Arterial Hypertension In Women

Arterial hypertension in women

V.S. Chistov

The first MGMU im. Sechenova

Arterial hypertension to date - one of the most common ailments: the diagnosis of "arterial
Hears about one in ten adults today.
The disease can be silent, for many years to destroy blood vessels and the heart, and in the absence of a qualified
Timely treatment, lead to heart attack, angina pectoris, weakness of the heart muscle, to the development of cardiac
Insufficiency, to stroke, blindness, kidney failure ... this list can be continued very, very long.
Fortunately, today there are many opportunities not just to reduce high blood pressure, but also
Maintain it for a long time at the optimal level - it is only necessary to pass the examination in time
And detect the disease.
It is necessary to know: for today every tenth adult person has the raised arterial pressure, but
Only half of people know about their problem. And even fewer people who receive proper treatment: some
Patients do not see the need for treatment with a good state of health, others do not know about the existence of modern
Highly effective and perfectly tolerated drugs to reduce blood pressure. Meanwhile, to treat
Arterial hypertension is necessary - even if the disease is asymptomatic, it can lead to very
Sad consequences. Do not risk your health, and even your life.
Consequences of arterial hypertension in women
Isolated increase in blood pressure (i.e., arterial hypertension without concomitant risk factors) in
70% of cases lead to a stroke in women. For comparison, in men with AH without concomitant risk factors, it ends
Stroke in only 30% of cases.
The effectiveness of antihypertensive therapy among men and women is the same. However, with age, the effectiveness
Antihypertensive therapy in women decreases, which is caused by the characteristics of postmenopause (about that just below).
To date, complications of arterial hypertension are the 1 st place, if we talk about mortality in the female
Population. The magnitude of systolic blood pressure in women is the second most significant risk factor
Development of ischemic heart disease (CHD).
IHD and AH in women
A woman from a man is distinguished not only by primary and secondary sexual characteristics, but also differences are noted in
Hormones, genes, lifestyle - all this, of course, is reflected in the course of various diseases, on safety and
Effectiveness of treatment.
For many years, there was an opinion that the risk of developing coronary heart disease in women is significantly lower than that of
Men. In fact, this is not the case, the risks in both sexes are the same, moreover, in recent years there has been a trend towards
The increase in mortality from cardiovascular disease is in women.
In order to solve this problem, it is necessary, as a minimum, to determine the main risk factors for cardiovascular
Diseases in women, as well as to look for ways to correct them. All risk factors of cardiovascular
Diseases can be divided into two groups: specific (specific for a particular sex, in our case for
Women), nonspecific (common for both women and men).
Nonspecific factors include age, early manifestation of symptoms of cardiovascular disease in
Relatives, smoking, diabetes, obesity, sedentary lifestyle, impaired glucose tolerance,
Increase in OXC, LDL cholesterol, decrease in cholesterol levels * HDL. Despite the fact that these factors are nonspecific, in
The peculiarities of their effect on the formation of the pathology of the cardiovascular system in women and men have differences.
As for specific signs, they can include metabolic disorders during pregnancy,
Menopause, hormonal contraception, hysterovariectomy.
It is proved that women with obesity also fall into the group of increased risk of cardiovascular diseases: the risk
Increases 4-fold. Mechanisms that play a role in this process are still unknown, but the relationship between obesity and
Blood pressure is accurate.
With regard to lifestyle, it is proven that the lack of regular physical activity leads to an increased risk
Occurrence and development of cardiovascular diseases twice. Regardless of weight changes against the background of physical
Activity normalization of blood pressure indicators is observed. It is believed that a positive impact
Physical loads associated with existing mediated and direct mechanisms that contribute to reducing
Blood pressure, providing the myocardium with oxygen, in addition, exercise exerts a beneficial effect on
Clotting factors contribute to the improvement of the lipid spectrum of the blood.
Unfortunately, in our country, arterial hypertension among women is widespread and is observed in 41.1%.
Arterial hypertension in women of different ages
For the first time, differences in the level of blood pressure, depending on gender, can be
Six years of age. Higher blood pressure values are observed in girls from the age of six to
Pubertal period. But from the moment of puberty and until the onset of menopause, you can note more
Low blood pressure in women. After the menopause has come, all the differences disappear, and
Women face a higher risk of developing cardiovascular disease, hypertension compared with
Men.
The prevalence of arterial hypertension among young women is low, but after menopause the risk of
And the development of this disease significantly increases. However, not every woman has high blood pressure
Coincides in time with the onset of sexual involution. In recent years, the increase in blood pressure is noted and
Among young women, including pregnant women. In Russia, hypertensive syndrome can be observed in 15-30% of pregnant women,
Which leads to serious complications not only during the period of pregnancy and childbirth, but also has a negative
Impact on long-term prognosis in women. It often happens that arterial hypertension appears during
Pregnancy ... and remains with a woman forever.
Arterial hypertension in women and oral contraceptives
Taking oral contraceptives is one of the main reasons for the development of arterial hypertension in
Women. It is proved that women taking these drugs, with arterial hypertension, collide 2-3 times
More often women who do not take such a tool. In addition, contraceptive oral agents are capable of
Worsen the course of previously observed arterial hypertension. Risk of arterial hypertension on admission
Contraceptive oral agents is increased in women over 35 years of age if a woman smokes and / or if
Obesity.
A presumptive mechanism for increasing blood pressure in women who take birth control pills
Oral preparations: weight, volume of circulating blood increases, insulin resistance appears,
There is a delay in the body of sodium.
Normalization of blood pressure is observed a few weeks after the end of the medication. But if
While a woman on the background of taking contraceptives has already developed arterial hypertension, if the risk of consequences
Possible pregnancy will be higher than the risk of AH progression, then it is recommended to continue taking contraceptives with
Simultaneous treatment with antihypertensive drugs.
The risk of developing arterial hypertension is increased if:
- there is arterial hypertension in a family history - there is obesity - kidney pathology is observed - a woman is over 35 years old - a woman takes contraceptives for a long time - if the arterial blood pressure was increased during the previous pregnancy.

