after a comprehensive examination
- "Methyldopa" is an alpha2 blocker responsible for the inhibition of the sympathetic nervous system.
- Albarel is an alpha2 blocker that suppresses sympathomimetic activity.
The drugs eliminate vasospasm by inhibiting the sympathetic nervous system and reducing the number of receptors that bind substances that increase pressure. As a result of the reception, both the upper and lower pressures decrease, the indicators normalize. You can buy the drug only on the basis of prescriptions written by a specialist.
Basic therapy high blood pressure supplemented with conventional antihypertensive drugs in the form of ACE inhibitors or ARA2. Before prescribing funds, it is important to check the degree of renal artery stenosis. A significant degree of narrowing is a contraindication to taking APA2 and ACE inhibitors. If stenosis of the renal artery is fixed, it is necessary to choose calcium antagonists or new drugs - renin antagonists. The representative of this group is Aliskiren.
As ACE inhibitors are used:
- "Captopril",
- "Enalapril",
- "Lisinopril"
- "Pyrindopril".
They are often combined with diuretics. You can take APA2 drugs in the absence of contraindications, namely:
- "Losartan"
- "Valsartan"
- "Candesartan".
These groups have the least number of contraindications and side effects. They are well tolerated by patients with long-term therapy for two months.
To find out exactly what to do if the pressure (systolic or diastolic) is elevated, you need to contact your doctor, check the readings on the tonometer. You can independently keep a notebook and write down the results of examinations in it in order to track the indicator in dynamics. It is required to measure up to five times a day and at the time of ailments.
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What is lower and upper pressure
Tachycardia at low pressure
What happens to vessels at high and low pressure?
Features of the circulatory system of the heart
Ensuring normal human life is engaged in the most important system of the body - the blood circulation of the heart. Naturally, the cardiac organ is fundamental in this system. Blood circulation occurs from the heart and back, the task of which, on the one hand, is to timely deliver nutrients and oxygen, and on the other hand, in the removal of harmful toxins and carbon dioxide.
Organ structure
To understand the role of the heart in blood circulation, one should consider its structure in more detail.
The transport of blood is carried out thanks to the uninterrupted contractions of a hollow organ, that is, the heart. This peculiar cone-shaped pump is located in the chest cavity, or more precisely, a little to the left of the central part. The organ is surrounded by a pericardial sac, which contains a fluid that reduces friction during contractions.
The mass of a hollow organ varies from 250 to 300 g. The structure of the heart is quite complex.
It is necessary to distinguish between the presence of four chambers:
- left and right atria;
- left and right ventricles.
The dimensions of the atria, as well as the wall thickness, are smaller. A solid partition is installed between both parts.
Such a device of the main pump can be explained by the fact that each cavity has its own function. Blood flows in only one direction - from the atria to the ventricles, and already those, in turn, contribute to the expulsion of blood into the circulatory circles.
The heart wall is made up of 3 layers:
- Epicardium.
- Myocardium.
- Endocardium.
Why is there a rhythmic contraction and relaxation in the organ? Because in the middle layer, that is, the myocardium, there are bioelectric impulses. The place where they appear is called the sinus node. It is located in the right atrium. If we talk about the processes occurring in the body of an adult, then in a normal state, about 80 impulses are generated by the node in one minute. Accordingly, the myocardium is reduced by the same amount.
But when the blood supply to the sinus node is disrupted or its work is inhibited due to some negative factors arrhythmia is diagnosed.
For 0.3 seconds, the heart contracts, then it rests for 0.4 seconds. The performance of the body is truly fantastic. During the day, he is able to pump approximately 14 tons of blood. How better circulation will function, the work of the heart will be more efficient. Providing the body with oxygen and substances depends on the condition of the coronary arteries.
Features of the blood supply system
There is a certain pattern of blood circulation.
In the area where the heart is located, the blood vessels intertwine and, accordingly, form circles of blood circulation:
- big;
- small.
The right ventricle is the place where the small circle originates. From it comes the flow of venous blood into the pulmonary trunk. This is the largest vessel. central part small circle - lungs.
Each circle has its own purpose. If the large one is engaged in the blood supply to all organs without exception, then the task of the small one is gas exchange in the pulmonary alveoli and heat transfer.
In addition, it is necessary to say about the presence of additional circles of blood flow:
- placental (when maternal blood containing oxygen enters the developing fetus);
- willisian (engaged in blood saturation of the brain and is located at its base).
The blood supply system is characterized by some features:
- Arteries have more high level elasticity, but their capacity is less than that of veins.
- Despite its isolation, the vascular system boasts a large branching of the vessels.
- Tubular formations have a variety of diameters - from 1.5 cm to 8 microns.
General characteristics of vessels
If the blood circulation functions without disturbance, there will also be no failures in the heart.
Blood circulation in the human body is carried out thanks to five types of vessels:
- arteries. They are the most durable. Through them, blood flows from the fibromuscular hollow organ. Muscle, collagen and elastic fibers form their walls. For this reason, the diameter of the arteries increases or decreases depending on the amount of blood that passes through them.
- Arterioles. Vessels that are slightly smaller than the previous ones.
- Capillaries - the thinnest and shortest tubular formations. Consist of a single layer of epithelium.
- Venulam. Formations, although small, are responsible for the removal of blood containing carbon dioxide.
- Venam. Wall thickness is medium. They carry blood to the heart. They contain more than 70% liquid mobile connective tissue.
The movement of blood through the vessels is carried out due to the functioning of the heart and the resulting pressure difference.
Not so long ago, there was an opinion that veins have a passive role. However, according to the results of the study, scientists were able to find that these vessels are a kind of reservoirs, thanks to which the amount of circulating blood is controlled. Thus, the human body relieves the heart muscle of unnecessary stress or increases it as needed.
When the blood flow presses on the walls of both the vessels and the heart, this phenomenon is called blood pressure. Normal material metabolism and urine formation depend on this parameter.
The pressure can be:
- Arterial. It occurs when the ventricles contract as blood flows out of them.
- Venous. The tension created in the right atrium.
- Capillary.
- Intracardiac. Its formation occurs at the moment when the myocardium is relaxed.
The heart is an organ, although small in size, but truly amazing and hardy. It has been proven that age does not affect its functioning. In the absence of diseases and the presence of moderate physical exertion, it works effectively for anyone. If the load is continuous, and nutrients will come irregularly, for short time appears oxygen starvation and fatigue of the heart muscle. Accordingly, these factors contribute to the rapid wear of the organ.
Therefore than better man takes care of his health, the less likely to end up in a hospital bed.
The pressure exerted on the wall of an artery by the blood in it is called blood pressure. Its value is determined by the strength of heart contractions, blood flow into the arterial system, cardiac output, elasticity of vessel walls, blood viscosity and a number of other factors. Distinguish between systolic and diastolic blood pressure.
systolic blood pressure- the maximum value of pressure, which is noted at the time of cardiac contraction. diastolic pressure - the lowest pressure in the arteries when the heart relaxes. The difference between systolic and diastolic pressure is called pulse pressure. Average dynamic pressure is the pressure at which, in the absence of pulse fluctuations, the same hemodynamic effect is observed as with natural fluctuating blood pressure. The pressure in the arteries during ventricular diastole does not drop to zero, it is maintained due to the elasticity of the arterial walls, stretched during systole.
