Kuzmenko Ya. Yu.

LITERATURE REVIEWS

Scentific article

Arterial hypertension is characterized not only by elevated blood pressure, but by significant structural changes in the function and structure of the myocardium and vessels: left ventricular hypertrophy, vascular wall atherosclerosis, gradual development of cardiovascular insufficiency. Changes in the heart with hypertension are called structural remodeling of the heart. In the case of remodeling of the heart, there are changes in intramocardial vessels with accumulation in collagen adventitia, microscopic scarring in the area of necrotizing myofibrils of the heart and fibrous fibers in the left and right ventricles. According to modern ideas in the development of hypertension, multifactorial etiopathogenetic mechanisms are important. These major factors include enhancement of the renin-angiothecinoma system, in particular, an increase in the synthesis of renin and metabolism of electrolytes: calcium, magnesium, sodium, potassium. It is important to increase the activity of the sympathetic system (hyperadrenalemia, increase the sensitivity of the vessels to catecholamines) and change the function of intracellular mediators (prostaglandins, bradykinin, and others). Disturbances of metabolism in the body: energetic, protein, lipid, vascular endothelium dysfunction, microcirculation, apoptosis, lipid peroxidation, tissue hypoxia. According to the recommendations of the Ukrainian Society of Cardiologists, a “step by step” scheme for the treatment of hypertension was adopted. When soft and moderate AG treatment start with monotherapy with one of the medicines of the first row, and in severe form of hypertension – with the combined use of two or three drugs. The patient is prescribed the first-line antihypertensive medication in the middle dose. If a hypotensive effect is achieved then continue treatment. In the case of insufficient hypotensive action, if within 4 weeks of monotherapy with a hypotensive drug no therapeutic effect is achieved, then switch to a combined pharmacotherapy. AG is a pathogenetically heterogeneous disease; in different patients, elevated blood pressure is due to heterogeneous mechanisms. Determining the leading factor in increasing pressure in the patient is difficult enough. Therefore, it is more appropriate to use combined medications. The benefits of combination therapy are that a combination of two or more antihypertensive agents that affect various mechanisms of increased blood pressure, contributes to a more pronounced therapeutic effect, reduces the side effects of drugs, since the latter are used in smaller doses, it is possible to conduct long-term pharmacotherapy in the outpatient setting. In connection with the increase in the number of local military conflicts, terrorist acts and the threat of their occurrence, the problem of the development of social and stress violations received in an atmosphere of combat or close to it becomes more and more relevant. Of particular importance is the study of the influence of factors of military service on the course of hypertension in the military. A peculiarity of the present is the formation of a professional army. The professionalization of the Armed Forces of Ukraine is a complex process, which envisages, first of all, the recruitment of personnel by contract servicemen. Military service – a special type of human activity, which is characterized by an irregular working day, physical and psychological overload, limited ability to make decisions and other stressful situations. The social condition of the profession of a service man is an independent risk factor and the psychological status in them is characterized by emotional instability, an increased level of neuroticism, which should be taken into account when analyzing the causes of the onset and the clinical course of hypertension.

hypertonic disease, monitoring of blood pressure, cardiovascular diseases, combination therapy of hypertension, antihypertensive therapy

