Arterial hypertension in adolescents. What to consider arterial hypertension in children. Forms of children's hypertension

Unfortunately, hypertensive disease is increasingly diagnosed at a young age. Conducted by this worsening ecology and food. Hypertension in adolescents can be a consequence of various factors of both external and internal. The condition is quite dangerous and requires careful control by the specialist.

Just as in the elderly, the disease appears due to violations in the heart and vascular system. Most often, such a state is celebrated in smoking adolescents and drinking alcoholic beverages. Because of the harmful habits, the metabolism is disturbed, the nervous system is suffering, and the vessels and the heart muscle are weakened.

In addition, adolescents have periods when the organism is restructuring. At this time, a hormonal imbalance is possible, and this often leads to an increase in blood pressure. If the young man or a girl does not abuse harmful habits, the change in blood pressure indicators can occur due to frequent experiences, for example, at school or college.

Main reasons

Hypertension in children and adolescents can be primary. It most often becomes a consequence of genetic predisposition, and secondary - appears against the background of various pathological processes.

The main factors that may affect the development of hypertensive disease is:

• Disorders of the emotional background (stress, experience, nervous overvoltage);
• Diseases of internal organs (liver, kidneys, thyroid gland, heart, vessels);
• Reception of any drugs that increase the pressure;
• Excess body weight, improper nutrition, receiving harmful food;
• Heavy brain injuries or spinal spinal;
• Alcohol abuse, tobacco and narcotic substances.

A sedentary lifestyle often causes congestion phenomena in the body and leads to dysfunction of the cardiovascular system. This, in turn, leads to a violation of blood pressure and cardiac rhythm.

Note. The transition age begins on average from 14 to 18 years. At this time, it is important to follow the mental state of the child, and in the case of violations of the nervous system, take all necessary measures to eliminate the problem. This will help to avoid the development of pathologies associated with the heart and nervous system.

Risk factors

Most pathologies are subject to children who have genetic predisposition and adolescents leading the wrong lifestyle. Also, the disease is often diagnosed in girls and boys, which are very impressionable and painfully react to everything that happens around them.

In addition, teenage hypertension arises in young patients leading a low-effective lifestyle and eating, which leads to overweight. In the period of growth, children need careful supervision and adjustment of lifestyle.

1. Products must be rich in vitamins and useful trace elements.
2. From drinks it is better to use compotes, homemade juices and fruit-berry decoctions.
3. The time of full sleep should not be less than 8 hours.
4. It is important that the child engaged in active sports or at least a daily charge.

The most important thing is moral support. The child should feel support for the parents, since only in this case can be achieved by moral equilibrium and prevent nervous disruptions. Calm and mental harmony is the best prevention of cardiovascular diseases.

Clinical picture of the disease

The clinical picture is practically no different from the one that is characteristic of arterial hypertension in adults. In adolescence, pathology may be accompanied by:

• Regular headaches;
• Sleep and breathing disorders;
• Frequent nausea and ailment;
• Increased overwork;
• Frequent change of mood;
• Dream in the eyes with a sharp change of body position.

Headaches with hypertensive disease are most often localized and / or the patterns. In such a state, antispasmodics are able to weaken pain syndrome, but not long. So far, the main pathology will not be eliminated, poor well-being will be pursued by the child.

Methods for diagnosing teenage hypertension

To establish an accurate diagnosis as quickly as possible, the doctor appoints a number of diagnostic procedures. As a rule, this is:

• General blood and urine tests;
• Blood chemistry;
• Daily monitoring of blood pressure;
• Heart ultrasound and / or kidney;
• Electrocardiogram and / or echocardiogram.

Specific research can be assigned to evaluate the vascular system, including dopplerography. Also, the teenager can be sent to a counseling to a neurologist, an endocrinologist and other narrow-profile specialists.

Features of the treatment of teenage hypotension

If pathology proceeds in easy form and there are no structural changes of any internal organs, doctors prefer to treat disease:

• Medicinal physical education;
• and the exception of salt from the menu;
• Adjusting the mode of sleep and rest;
• The exception of harmful factors;
• Adopting a contrast soul and soothing baths.

In the case of a disease that arose against the background of experiences, it will be technically the reception of tinctures and decoctions prepared on the basis of the root of valerian or dyeing. Useful will be the use of rosic tea and brakes from herbs, for example, sage, donel or yarrow. It is better to eat more fruits and vegetables from products. You can make salads or fresh juices.

Proper nutrition - excellent disease prevention

With hypertensive disease, salty and fatty food is harmful, so it needs to be excluded. From sporting events more likely running and / or swimming. These sports help strengthen the heart, vessels and the whole organism as a whole. It is important to devote more time to sleep and rest, and it is also necessary to exclude a sedentary lifestyle.

Medical therapy

In adolescence, some hypotensive drugs bring more harm than good. Therefore, the selection of the therapeutic course can only be carried out by the doctor. Medicines are discharged depending on the complexity of the pathology and age of the patient.

Most often for teenagers are assigned:

1. Means for eliminating excess fluid from the body (in case of sequity).
2. Medicines from a group of soothing drugs.
3. Preparations for the normalization of the cardiovascular system and pressure reduction (ACE inhibitors, beta-adrenoblays, calcium antagonists).

Treatment with these medicines begins with minimal doses. As a rule, they are 2 times less than for patients of mature age. If the therapeutic effect does not give the necessary results, then the doses can be increased, but only in coordination with the attending physician.

Important! Self-treatment is strictly prohibited. Overdose of medicines and their irregular selection leads to a deterioration in the state of the child, and the drop of blood pressure to life-threatening indicators.

Forecasts will be favorable only if the child will begin treatment when the first symptoms are found, characteristic of adolescents. In this case, preventive measures are most often help. If you launch pathology, then the heart and vessels weaken the day after the day, which leads to serious complications and the transition of the disease in a chronic form.

Arterial hypertension in children - the phenomenon is quite common in the modern world. It is noted in third cases upon admission to the reception or ordinary medical examinations. But what are its causes and symptoms at different stages - few people know. And this is important, because with timely detection of the problem, you can start an effective treatment and give a child a healthy future.

Causes of children's hypertension

More than two third cases in children are observed by secondary hypertension, which is a symptom of a concomitant disease.

These diseases include:

• stenosis of kidney vessels, aortic stenosis or pulmonary arteries;
• thromboembolism of kidney vessels;
• inflammatory changes in various kidney anatomical structures;
• diseases of kidney parenchymal etiology.

The cause of secondary hypertension in children and adolescents can also be inflammatory diseases of the vessels, diseases of endocrine glands and connective tissue.

Among them are distinguished:

1. Tumors of the brain part of the adrenal cortex.
2. Diseases of thyroid and parathyroid glands.
3. Diseases of pituitary and epiphyse.

Arterial hypertension as an independent disease occurs much less frequently secondary form. This diagnosis is called only after a deep differential diagnosis with secondary hypertension.

The development of an independent form of the disease is taken to communicate with some important reasons, among which they call:

• severe genetic heredity;
• constant stressful situations;
• long depression;
• existence of excess weight;
• various metabolic disorders;
• abnormal reception of certain drugs.

It is also possible to increase the pressure in adolescents as a result of a puberty period, which does not bear much danger.

Symptoms of increased pressure in children

Hypertensive disease in children may have different symptoms that directly depend on the stage of the disease.

In this regard, at the first stages of the disease, the following symptoms can be observed:

• the pressure rises from 115 mm Hg. Art. up to 145 mm. RT. Art.;
• the occurrence of headaches;
• frequent fatigue;
• impairment of vegetative functions;
• increase body weight.

Over time, the symptoms of the disease are enhanced, since hypertension progresses and moves in recent stages.

This is expressed in the following signs:

• children have a quick fatigue;
• they constantly feel bad;
• migraines are becoming more frequent;
• periodic dizziness and memory dysfunction are observed;
• the level of attentiveness is reduced;
• hypertension indicators can increase to 160 mm Hg. Art.;

• pains in the chest, tachycardia appear;
• they observe the displacement of the hearts of the heart closer to the sternum, the second tone becomes clearer.

In the renal genesis of hypertension, you can see a persistent increase in pressure indicators. The effect of the treatment of hypertension in this case is extremely low, while the mortality rate is high enough.

Hypertension in children and adolescents can flow smoothly, but often there are rapidly progressive cases. This is called a hypertonic crisis.

It is characterized by the formation of three major symptoms:

1. The rapid development of disorders of the structures of the brain, which are accompanied by a headache, gastralgic symptomatomy, loss of vision and consciousness, as well as frequent attacks of seizures that may be caused by increased pressure in a teenager.
2. The lightning development of acute heart failure, which is accompanied by an ethnic hypertension.
3. Very rapid development of renal failure with Anuria, hematuria, proteinuria and other symptoms.

The residual diagnosis of "arterial hypertension" doctors post after three measurements of pressure indicators, in which both numbers are above 95 mm RT. Art., While the hypertension in infants is placed on the basis of numbers, which are above 85 mm Hg. Art.

There is also a table that contains numbers whose indicators are bordered with hypertensive disease. Children from seven to nine years have discovered increased pressure with indicators above 125/75 mm RT. Art.; In children from ten to thirteen years above 130/80 mm Hg. Art.; High pressure in the adolescent indicate indicators that are higher than 135/85 mm Hg. Art.

To confirm the diagnosis, it is necessary to conduct daily measurements of the blood pressure, the samples of the physical and emotional load for the creation of high pressure, among which the cyergometry and teleigrue are isolated.

Also carry out an electrocardiogram, an echocardiogram, examine the kidneys, heart, light, brain, determine the degree of their functioning. Examination of the work of endocrine glands is also necessarily in this case.

Differential diagnosis is carried out between the primary and secondary form of the disease. This is necessary to select the correct strategy of therapy.

Therapy and disease prevention

The treatment of hypertension in adolescents and children is often carried out without drug therapy.