Blood pressure is not the same in different parts of the vascular system. Blood pressure decreases along the course of the vessels from the aorta to the veins. In the aorta, the pressure is 200/80 mm Hg. Art.; in the arteries of medium caliber - 140/50 mm Hg. Art. In the capillaries, the pressure at the time of systole and diastole does not fluctuate significantly and is 35 mm Hg. Art. In small veins, blood pressure does not exceed 10-15 mm Hg. Art.; at the mouth of the vena cava, it is close to zero. The difference in pressure at the beginning and at the end of the vascular system is a factor that ensures the movement of blood.
Some fluctuation in pressure is due to respiratory movements: inhalation is accompanied by its decrease (blood flow to the heart increases), and exhalation is accompanied by an increase (blood flow to the heart decreases). Periodically, the pressure rises and falls due to an increase and decrease in tone. nerve center systems.
Arterial blood pressure is determined by two methods: direct (bloody) and indirect.
At direct method blood pressure measurements are introduced into the artery with a hollow needle or glass cannula connected to a manometer by a tube with rigid walls. The direct method for determining blood pressure is the most accurate, but it requires surgical intervention and therefore not used in practice.
Later, to determine the systolic and diastolic pressure, N.S. Korotkov developed an auscultatory method. He suggested listening to vascular tones (sound phenomena) that occur in the artery below the cuff. Korotkov showed that in an uncompressed artery, sounds are usually absent during the movement of blood. If the pressure in the cuff is raised above the systolic pressure, then the blood flow in the clamped brachial artery stops and there are also no sounds. If you gradually release air from the cuff, then at the moment when the pressure in it becomes slightly lower than systolic, the blood overcomes the squeezed area, hits the wall of the artery and this sound is picked up when listening below the cuff. The indication of the manometer at the appearance of the first sounds in the artery corresponds to the systolic pressure. As the pressure in the cuff decreases further, the sounds first increase and then disappear. Thus, the pressure gauge reading at this moment corresponds to the minimum - diastolic - pressure.
The external indicators of the beneficial result of the tonic activity of the vessels are: arterial pulse, venous pressure, venous pulse.
arterial pulse - rhythmic oscillations of the arterial wall caused by a systolic increase in pressure in the arteries. A pulse wave occurs in the aorta at the moment of expulsion of blood from the ventricle, when the pressure in the aorta rises sharply and its wall stretches. The wave of increased pressure and the oscillation of the vascular wall caused by this stretching propagate at a certain speed from the aorta to the arterioles and capillaries, where the pulse wave goes out. The pulse curve registered on a paper tape is called a sphygmogram (Fig. 14.2).
On the sphygmograms of the aorta and large arteries, two main parts are distinguished: the rise of the curve - anacrota and the decline of the curve - catacrota. Anacrota is caused by a systolic increase in pressure and stretching of the arterial wall by blood ejected from the heart at the beginning of the exile phase. Catacrot occurs at the end of the systole of the ventricle, when the pressure in it begins to fall and there is a decline in the pulse.
Rice. 14.2. Arterial sphygmogram of the owl curve. At the moment when the ventricle begins to relax and the pressure in its cavity becomes lower than in the aorta, the blood ejected into the arterial system rushes back to the ventricle. During this period, the pressure in the arteries drops sharply and a deep notch appears on the pulse curve - an incisura. The movement of blood back to the heart encounters an obstacle, since the semilunar valves close under the influence of the reverse flow of blood and prevent its entry into the left ventricle. The blood wave reflects off the valves and creates a secondary pressure wave called dicrotic rise.
The pulse is characterized by frequency, filling, amplitude and rhythm of tension. Pulse of good quality - full, fast, full, rhythmic.
Venous pulse noted in large veins near the heart. It is caused by obstruction of blood flow from the veins to the heart during atrial and ventricular systole. A graphical recording of a venous pulse is called a phlebogram.
The level of blood pressure is measured in mmHg and is determined by a combination of different factors:
1. By the pumping power of the heart.
2. Peripheral resistance.
3. The volume of circulating blood.
The pumping power of the heart. The main factor in maintaining the level of blood pressure is the work of the heart. Blood pressure in the arteries fluctuates constantly. Its rise during systole determines maximum (systolic) pressure. In a middle-aged person in the brachial artery (and in the aorta), it is 110–120 mm Hg. The pressure drop during diastole corresponds to minimum (diastolic) pressure, which is equal to an average of 80 mm Hg. It depends on peripheral resistance and heart rate. Oscillation amplitude, i.e. difference between systolic and diastolic pressure is pulse pressure is 40–50 mm Hg. It is proportional to the volume of ejected blood. These values are the most important indicators of the functional state of the entire cardiovascular system.
The blood pressure averaged over the time of the cardiac cycle, which is the driving force of blood flow, is called medium pressure. For peripheral vessels, it is equal to the sum of diastolic pressure + 1/3 of pulse pressure. For the central arteries, it is equal to the sum of diastolic + 1/2 pulse pressure. The mean pressure decreases along the vascular bed. Systolic pressure gradually increases with distance from the aorta. In the femoral artery, it rises by 20 mm Hg, in the dorsal artery of the foot by 40 mm Hg more than in the ascending aorta. Diastolic pressure, on the contrary, decreases. Accordingly, pulse pressure increases, which is due to peripheral vascular resistance.
In the terminal branches of the arteries and in the arterioles, the pressure decreases sharply (up to 30–35 mm Hg at the end of the arterioles). Pulse fluctuations significantly decrease and disappear, which is due to the high hydrodynamic resistance of these vessels. In the hollow veins, the pressure fluctuates around zero.
mm. rt. Art.
The normal level of systolic pressure in the brachial artery for an adult is usually in the range of 110-139 mm. rt. Art. The normal range for diastolic pressure in the brachial artery is 60-89 Cardiologists distinguish concepts:
optimal level Blood pressure when systolic pressure is slightly less than 120 mm. rt. Art. and diastolic - less than 80 mm. rt. Art.
normal level- systolic less than 130 mm. rt. Art. and diastolic less than 85 mm. rt. Art.
high normal level- systolic 130-139 mm. rt. Art. and diastolic 85-89 mm. rt. Art.
Despite the fact that with age, especially in people over 50 years of age, blood pressure usually rises gradually, at present it is not customary to talk about the age-related increase in blood pressure. With an increase in systolic pressure above 140 mm. rt. Art., and diastolic above 90 mm. rt. Art. it is recommended to take measures to reduce it.
