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"Emergency medicine" 7 (70) 2015

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Hypertension: a Disease or a Risk Factor?

Authors: Vasquez Abanto J.E.(1), Vasquez Abanto A.E.(2), Arellano Vasquez S.B.(3)
(1) - Candidate of Medical Sciences, Physician in the Emergency Department of Obolon District (Center for Primary Health Care № 2), Kyiv, Ukraine
(2) - Medical Intern of the Cardiology Department of Kyiv Municipal Clinical Hospital № 8, Kyiv, Ukraine
(3) - Specialist in Physical Therapy and Rehabilitation, University of San Pedro, Academic and Professional School of Medical Technology, Chimbote, Peru

Categories: Medicine of emergency

Sections: Specialist manual

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Summary

В исследованиях, опубликованных как одними исследователями (De la Sierra A. и González-Segura D.) в 2011 г., так и другими (Martell-Claros N., Galgo-Nafria A.) в 2012 г., изучались факторы риска сердечно-сосудистых заболеваний, что подчеркивает их определяющую роль в возникновении сердечно-сосудистых событий. Наряду с дислипидемией гипертония является серьезнейшим фактором развития сердечно-сосудистых заболеваний и ухудшения их прогноза.
На уровне первичного звена оказания медицинской помощи, в частности в медицине неотложных состояний, отмечается высокий показатель вызовов по болезням кровообращения, среди которых преобладают вызовы по гипертонии. При этом гипертония в качестве сопутствующего диагноза сопровождает практически каждый случай вызова по болезням кровообращения.
Количественный анализ вызовов, обслуженных бригадой неотложной медицинской помощи, по нозологическим единицам позволяет сделать вывод, что в основном обслуживаются вызовы по болезням органов кровообращения, гипертонической болезни с кризами, болезням органов дыхания, пищеварения и нервной системы. В процентном соотношении болезни органов кровообращения и гипертоническая болезнь с кризами среди всех обслуженных вызовов имеют (за 3-годичный период) такие показатели: 40,84 и 25,74 % соответственно.

У дослідженнях, опублікованих як одними дослідниками (De la Sierra A. і González-Segura D.) в 2011 р., так і іншими (Martell-Claros N., Galgo-Nafria A.) в 2012 р., вивчалися фактори ризику серцево-судинних захворювань, що підкреслює їх визначальну роль у виникненні серцево-судинних подій.
На рівні первинної ланки надання медичної допомоги, зокрема в медицині невідкладних станів, відзначається високий показник викликів по хворобах кровообігу, серед яких переважають виклики по гіпертонії. При цьому гіпертонія як супутній діагноз супроводжує практично кожен випадок виклику з хвороб кровообігу.
Кількісний аналіз обслугованих бригадою невідкладної медичної допомоги викликів за нозологічними одиницями дозволяє зробити висновок, що в основному обслуговуються виклики з хвороб органів кровообігу, гіпертонічної хвороби з кризами, хвороб органів дихання, травлення та нервової системи. У процентному співвідношенні хвороби органів кровообігу і гіпертонічна хвороба з кризами серед усіх обслугованих викликів мають (за 3-річний період) такі показники: 40,84 та 25,74 % відповідно.

In studies, published by some researchers
(De la Sierra A. and González-Segura D.) in 2011, and by others (Martell-Claros N., Galgo-Nafria A.) in 2012, there were stu-died the risk factors for cardiovascular diseases that emphasizes their crucial role in the occurrence of cardiovascular events. In addition to dyslipidemia, hypertension is an important factor for cardiovascular diseases and worsening of their prognosis.
At the level of primary health care, particularly in emergency medicine, there are high rates of calls due to circulatory di-seases, among which calls due to hypertension are dominated. At that, hypertension as a concomitant diagnosis accompanies almost every case of the call for circulatory diseases.
Quantitative analysis of calls serviced by emergency team, according to disease entities, leads to the conclusion that most serviced calls are the calls due to circulatory diseases, essential hypertension with crises, respiratory, digestive and nervous system diseases. The percentage of circulatory diseases and essential hypertension with crises among all served calls (for 3-year period) is 40.84 and 25.74 %, respectively.


Keywords

гипертензия, сердечно-сосудистые заболевания, риск, кардиология, давление.

гіпертензія, серцево-судинні захворювання, ризик, кардіологія, тиск.

hypertension, cardiovascular diseases, risk, cardiology, pressure.