In this case, you need:

• try to avoid stress and depressive states;
• it is less time to carry out the computer and TV;
• pour it right, eliminate fat and fried food;
• lead a healthy lifestyle;
• it is more common to spend time outdoors.

The therapy of vegetative violations is physiotherapy, therapeutic massage, mud baths and reflexotherapy. Also use phytotherapy.

But if these treatments did not meet expectations, doctors can resort to therapy with medicines.

For this, there are the following drugs:

• beta adrenoblockers (metaprolol, pindolol, atenolol);
• preparations that inhibit ACE (Enalhold, Captopril);
• preparations that block angiotensin receptors (Losartan);
• mesrechonny (puposide, dichlotiazide);
• means that are calcium antagonists (nifedipine).

Also for treatment it is necessary to ensure peace and appoint a course of soothing drugs. For the prevention of hypertension, you need to conduct a healthy lifestyle, have the right routine of the day and eat well. It is also necessary to avoid stressful situations in the family.

Hypertension in children

Increased blood pressure is considered an adult disease. However, in recent years, the number of children and adolescents with high pressure is growing. Hypertensive disease in children is a serious illness that requires the close attention of parents, responsible treatment and care.

Children's hypertension

Normal toddler pressure up to 7 years is 90/55 mm mercury post. An increase in top level means that the choroid system of the child is susceptible to the disease.

Hypertension in a child can manifest itself in the first months or after 10 years - it is impossible to predict in advance. You can try to establish the exact cause of the disease, determine the type of hypertension - it happens primary and secondary.

Primary occurs without a reason, without congenital vices. It is easy to suppress, tracking the change in pressure against the background of the emotional state of the child and physical exertion. Parents must give the baby to the maximum amount of attention, adjust the joint pastime.

Secondary is related to chronic pathologies. Treatment and prevention directly depends on the overall and private etiology of the disease - the reasons for its appearance:

• endocrine diseases of the thyroid gland and adrenal glands, weakening the immune system of the body;
• vegeta dystonia, often affecting the heart. The negative effect is enhanced by the overdose of drugs;
• excess weight. Hypertension in a child with a high probability will manifest itself in the future: the toddler pressure, prone to obesity, is always high.

The reason is often bad heredity - the disease is transmitted from close relatives.

Infants, especially premature, are necessary to finish with breast milk as much as possible. Milk forms and strengthens the immune, mental system. Hypertension in a older child is manifested due to a low-propelled lifestyle, excessive mental loads - parents need to follow the past pastime.

Children of all ages need to periodically measure pressure. Breast kids are better to lead to the clinic - an ultrasonic tonometer installed in medical institutions will give more accurate readings. It is necessary to apply prophylactic actions during pregnancy, even before conception is the responsibility of future parents. It is necessary to attend medical examinations, lead a healthy lifestyle, avoid severe stress. Hypertension in adolescents and children directly depends on the health and mental state of the parents.

Teenage hypertension

Teenage pressure after 17 years in terms of indicators is approaching adult. Excess of the indicators of 120/80 mm mercury post - reason to suspect the disease. Researchers are confident - a chronic high pressure in an adult manifests itself in the youthful age. The reasons for the manifestation of hypertension among adolescents are as follows:

• Passive lifestyle. The absence of the necessary amount of fresh air, physical exertion - the correct cause of the frequent extension of the vessels.
• Excess weight. In adolescents, this factor is directly related to incompleteness and unfavorable heredity.
• Bad habits. Smoking, the use of alcoholic beverages weakens the immune system, leads to chronic diseases - in their background, teenage hypertension may develop.
• Stress associated with mature - adolescent is not easy to get used to the "adult" behavior, responsibility, duties.
• Excessive mental loads.

Hypertension in adolescents is often manifested after emergencies - the loss of a loved one, a sharp change of the decor. The ethiology of the disease in adolescents is extensive, it is infrequently possible to establish a precise cause.

In addition to medical examinations and medical treatment, hypertension in children and adolescents requires the close attention of parents. When stress and mental fatigue, the young man needs support, understanding. Overcoming new difficulties, to understand "adults" problems are difficult without advice and family assistance. It is necessary to watch the peers, friends, any collective relationships of the teenager - to help build contacts, resolve conflicts.

Parents need to track the physical condition of the child. Frequent walks, active lifestyle, joint failure of bad habits - a friendly calm situation will help a teenager to overcome hypertension, slow down or stop the development of the disease.

Hypertension in adolescents and children

Arterial hypertension or hypertension in children, unfortunately, is not uncommon. Much reasons affects previously the development of hypertension, but an important role is played by heredity. In addition, the child makes daily discoveries that are not always positive, which also prepares the foundation for the appearance of a disease since childhood. Is it possible to save the child from increased blood pressure? Is it possible to cure a hypertension in a child? To begin with, consider the more detailed reason for the occurrence of pathology.

Causes of hypertension in children

Hypertensive disease in children is divided into 2 types: primary and secondary. Primary, as a rule, does not have a serious reason, it is easy to cure it, and in many ways the therapy has depends on the rate of parental reaction. This species may be caused by heredity. Secondary hypertension in children is associated with congenital vices and anomalies of the heart, kidney, endocrine system.

According to studies, hypertension in children and adolescents is 12 - 18%.

Consider the reasons that cause primary and secondary hypertension in a child:

Often hypertension in children wears secondary character and depends on age:

• Children's hypertension (6-10 years old) develops against the background of renal dysfunctions (pyelonephritis, renal arterial stenosis, parenchymal kidney diseases).
• Teenage hypertension is developing mainly from parenchymal kidney disease.

The lecture presents the basic principles of the treatment of arterial hypertension in children. It is necessary to establish complete contact and mutual understanding with the parents of the child and the child himself (adolescence). Optimization of psychological relations in the family, school, regulation of physical activity, normalization of body weight, reducing the consumption of cooking salts. Medical therapy is based on the specific causes of the AG in this patient. It is necessary to start treatment with one drug with a long validity period, with a minimum dose, raise stepped. The second drug is appointed only with the failure of monotherapy.

Treatment of Arterial Hypertension in Children and Adolescents

The Lecture Presents The Basic Principles of Treatment of Arterial Hypertension in Children. There SHOLD BE FULL CONTACT AND MUTUAL Understanding with the Child's Parents and The Child (Teenager). To Optimize The Psychological Relations in The Family, School, Regulation of Physical Activity, Body Weight, Reducing Salt Intake Are Required. Drug Therapy Is Tailored to the Speci Fi C Causes of Hypertension In This Patient. Treatment Should Begin With A Single Drug With A Minimum Dose, To Increase Gradually. The Second Drug Is Given Only When The Failure of Monotherapy.

The treatment helps only if the patient himself wants to be treated. The doctor should use the patient's trust and be able to demonstrate empathy. The desire of the patient is to be treated and follow the advice of a doctor, and not an extraneous person depends on the cultural level, social status, religion, confidence in medical professionals.

With parents of a child, and from a certain age and with a child himself (adolescence), it is necessary to discuss the desired level of blood pressure (AD), the way to achieve optimal indicators. Often, patients do not realize, underestimate or strive not to realize (the desire to drive the fear of the inside) the danger of the disease, do not understand the essence of treatment, fear of complications, side effects of drugs. Teenagers neglect the treatment due to the desire to appear healthy, do not stand out from the group of peers. Additional obstacles to success - high cost of drugs and organizational difficulties.

Rational hypotensive therapy with simultaneous control of risk factors is able to significantly change the natural course and forecast of arterial hypertension (AG). The probability of risk of cardiovascular disasters, organic pathology without effective hypotensive therapy is very large. Since children are usually secondary in nature, the prevention of organ changes requires round-the-clock control of blood pressure. The stringly the blood pressure is controlled, the lower the likelihood of the development of complications, the more significant the frequency of heart lesions, kidney, brain decreases. In patients with AG I stage (140-159 / 90-99 mm Hg. Art. For adults) decreased systolic blood pressure by 12 mm RT. Art. For 10 years, it allows you to prevent 1 death on 11 treated patients. In the presence of cardiovascular diseases or damage to target organs, the same decrease in blood pressure allows you to prevent 1 death on every 9 treated patients.

Children accepted to strive to reduce hell to age norm. Principal differences in the therapy of hypertension in children, adolescents and adults do not exist. The choice of drugs is carried out according to the same testimony as in adults. However, often children need smaller doses, and their increase is more careful. Inhibitors angiotensin-convertine enzyme (ACE) and blockers angiotensin receptors are preferably not used to girls after puberty period. Many modern drugs, especially combined, have not yet received permission to use in pediatric practice. In our country, patients aged 15 and older can be treated according to principles and diagrams using drugs and their doses adopted in therapeutic practice.

Principles of therapy of arterial hypertension

Non-media therapy

• Restoration of psychological relations in the family, at school. Compliance with the time mode, removal of physical overloads, pauses for recreation. The ten-day stay in the hospital in itself leads to a decrease in blood pressure by 10 mm Hg. Art.
• The physical activity of children with uncomplicated hypertension is not limited, since regular physical education occupation leads to a decrease in blood pressure. Showing swimming, horse riding. Isometric loads should be avoided. Regular aerobic loads (daily walks with a duration of 20-30 minutes.) Reduce systolic blood pressure by 10 mm RT. Art.
• Normalization of excess body body, introducing a sufficient amount of fiber in a daily diet (at least 300 g of vegetables or fruits). Absolutely contraindicated anabolic steroids. For every 10 kg of excess weight, hell rises by 5-20 mm Hg. Art.
• Termination of smoking and alcohol intake. The restriction of alcohol consumption leads to a decrease in blood pressure by 2-4 mm Hg. Art.
• Consumption of salt no more than 5 g / day. The decrease in sodium consumption leads to a decrease in systolic pressure by 4.9 mm Hg. Art., and diastolic - by 2.6 mm Hg. Art. Moreover, a decrease in the consumption of the table salt up to 1.6 g / day in combination with the hypotensive diet as efficiently as monotherapy by any hypotensive means, and a comprehensive lifestyle change gives even more impressive results.
• High sodium and / or extractive products are placed to enhanced blood pressure: sauces (including soy), spices, vinegar and marinades, chips, all salted sticks and pretzels, salted popcorn, salt nuts, etc., Coca-Cola, chocolate, smoked, oysters, sausages, hamburgers, sour cabbage, broth, olives. A diet rich in fiber, fruits, vegetables, with low fat (especially saturated) reduces blood pressure by 8-14 mm Hg. Art.
• Control of other risk factors (hyperlipidemia, diabetes, male floor, family hypertension, cases of cardiovascular disasters from relatives of the first degree of kinship).
• The use of such psychological techniques as creating positive motivation, positive feedback, hypnosis.