An increase in blood pressure relative to the values \u200b\u200bdefined for a particular organism is called hypertension(140–160 mm Hg), reduction - hypotension(90–100 mm Hg). Under the influence of various factors, blood pressure can change significantly. So, with emotions, there is a reactive increase in blood pressure (passing exams, sports competitions). There is a so-called advancing (prelaunch) hypertension. Daily fluctuations in blood pressure are observed, during the day it is higher, during a quiet sleep it is slightly lower (by 20 mm Hg). When eating, systolic pressure moderately increases, diastolic moderately decreases. Pain is accompanied by an increase in blood pressure, but with prolonged exposure to a painful stimulus, a decrease in blood pressure is possible.
During physical exertion, systolic - increases, diastolic - may increase, decrease, or does not change.
Hypertension occurs:
With an increase in cardiac output;
With an increase in peripheral resistance;
An increase in the mass of circulating blood;
With a combination of both factors.
In the clinic, it is customary to distinguish between primary (essential) hypertension, which occurs in 85% of cases, the causes are difficult to determine, and secondary (symptomatic) - 15% of cases, it accompanies various diseases. Hypotension is also distinguished primary, secondary.
When a person moves to a vertical position from a horizontal one, blood is redistributed in the body. Temporarily decrease: venous return, central venous pressure (CVP), stroke volume, systolic pressure. This causes active adaptive hemodynamic reactions: narrowing of resistive and capacitive vessels, increased heart rate, increased release of catecholamines, renin, vozopressin, angiotensin II, aldosterone. In some individuals with low BP, these mechanisms may not be sufficient to maintain normal upright BP levels and fall below acceptable levels. There is orthostatic hypotension: dizziness, darkening in the eyes, loss of consciousness is possible - orthostatic collapse (fainting). This can be observed when the ambient temperature rises.
peripheral resistance. The second factor that determines blood pressure is peripheral resistance, which is determined by the state of resistive vessels (arteries and arterioles).
The amount of circulating blood and its viscosity. When transfusing large amounts of blood, blood pressure rises, with blood loss it decreases. BP depends on venous return (for example, during muscular work). BP constantly fluctuates from some average level. When recording these oscillations on the curve, they distinguish: waves of the first order (pulse), the most frequent, reflect the systole, diastole of the ventricles. Waves of the second order (respiratory). On inspiration, blood pressure decreases, on expiration it rises. Waves of the third order reflect the influence of the central nervous system, they are rarer, perhaps this is due to fluctuations in the tone of peripheral vessels.
Techniques for measuring blood pressure
In practice, two methods of measuring blood pressure are used: direct and indirect.
Direct (bloody, intravascular) is carried out by introducing a cannula or catheter connected to a recording device into the vessel. It was first carried out in 1733 by Stephen Hels.
Indirect (indirect or palpatory) proposed by Riva-Rocci (1896). Used clinically in humans.
The main device for measuring blood pressure is sphygmomanometer. A rubber inflatable cuff is superimposed on the shoulder, which, when air is injected into it, compresses the brachial artery, stopping blood flow in it. The pulse in the radial artery disappears. When releasing air from the cuff, monitor the appearance of a pulse, registering the pressure at the time of its appearance using a manometer. This method ( palpatory) allows you to determine only systolic pressure.
In 1905, I.S. Korotkov suggested auscultatory method, by listening to sounds (Korotkoff sounds) in the brachial artery below the cuff using a stethoscope or phonendoscope. When the valve opens, the pressure in the cuff decreases, and when it falls below systolic pressure, short, clear tones appear in the artery. The systolic pressure is noted on the manometer. Then the tones become louder and further fade, while diastolic pressure is determined. Tones may be constant or rise again after fading. The appearance of tones is associated with the turbulent movement of blood. When laminar blood flow is restored, the tones disappear. With increased activity of the cardiovascular system, tones may not disappear.
- pharmachologic effect
- Pharmacokinetics
- Indications for use
- Dosage
- Side effects
- Contraindications
- Pregnancy and breastfeeding
- drug interaction
- Overdose
- Release form
- Terms and conditions of storage
- Compound
- The use of metoprolol
- Dosage forms: tartrate and succinate
- Clinical researches
- Comparison with other beta blockers
- Prices in online pharmacies
- Dosage of metoprolol for various diseases
- How to switch to bisoprolol or carvedilol
- Patient reviews
- Frequently Asked Questions and Answers
- conclusions
Metoprolol is a drug that doctors often prescribe for hypertension, coronary heart disease, chronic heart failure, and to prevent a first and second heart attack. Used since the 1980s, well studied. Metoprolol exists in the form of two dosage forms: tartrate and succinate. There are differences between them that are important to understand. They are detailed below in the article. Metoprolol is classified as a beta-blocker. It reduces the effect of adrenaline and other stimulating hormones on the heart muscle. Due to this, the pulse becomes less frequent, blood pressure normalizes, and the load on the heart decreases. Below you will find instructions for use, written in an accessible language. Read the indications for use, contraindications, dosages. Find out how to take metoprolol - before or after meals, for how long, at what dosage.
Metoprolol: instructions for use
| pharmachologic effect | Selective beta1-blocker. Reduces the stimulating effect that adrenaline and other catecholamine hormones have on cardiac activity. Thus, the drug prevents an increase in heart rate, minute volume and increased contractility of the heart. With emotional stress and physical exertion, there is a sharp release of catecholamines, but blood pressure does not rise so much. |
| Pharmacokinetics | Metoprolol is rapidly and completely absorbed. Taking it with food can increase its bioavailability by 30-40%. Extended-release tablets contain microgranules from which the active substance, metoprolol succinate, is slowly released. Therapeutic effect lasts more than 24 hours. Fast-acting metoprolol tartrate tablets stop their action no later than 10-12 hours later. This drug undergoes oxidative metabolism in the liver, but approximately 95% of the administered dose is excreted by the kidneys. |
| Indications for use |
Important! Heart failure, reduced mortality and re-infarction rates are only indications for metoprolol succinate extended-release tablets. Fast-acting metoprolol tartrate tablets for heart failure and after myocardial infarction should not be assigned. |
See also video about treatment of coronary artery disease and angina
| Dosage | Read more about the dosage of metoprolol succinate and tartrate for hypertension, angina pectoris, heart failure here. Tablets can be divided in half, but not chewed or crushed. May be taken with food or on an empty stomach, whichever is more convenient. The dose must be selected individually for each patient and increased slowly so that bradycardia does not develop - the pulse is below 45-55 beats per minute. |
| Side effects | Frequent side effects:
For any rare or severe side effects, contact your doctor immediately! |
| Contraindications |
|
| Pregnancy and breastfeeding | The use of fast-acting or "slow" tablets of metoprolol during pregnancy is possible only if the benefit to the mother outweighs the risks to the fetus. Like other beta-blockers, metoprolol can theoretically cause side effects - bradycardia in the fetus or newborn. A small amount of the drug is excreted in breast milk. When prescribing medium therapeutic doses, the risk of side effects for the baby is not high. Nevertheless, it is necessary to carefully monitor the possible appearance of signs of blockade of beta-adrenergic receptors in a child. |
| drug interaction | Non-steroidal anti-inflammatory drugs weaken the action of metoprolol to lower blood pressure. Other drugs for hypertension - on the contrary, increase it. Do not take this drug at the same time as verapamil or diltiazem. Listed drug interactions metoprolol - incomplete. Tell your doctor about all medicines, supplements, and herbs you are taking before you get a prescription for hypertension and heart disease medicines. |
| Overdose | Symptoms are low heart rate and other heart problems. Also, depression of lung function, impaired consciousness, possibly uncontrolled trembling, convulsions, increased sweating, nausea, vomiting, fluctuations in blood sugar. Treatment - first of all, reception activated carbon and gastric lavage. Next - resuscitation in the intensive care unit. |
| Release form | Tablets 25 mg, 50 mg, 100 mg, 200 mg, film-coated. |
| Terms and conditions of storage | Store at a temperature not exceeding 30 ° C, shelf life - 3 years. Do not use after the expiry date stated on the packaging. |
| Compound | The active substance is metoprolol succinate or tartrate. Excipients: methylcellulose; glycerol; corn starch; ethylcellulose; magnesium stearate. Film shell: hypromellose, stearic acid, titanium dioxide (E171). |
How to take metoprolol
First of all, make sure that you are prescribed a drug whose active ingredient is metoprolol succinate. Today there is no reason to use obsolete tablets containing metoprolol tartrate. They need to be taken several times a day, which is inconvenient for patients. They cause blood pressure spikes. It's bad for blood vessels. Take Betaloc ZOK or Egiloc S at the dosage prescribed by your doctor and for as long as your doctor recommends. These drugs need to be taken for a long time - several years, or even for life. They are not suitable for situations where you need to quickly bring down blood pressure or relieve an attack of chest pain.