In the report on the occasion of world health day 2013 "General overview of hypertension in the world", WHO is clearly concerned about this problem that is reflected in the 40 pages of information, facts and figures. 
All of these concepts and information about hypertension are reviewed periodically by the international medical community, in accordance with studies and experience in daily practice. WHO in his report “General information about hypertension in the world. World health day 2013" examines the reasons for hypertension RF related to behavior, socioeconomic factors, and also group factors that may hide genetic constituting a secondary character (for example, renal or endocrine disease), or perhaps the factors associated with temporary anxiety (fear) before the medical consultation ("white coat hypertension"). 
The risk factor for the adoption of the WHO is a property or feature of a specific person or any impact on him, which increases the likelihood of future disease or injury. According to WHO research, significantly increase the risk of sudden death three main factors: hypertension, hypercholesterolemia and smoking. The main RF in the occurrence of CVD (over 80%) are considered to be unhealthy and unbalanced diet, inactivity and tobacco use. The consequence of poor diet and a sedentary lifestyle are the factors for increasing the blood pressure, increasing the level of glucose in the blood, high amount of fats in the blood, overweight and obesity. All this combine a generic term "intermediate risk factors". There are also many underlying causes that have a direct influence on the formation of chronic diseases (including hypertension) – globalization, urbanization, aging population, and poverty and stress.
Concerning risk factors (RF) in a multicenter study, where were involving 6762 patients with AH, without previous cardiovascular events (authors: De la Sierra A., González-Segura D.), published in the magazine "Medicina clínica de la Facultad de Medicina de Barcelona” in may 2011, where the majority of patients positively met the criteria of high or very high cardiovascular risk, the most often were identified factors of dyslipidemia (73,6%), elderly age (50,8%) and abdominal obesity (31,7%). As for damage in target organs, anomalies of the kidney were observed the most (24,1%), left ventricular hypertrophy (16,4%) and microalbuminuria (10,7%). 
In the another study (authors: Martell-Claros N., Galgo-Nafria A.), published in the magazine European journal of preventive cardiology in June 2012 was noted that newly-diagnosed patients among hypertensive patients (< 55 years) at the primary health care in Spain have expressed association of FR cardiovascular disease (CVD) and high cardiovascular risk. In this study, among all patients with hypertension, 5.8% didn’t have RF CVD, at 23.2% was recorded at least 1 PHR, associated with high BP, at 32,8% – 2, at 24,7% – 3, at 11.3 % – 4, and 2.3% were identified 5 RF CVD. The most widespread RF CVD was the dyslipidemia that occurs in 80,4% (at 37,9% with treatment), with subsequent abdominal obesity, at 45,9% of patients with hypertension. The prevalence of metabolic syndrome accounted 44.4%. Cardiovascular risk met at an average at 0.2% of the sample with low concentration at 5%, moderate at 26,1 %, with a high content at 47.3%, and very high content at 21.4%. 
Starting from the already known concept of blood pressure, BP (the force, which affects the blood on the walls of blood vessels, particularly arteries, when it is ejected by the heart), the higher it is, the more efforts are necessary for the heart to pump blood. Normal BP for adults is considered to be 120 mmHg.PT. (systolic pressure, SP) and 80 mm Hg.PT. (diastolic blood pressure, DBP), high or increased, when the SP is ≥ 140 mmHg.PT. and/or DBP ≥ 90 mmHg.PT. 
As a result of high or increased BP, especially if it has already switched to hypertension and is not controlled by the doctor, negative health effects can be exacerbated by such RF, which increase the likelihood of complications and progression of this condition: tobacco use, unhealthy diet, alcohol abuse, minor physical activity and the impact of continuous stress, and so is obesity, high level of cholesterol and diabetes. 
In studies, published as some researchers (De la Sierra A. and González-Segura D.) in 2011, and other (Martell-Claros N., Galgo-Nafria A.) in 2012, were studied the risk factors for cardiovascular diseases, which emphasizes their crucial role in the occurrence of cardiovascular events.
At the primary level of medical care, particularly in emergency medicine, high rates of calls circulatory diseases, which are dominated by calls for hypertension. Thus, hypertension as an associated diagnosis accompanies almost every cases call for circulatory diseases.
Quantitative analysis of calls serviced medical emergency brigade of disease entities leads to the conclusion that mainly serves to call the diseases of the circulatory system, hypertension with crises, diseases of the respiratory, digestive and nervous system. The percentage of circulatory diseases and hypertension with crises on all serviced calls have (for the 3 year period) such indicators: 40.84% and 25.74% respectively.

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