Medical therapy

In adolescents, antihypertensive drugs are necessarily shown in the presence of symptoms, a critical increase in blood pressure ( increase diastolic blood pressure by 12 mm Hg. Art. And more over the 99th percenter or an increase in systolic blood pressure by 25 mm Hg. Art. and more over the 99th percenter), organ changes). In dubious cases, both in children without specific symptoms, proteinuria, cardiomegaly, echographic signs of the left ventricular hypertrophy can be lined with the beginning of hypotensive therapy until all the nuances of the disease. Educational programs are absolutely necessary for the reasons of hypertension, its flow and possible therapeutic interventions. Teenagers should imbued with a sense of responsibility for their treatment. Treatment should be easy to achieve the maximum possible compline.

The perfect hypotensive drug must meet the following requirements:

• reduce blood pressure in all patients with any type of hypertension;
• influence the specific pathogenetic mechanism;
• improve hemodynamics;
• influence several biochemical processes;
• do not have side effects or have a very small number of non-volatile side effects;
• act when taking one time per day;
• be cheap.

There is no such drug, and it is unlikely to appear. Therefore, the discussion on the choice of the drug for monotherapy and the optimal combinations of drugs. Preparations should be prescribed, taking into account objective (related diseases) and subjective factors (tolerability). Treatment should be started with minimal doses, preferring preparations with a long validity period (by rare reception, the familiar life of the patient suffers less). Diuretics and β-blockers can be used for initial monotherapy. Ace-inhibitors are preferable in children and adolescents with a renal form AG.

General principles of drug treatment ag They are to use prolonged metabolic neutral hypotensive drugs. The choice of starting drugs is largely determined by the cause of AG. A special place is owned by ACE inhibitors. If the kidney function is violated and reduced the speed of glomerular filtration, it is advisable to assign drugs eliminated through the liver. Therapy begins with minimal doses, when the failure goes to the reception of combined drugs or prescribe combined therapy. In the last embodiment, along with the use of hypotensive drugs, different classes are prescribed correctors of lipid, purine, carbohydrate exchange, disagrements, tend to normalize microcirculation.

Treatment AG is long. It is carried out using drugs of such classes as AAC inhibitors, AT-1 receptor blockers, calcium channel blockers, diuretic (thiazide and thiazide-like), β-adrenoblocators. Fully lost their meaning for long-term therapy AG sympatholyticity, α2-adrenoreceptor agonists, potassium channel activators and direct vasodilators.

Each class of drugs has its advantages and contraindications. The choice of the drug is carried out taking into account the cause of the AG, the values \u200b\u200bof blood pressure, the age of the patient concomitant.

Table 1.

Calcium antagonists

	Nifedipine	Verapamil	Diltiazem
Coronary resistance
Peripheral resistance
HELL
Heart abbreviation frequency
Speed \u200b\u200bof atrioventricular transmission
Society

Among all the factors determining the choice of treatment tactics and listed earlier, nationality and races should be taken into account. Unfortunately, in our country there were no such studies. But in foreign literature, the racial and national factor of success or failure of treatment is studied very carefully. The most difficult to treat Mexicans and Indians. Among the blacks morbidity, the severity and risk of AG are especially high. Moreover, β-adrenoblockers, ACE inhibitors and angiotensin receptor blockers in the form of monotherapy they are less effective than calcium antagonists and diuretics. Differences allows to overcome combination therapy, including a diuretic in a sufficient dose. Negroes when taking ASA inhibitors, the risk of developing angioedema edema 2-4 times more than that of white.

ASA inhibitors Due to the suppression of the Renin-angiotensin-aldosterone system. At the same time, the activation of the sympatho-adrenal system is activated. Against the background of the use of ASA inhibitors, there is an increase in the elasticity of vessels, they become compatible, the renal blood flow increases, the speed of glomerular filtration increases. It is possible to restore the normal structure of the myocardium and walls of vessels, improvement of the endothelium state. The higher the initial activity of the Rhenin-angiotensin system, the fact that the reaction to the ACE blockers is expressed. The maximum therapeutic effect of AAC inhibitors is registered on the 3-4th week of regular reception. The first clinically significant drug of the group of ACE inhibitors was captive. But from the group of drugs recommended for the treatment of chronic disease, he moved to a group of medicines used to treat urgent states. Recognition received such drugs such as Perindopril, Enalapril, Fozinopril, Trandolapril. The last two drugs have a double elimination path and are most shown to patients at a reduced flushing filtration rate.

Blockers angiotensin receptors - relatively new class of hypotensive drugs. Their effectiveness is explained by the fact that the essential share of tissue angiotensin is formed without the participation of ACE.

Calcium antagonists. An important pathogenetic agricultural mechanism is an increase in peripheral vascular resistance by increasing the tone of smooth muscle cells of the vascular wall. Smooth muscle cells are reduced due to the enhanced flow of calcium inside the cells. Calcium antagonists (calcium channel blockers) prevent calcium intake into cardiomyocytes and in smooth muscle cells of the vascular wall, which leads to a decrease in the heart rate, reduce myocardial reductions, an increase in its elasticity, an expansion of the arteries. The phenylalkylamine derivatives (verapamil) and benzothiazepine (diltiazem) are characterized by cardiotropic and vessels. Dihydropyridine derivatives (nifedipine) have a high selectivity with respect to calcium channels of smooth muscle cells of vessels, but do not have a clinically significant effect on the heart rate, conductivity and myocardial reduction (Table 1).

Blockers of calcium channels I generations (nifedipine, verapamil, dyltehaze) are valid for a very short period of time, and for a significant clinical effect they must be taken 3-4 times a day. Their plasma concentration quickly reaches its peak and decreases just as quickly. As a result, sharp vasodilation with the trace compensatory hyperactivity of the Renin-angiotensin system and the sympathy-adrenal system is possible. Therefore, for calcium antagonists, the I generation is characterized by the abolition syndrome: an increase in blood pressure after the cancellation of the drug. Based on this, nifedipine, verapamil and diltiazese are recommended only for the treatment of acute increase in blood pressure.

For long-term control of blood pressure and prolonged treatment, AG is recommended:

• preparations with slow release of nifedipine, verapamil and diltiazem;
• calcium antagonists II (Dihydropyridid \u200b\u200bderivatives of the average duration of action - felodipine, nifedipine longer action);
• calcium III antagonists (Dihydropyrididin derivatives of continued action - amlodipine and lacidipine). Lacidipine is eliminated mainly by the hepatic path, therefore it is prescribed to patients with a reduced flushing filtration rate.

The maximum hypotensive effect of calcium channel blockers is achieved through 3-4 weeks of regular reception.

Diuretic drugs Reduce the speed of sodium tubular reabsorption. Sodium excretion leads to the release of equivalent volume of water, a decrease in intravascular volume and cardiac output. Due to the adaptive reflex mechanisms (activation of the sympathetic nervous system, the aldosterone-renin-angiotensin system) compensatory increases peripheral vascular resistance. But in patients sensitive to diuretics, the resistance of the peripheral vascular channel increases to a lesser extent than reducing the emission. This difference and provides reduction in blood pressure. After 6-8 weeks of continuous therapy, the diuretic effect decreases due to the high activity of pressing systems, the heart emission is gradually normalized. But overall peripheral resistance decreases to the indicators below the source. It is likely that it is due to the depletion of intracellular sodium and calcium reserves in smooth muscle elements of the vascular wall.

For the treatment of AG apply three main groups of diuretics:

1. loopers;

2. Tiazide and thiazid-like;

3. Potassy-saving.

Loop diuretics Have the most pronounced diuretic effect. They suppress sodium reabsorption in the ascending segment of the loop of Genela, where 25% of the excreated sodium is absorbed. Along with the sodium, a large number of potassium salts, magnesium and calcium is distinguished. The hypotensive effect of short-acting loop diuretics (furosemide, bumetate) is relatively weak. Sodium selection with a single reception expressed, but short-term. Then sodium compensatory is delayed, the daily sodium and does not increase significantly, and the blood pressure is usually significantly reduced. Reducing the blood pressure when using loop diuretics of long-term action (ToramSemp, PIRTERID) corresponds to the effect of thiazide and thiazide diuretics.

Tiazide and thiazid-like diuretics (hydrochlorothiazide, chlorotalidone, indapamide) act at the level of the distal tubule, where 5-10% sodium is rebucing. Their action is long, and the sodium-ethical, magnicuretic and the potassium effect is lower than the loop diuretics. The maximum effect of thiazide and thiazid-like diuretics is developing after 2-4 weeks of regular reception. The optimal diuretic hypotensive drug is considered to be Indapamide. The hypotensive effect is due to a moderate decrease in sodium reabsorption in distal tubules, limiting calcium intake to the contracting apparatus of cells, increased bradykinine synthesis with subsequent vasodium. The prolonged form of indapamide has high hypotensive efficacy with minimal effect on diuresis, metabolic indifference, lack of influence on Renin-angiotensin-aldosterone and sympathetic-adrenal. At the same time, a decrease in platelets aggregation and improved endothelium functions are recorded.

Potassiabelling diuretics include the following medicines:

1) Competitive Aldosterone Antagonist - Spironolactone;

2) Indirect aldosterone antagonists - triamteren and amyloride.