How long can metoprolol be taken?
Metoprolol should be taken for as long as the doctor instructs. Visit your doctor regularly for follow-up examinations and consultations. You can not arbitrarily take breaks, cancel the medicine or reduce its dosage. Maintain a healthy lifestyle while taking your beta-blocker and other prescribed medications. This is the main treatment for hypertension and cardiovascular disease. If you do not follow the recommendations for a healthy lifestyle, then over time, even the most expensive pills will stop helping.
How to take metoprolol: before meals or after?
The official instructions do not indicate how to take metoprolol - before or after meals. Authoritative site on English language(http://www.drugs.com/food-interactions/metoprolol,metoprolol-succinate-er.html) says that medications containing metoprolol succinate and tartrate should be taken with food. Food enhances the effect of the drug, compared to taking it on an empty stomach. Find out what a low-carbohydrate diet is, how it is useful for hypertension and cardiovascular disease. Discuss with your doctor if you can follow it.
Are metoprolol and alcohol compatible?
Tablets containing metoprolol tartrate are poorly tolerated, and drinking alcohol further increases their side effects. Hypotension can happen - blood pressure will drop too much. Symptoms of hypotension: dizziness, weakness, even loss of consciousness. Preparations whose active ingredient is metoprolol succinate are compatible with reasonable alcohol consumption. You can drink alcohol only if you are able to maintain moderation. Getting drunk while taking beta-blockers is dangerous. It is advisable not to drink alcohol for the first 1-2 weeks from the start of treatment with metoprolol, as well as after increasing the dose of the drug. During these transitional periods, one should also not manage vehicles and dangerous machinery. 
Prices for drugs in which the active ingredient is metoprolol succinate
Prices for drugs in which the active ingredient is metoprolol tartrate
The use of metoprolol
Metoprolol is a popular medicine all over the world for arterial hypertension, coronary heart disease, and heart rhythm disturbances. Since the 2000s, additional indications for use have appeared. He was also prescribed for chronic heart failure, along with traditional drugs - ACE inhibitors, diuretics and others. Let's see how metoprolol works, what its dosage forms are and how they differ from each other.
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Adrenaline and other hormones, which are catecholamines, excite the heart muscle. As a result of this, the pulse rate and the volume of blood that the heart pumps with each beat increase. Arterial pressure increases. Beta-blockers, including metoprolol, weaken (block) the effect of catecholamines on the heart. As a result, blood pressure and heart rate drop. The load on the heart is reduced. The risk of the first and repeated heart attack decreases. The life expectancy of people who have developed coronary heart disease or chronic heart failure is increasing.
Dosage forms of metoprolol: tartrate and succinate
In tablets, metoprolol is contained in the form of salts - tartrate or succinate. Traditionally, metoprolol tartrate has been used to produce fast-acting tablets, from which the drug immediately enters the bloodstream. Succinate - for sustained release dosage forms. Extended release metoprolol succinate tablets are manufactured using CR/XL (Controlled Release/Extended Release) or ZOK (Zero-Order-Kinetics) technologies. Fast-acting metoprolol tartrate has significant disadvantages. It is less effective than the newer beta-blockers and is less well tolerated.
| How many times a day to take | 2-4 times a day | It is enough to take 1 time per day. Each dose taken lasts about 24 hours. |
| Stable concentration of the active substance in the blood | No | Yes |
| Inhibits the development of atherosclerosis | No | Yes, slightly enhances the effect of statin drugs |
| Tolerability, frequency of side effects | Worse tolerated than sustained release metoprolol tablets | Well tolerated, side effects - rare |
| Efficacy in heart failure | Weak | Yes, comparable to other modern beta-blockers |
Most of the studies that have proven the effectiveness of metoprolol in cardiovascular diseases have used sustained release preparations containing succinate. Manufacturers of metoprolol tartrate could not watch this indifferently and took retaliatory measures. In the mid-2000s, a “slow” tartrate called Egilok retard began to be sold in Russian-speaking countries.
A wave of articles appeared in medical journals proving that it helps no worse than metoprolol succinate, in particular, the original drug Betaloc ZOK. However, these articles are not credible. Because they were clearly financed by the tablet manufacturer Egilok retard. In such a situation, it is impossible to conduct objective comparative studies of drugs. In English-language sources, it was not possible to find any information about the preparations of metoprolol tartrate sustained release.