1. Nakaz Dyrektora DOZ MO Ukrayiny № 113 vid 6.11.2006 r. «Metodyka dyspansernoho dynamichnoho nahlyadu pry osnovnykh zakhvoryuvannyakh ta analizu dyspanseryzatsiyi». [in Ukrainian].
2. Kozlovskiy IV. Arterialnaya gipertoniya: voprosy podderzhivayushchey terapii. Terapevticheskiy arkhiv. 2006;4:50-3. [in Russian].
3. Borzova NV, Gorbachenkov AA. Regress gipertrofii i uluchsheniye diastolicheskoy funktsii levogo zheludochka u bol’nykh arterial’noy gipertoniyey pod vliyaniyem gipertenzivnoy terapii. Kardiologiya. 2008;48(6):44-50. [in Russian].
4. Ageyev FT, Fofanov TB. V poiskakh idealnogo gipotenzivnogo sredstva. Fiksirovannaya kombinatsiya ingibitora APF i tiazidnogo diuretika. Serdtse. 2004;5:267-70. [in Russian].
5. Lashkul DA. Poshyrenist i korelyatsiyno-statystychni vzayemozvyazky dysfunktsiyi nyrok u khvorykh na khronichnu sertsevu nedostatnist ishemichnoho genezu. Zaporozhskyy medytsynskyy zhurnal. 2014;1(82):26-9. [in Ukrainian].
6. Kobalova ZhD, Kotovskaya YuV, Villevad’de SV. Rekomendatsii po arterialnoy gipertonii: tekst, kontekst i razmyshleniya. Kardiologiya. 2008;48(2):72-87. [in Russian].
7. Kovaleva ON, Demidenko AV, Vishnyakov AYe. Funktsionalnoye sostoyaniye endoteliya sosudov u bolnykh s arterialnoy gipertenziyey i izbytochnoy massoy tela. Krovoobіg ta gemostaz. 2005;2:40-4. [in Russian].
8. Kovalenko VM, Dorohoy AP, Kornatskyy VM. Smertnist ta invalidnist naselennya vnaslidok sertsevo-sudynnykh ta sudynno-mozkovykh zakhvoryuvan – problema suchasnosti. Ukrayinskyy kardiolohichnyy zhurnal. 2003;6:9-12. [in Ukrainian].
9. Koval OV, Byelov OA, Lopin YeB. Zahalna bahatorichna zakhvoryuvanist viyskovosluzhbovtsiv Zbroynykh Syl Ukrayiny: zakhvoryuvanist viyskovosluzhbovtsiv ofitserskoho skladu (povidomlennya pershe). Problemy viyskovoyi okhorony zdorovya: zb. nauk. prats. K.: UVMA. 2009;25:121-30. [in Ukrainian].
10. Bilyy VYa, Sokhin OO, Vovkodav MM, Varus VI. Kontseptsiya profesiynoho zdorovya viyskovosluzhbovtsiv u Prohrami budivnytstva ta rozvytku Zbroynykh Syl Ukrayiny. Nauka i oborona. 2000;3:22-6. [in Ukrainian].
11. Rumyantsev YuV. Zdorovya viyskovosluzhbovtsiv yak faktor natsionalnoyi bezpeky Ukrayiny. Problemy viyskovoyi okhorony zdorovya. Zb. nauk. prats UVMA. Kyyiv. 2008;23:274-82. [in Ukrainian].
12. Yeganyan PA, Kalinina AM, Syrtsova LE, Lakhman YeYu. Samootsenka zdorovya i otnosheniye k profilakticheskim meropriyatiyam lits s myagkoy i umerennoy AG. Obshchestvennoye zdorovye i profilaktika zabolevaniy. 2005;2:19-25. [in Russian].
13. World Health Organization. The World Health Report 2002. Reducing Risks, Promoting Healthy Life. World Health Organization: Geneva, 2002.
14. Kovalenko VM, Lutay MI. Sertsevo-sudynni zakhvoryuvannya. Klasyfikatsiya, skhemy diahnostyky ta likuvannya. K.: Chetverta khvylya; 2003. 78 s. [in Ukrainian].
15. Kovalenko VN, Sirenko YuM. Realizatsiya natsionalnoyi prohramy profilaktyky i likuvannya arterialnoyi hipertenziyi v Ukrayini. Ukrayinskyy medychnyy chasopys. 2003;5(37):97-101. [in Ukrainian].