Painting diereting diuretics suppress sodium tubular reabsorption in the cortical segment of the collecting tubes (at the point of the aldosterone application), where 3-5% of the sodium highlighted sodium is rebucing. Therefore, the diuretic effect compared to other diuretics groups is relatively weak. The hypotensive effect is low. As monotherapy, potassium-saving diuretics are rarely used. The appointment of the competitive preparation of aldosterone, Spironolactone is absolutely shown only in the treatment of primary or secondary hyperaldosteroneism. In other cases, the potassium-saving diuretics are prescribed in a complex with loop, thiazide and thiazid-like diuretics for the prevention of electrolyte and metabolic disorders.

Beta adrenoblocators Reduce the frequency and power of myocardial cuts, reduce basal and stimulated by catecholamines secretion of renin. Non-selective β-adrenobloclars affect β2-adrenoreceptors located in the wall of the vessels and responsible for their expansion. It is advisable to use selective β1 adrenobloclars (bisoprolol, nebivolol), since they are less compared with non-selective β-blockers on the function of the lungs, peripheral blood circulation, fat and carbohydrate exchange, but significantly reduce blood pressure. In patients sensitive to β-adrenoblockers, the resistance of the vascular channel increases to a lesser extent than it would correspond to a reduction in cardiac output. With prolonged use of β-adrenoblockers, the increase in total peripheral resistance becomes less or disappears at all. The maximum hypotensive effect of β-adrenoblastors is developing after 3-4 weeks of regular reception. However, during long-term reception, the development of resistance to drugs is possible. The effect is explained by a compensatory increase in the number of β1-adrenoreceptors on effector cells. The same mechanism explains the abolition syndrome: an increase in blood pressure and tachyarithmia after a sharp abolition of β-adrenobloclars.

Combined AG therapy. AG is multidimensional pathology. Maintaining blood pressure in normal limits or increased blood pressure is due to the action of a whole group of factors, each of which itself is ambiguous. Effective control of blood pressure when appointing one drug is possible not more than 30-50% of cases at AG I-II Art. severity. Monotherapy is almost ineffective if there is AG III Art. severity, diabetes, targeted targets, cardiovascular complications. "Average", "standard" doses do not lead to control over blood pressure. The question arises, whether to increase the dose of the drug to maximum (but also with the maximum probability of adverse reactions) or to a small dose of the previously appointed drug. On the recommendations of foreign experts and the All-Russian Scientific Society of Cardiologists (2001), the combination of drugs is optimal. Applying combined therapy, it is possible to normalize the pressure faster. But some patients (with diabetes mellitus, vegetative disorders, children and elderly) are subject to orthostatic hypotension. They require special observation. The cost of treatment is reduced when using non-proprietary drugs.

Combined hypotensive therapy can be appointed at the start of treatment to patients:

• with malignant hypertension;
• with ag II and III degree;
• when combined with diabetes;
• with proteinuria, chronic renal failure;
• with targeting organs.

As a reflection of this trend in AG therapy, fixed combinations of drugs are proposed and rational combinations are determined. Each of the combinations has its own positive and negative consequences (Table 2).

Table 2.

Positive and negative effects of rational combinations of antihypertensive drugs

Combination of drugs	Positive effect	Negative effect
	Low cost. Reducing the risk of fractures during long-term reception	Possible violations of lipid and carbohydrate metabolism. Reduced potency
Diuretics and ASA inhibitors	Preventing hypocalemia, violations of lipid, carbohydrate and purine metabolism. Pronounced organoprotective effect. The combination is optimal for patients with severe ag, chronic heart failure, left ventricular hypertrophy, diabetic nephropathy, elderly
	All the advantages of the combination of diuretics and AAC inhibitors. Portability is better than Asse inhibitors
	Pronounced organoprotective effect even when using small doses of drugs
	Well tolerated. Rarely arise ankle swelling (typical with an isolated use of calcium antagonists) and tachycardia. Optimal combination for patients with severe hypertension and combination of AG with coronary vessel pathologies
α- and β-adrenobloclars	Rarely arises tachycardia. Metabolic neutrality
Calcium and diuretics antagonists		Do not allow drugs to mutually level side effects

The advantages of combination therapy, fixed and rational combinations consist in ease of destination, which increases compline. The hypotensive effect is mutually potentially potentially potentially potentially potentially potentially. This leads to an increase in the number of patients with a positive effect of therapy. The frequency of side effects is reduced, because In the complex drug dosage, each of the components is usually lower than when they are isolated. In addition, mutual neutralization of side effects is possible. Combined therapy significantly reduces the risk of organ complications and cardiovascular disasters. Fixed combinations of drugs serve as a guarantee from irrational combinations.

Fixed combinations of hypotensive drugs have certain disadvantages. Fixing doses makes it difficult for a doctor's maneuver to "titration therapy", which often determines the effectiveness of control of blood pressure. Currently, there are combinations containing different doses of the same components. To another negative property of fixed combinations of hypotensive drugs, the difficulty of interpreting adverse reactions. In the occurrence of adverse reactions against the background of receiving fixed combinations, they are difficult to identify with one or another component.

The optimal, permissible and unwanted variants of the combination of hypotensive drugs are presented in Table. 3.

Table 3.

Optimal (++), permissible (+) and unwanted (-) combinations
hypotensive drugs

As can be seen from the table. 3, a large number of optimal combinations of antihypertensive drugs are possible. However, in practice, ready-made dosage forms are more often used.

Diuretics and β-adrenoblays - Some of the most frequently appointed preparations of the first choice. The combination of diuretics and β-adrenobloclars is the cheapest of all possible combinations of hypotensive drugs. The effectiveness and safety of both isolated and combined applications are proved. The use of β-adrenoblockers prevents the development of hypokalemia arising against the background of receiving diuretics. The main disadvantage of this combination is a negative impact on the metabolism of lipids and carbohydrates, a reduction in potency. Therefore, the combination of diuretics and β-adrenoblockers is not recommended for long-term treatment. In order to reduce the adverse reactions of diuretics, prescribed in very small doses, which are equivalent to 6.25-12.5 mg of hydrchlorothiazide.

The most famous fixed combinations of diuretic and β-adrenoblockers include:

• Tenoric (atenolol 50/100 mg + chlorotalidone 25 mg);
• Loprestor (HGT metoprolol 50/100 mg + hydrochlorothiazide 25/50 mg);
• Indyride (Popranolol 40/80 mg + hydrochlorothiazide 25 mg);
• CORZOID (Superstomol 40/80 mg + bendaflumetazide 5 mg);
• Viskaldiks (pindolol 10 mg + clopamide 5 mg).

Diuretics and ASA inhibitors - The most frequently appointed combination of hypotensive drugs distinguished by efficiency and security. The sharing of diuretics and ACE inhibitors allows to achieve a positive effect not only in patients with high activity of the Renin-angiotensin system, but also in patients with normo and even hyphenin variants of AG. Reducing the doses of diuretics and an Ace inhibitor with their combination not only does not lead to a decrease in treatment efficacy, but is characterized by an increase in the hypotensive effect and a decrease in the frequency of adverse reactions. The use of a combination of diuretics and AAC inhibitors is accompanied by the achievement of blood pressure control in 80% of patients.

The most famous dosage forms are:

• Caposide (25/50 mg adjustment + hydrochlorothiazide 12.5 / 25 mg);
• Co-rhenatee (enalapril 20 mg + hydrochlorothiazide 12.5 mg);
• MEX-PLUS (Mauccipril 7.5 mg / 15 mg + hydrochlorotiazide 25 mg);
• ENAP-H (ENALAPRIL 10 mg + hydrochlorothiazide 25 mg);
• ENAP-HL (enalapril 10 mg + hydrochlorothiazide 12.5 mg);
• Naliprell Forte (perindopril 4 mg + Indapamide 1.25 mg).

Diuretics and angiotensin receptor blockers In combination, they have the same positive effects as the combination of diuretics and AAC inhibitors. But thiazide diuretics not only extend, but also enhance the hypotensive effect of the Blockers of the AT receptors. Sharing the use of diuretic and Blockers AT receptors is effective in 80% of patients and justified in patients with high and low renin activity.

The following combinations of this group are most common:

• Hyzar (Lozartran 50 mg + hydrochlorothiazide 12.5 mg);
• Lozec-plus (Lozartran 50 mg + hydrochlorothiazide 12.5 mg);
• Co-Approvnel (Irbesartan 150/300 mg + hydrochlorothiazide 12.5 mg);
• Ko-duvan (Valsartan 80 mg + hydrochlorothiazide 12.5 mg);
• Mycardis Plus (Telmisarthane 80 mg + hydrochlorothiazide 12.5 mg).

Calcium antagonists and AAC inhibitors Reduce the blood pressure due to the extension of the vessels, but the mechanism turns out to be different. This determines the combination of two types of drugs. The combination is effective in patients with high and low rhenin activity. The use of calcium antagonists reduces the frequency of dry cough, the most likely side effect of the drugs of the AAC inhibitors. The combination of Calcium ACE inhibitors and antagonists (primarily nonhyllimidine series) has a pronounced renoprotective action. At the same time, ACE inhibitors act mainly on the efferent arterioles of the glomers, and calcium antagonists - on afferent vessels. If dihydropyridine calcium antagonists practically do not affect the efferent vessels, the verapamil and diltiazese are expanding both leading and discharge arterioles of the glomers. Therefore, the joint use of calcium antagonists and AAC inhibitors is accompanied by a decrease in intraccurry pressure and excretion of albumin. Based on this, this combination is especially justified in patients with diabetic nephropathy. In addition, the combination of calcium inhibitors and calcium antagonists belongs to metabolically neutral combinations, which serves as a justification for their combined use in patients with a violation of fatty, carbohydrate and purine metabolism.