Clinical researches
Metoprolol tablets have been prescribed to patients for hypertension and cardiovascular disease since the 1980s. Dozens of large-scale studies of this beta-blocker have been conducted, involving thousands of patients. Their results have been published in reputable medical journals.
| Hjalmarson A., Goldstein S., Fagerberg B. et al. Effects of controlled-release metoprolol on total mortality, hospitalizations, and well-being in patients with heart failure: the metoprolol CR/XL randomized intervention trial in congestive heart failure (MERIT-HF). JAMA 2000;283:1295-1302. | The effect of metoprolol extended release tablets on overall mortality, hospital admissions and quality of life in patients with chronic heart failure | Metoprolol succinate in the form of sustained release is effective in heart failure. However, it was not compared with other beta-blockers in this study. |
| Deedwania PC, Giles TD, Klibaner M, Ghali JK, Herlitz J, Hildebrandt P, Kjekshus J, Spinar J, Vitovec J, Stanbrook H, Wikstrand J. Efficacy, safety and tolerability of metoprolol CR/XL in patients with diabetes and chronic heart failure: experiences from MERIT-HF. American Heart Journal 2005, 149(1):159-167. | Efficacy, safety and tolerability of metoprolol succinate in patients with diabetes and chronic heart failure. Data from the MERIT-HF study. | Patients with type 2 diabetes tolerate well metoprolol succinate, prescribed to them for the treatment of chronic heart failure. The drug improves survival and reduces the frequency of hospitalizations. However, it does not increase blood sugar. |
| Wiklund O., Hulthe J., Wikstrand J. et al. Effect of controlled release/extended release metoprolol on carotid intima-media thickness in patients with hypercholesterolemia: a 3-year randomized study. Stroke 2002;33:572-577. | Effect of metoprolol in sustained release tablets on the thickness of the intima-media complex of the carotid artery in patients with elevated blood cholesterol. Data from a 3-year study compared to placebo. | Metoprolol extended release tablets (succinate) inhibit the development of atherosclerosis when given to patients in addition to statins. |
| Heffernan KS, Suryadevara R, Patvardhan EA, Mooney P, Karas RH, Kuvin JT. Effect of atenolol vs metoprolol succinate on vascular function in patients with hypertension. Clinic Cardiol. 2011, 34(1):39-44. | Comparison of the effect of atenolol and metoprolol succinate on vascular function in patients with high blood pressure. | Atenolol and metoprolol succinate equally lower blood pressure. At the same time, metoprolol better protects the vessels. |
| Cocco G. Erectile dysfunction after therapy with metoprolol: the hawthorne effect. Cardiology 2009, 112(3):174-177. | Erectile dysfunction while taking metoprolol. | The weakening of potency in men while taking metoprolol succinate in at least 75% of cases is caused by a psychological attitude, and not by the real effect of the drug. Placebo restores potency no worse than tadalafil (Cialis). |
We emphasize that only metoprolol succinate has a solid evidence base. It works well, especially in combination with other drugs, and rarely causes side effects. In particular, this beta-blocker does not impair male potency. Metoprolol tartrate cannot boast of any special advantages. Today, it is no longer advisable to use it, even despite the low price.
Comparison with other beta blockers
Recall that metoprolol has been used in medical practice since the 1980s. Even improved performance metoprolol succinate sustained release tablets are no longer a novelty. This beta blocker occupies a large share of the pharmaceutical market. It is well known by doctors and willingly prescribed to their patients. However, it tends to be replaced by other drugs.
Beta-blockers - competitors of metoprolol:
| Espinola-Klein C, Weisser G, Jagodzinski A, Savvidis S, Warnholtz A, Ostad MA, Gori T, Munzel T. Beta-Blockers in patients with intermittent claudication and arterial hypertension: results from the nebivolol or metoprolol in arterial occlusive disease trial. Hypertension 2011, 58(2):148-54 | The effect of beta-blockers on patients with intermittent claudication and high blood pressure. Results of a comparative study of nebivolol and metoprolol in circulatory disorders in peripheral arteries. | Metoprolol and nebivolol equally well help patients who have circulatory disorders in the legs. There is no difference in efficacy between drugs. |
| Kampus P, Serg M, Kals J, Zagura M, Muda P, Karu K, Zilmer M, Eha J. Differential effects of nebivolol and metoprolol on central aortic pressure and left ventricular wall thickness. Hypertension.2011, 57(6):1122-8. | Differences in the effect of nebivolol and metoprolol on central aortic pressure and wall thickness of the left ventricle of the heart. | Nebivolol and metoprolol similarly lower pulse rate and mean blood pressure. However, only nebivolol significantly normalizes central SBP, DBP, central pulse pressure and left ventricular wall thickness. |
| Phillips RA, Fonseca V, Katholi RE, McGill JB, Messerli FH, Bell DS, Raskin P, Wright JT Jr, Iyengar M, Anderson KM, Lukas MA, Bakris GL. Demographic analyzes of the effects of carvedilol vs metoprolol on glycemic control and insulin sensitivity in patients with type 2 diabetes and hypertension in the Glycemic Effects in Diabetes Mellitus: Carvedilol-Metoprolol Comparison in Hypertensives (GEMINI) study. Journal of the CardioMetabolic Syndrome 10/2008; 3(4):211-217. | A demographic analysis of the effect of carvedilol and metoprolol on glycemic control and insulin sensitivity in patients with type 2 diabetes and hypertension. Data from the GEMINI study. | In patients with type 2 diabetes, carvedilol has a better metabolic effect than metoprolol. However, the study used metoprolol tartrate and not succinate. |
| Acikel S, Bozbas H, Gultekin B, Aydinalp A, Saritas B, Bal U, Yildirir A, Muderrisoglu H, Sezgin A, Ozin B. Comparison of the efficacy of metoprolol and carvedilol for preventing atrial fibrillation after coronary bypass surgery. International Journal of Cardiology 2008, 126(1):108-113. | Comparison of the effectiveness of metoprolol and carvedilol in preventing arterial fibrillation after coronary bypass surgery. | In patients undergoing coronary bypass surgery, carvedilol is better at preventing atrial fibrillation than metoprolol succinate. |
| Remme WJ, Cleland JG, Erhardt L, Spark P, Torp-Pedersen C, Metra M, Komajda M, Moullet C, Lukas MA, Poole-Wilson P, Di Lenarda A, Swedberg K. Effect of carvedilol and metoprolol on the mode of death in patients with heart failure. European Journal of Heart Failure 2007, 9(11):1128-1135. | Influence of carvedilol and metoprolol on the causes of mortality in patients with heart failure. | In patients with heart failure, carvedilol is better at reducing all-cause mortality than metoprolol tartrate, and especially stroke mortality. |
It is possible that competing beta-blockers are superior to metoprolol in efficacy. However, metoprolol succinate extended-release tablets also work well. Doctors are conservative. They are in no hurry to replace the drugs that they have long been accustomed to prescribing to patients with others. Moreover, metoprolol preparations have a relatively affordable price. In pharmacies, the demand for tablets Betalok ZOK, Egilok S, Metoprolol-Ratiopharm, if it falls, then slowly, or remains stably high.
