Arterial hypotension

Arterial hypotension is characterised by clinical depression of arterial pressure below 100/60 mm hg For persons aged till 25 years and below 105/65 mm hg For persons is more senior 30 years.

Etiology and Pathogenesis

In modern clinical practice distinguish hypotensions physiological and pathological: though accurate border between them to spend it is not possible. The physiological arterial hypotension caused in basic constitutional and hereditary factors, meets quite often at absolutely healthy humans performing usual physical work, and is not accompanied by any complaints and pathological changes in an organism. The physiological hypotension of passing character at sportsmen is known.

Pathological hypotension is sectioned on primary and secondary (symptomatic), in each of which excrete acute and chronic forms. The neurocirculatory dystonia on a hypotonic type in essence is a hypotension synonym (or a primary arterial hypotension).

At the heart of a primary arterial hypotension rising of a tonus of parasympathetic part of vegetative excitatory system, disturbance of function of the higher vegetative centres of the vasculomotor regulation, conducting to nonperishable reduction of the general peripheric resistance to a blood flow lays. The compensatory augmentation of warm outlier in these cases appears insufficient for normalisation of arterial pressure. Rate of a blood flow at a primary chronic arterial hypotension usually it is not variated. The volume of circulating blood is in limens of norm or is a little lowered: sometimes there is a predilection to an euvolemic polycythemia.

Specified alterations are caused most likely by distinct reduction of cash and reserve glucocorticoid activity of a cortex of adrenals at not variated mineralocorticoid activity.

Egestion with adrenaline urine is authentically lowered, and Dofaminum - is raised. Electrolytic alterations (the tendency to a hyperpotassemia and a hyponatremia have certain value also at some enlarged egestion with urine of ions of sodium and reduced - potassium ions.

The major importance in hypotension occurrence, apparently, belongs to a long psychoemotional strain, on occasion - a mental trauma. On modern representations, the primary hypotension is the special form of a neurosis of the higher vasomotor centres with disturbance of regulation of a vascular tonus.

Clinical Picture

Complaints of patients are extraordinary various and numerous (slackness, apathy, sensation of sharp delicacy and fatigability in the mornings, the lowered working capacity).

Often the sensation of shortage of air in rest and the expressed dyspnea becomes perceptible at moderate physical work, edemas of anticnemions and autopodiums by the evening. At the majority of patients irritable emotional instability, disturbance of a sleep, a potency and a libido at men and a menstrual cycle at women become perceptible. Heavy feelings quite often join it in epigastric range and bitterness in a mouth, appetite depression, an eructation air, a heartburn, a meteorism, constipations.

On the basis of prevalence of pains in the field of heart or headaches distinguish mainly cardial or cerebral form of a primary arterial hypotension.

In difference from a stenocardia attack at a primary arterial hypotension stupid, pricking or aching (is much rarer pressing or compressing) the pain is localised basically in the field of a heart apex, does not irradiate, appears usually in rest or in the morning, after a sleep (occasionally at an excessive exercise stress). The pain proceeds some hours, is not stopped by antianginal agents (Nitroglycerinum application, on the contrary, worsens a condition of the patient) and taken out sometimes after easy physical exercises.

The habitual headache sometimes is the unique complaint of the patient, arises after a sleep (especially diurnal) or physical or mental work, (up to sensation of exhaustion). The stupid, pulling together, arching or pulsing headache grasps more often frontotemporal or parietofrontal range and proceeds from several o'clock till 2-3 days.

Periodic giddinesses with hypersensitivity to bright light, hum, loud speech and tactile stimuluses, a staggering are not less characteristic for a primary arterial hypotension at walking and syncopal conditions.

At a number of patients the position hypotension is observed. So, at transition from horizontal position in the erect the orthostatic or postural hypotension with sharp falling of mainly systolic arterial pressure and a loss of consciousness educes. In horizontal position the consciousness is quickly recovered.

In the first 8-12 weeks and in last trimester of pregnancy at the women, suffering the primary arterial hypotension, quite often observes an acute arterial hypotension in position on a back. Development of this syndrome is bound to a prelum the enlarged uterus of the inferior vena cava in position of the woman on a back.

At objective research at the majority of patients those or other vegetative disturbances are taped: a hyperhidrosis of anticnemions and autopodiums, a tremor of eyelids and dactyls of arms, pallor of a skin with an easy Crocq's disease, a nonperishable red dermographism and disorders of a thermoregulation with the expressed daily fluctuations of a body temperature and its falling in the mornings more low 36.

At acute depression of arterial pressure development Meniere's disease - epileptiform attacks and diencephalic paroxysms with a fever or abundant cold then, distinct paresthesias in extremities, imperative desires to an emiction and instability in a Romberg's position is possible, at some patients largly wide nystagmus thus becomes perceptible.

Arterial pressure and sphygmus are very labile and conditions of the patient depend on position of a body, time of days. Practically at all patients stable depression of arterial pressure in a humeral artery takes place.

Heart borders usually are not variated, however probably small augmentation of the dimensions of its relative dullness basically for the account of dilating of a left ventricle. Over a heart apex the muting of 1st tint, sometimes easy systolic hum is defined.

Electrocardiographic data testify in some cases to a deflection of an electrical axis of heart to the left, a low voltage of a teeth and a sinus bradycardia.

Data of laboratory researches do not leave, as a rule, for norm limens. Only the small part of patients has a predilection to a moderate anaemia, a leukopenia with a lymphocytosis and ESR retardation. The tendency to a lipidemia, insignificant augmentation level of a filtrate nitrogen, a hypercholesteremia is possible also at the normal maintenance B - lipoproteins, to reduction of coagulabling ability of blood, depression of indicators of standard metabolism.

Differential diagnosis

Primary and secondary arterial hypotensions differentiate by an exception of the various pathological processes conducting to nonperishable depression of arterial pressure.

Treatment

Treatment of a chronic arterial hypotension assumes first of all performance of some hygienic actions. Them concern:

1. an accurate regimen of day (a night sleep not less than 8 hours, morning and industrial gymnastics, water tonic procedures)
2. correct organisation of work
3. high-grade and various four single food

The big diffusion to hypotension treatment have received vegetative and biological neurostimulator which the Eleuterococus extract, magnolia-vine tincture, Extractum Rhodiolae fluidum concern Pantocrinum, Tinctura Araliae, tinctura echinopanacis.

They are recommended to be prescribed a place with tincture from Valeriana root. Efficacyy of a combination of an Eleuterococus with Pantocrinum is noted. The positive effect gives application of Saparalum, caffeine (on 0,05 - 0,1gm. 2-3 times a day).

It is necessary to notice, that at headaches at sick of an arterial hypotension analgetics are ineffective, while at reception of caffeine and horizontal position of a pain decrease or disappear.

In refractory cases use Phethanolum on 1gm. 1 % of solution subcutaneously or inside on 0,005 gm 2-3 times a day; Securininum on 1gm 0,2 % of solution subcutaneously or inside on 0,002gm 2-3 times a day.