Refixed dosage forms include:

• Tarka (transdolapril 1/2/4 mg + verapamil SR 180/240 mg);
• Lotter (Benazepreen 10/20 mg + amlodipine 2.5 / 5 mg);
• Text (enalapril 5 mg + diltiam 180 mg);
• Lexell (Enalapril 5 mg + Felodipine 5 mg).

Table 4.

Doses, multiplicity of administration, side effects of the most used hypotensive preparations (recommended for children)

Group name	Dose daily	Interval in the clock	Side effects
Ace-inhibitors
- Captor	0.5-3 mg / kg	8-12	Obsessive cough, swelling of quinque, impaired taste, neutropenia
- Enalapril	0.1-0.5 mg / kg	12-24
- Fozinopril	only teenagers 5-20 mg / day per one	24
- Perindopril 1.	0.5-2 mg / day Children, 1-4 mg / day adolescents	24
Angeiotensin receptor antagonists
- Lozartan (Kozar)	Only teenagers 25-50-100 mg / day	24	Dizziness, headache, weakness, peripheral edema
- Eprosartan 1.	100-300 mg / day Children, 150-600 mg / day adolescents
Alpha blockers
- Pradozin	0.02-0.05 mg / kg	8-12	Orthostasis
Beta blockers
- Propranolol	1-5 mg / kg	6-8	Bradycardia, Av-blocade, hyperglycemia, hyperlipidemia, bronchospasm, impotence
- Atenolol	1-2 mg / kg	12-24
- Metoprolol	only teenagers 50-100 mg / day	12-24
- Bisoprolol 1.		24
- Nevibolol 1.	1.25-2.5 mg / day Children, 2.5-5 mg / day adolescents	24
Calcium antagonists
- Nifedipine	0.5-2 mg / kg	8-12	Tachycardia, tides, dizziness, edema, bradycardia, av-blockade
- Amlodipine	0.5-5 mg (Children), adolescents 5-10 mg once a day	8
- Verapamil (Retard) 1	180-360 mg / day adolescents	12-24
- Dilteham (Retard) 1	120-360 mg (only teenagers)	12-24
- Lazidipin 1.	0.5-1-2 mg (Children), 1-4 mg (adolescents)	24
Diuretics
- Furosemid	1-5 mg / kg	8-12	Hypokalemia, hypomagnemia
- hydrochlorothiazide	0.5-2 mg / kg	12
- Indapamide 1.	only teenagers 1.5 mg / day	24
Vasodilitators
- Dihydralazine	1-5 μg	8-12	Tachycardia, headaches, nausea
Central Action Preparations
- Klonidin	0.005-0.03 mg / kg	8-12	Inhibition, dry mouth, sodium delay

1 - drugs whose use in children has not been studied or not studied.

Calcium antagonists and angiotensin receptor blockers In combination, according to its effectiveness, the combination of calcium antigonists and ACE inhibitors correspond to. A fixed combination of calcium antagonists and angiotensin receptor blockers currently does not exist, but their sharing allows you to achieve control of blood pressure even at small doses of each of the drugs. Proved security of such a combination.

β-adrenoblocators and calcium antagonists Dihydropyridine row complement each other. β-adrenoblockers prevent the development of tachycardia and the activation of the sympathetic nervous system, which may occur at the initial stage of treating calcium antagonists. With the joint use of these drugs, the ankles and tachycardia are less commonly characteristic of calcium dihydropyridine antagonists. β-adrenoblockers and calcium antagonists have a positive effect on the lipid spectrum of blood, which reduces the risk of cardiovascular disasters.

The most famous combination of calcium β-adrenobators and antagonists:

• Logmax (metaprolol SUCcinate 50 mg + Felodipine 5 mg).

The combination of β-adrenobloclars with nonhydropyridine calcium antagonists (verapamil and diltiazem) is fraught with the development of severe conductivity disorders, especially with a combination of hypertension with ischemic heart disease.

Very low-dose combinations attract more attention. From fixed combinations are most famous:

• Naliprell (perindopril 2 mg + indapamide 0.625 mg);
• Lodz (bisoprolol 2.5 / 5 mg + hydrochlorothiazide 6.25 mg).

Very low-dose combinations showed itself as dosage forms with a minimal risk of adverse reactions with a high percentage of positive effects of therapy.

After achieving control over blood pressure, a dose of drugs or the cancellation of one of the drugs is possible. This stage is extremely responsible, it must pass under the strictest control against the background of non-drug therapy.

Treatment of hypertensive crisis.

Reducing the blood pressure to normal numbers (below the 95th percented) is carried out gradually. In the first 6-12 hours, hell is recommended to reduce 1/3 of the planned reduction. By the end of the first day, the blood pressure is reduced by 1/3, the full normalization of hell is achieved in the next 2-3 days.

1st stage

- nifedipine under 0.5-1.0 mg / kg.

when unsatisfactory response:

- Repeat in 15-30 minutes.

When unsatisfactory response:

- dihydralazine V / 0.3 mg / kg or

- clonidine in / in 2-6 μg / kg (insert slowly for 10 minutes) or

- Nifedipine in / in drip 10-20 mg / m 2 / day.

Table 5.

Hypotensive preparations for adolescents and adults

Class of preparations	A drug	Conventional doses (mg / day)	Multiplicity of reception per day
Tiazid diuretics	Hydrochlorostiazide
	Indapamil
	Metosalon
	Politizid
	Chlortalidon
	Hloostiazide
Loop diuretics	Bometanide
	Torisyid
	Furosemid
Potassiabelling diuretics	Amyloride
	Triamteren.
Aldosterone electoral antagonists	Spironolakton
	Eplerenon
β-adrenoblocators	Atenolol
	Betacokoxolol
	Bisoprolol
	Metaprolol
	Long-term metaprolol
	Propranolol
	Propronalol longer action
- with internal sympathomimetic activity	Acebutolol.
	Penbutolol
	Pindolol
- α- and β-adrenoblays	Carvedilol
	Labetolol.
ASA inhibitors	Benazeprin
	Captor
	Lysinopril
	Muelxipril
	Perindopril
	Ramipril
	Trandolapril
	Fozinopril
	Hinapril
	Enalapril
Blockers angiotensin receptors	Kandesartan.
	Eprosartan
	Irbesartan.
	Losaryan.
	Olmertan
	Telmisartan
	Valsartan
Calcium antagonists
benzodiazepines	Diltiaze Durable action
diphenylalkylamines	Verapamil short action
	Long-term verapamil
dihydropyridines	Amlodipine
	Isragian
	Nicardipine long-term action
	Nisoldpin
	Nifedipine longer action
	Felodipine
α1-adrenoblastors	Doxasasin
	Prazozin
	Tererozoin
α2-adrenostimulants and other drugs	Guangfacin
	Klonidin
	Clonidine plaster		1 time per week
	MethylDofa
	Reserpine
Straight vasodilators	Hyralazine
	Minoxidil

1 - can be given 0.1 mg every day until this dose is achieved.

Medical therapy of chronic arterial hypertension

Monotherapy (Dana Descending Effect):

- beta blockers;

- calcium antagonists;

- Ace-inhibitors (ANGIOTENSIN Converting Enzyme);

- Diuretics.

For the treatment of young patients with ag arising against the background of exercise, beta blockers are preferred. Physically active adolescents (athletes) treatment should be started with Ace-inhibitors. With the failure of monotherapy after 4 weeks it is advisable to go to a combination of two drugs. But it is necessary to check if the patient adopted the funds recommended by you.

- β-blockers + calcium antagonists, or

- β-blockers + asse-inhibitors, or

- β-blockers + diuretics.

- diuretics + β-blockers (or clonidine) + calcium antagonists (or asse-inhibitors or alpha blockers), or

- Diuretics + Ace-inhibitors + calcium antagonists.

Arterial hypertension in newborns and breast-age children as a problem began to be discussed from the 70s of the last century. Hypertension in newborns is most often nephronic, although cardiac, endocrine and pulmonary mechanisms are possible. Clarification of the causes of AG in newborns determines the treatment. For example, renal hypertension is due to the excessive secretion of renin, and hypertension for bronchological dysplasia is associated with hypoxia.

The frequency AG among newborns reaches, according to American researchers, 0.2-3%. Among children undergoing catheterization of the umbilical artery, the frequency ag reaches 9%.

The risk group for the development of AG during the newborn and in the first year of life includes the following children (descending significance of the reasons):

1) Low indicators of apgar scales at birth;

2) Renovascular disorders. An innate narrowing of the kidney arteries, thrombosis after catheterization of the umbilical artery (the longer there was a catheter in the artery, the higher the probability of thrombosis and embolism with the development of AG). Calcification of the renal artery after a red infection. Compression of vessels with a tumor, polycystic kidney, other intra-abdominal formations;

3) the anomalies of the ureters;

4) Bronchildly light dysplasia (as the cause of hypertension in newborns - in second place after renovascular changes). In children with bronchopulmonary dysplasia, AG was registered in 43% of cases against 4.5% in the control group;

5) subdural hematoma, intracranial hypertension; a forcepets for childbirth ("traction child");

7) long-term full parenteral nutrition (hypercalcemia);

8) extracorporeal membrane oxygenation;

9) hemorrhage into the adrenal gland;

10) the closure of the defects of the front abdominal wall;

11) Congenital hyperplasia of adrenal cortex;

12) more rare reasons:

a) renoparyenchymatic diseases (kidney cortex necrosis, hemolytic-uremic syndrome, kidney polycystic);

b) Yatrogenic causes (appointment of adrenergic drugs, including vasoconstrictor droplets with rhinitis, otitis, etc.; corticosteroids; use of heroin or cocaine mother; neuroblastoma).

Clinical manifestations of AG in newborns and infants:

• delay in the injection of body weight and growth;
• retardation in psychomotor development;
• overall anxiety, irritability, unmotivated crying;
• lethargy;
• cramps.

In most cases, the routine measurement of blood pressure in newborns, unfortunately, is not carried out. AG is diagnosed when monitoring the vital functions of a severely ill child. The most accurate method is the direct measurement of pressure through the catheter in the umbilical or radial arteries.