Dosage of metoprolol for various diseases
Metoprolol is contained in tablets in the form of one of two salts - tartrate or succinate. They act differently, provide a different rate of entry of the active substance into the blood. Therefore, for fast-acting tablets of metoprolol tartrate, one dosing regimen, and for the "slow" metoprolol succinate - another. Please note that metoprolol tartrate is not indicated in heart failure.
| arterial hypertension | 50-100 mg once a day. If necessary, the dose can be increased to 200 mg per day, but it is better to add another antihypertensive agent - a diuretic, a calcium antagonist, ACE inhibitor. | 25–50 mg twice a day, morning and evening. If necessary, the dose can be increased to 100-200 mg per day or other drugs that lower blood pressure can be added. |
| angina pectoris | 100-200 mg once a day. If necessary, another antianginal drug may be added to therapy. | The initial dose is 25-50 mg, taken 2-3 times a day. Depending on the effect, this dose can be gradually increased to 200 mg per day or another angina medicine can be added. |
| Stable chronic heart failure functional class II | The recommended starting dose is 25 mg once daily. After two weeks of treatment, the dose may be increased to 50 mg once daily. Further - doubling every two weeks. maintenance dose for long-term treatment- 200 mg once a day. | Not shown |
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| Stable chronic heart failure III-IV functional class | It is recommended to start with a dose of 12.5 mg (1/2 tablet of 25 mg) once a day for the first two weeks. The dose is selected individually. After 1-2 weeks from the start of treatment, the dose may be increased to 25 mg once a day. Then, after another 2 weeks, the dose can be increased to 50 mg once a day. And so on. For patients who tolerate the beta-blocker well, the dose can be doubled every 2 weeks up to a maximum dose of 200 mg once daily. | Not shown |
| Heart rhythm disorders | 100-200 mg once a day. | The initial dose is 2-3 times a day, 25-50 mg. If necessary, the daily dose can be gradually increased to 200 mg / day or another agent that normalizes the heart rhythm can be added. |
| Supportive care after myocardial infarction | The target dose is 100-200 mg per day, in one or two doses. | The usual daily dose is 100–200 mg divided into two divided doses, morning and evening. |
| Functional disorders of cardiac activity, accompanied by tachycardia | 100 mg once a day. If necessary, the dose can be increased to 200 mg per day. | The usual daily dose is 50 mg twice a day, morning and evening. If necessary, it can be increased to 2 times 100 mg. |
| Prevention of migraine (headache) attacks | 100–200 mg once a day | The usual daily dose is 100 mg divided into two divided doses, morning and evening. If necessary, it can be increased to 200 mg / day, also divided into 2 doses. |
Note on the dosage of metoprolol succinate in heart failure. If the patient develops bradycardia, i.e., the pulse drops below 45-55 beats per minute, or the "upper" blood pressure is below 100 mm Hg. Art., then you may need to temporarily reduce the dose of the drug. At the beginning of treatment, there may be arterial hypotension. However, after some time, in many patients, the body adapts, and they normally tolerate therapeutic doses of the drug. Drinking alcohol increases the side effects of metoprolol, so it is better to abstain from alcohol.
How to switch to bisoprolol or carvedilol
It may happen that the patient will need to switch from metoprolol to bisoprolol (Concor, Biprol or another) or carvedilol. The reasons may be different. Theoretically, switching from one beta-blocker to another does not provide significant benefits. In practice, the gain may appear. Because the effectiveness and tolerability of drugs for each person is individual. Or the usual metoprolol tablets may simply disappear from the market, and they will have to be replaced with another drug. The table below may be helpful to you.
Source - DiLenarda A, Remme WJ, Charlesworth A. Exchange of beta-blockers in heart failure patients. Experiences for the poststudy phase of COMET (the Carvedilol or Metoprolol European Trial). European Journal of Heart Failure 2005; 7:640-9.
The table shows metoprolol succinate. For metoprolol tartrate in fast release tablets, the equivalent total daily dose is about 2 times higher. Bisoprolol is taken 1 time per day, carvedilol - 1-2 times a day.
Patient reviews
Metoprolol succinate extended-release tablets cause side effects much less frequently than fast-acting tartrate. Not surprisingly, reviews of controlled release drugs (Egiloc C, Betaloc LOK) are much more positive than fast-acting drugs in which active substance- metoprolol tartrate.
If you have high blood pressure and both prediabetes or type 2 diabetes, then you need to study and follow a type 2 diabetes treatment program. This technique normalizes blood pressure and sugar. The glucometer and tonometer will show you the first results in 2-3 days. All this without insulin shots, fasting and low-calorie diets.
Read the article "Causes of hypertension and how to eliminate them". Be examined, as it is written there, and then follow the recommendations for treatment. With a high probability, you will be able to maintain normal pressure without drugs, and you will not have to experience their side effects.
Heart problems do not occur due to a lack of metoprolol in the body. The real reason is the lack of nutrients that the heart needs for its work. First of all, it is magnesium and coenzyme Q10. Try taking these drugs along with a beta blocker. Surely you will feel better. Also pay attention to your diet. Switch from junk fast food to natural products. 
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Proven effective and cost-effective blood pressure supplements:
- Magnesium + Vitamin B6 from Source Naturals;
- Taurine from Jarrow Formulas;
- Fish oil from Now Foods.
Read more about the technique in the article "Treatment of hypertension without drugs". How to order hypertension supplements from the USA - download instructions. Get your blood pressure back to normal without the harmful side effects that Noliprel and other "chemical" pills cause. Improve heart function. Become calmer, get rid of anxiety, sleep like a baby at night. Magnesium with vitamin B6 works wonders for hypertension. You will have excellent health, to the envy of your peers.
Frequently Asked Questions and Answers
Below are answers to questions that often arise in patients taking metoprolol for high blood pressure and cardiovascular disease.
Metoprolol or Betaloc ZOK: which is better?
Betaloc ZOK is tradename medicines whose active ingredient is metoprolol succinate. It cannot be said that metoprolol is better than Betaloc ZOK, or vice versa, because they are one and the same. Betaloc ZOK is better than any tablet containing metoprolol tartrate. The reasons for this are detailed above. Metoprolol tartrate today can be considered an outdated drug.
Metoprolol or Concor: which is better?
In mid-2015, a study was completed that compared the effectiveness of metoprolol succinate and Concor (bisoprolol) in the treatment of hypertension. It turned out that both drugs equally lower blood pressure and are well tolerated. Unfortunately, there is no reliable information which of these drugs is better for patients with heart failure, coronary artery disease and angina pectoris. Which is better: Concor, Betalok ZOK or Egilok S? Leave the decision of this issue at the discretion of your attending physician. However, you should not take pills, the active ingredient of which is metoprolol tartrate. They are definitely worse than the drugs listed above.
Is metoprolol good for high blood pressure?
Metoprolol succinate helps with pressure no worse than other modern beta-blockers - bisoprolol, nebivolol, carvedilol. There is no reliable information which of these drugs is better than others. However, it is known for certain that metoprolol tartrate is an outdated medicine that is best not to be used. These tablets must be taken several times a day, which is inconvenient for patients. They cause significant jumps in blood pressure. It's bad for blood vessels. Metoprolol tartrate does not sufficiently reduce the risk of heart attack and other complications of hypertension.
If your doctor has prescribed you metoprolol for blood pressure, then take Betaloc ZOK or Egiloc C. As a rule, these drugs should be used together with other drugs for hypertension that are not beta-blockers. Taking multiple drugs at low doses is better than taking a single drug at a high dosage. Remember that the main treatment for hypertension is a healthy lifestyle. If you don't follow the recommendations for nutrition, physical activity, and stress management, soon even the most expensive pills won't work.
Can this beta-blocker and lisinopril be taken together?