16. Kuzminova NV, Syerkova VK. Vplyv antyhipertenzyvnykh preparativ na endotelialnu dysfunktsiyu u patsiyentiv z hipertonichnoyu khvoroboyu. Ukrayinskyy medychnyy chasopys. 2008;2/64(III-IV):66-72. [in Ukrainian].
17. Lee DS, Ghosh N, Floras JS. Association of blood pressure at hospital discharge with mortality in patients diagnosed with heart failure. Circ Heart Fail. 2009;2(6):616-23.
18. Konsensus po primeneniyu ingibitorov angiotenzinprevrashchayushchego fermenta pri serdechno-sosudistykh zabolevaniyakh. Rabochaya gruppa Yevropeyskogo kardiologicheskogo obshchestva. Meditsina svіtu. 2005;XIII(2):113-21. [in Russian].
19. Geltser BI, Savchenko SV, Kotelnikov VN. Kompleksnaya otsenka vazomotornoy funktsii sosudistogo endoteliya u bolnykh s arterialnoy gipertoniyey. Kardiologiya. 2004;44(4):24-8. [in Russian].
20. Kovalenko VM, Kornatskyy VM. Dynamika stanu zdorovya narodu Ukrayiny ta rehionalni osoblyvosti. Analityko-statystychnyy posibnyk. Kyyiv: 2012. 211 s. [in Ukrainian].
21. Martynov AI, Ostroumov OD, Mamayev VI. Variabelnost arterialnogo davleniya pri arterialnoy gipertenzii i vliyaniye antigipertenzivnoy terapii. Klinicheskaya meditsina. 2002;80(6):4-7. [in Russian].
22. Kobalava ZhD, Gudkov KM. Evolyutsiya predstavleniy o stress-indutsirovannoy arterialnoy gipertonii i primenenii antagonistov retseptorov angiotenzina-ІІ. Kardiovaskulyarnaya terapiya i profilaktika. 2002;2:4-15. [in Russian].
23. Kovaleva ON, Shapovalova SA. Farmakoterapiya gipertonicheskoy bolezni. KH.; 2005. 136 s. [in Russian].
24. Malaya LG, Korzh AN, Balkovaya LB. Endotelialnaya disfunktsiya pri patologii serdechno-sosudistoy sistemy. Kh.: Torsing; 2002. 423 s. [in Russian].
25. Mamedov MN. Obsuzhdeniye osnovnykh tezisov II Mezhdunarodnoy Nyu-Yorkskoy konferentsii «Metabolicheskiy sindrom i dislipidemiya»: kak adaptirovat rezultaty krupnykh issledovaniy k realnym rossiyskim usloviyam? Rossiyskiy kardiologicheskiy zhurnal. 2005;5:95. [in Russian].
26. Kundiyev YuI, Nahorna AM. Profesiyne zdorovya v Ukrayini. Epidemiolohichnyy analiz. K.: Avitsena; 2006. 316 s. [in Ukrainian].
27. Martynov AI, Ostroumova OD, Mamayev VI. Vliyaniye gipotenzivnoy terapii na regress gipertrofii miokarda levogo zheludochka pri arterial’noy gipertenzii. Mezhdunarodnyy meditsinskiy zhurnal. 2003;7(2):11-5. [in Russian].
28. Mazur YeS, Mazur VV, Bogdanova YeK. Osobennosti remodelirovaniya levogo zheludochka serdtsa u bolnykh arterialnoy gipertenziyey s narushennym sutochnym ritmom arterialnogo davleniya. Kardiologiya. 2004;11:75-6. [in Russian].
29. Buiciuc O, Rusinaru D, Levy F, Peltier M, Slama M, Leborgne L, et al. Low systolic blood pressure at admission predicts long-term mortality in heart failure with preserved ejection fraction. J Card Fail. 2011;17(11):907-15.
30. Voronkov LH, Amosova KM, Bahriy AE. Rekomendatsiyi z diahnostyky ta likuvannya khronichnoyi sertsevoyi nedostatnosti. Sertseva nedostatnist. 2012. [in Ukrainian].

«Bulletin of problems biology and medicine» Issue 1 Part 1 (148), 2019 year, 47-52 pages, index UDK 616.12-008.331.1:615.225.1:355:11 К 89

10.29254/2077-4214-2019-1-1-148-47-52