If the blood pressure is detected, it is necessary to measure blood pressure on all four limbs, clarify the conditions of birth, estimate the dysmorticity (adrenogenic syndrome, other genetic syndromes), to exclude the pathology of the kidney vessels, the kidney itself, the aortage coarse.

Table 6.

Preparations of selection and preparations of exception in patients with hypertension and concomitant diseases

Relative state	Recommended drugs	Contraindicated drugs
Heart failure	Diuretics	β-blockers
	Asse blocters
	Alpha blockers
	Dihydralazine
Coronary heart disease	β-blockers (without isoptin)	Dihydralazine
	Calcium antagonists
	Asse blocters
Bradycardia	Dihydralazine	β-blockers (without isoptin)
	Calcium antagonists (type of nifedipine)	Calcium antagonists (type verapamila *)
	Alpha blockers	Klonidin
Tachycardia	Alpha blockers	Dihydralazine
	Calcium antagonists (type verapamila)	Calcium antagonists (type of nifedipine **)
	Klonidin
Disorders of peripheral blood circulation	Calcium antagonists	β-blockers
	Alpha blockers	Klonidin
	Dihydralazine
	Asse blocters
Obstructive lung diseases	Calcium antagonists	β-blockers
	Alpha blockers
	Asse blocters
Diabetes	Asse blocters	Diuretics
	Calcium antagonists	β-blockers
	Alpha blockers
Violations of fat exchange	Calcium antagonists	Diuretics
	Asse blocters	β-blockers
	Alpha blockers
Hyperuricemia	β-blockers	Diuretics
	Calcium antagonists
	Asse blocters
Renal failure with serum creatine<2 мг%	Diuretics
	β-blockers
	Calcium antagonists
	Asse blocters
Renal failure with serum creatinine\u003e 2 mg%	Loop diuretics	Potassiabelling diuretics
	β-blockers
	Calcium antagonists
	Asse blocters
Hypercalemia	Tiazida	Potassiabelling diuretics
	Loop diuretics	Asse blocters

* Calcium antagonists type verapamil: Gallopamil

** Nifedipine Calcium Antagonists: Nitrendipin, Nimodipine

Diltiazem type calcium antagonist: diltia

Others - Fendilamine

Table 7.

Fixed and contraindicated drugs in secondary arterial hypertension

Table 8.

Preparations for intravenous administration in severe arterial hypertension in newborn and breast-age children *

A drug	Class	Dose for intravenous administration	Notes
Diazoxide	Arterial vasodilator	2-5 mg / kg on bolus fast in / in Introduction	Slow in / in the introduction is inefficient. The duration of action is difficult to predict. May cause the rapid development of the hypotension. Increases blood glucose concentration
Esolol	β-adrenoblocator	100-300 μg / kg / min. V / B.	Very short action. It is necessary permanent / in the introduction
Hyralazine	Arterial vasodilator	0.15-0.6 mg / kg is once in the form of a bolus in / in administration. Repeat every 4 hours or 0.75-5 μg / kg / min to / in constantly	Tachycardia
Labetolol.	α- and β-adrenoblocator	0.2-1 mg / kg in / in bolus or 0.25-3 μg / kg / hour in / in constantly	Perhaps the development of heart failure. Relative contraindication - bronchopal dysplasia
Nagardipin	Calcium channel blocker	1-5 μg / kg / min. in / in constant infusion	Tachycardia
Nitroprusside sodium	Vasodilator arterial and venous	0.5-10 μg / kg / min. in / in constant infusion	Tyocionate toxicity is manifested with long-term use (more than 72 hours) or renal failure. The usual dose sufficient to control the blood pressure is less than 2 μg / kg / min. For 10-15 min. You can give 10 μg / kg / min.

* For the treatment of hypertension, newborn uses a large number of drugs of various classes. The choice is determined by the causes of hypertension, its severity. Before treatment, it is necessary to eliminate the easily corrected yatrogenic causes of hypertension: pain, injection of inotropic drugs, volumetric overload. As initial therapy, constant / in the introduction of drugs is usually applied. The drug is selected, which allows you to quickly lower or (when canceling it) increase blood pressure. As with any patient of any age with malignant AG, reduce blood pressure must be carefully to avoid ischemic or hemorrhagic cerebral stroke. A group of special risk - prematurely due to the immaturity of the system of perivanicular microcirculation. Evaluable research on the choice of hypotensive drugs in this group of patients is extremely small, so the choice is determined by the individual experience of the doctor. It is believed that the drug selection should be considered Nipippine, which has a number of advantages over Nitroprusside. Hell must be monitored every 10-15 minutes., Which allows you to "Title" therapy.

Table 9.

Preparations for oral administration in arterial hypertension in newborn and chest children *

A drug	Class	Dose	Notes
Captor	Ace-inhibitor	Up to 3 months: 0.01-0.5 mg / kg at the reception twice a day. Do not exceed a dose of 2 mg / kg / day. After 3 months: 0.15-0.3 mg / kg on reception 2 times a day. Do not exceed a dose of 6 mg / kg / day	Monitor whevatinine and potassium concentration
Klonidin	Central agonist	0.05-0.1 mg / kg twice and three times a day	Rebaund effect of the return of hypertension after a sharp discontinuation of the drug. Dryness mucous, depression
Hyralazine	Arterial vasodilator	0.25-1 mg / kg / at the reception twice-four times a day. Do not exceed a dose of 7.5 mg / kg / day	Frequently, fluid delay and tachycardia. Possible milk-like syndrome
Isragian	Calcium channel blocker	0.05-0.15 mg / kg / at the reception 4 times a day. Do not exceed a dose of 0.8 mg / kg / day or 20 mg / day	Used to treat acute and chronic ag
Amlodipine	Calcium channel blocker	0.1-0.3 mg / kg / on reception twice a day. Do not exceed a dose of 0.6 mg / kg / day or 20 mg / day	The probability of acute hypotension is lower than when using isradipine
Minoxidil	Arterial vasodilator	0.1-0.2 mg / kg / on the reception two or three times a day	Very effective in refractory hypertension
Propranolol	β-blocator	0.5-1 mg / kg / at the reception three times a day	The maximum dose is determined by the heart rhythm: one can be prescribed to 8-10 mg / kg / day in the absence of bradycardia. Do not apply in children with bronchopulmonary dysplasia
Labetalol	α- and β-blocker	1 mg / kg / reception 2-3 times a day to 12 mg / kg / day	Monitor heart rhythm. Do not apply in children with bronchopulmonary dysplasia
Spironolactone (Veroshpiron)	Aldosterone antagonist	0.15-1.5 mg / kg / on reception 2 times a day	Monitor electrolytes. To achieve the effect you need a few days
Hydrochlorotiazide	Tiazid diuretik	2-3 mg / kg / day in 2 reception	Monitor electrolytes
Chlorothiazide	Tiazid diuretik	5-15 mg / kg / on reception 2 times a day	Monitor electrolytes

* Tableted drugs are recommended for children with moderate ag or after relieving a hypertensive crisis for chronic hypertension treatment. As a drug selection for a long time, captive was recommended, but recently it is proved that it violates the development of the kidneys, especially distinctly in premature.

β-blockers are not recommended for long-term use in children with bronchopulmonary dysplasia. For such patients, the most suitable drugs are diuretics. They allow not only to control the blood pressure, but also improve the function of the lungs.

Nifedipin reduces the pressure quickly, significantly, but briefly, it is difficult to prescribe minimal doses, so this drug in newborns and infants is rarely used.

For children with moderate hypers, which due to gastroenterological problems cannot receive PER OS medications, preferably periodically prescribed drugs. It is called enalapril as a drug, an intravenous ACE blocker is called extremely active with renovascular aging newborns. But it should be used with great care due to the likelihood of persistent arterial hypotension and acute oligouyromic renal failure.

Surgical treatment of hypertension in newborns and breast-age children is rarely applied. The exceptions represent cases of obstructive nephropathy, coarctation of aorta, tumors. Children with stenosis of the renal artery are usually treated with drugs until the weight-growth characteristics will not allow surgically anomaly.

Food of children of this age group is poor sodium, therefore, a special diet (salt limitations) is not required.

Even with the achievement of control over blood pressure after discharge to control the normal development of the kidneys every 6-12 months. A ultrasound examination of the kidneys is required.

Refractory arterial hypertension

In some cases, it is not possible to achieve reduced blood pressure to the desired digits. In this case, they talk about refractory hypertension. The reasons for refractory ag can be:

- Hypervolemia

• Excessive consumption of cook salt
• Liquid delay in kidney disease
• Low dose diuretikov

- Drug Ag, Wrong Treatment

• Non-compliance with the prescriptions of the doctor
• Incorrect doses
• Incorrect combination of medicines
• Non-steroidal anti-inflammatory funds, including cycoxygenase-2 inhibitors
• Cocaine, Amphetamine, Other Drugs
• Sympathomimetics (Means against Rubber, Anorexands)
• Oral contraceptives
• Corticosteroids
• Cyclosporine and Torolimus
• Erythropoetin
• Some non-delicate food and biologically active additives

- Accompanying illnesses

• Obesity
• Alcoholism

- symptomatic (secondary) arterial hypertension

- incorrect measurement hell

Tactics dispensary observation

If possible, risk factors are eliminated, normalize lifestyle. Patients teach the right self-measuring hell. With secondary AG dispensary observation is determined by the disease that caused an increase in blood pressure. If necessary, change the doses of drugs or the form of medicines. After appropriate hypotensive therapy, patients are observed monthly until the hell is reduced to the desired level.

With AGI II degree or defeat of target organs, the examination is carried out more often. The concentration of creatinine and serum potassium is measured at least 1 time in 6 months. After a resistant decrease in Hell to the desired level of patients inspect every 3 months. Aspirin in low doses is prescribed only after normalization of blood pressure, otherwise it increases the risk of hemorrhagic stroke. Evaluable research on multiplicity and features of dispensary observations in children and adolescents is clearly not enough.