Yes, metoprolol and lisinopril can be taken together as directed by your doctor. These are compatible drugs. Do not take any of the medicines listed in this article on your own. Find an experienced doctor to select the best high blood pressure medication for you. Before you are prescribed medication, you need to pass tests and undergo an examination. Revisit your doctor at least once every few months to adjust your medication regimen based on past treatment results.
I was prescribed the medicine metoprolol (Egilok C) for pressure. I started taking it - my eyesight fell and I often get up at night to go to the toilet. Also, ulcers appeared on the legs, they do not heal well. This side effects tablets?
No, Egilok tablets have nothing to do with it. Rather, you are exhibiting complications of type 2 diabetes. Read the article "Symptoms of Diabetes in Adults", then go to the laboratory to take blood sugar tests. If you have diabetes, treat it.
How quickly does blood pressure drop after taking metoprolol?
Tablets, the active substance of which is metoprolol succinate, act smoothly. They are not suitable if you need to quickly stop a hypertensive crisis. Preparations that contain metoprolol tartrate begin to lower blood pressure after 15 minutes. The full effect develops in 1.5-2 hours and lasts about 6 hours. If more is required fast remedy, then study the article "How to provide emergency care in a hypertensive crisis.
Is metoprolol compatible with ... such and such a drug?
Read the instructions for the drug you are interested in. Find out which group it belongs to. It can be a diuretic (diuretic), an ACE inhibitor, a blocker angiotensin-II receptors, a calcium antagonist (calcium channel blocker). Metoprolol is compatible with all the listed groups of drugs for hypertension. For example, you are interested in Prestarium. In the instructions, find that it is an ACE inhibitor. Metoprolol is compatible with it. Indapamide is a diuretic. You can also take it with him. And so on. Usually, patients are prescribed 2-3 drugs for pressure at the same time. Read more in the article "Combined drugs for hypertension - the most powerful".
Metoprolol is a beta blocker. Do not take two beta-blockers at the same time. Therefore, do not take it together with bisoprolol (Konkon, Biprol, Bisogamma), nebivolol (Nebilet, Binelol), carvedilol, atenolol, anaprilin, etc. In general, you should not take two drugs for hypertension at the same time, which belong to the same group.
How high is the risk that psoriasis will worsen from taking Egiloc C or Betaloc ZOK?
No higher than other modern beta-blockers. There are no exact data in the literature.
I have hypertension due to nervous work, frequent scandals. The doctor prescribed metoprolol. I read that one of the side effects is depression. And I'm all on my nerves. Should I take these pills?
depression and nervous excitement are opposites. Depression is powerlessness, apathy, melancholy. Judging by the text of the question, you are experiencing the opposite emotions. It is likely that taking metoprolol will have a sedative effect, and this will benefit you.
Metoprolol lowered blood pressure, but my hands and feet began to get cold. Is this normal or should I stop taking it?
Hands and feet become cold - this is a common side effect of beta-blockers, including metoprolol. If you feel that the benefits of taking the medicine are greater than the harm from its side effects, then continue taking it. If you feel unwell, ask your doctor to select another drug for you. Keep in mind that taking beta-blockers in the first week may make you feel worse, but then the body adapts. So it's worth waiting a while if the "upper" pressure remains above 100 mmHg. Art. and the pulse does not fall below 55 beats per minute.
The doctor advised me to replace the hypertension medicine Metoprolol-Ratiopharm with the more expensive Betaloc ZOK. Is it worth it?
Yes, it's worth it. The active ingredient of Ratiopharm's drug is metoprolol tartrate, and Betaloc ZOK is succinate. The difference between them is detailed above. You are unlikely to feel how much better a new drug protects you from a heart attack. But you will surely like that now the pills can be taken only once a day. Your blood pressure will become closer to normal, its jumps during the day will decrease.
conclusions
Metoprolol is a worldwide popular pill for high blood pressure, coronary heart disease (angina pectoris), heart failure and arrhythmias. The article gives all the information about this medicine that doctors and patients may need. Links are also provided to primary sources - the results of clinical studies, for in-depth study.
To date, only metoprolol succinate, sustained release tablets, is recommended for use. This remedy is enough to take 1 time per day. Medicines, the active substance of which is metoprolol tartrate, should be taken 2-4 times a day. They are inferior in effectiveness to other beta-blockers and are worse tolerated. If you are taking them, then discuss with your doctor if you should change to some other drug.
Perhaps bisoprolol, carvedilol and nebivolol help patients better than metoprolol succinate and even more so tartrate. This is proven by the many articles that have appeared in medical journals since the mid-2000s. However, Betaloc ZOK and Egiloc S tablets are in no hurry to give up their market share to competitors. Because doctors have been prescribing these drugs for a long time, they know their effects well and are in no hurry to give them up. Moreover, metoprolol preparations have a more attractive price compared to other beta-blockers.
- Beta blockers: general information
- Diuretic drugs
- Hypertension medications for the elderly
Angioscan - if there is nowhere to spend money
With the growing distrust of domestic medicine, the number of "enterprising" people who are trying to completely legally mislead patients by creating useless devices with a completely scientifically based principle of operation is also growing. It is obvious that Angioscan is one of such devices.
What is Angioscan?
In fact, it is long thought up and implemented in medical practice instrument is a pulse oximeter. Not a single modern intensive care unit can do without it, you probably saw it in the movies - such a clothespin on your finger. This "clothespin" is really capable of determining several basic characteristics of the pulse (its frequency, speed and filling), as well as blood oxygen saturation, but this is where its capabilities end. The pulse oximeter is mainly used in intensive care and intensive care units to monitor cardiopulmonary activity in critically ill patients.
Our "scientists" came up with the idea of putting this "clothespin" on a healthy person and called it Angioscan.
It should be noted that the idea of using a pulse oximeter for diagnostics is quite interesting and not devoid of common sense, why not? A complex computerized statistical analysis technique was developed to determine dozens of associated parameters. But when it became clear that all these completely existing data are useless for the doctor and the patient and are of purely scientific interest, the project had to sink into oblivion. After all, diagnostic methods are not created in order to exist just like that, but in order to provide information that could be used in practice. But someone decided that the device can be moved to the masses, endowing it with "useful" qualities.
In our country, many doctors and private clinics can be interested in promoting the apparatus for material or other benefits. The main thing is to correctly present information about the device: a few small, own studies with a known result, which will give it the right to life. The patient should be given to understand that without this device it is simply impossible to live. The device also needs to be certified, “fortunately” this is not very difficult, since it is unlikely that the inspection authorities will refuse to certify a conventional pulse oximeter complete with a microcomputer. After all, not everyone knows that certificates do not always guarantee that the device is useful, but only that it is harmless and safe. But in order not to be unfounded, I will tell you in detail about all those declared qualities of angioscan in order.
Information from the official website of the developer about what can determine the angioscan.
Arterial wall stiffness – arterial stiffness is believed to be associated with increased cardiovascular risk, that's right. But there is another long-known fact that the stiffness of the arteries increases with age and the older the person, the higher his risk of dying. In order to understand this, do we need some kind of device? Besides, there are no methods to reduce the stiffness of the arterial wall, so why do we need to know this stiffness?
