RESUMEN
The data collected by Burdenko Military Hospital indicate that in the 1980s hypertensive crisis (HC) occurred in roughly 30% of the patients with AH. This value fell down to 16% by 2012, with a rise in the number of uncomplicated crises from 46 to 62%. Analysis of the causes behind these changes showed that half of the patients simply experienced an elevated arterial pressure with minimal clinical symptoms. The decrease in the number of complicated cases from 54 to 39% is doubtful bearing in mind that ICD-10 gives the status of nosological entities to complications of hypertensive crisis (stroke, myocardial infarction, etc.) but not to the HC syndrome proper requiring urgent hospitalization; due to this hypertensive crisis itself tends to be disregarded and not included in statistics. HC with acute clinically significant lesions of target organs requires intensive care or resuscitation using infusion of vasodilators and loop diuretics to stabilize arterial pressure. In case of uncomplicted HC and aggravation of hypertensive disease, the medications of choice are oral short-acting ACE inhibitors and imidazoline receptor agonists.
Asunto(s)
Antihipertensivos , Cuidados Críticos/métodos , Hipertensión Maligna , Infarto del Miocardio , Accidente Cerebrovascular , Anciano , Antihipertensivos/clasificación , Antihipertensivos/farmacología , Presión Sanguínea/efectos de los fármacos , Femenino , Hospitalización , Humanos , Hipertensión Maligna/diagnóstico , Hipertensión Maligna/fisiopatología , Hipertensión Maligna/terapia , Masculino , Persona de Mediana Edad , Infarto del Miocardio/etiología , Infarto del Miocardio/prevención & control , Evaluación de Resultado en la Atención de Salud , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/prevención & controlRESUMEN
The authors analysed clinical, radiological and laboratory aspects of respiratory tract sarcoidosis in servicemen, analysed the quality of life, correlation analysis to determine the risk factors for relapse of the disease. It was found that respiratory tract sarcoidosis of I and II stage was diagnosed in 85.5% of servicemen; in 72% of servicemen prevails asymptomatic course of a disease. Despite the prevalence of asymptomatic forms of the disease, the quality of life of servicemen with sarcoidosis has reduced. The factors associated with recurrent disease: age > 35 years; the presence of clinical manifestations; forced vital capacity < 85% of predicted values; systemic glucocorticoid therapy in history. Designed range forecast recurrent course of sarcoidosis in young patients having a high predictive value.
Asunto(s)
Personal Militar , Sarcoidosis Pulmonar/diagnóstico , Sarcoidosis Pulmonar/tratamiento farmacológico , Sarcoidosis Pulmonar/fisiopatología , Adulto , Factores de Edad , Femenino , Humanos , Masculino , Pronóstico , Calidad de Vida , Factores de RiesgoRESUMEN
Emergency state of health by arterial hypertension. According to the Burdenko Main Military clinical hospital at the present time the frequency of crisis hypertensive heart disease is 16% from the total number of all patients with this nosology. Rapid relief of hypertensive crisis should be provided for patients' status assessment from the position of development of fatal complications. Herewith the main task when treating hypertensive crisis is not normotension, but reduction of blood pressure to safe level, taking into account potential risk of hypotonia and hypoperfusion in case of too aggressive hypotensive therapy. The main factor of hypertensive crisis development is the absence of compliance. The authors gave recommendations on treatment of complicated and non-complicated forms of hypertensive crisis, and provided indications for hospitalization.
Asunto(s)
Presión Sanguínea , Servicios Médicos de Urgencia/métodos , Hipertensión/fisiopatología , Hipertensión/terapia , Servicios Médicos de Urgencia/organización & administración , HumanosRESUMEN
Resistant hypertension occurs in up to 15% of patients with arterial hypertension in Russia. Medical treatment of resistant hypertension must include minimum 3 medications with maximum or maximum tolerated doses besides one of the medications must be diuretic. According to department of arterial hypertension of the Burdenko Main Military Clinical Hospital to achieve the target levels of arterial blood pressure it was necessary to prescribe 4-5 components antihypertension therapy in patients. Authors suggested an algorithm of diagnosis and treatment of patients with resistant hypertension with the help of surgical method. This method is based on decreasing of sympathic nervous system activity by selective break of neuronal connections with the help of interventional intravascular radio-wave ablation. Endovascular renal sympathetic denervation allows to effectively control arterial blood pressure, to optimize antihypertensive therapy, but this method does not cure from arterial hypertension.
Asunto(s)
Algoritmos , Antihipertensivos/uso terapéutico , Hipertensión/diagnóstico , Hipertensión/tratamiento farmacológico , Humanos , Hipertensión/sangre , Hipertensión/patología , Hipertensión/fisiopatología , Relación Normalizada Internacional , Riñón/inervación , Riñón/metabolismo , Riñón/patología , Riñón/fisiopatología , Sistema Nervioso Simpático/metabolismo , Sistema Nervioso Simpático/patología , Sistema Nervioso Simpático/fisiopatologíaRESUMEN
The prevalence of refractory arterial hypertension in Russia is estimated at 15%. We report the first experience with surgical treatment of this pathology. The method is based on the reduction of activity of the sympathetic nervous system by selective breaking of connections between of neurons with the help of interventional intravascular radiowave ablation. Renal endovascular sympathetic denervation allows to more effectively control AP and optimize antihypertensive therapy but does not ensure recovery from AH.