V. M. Delyagin, W. Levano, B. M. Blokhin, A. W. Urazbagambetov

Federal Scientific and Clinical Center for Children's Hematology, Oncology and Immunology, Russian State Medical University.

Delledge Vasily Mikhailovich - Doctor of Medical Sciences, Professor of the Department of Polyclinic Pediatrics RGMU

Literature:

1. Avtandilov A. G., Alexandrov A. A., Kislyak O. A., Kon I. Ya. And others. Recommendations for the diagnosis, treatment and prevention of arterial hypertension in children and adolescents. - Pediatrics, 2003. - 2. - Appendix 1. - 31 s.

2. Avtandilov A. G., Alexandrov A. A., Kislyak O. A., Kon I. Ya. And others. Recommendations for the diagnosis, treatment and prevention of arterial hypertension in children and adolescents. All-Russian Scientific Society of Cardiologists, Association of Children's Cardiologists of Russia. 2005. Cardiosite.ru.

3. Vadia A. S., Ioseliani D. G. Vazzorenal Hypertension: Diagnostics and Principles of Treatment // Therapeutic Case, 2007. - 4. - S. 11-17.

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Why are the teenagers there are "jumps" of pressure, which pressure indicators can be considered high, how to recognize hypertension and how to reduce the indicators hell need to be discussed with a cardiologist. Not all drugs are shown to teenagers, and sometimes they are not needed.

The problem of increased pressure can manifest themselves at any age, therefore it is recommended to check hell indicators even in children. Increasingly, with mandatory medical examinations, doctors detect the symptoms of hypertension in the boys and girls. If such a state is diagnosed, parents often do not understand what the high pressure says in the teenager. It is not always dangerous. However, it should be understood at what signs it is necessary to worry about the doctor inspecting the doctor. Parents are helpful to know about how to normalize pressure in transition.

Arterial hypertension can be primary and secondary. The first may develop if there is a predisposition in the family, it arises under the influence of the lifestyle of a teenager. The cause of the second is the resulting pathology.

Arterial hypertension in children and adolescents in most cases turns out to be primary.

The grounds for the diagnosis of hypertension in young people must be confirmed by measurements carried out not once. It should be borne in mind that if you measure hell immediately after physical exertion, recently stress recently, the indicators will increase. If during the examination, an increase in pressure was detected, it is necessary to repeat the measurement after a while. It is important that the child at this moment is calm.

If the survey conducted a doctor, for example, school, he can recommend parents of a particular specialist. In the case when adults themselves, with a home tonometer, suspected high pressure in a teenager, they need to contact the hospital for a deeper diagnosis.

Adults can panic, finding hell at hell, exceeding the well-known standard 120/80. In fact, the pressure level in an adult can fluctuate during the day in such a framework: systolic 110-140 mm Hg. Art. (upper) and diastolic 60-90 mm Hg. Art. (Lower).

• in 12-13 years, the level of the upper blood pressure should not exceed 125 mm Hg. Art.
• in 14-15 years, it can rise to 130 mm Hg. Art.
• in 16 years, the level of systolic blood pressure 125-135 mm RT is considered permissible. Art. and diastolic - 80-85 mm RT. Art.
• at the age of 17, it does not matter that the blood pressure has increased when the upper remains within 140, and the lower 90 mm Hg. Art.

Normal for teenagers "jumps" hell can manifest itself in the girl from the age of 12, and the boy from 14 years old. This is due to the beginning of puberty and, if there are no other symptoms, it does not threaten health. At the age of 15-17 years, it is recommended to check the blood pressure from adolescent annually.

Causes of hypertension in adolescents

It is worth paying attention to what the reasons for high pressure, steadily emerging beyond the norm, are called doctors. Primary hypertension occurs with such states:

• typical heredity;
• against the background of high blood cholesterol;
• with excess weight;
• after receiving some drugs (this also applies oral contraceptives);
• due to an inactive lifestyle;
• during smoking, alcohol abuse.

In 95% of cases, for these reasons, hypertension appears in children and adolescents. But sometimes the diagnosis can detect diseases that led to the formation of hypertonic syndrome. These include such diseases:

• kidney pathology;
• congenital heart disease;
• head injuries caused to increase intracranial pressure;
• drug addiction;
• obesity;
• burns;
• oncology.

Since 2002, every year, excessive body weight and increased pressure in adolescents associated with obesity are increasingly diagnosed.

Symptoms

The doctor may suspect a child not just "jumps" associated with excess emotions or transitional age, but a serious illness on the presence of characteristic complaints.

The main symptom of hypertension is a systematic increase in pressure in adolescents. Children often complain about such manifestations:

• for general deterioration of well-being;
• on frequent headaches;
• on problems with sleep:
• for a malfunction;
• on a strong sweating;
• for fatigue;
• on nausea;
• on pain in the heart;
• on bleeding from the nose;
• on dizziness.

Parents themselves may noted that the child has become very nervous, irritable

What to do

Violations of hell is a common problem among children and adolescents. In addition to hypertension, there are cases when, on the contrary, it is necessary to increase the pressure.

The mistake of parents in the event of such a problem may be confidence that they themselves know how to increase or reduce pressure, but incorrect treatment can only aggravate the situation and lead to development in patient cardiovascular pathologies.

Only a doctor, examining the patient and receiving the results of the diagnosis, decides what to do in a specific situation. For adolescents, this most often means the normalization of blood pressure in accordance with age, gender and physical parameters.

Basically, the pressure reduction is carried out by non-drug therapy methods, aimed at changing the lifestyle of a teenager:

• getting rid of excess body weight;
• improving physical activity;
• adjusting the power mode, restrictions on some products in the diet.

Determining how to reduce blood pressure, the doctor can advise not too heavy, but active loads: long walks on foot, cycling, coward longer than 30 minutes.

One of the main measures that reduce pressure in adolescents is the elimination of negative emotional factors. It is important to find out what could cause the mental instability of the child who led to hypertension: problems with study, conflicts with peers or in the family. To do this, you may need the help of a psychologist or psychotherapist. So that the effect of therapy appeared rather, to attend a specialist preferably with the whole family.

Diet for hypertensive is based on such rules:

• to consume no more than 7 g of salt;
• minimize the amount of simple carbohydrates;
• prefer vegetable fats (not less than a third of the firing of vegetable origin);
• forget about coffee and strong tea;
• exclude alcohol;
• there is no fatty meat and fish;
• do not eat canned, sharp and smoked;
• do not add spices;
• use vitamins;
• feed on a fractional principle (4-5 times a day).

Add to a menu of a teenager suffering from hypertension, you need products containing magnesium and potassium: dried fruits, zucchini, bananas, peaches, cauliflower, oatmeal, cottage cheese, solid cheese.

Pressure tablets can assign in case there is no effect of non-drug therapy.

When developing secondary hypertension, drugs are assigned. In this case, therapy of the underlying disease is also prescribed. Be sure to take medications if the target organs were amazed: the retina (degenerative changes of a non-visual character), the heart (left ventricular hypertrophy).

Conclusion

If the teenager periodically rises hell, it can be a manifestation of transitional age. But very often such problems as overweight, emotional overloads, physical passivity can lead to the fact that the child will be diagnosed with hypertension. With a timely handling of the doctor, this problem can be solved by techniques for non-drug therapy.

It is impossible to engage in self-medication. In rare cases, serious pathologies, which can be found only with medical examination, lead to increased blood pressure.

Hell in children are much lower than adult individuals. Conducted this feature of the structure of the vascular wall - there is more elastic fibers in it. The clearance of children's veins and arteries is much wider, and the network of capillaries is stronger.

Up to five years, belonging to a certain floor does not affect the pressure, and after this age, lower numbers are observed in girls.

There are special formulas for which the pressure rate is calculated for a specific age. For infants (to year), the norm of the upper pressure is defined as follows: 76 + 2 * M, where M is the age defined in months.

For older children, the normal systolic pressure value is equal to the amount of 90 and 2 * L (age in years).

As for the lower pressure numbers, their value reaches from two thirds to half the value of the upper pressure, and at the age of the year is calculated as the sum of 60 and the age of the baby in the years.

Change hell in children

Should the children's pressure be stable? At this age, the adhesiveness is often observed - it can be both elevated and reduced. The pronounced blood pressure fluctuations for a period in which the sex hormones are raging - the period of pubertata are especially characteristic. The prevailing hormones - adrenaline and aldosterone are strongly narrowing the vessels, which is why the hell is observed.

The main problem of the differences in pathology from the norm in childhood is the lability of blood pressure, due to the imperfection of endocrine and nervous systems. Blood pressure in children requires a thorough examination with suspected pathological changes. So, often under the mask of arterial hypertension is masked by such a "teenage" disease as a vegetative dystonia.

Distinguish the norm and pathology

Vegeta dystonia is a disease, most often occurring in emotional, easily excitable personalities. Under this characteristic, 80-90% of all adolescents of both sexes are suitable.

They have the dysfunction of the nervous system, which loses control over the periphery, respectively, and above the tone of the vessels. Unable to adequately react to external influences (excitement, stress, anxiety, physical exertion), the arteries are narrowed, then expands. At the same time, the level of hesitation hell in a child can be very high.

Distinguish the manifestations of vegetative dystonia from serious pathology is very difficult. A variety of concomitant symptoms often confuses, so in case of serious changes, the adhesion in the child requires a comprehensive examination: UZS, Doppler, daily monitoring of pressure. Children who are sick-seeking dystonia, irritable, preplays complaints of pain in the heart of the heart, strong migrae-like pain.

It is possible to suspect the hypotonic version of the VD without measuring pressure. External signs are sent to mood, capriciousness, high fatigue, weakening. Often there are dizziness - especially in the morning, immediately after sleep, also with long starvation. Such a child sweats, he has cold and wet palms, it is very easy to pale and blushes.