But it is known that the stiffness of the arterial wall is always higher in patients suffering from coronary artery disease or hypertension, but at the same time, stiffness does not affect the diagnosis in any way, since it cannot either confirm or exclude a particular disease. In addition, it is also impossible to influence this rigidity.
elasticity of the aorta. The aorta is the same artery, only larger, which undergoes changes with age. In the elderly and patients with atherosclerosis, its elasticity is lost, this can be seen on ultrasound of the heart or some features of blood pressure.
The tone of small resistive arteries - for example, can be determined, but just like with the stiffness of the arteries, it is not clear why this is needed.
The value of central arterial pressure, pressure in the aorta - pressure in the aorta can be determined indirectly only by means of ultrasound with Dopplerography, and then very approximately. This indicator has no practical application.
The principle of operation of the pulse oximeter is based on measuring the capillary pulse by shining a finger with a bright light source. When pulsating, small capillaries either fill with blood or empty, as a result of which the fingertip passes either more or less light, which is picked up by a special sensor from the opposite surface of the finger. As you know, the diameter of the capillaries is only 0.01-0.02 millimeters (!), And the aorta is up to 40-50 millimeters. It is not difficult to guess that it is possible to reliably determine the pressure in the aorta by capillary pressure only mathematically, because the diameter of these vessels differs by tens of thousands of times. To do this, you need to use mathematical or physical formulas with coefficients that a priori cannot be the same for different people, because we are not talking about a water pipe, but about a complex, changeable biological system.
The state of endothelial function in the area of small resistive arteries (microcirculation system) and large arteries of the muscular type - at present, the detection of endothelial dysfunction is possible only by determining the level of "endothelin 1" in the blood. At the same time, you are unlikely to find a laboratory nearby that deals with the determination of endothelin 1, and not only because it is an expensive pleasure, but because it is of purely scientific interest. If Angioscan is able to determine dysfunction, then indirectly and very approximately with an error of "plus or minus bast shoes". Most likely, this method is based on how the vessels react to a short-term "light stroke". It's interesting, but nothing more.
The ability of endothelial cells to synthesize nitric monoxide, the most powerful anti-atherogenic agent, is hard to believe, but, for example, a healthy, young or elderly person who was examined on an angioscan will be at the reception and it will be revealed that endothelial cells synthesize nitric oxide poorly . It would never occur to a sane doctor to prescribe him some kind of treatment, and the fact that in sick people this indicator will be bad anyway is beyond doubt. It can be hypothesized that this parameter may even be derived from the stiffness of the artery - the stiffer the artery, the older the patient and the worse he produces nitric monoxide.
The duration of systole, the duration of the expulsion of blood by the left ventricle is a brilliant development, if not for the fact that no one uses this indicator anywhere, because it has no practical application. But if anyone is very interested, then the same can be done using a conventional phonendoscope or pulse palpation.
Amplitude and time ratios of early and late systolic waves - well, everything is clear here, because it is written for patients - long, abstruse and not clear. Even a specialist cannot understand what is at stake. This phenomenon is not described in any of the existing recommendations of the world, and even more so, what should be done by the doctor or the patient in case of violation of this very ratio. Probably, a hotel device will soon appear that will interpret this indicator for the layman.
The augmentation index (the contribution of the late or reflected wave to the value of pulse pressure) - for those who understand what was discussed in the previous paragraph, it will not be difficult to understand this. Everything is very clear. But seriously, this augmentation is a maximum of scientific interest for some regular meaningless dissertation.
Saturation index (saturation of hemoglobin with oxygen) - or oximetry, this is the pure truth, this pulse oximeter can. The indicator is certainly important, according to the level of saturation, resuscitators usually determine when it is necessary to connect the patient to the ventilator ( artificial ventilation lung) and the effectiveness of its implementation. Saturation is determined by determining the color of the fingertip, you probably know that when a person suffocates, he turns blue. A pulse oximeter or angioscan captures shades of red and of blue color thus determining blood oxygen saturation. In general, if you breathe, you don’t have shortness of breath at rest and, God forbid, you don’t turn blue, then you can understand for yourself that everything is in order with saturation.
To determine the stress index, to check the efficiency of the baroreceptor center is another notion of the creators of angioscan, nothing useful can be learned from this. Usually, the work of the baroreceptor center is checked by pressure and pulse in the standing, lying and sitting positions. The need for such a check with a doctor occurs every few months.
Find out the age of the vascular system - you can still go to a fortuneteller and listen to the cuckoo. Imagine that a person is 45 years old, and the device showed 55, all that remains is to go and drown himself. Or a person is 70, and the angioscan showed 55, you can stop drinking pills, maybe you will be a couple more years younger.
Check the correctness of the therapy, and what effect they have on cardiovascular system drugs and biological supplements (BAA) prescribed to the patient. With arterial hypertension, treatment is monitored by measuring blood pressure, with coronary heart disease (CHD) - by the disappearance of chest pain, a decrease in edema and shortness of breath, as well as a decrease in cholesterol and glucose levels, electrocardiogram dynamics, etc.
But about dietary supplements - this is a brilliant marketing notion, at a time when traditional medicine treat dietary supplements, to put it mildly, with caution, this medical device, it turns out, can evaluate the effectiveness of their action. And here it turns out that the creators and doctors who promote angioscan are not at all against dietary supplements, but even welcome their use. This calls into question if not the competence, then the sanity of these doctors. Dietary supplements are a separate issue.
Conduct a breath test - spend on health, just that it will make it difficult to understand. If you breathe often - the saturation will be greater, hold your breath - it will decrease.
Warn the patient about the possibility of developing cardiovascular diseases before they begin to develop. Why are doctors worse than angioscan in this regard? After 50-60 years, the likelihood of heart disease increases and every second or third person has something to be found. Come to the appointment every year, starting at the age of 45, and they will also be able to warn you in time. And then, after all, how our people act: they endure 3-5 years, and then they are brought in by ambulance.
Early detection of the possibility of kidney problems and endothelial dysfunction in the last third of pregnancy. In order to "check the kidneys" you need a urine and blood test and nothing more, if the problem is serious, it will be identified.
As you can see from the volume of this article, Angioscan is capable of a lot, but it is difficult to single out at least one indicator from all of this that could be used in practice to improve the health and quality of life of patients.
the only positive side of this device is that a patient with a cardiovascular disease and a disregard for himself will finally come running to a doctor if bad results are detected according to the angioscan data. I agree that this is not enough and can overshadow all the rest of his "useful" qualities. But the opposite situation may also arise - a young, healthy, but very hypochondriac patient will decide that he is terminally ill, and the doctors will not be able to do anything about it.
Finally, one piece of advice: if you are nevertheless offered to be examined on an angioscan, ask your doctor how this examination will affect your treatment or diagnosis. Treat such devices with care.
You have the information, but the decision is yours.
This article is the personal opinion of Dr. Lieberman.