The phenomenon of orthostatic syndrome is observed: when lifting the bed or with long-term finding on the legs, under the conditions of oxygen starvation, the pressure drops sharply, the child is in a fainted state.

Provice high or low pressure in children are capable of: a mode violation, low sleep duration, high load from a physical point of view, long-term contact with a computer, stress, increased fatigue, insufficient power. In this case, restore the normal blood pressure in the child is simple: it is enough to streamline the mode of work and rest, reduce the load, restore sleep.

Low hell in a child can have their own, well-founded from the point of view of physiology, reasons. So, the pressure decreases before the awakening, after eating, in a stuffy room, with strong physical or psychological fatigue and even when changing the situation.

Without any external signs, hell is able to decrease in adolescents actively engaged in sports living in regions with reduced atmospheric pressure during acclimatization.

Pathological changes

Systolic pressure above 135 is no longer the norm. The cause of high blood pressure may become the disease of the endocrine system, the pathology of the heart, blood vessels, diseases of the kidneys, the central nervous system. In these cases, primary or symptomatic hypertension is diagnosed.

Not considered normal and low pressure. The primary hypotension was mentioned above - this is one of the manifestations of vegetative dystonia. The reasons are secondary can be:

• pathology of the endocrine system;
• separately, hypothyroidism are isolated - as a result of insufficient nutrition;
• diseases of the hypothalamic-pituitary system;
• severe intoxicating intoxication, infection;
• hypo- and avitaminosis;
• allergies, neurodermatitis, bronchial asthma;
• cardiovascular diseases;
• anemia;
• chronic tonsillitis;
• weight deficiency.

For parents

It is not necessary to assume that arterial pressure problems are characteristic only for adults. Pay attention to your child, on his complaints. Do not disregard migraine or pain in the heart.

It is you can become the person who will be the first to suspect a serious pathology from your child, because it is you talk to him most and better than others know his individual features.

A child complains of headache bentlessly several times a week? Do not hurry to "order" by its citrate. Medicinal preparations are very strong on the liver, and then you will be treated not one, but two diseases. Do not be lazy to take the child to the pediatrician, to examine the cardiologist or neurologist.

What is arterial hypertension in children and how to cope with it

Arterial hypertension in children - the phenomenon is quite common in the modern world. It is noted in third cases upon admission to the reception or ordinary medical examinations. But what are its causes and symptoms at different stages - few people know. And this is important, because with timely detection of the problem, you can start an effective treatment and give a child a healthy future.

Causes of children's hypertension

More than two third cases in children are observed by secondary hypertension, which is a symptom of a concomitant disease.

These diseases include:

• stenosis of kidney vessels, aortic stenosis or pulmonary arteries;
• thromboembolism of kidney vessels;
• inflammatory changes in various kidney anatomical structures;
• diseases of kidney parenchymal etiology.

The cause of secondary hypertension in children and adolescents can also be inflammatory diseases of the vessels, diseases of endocrine glands and connective tissue.

Among them are distinguished:

1. Tumors of the brain part of the adrenal cortex.
2. Diseases of thyroid and parathyroid glands.
3. Diseases of pituitary and epiphyse.

Arterial hypertension as an independent disease occurs much less frequently secondary form. This diagnosis is called only after a deep differential diagnosis with secondary hypertension.

The development of an independent form of the disease is taken to communicate with some important reasons, among which they call:

• severe genetic heredity;
• constant stressful situations;
• long depression;
• existence of excess weight;
• various metabolic disorders;
• abnormal reception of certain drugs.

It is also possible to increase the pressure in adolescents as a result of a puberty period, which does not bear much danger.

Symptoms of increased pressure in children

Hypertensive disease in children may have different symptoms that directly depend on the stage of the disease.

In this regard, at the first stages of the disease, the following symptoms can be observed:

• the pressure rises from 115 mm Hg. Art. up to 145 mm. RT. Art.;
• the occurrence of headaches;
• frequent fatigue;
• impairment of vegetative functions;
• increase body weight.

Over time, the symptoms of the disease are enhanced, since hypertension progresses and moves in recent stages.

This is expressed in the following signs:

• children have a quick fatigue;
• they constantly feel bad;
• migraines are becoming more frequent;
• periodic dizziness and memory dysfunction are observed;
• the level of attentiveness is reduced;
• hypertension indicators can increase to 160 mm Hg. Art.;
• pains in the chest, tachycardia appear;
• they observe the displacement of the hearts of the heart closer to the sternum, the second tone becomes clearer.

In the renal genesis of hypertension, you can see a persistent increase in pressure indicators. The effect of the treatment of hypertension in this case is extremely low, while the mortality rate is high enough.

Hypertension in children and adolescents can flow smoothly, but often there are rapidly progressive cases. This is called a hypertonic crisis.

It is characterized by the formation of three major symptoms:

1. The rapid development of disorders of the structures of the brain, which are accompanied by a headache, gastralgic symptomatomy, loss of vision and consciousness, as well as frequent attacks of seizures that may be caused by increased pressure in a teenager.
2. The lightning development of acute heart failure, which is accompanied by an ethnic hypertension.
3. Very rapid development of renal failure with Anuria, hematuria, proteinuria and other symptoms.

The residual diagnosis of "arterial hypertension" doctors post after three measurements of pressure indicators, in which both numbers are above 95 mm RT. Art., While the hypertension in infants is placed on the basis of numbers, which are above 85 mm Hg. Art.

There is also a table that contains numbers whose indicators are bordered with hypertensive disease. Children from seven to nine years have discovered increased pressure with indicators above 125/75 mm RT. Art.; In children from ten to thirteen years above 130/80 mm Hg. Art.; High pressure in the adolescent indicate indicators that are higher than 135/85 mm Hg. Art.

To confirm the diagnosis, it is necessary to conduct daily measurements of the blood pressure, the samples of the physical and emotional load for the creation of high pressure, among which the cyergometry and teleigrue are isolated.

Also carry out an electrocardiogram, an echocardiogram, examine the kidneys, heart, light, brain, determine the degree of their functioning. Examination of the work of endocrine glands is also necessarily in this case.

Differential diagnosis is carried out between the primary and secondary form of the disease. This is necessary to select the correct strategy of therapy.

Therapy and disease prevention

The treatment of hypertension in adolescents and children is often carried out without drug therapy.

In this case, you need:

• try to avoid stress and depressive states;
• it is less time to carry out the computer and TV;
• pour it right, eliminate fat and fried food;
• lead a healthy lifestyle;
• it is more common to spend time outdoors.

The therapy of vegetative violations is physiotherapy, therapeutic massage, mud baths and reflexotherapy. Also use phytotherapy.

But if these treatments did not meet expectations, doctors can resort to therapy with medicines.

For this, there are the following drugs:

• beta adrenoblockers (metaprolol, pindolol, atenolol);
• preparations that inhibit ACE (Enalhold, Captopril);
• preparations that block angiotensin receptors (Losartan);
• mesrechonny (puposide, dichlotiazide);
• means that are calcium antagonists (nifedipine).

Also for treatment it is necessary to ensure peace and appoint a course of soothing drugs. For the prevention of hypertension, you need to conduct a healthy lifestyle, have the right routine of the day and eat well. It is also necessary to avoid stressful situations in the family.

The presence of arterial hypertension in children and adolescents is not a sentence. Now this disease is easily treated and led regression.

Symptoms and treatment of intracranial hypertension

For older children and adolescents, signs of increasing VCD are:

• drowsiness, syradiability, plasticity;
• heartbeat, increase blood pressure;
• in the eyes of bone, squint, outbreaks before eyes;
• nausea, convulsions;
• pain over the enemy, headache at night and in the morning, under the eyes of the bruise.

In adults, a picture of the manifestation of the disease is similar to the pattern of teenage disease. Men can noticeably reduce the sexual function. Sometimes a long and significant increase in CBD leads to a violation of the mental state, causes a pathological course and to whom.

During the diagnosis, intracranial hypertension symptoms are found already in the early stages of the disease. Especially noticeable changes in the eye bottom under filloscopy: there is no ripple of blood vessels of the retina, there is a swelling of an optic nerve, hemorrhage occurs, similar to flames.

Studies show differences in eye pupil sizes, changing the reaction to light. Further development of the disease can lead to the paralysis of the muscles of the eye, partial paralysis of nerves, hemorrhage to the retina. Significant increasing HBDs are able to cause muscle paresis, an increase in blood pressure, slowdown and violation of the rhythm of the pulse.

Treatment of intracranial hypertension

At high values \u200b\u200bof the GCH, first of all it is necessary to achieve its normalization. Diuretics are used to quickly reduce the HCD. With brain tumors, corticosteroids are prescribed for a rapid decline of the GFD. In critical states, in injuries, strokes resort to barbiturates, to the puncture of the ventricles of the brain.

It is necessary to identify the main disease, to find the reason for the increase in the GFD. If the reason is an infectious disease, the antibiotics of a narrow or wide spectrum are prescribed depending on the detected pathogen. In the case of brain edema, steroids are used. Events in the hospital allow you to achieve improved patient's condition. At the same time, it is necessary to observe a number of patient care rules:

• the headboard bed of the patient should be raised;
• it is necessary to treat increased blood pressure;
• monitor electrolyte equilibrium;
• neutralize the excitation of the nervous system.

The mansion is idiopathic intracranial hypertension in adults. The disease is susceptible to the most common women up to 45 years. The intracranial hypertension syndrome in this case is associated with obesity, diabetes, disorders of the menstrual cycle, pregnancy, drug intake, poisoning, hemophilia, quantity, some infectious diseases, syphilis.

In these cases, intracranial hypertension is a secondary disease, the treatment of the underlying disease leads to an improvement in the condition of the patient and the disappearance of the symptoms of intracranial hypertension. Treatment is to appoint diakarba and weight reduction. Sometimes a lumbal puncture is prescribed. The patient's condition after punctures is improved. The disease does not lead to a fatal outcome.