Hypertension in women during menopause and postmenopause
The increase in blood pressure during menopause is affected by many factors - this is a reduction
Physical activity, and increased body weight, and increased consumption of alcohol, salt.
During the postmenopause, the risk of developing cardiovascular diseases increases. This is due to the restructuring
Endocrine system during this period, as well as with a deficiency in the synthesis of estrogens, which have a beneficial effect on
Cardiovascular system.
The lack of estrogen can lead to increased pressor effectiveness of angiotensin II, a change in lipid
Blood spectrum against a background of increasing total cholesterol, lipoproteids of very low and low density, to a decrease
The number of high-density lipoproteins.
Among patients under 40 years of age from hypertension, women suffer less often than men, but by 45-55 years the situation
Changes, and the number of women with arterial hypertension begins to prevail.
Accordingly, much attention is now being paid to the search for safe and effective drugs for treatment
Hypertensive disease in postmenopausal women - not only to reduce blood pressure, but also
With the aim of correcting climacteric manifestations, which will offer an alternative to hormone replacement therapy.
Treatment of arterial hypertension in women
Today, the most urgent problem is the identification of the relationship between hypertension and various diseases with a view to
Development of an optimal integrated approach to prevention and treatment (Oganov RG, 2007; Anikin SG, 2009; Yakushin SS,
2010).
However, almost all modern specialists agree that for the treatment of arterial hypertension
It is preferable to prescribe antihypergene therapy.
An important place in the tactics of conducting women with arterial hypertension is given to non-drug therapy.
So, for example, a low-calorie diet for women with obesity can lead not only to weight loss, but also to
Lowering blood pressure, in addition, the diet will have a positive impact on such risk factors as diabetes,
Insulin resistance, myocardial hypertrophy of the left ventricle, hyperlipidemia.
Do not underestimate the role of physical activity: walking, swimming, exercising, exercising
Gymnastics and so on will help you reduce the risks of appearance, development of arterial hypertension.
In parallel with non-drug therapy it is necessary to prescribe antihypertensive drugs.
Before reviewing the most preferred drugs today, it is worth saying that the hope for efficacy
Hormone replacement therapy with the aim of a possible positive impact on blood pressure, were not justified. Moreover, in
In some cases (about 9%), there was not a decrease, but an increase in blood pressure
Hormone replacement therapy.
In addition, it should be noted that despite the rather wide, diverse choice of antihypertensive drugs,
Today the effectiveness of treatment of arterial hypertension remains at a sufficiently low level. In addition, the data,
Which were obtained in the study of men, can not be transferred to women automatically (Podzolkov NM, 2009;
Tkacheva ON, 2010). Accordingly, great importance is the problem of differentiated therapy of arterial
Hypertension in women, as well as evaluation of the effectiveness of functional non-invasive techniques, which will improve the prognosis,
Quality of long-term therapy. Thanks to the development of the algorithm, it will be possible to individualize the treatment
Women.
To date, with arterial hypertension, women are prescribed any antihypertensive drug (with
Absence of contraindications) of each group in the form of combined or monotherapy. To strengthen the hypotensive
The effect is usually prescribed hypothiazide (hydrochlorothiazide). Often to treat arterial hypertension in women
Use diuretics: arifon-retard, arifon, cardioselective beta-adrenoblockers (lokren (betaxolol), atenolol,
Less often bisoprolol).
If we talk about ACE inhibitors, then moexipril is usually used, sometimes fosinopril (monopril).
As for calcium antagonists in the form of dihydropyridine preparations of prolonged action (captive, norvask,
Kordafleks-retard), then their reception is quite possible, but it must be remembered that some patients may develop swelling
On their feet, or they can become more pronounced.

1. Ageev FT, Fomin IV, Mareev Yu.V. The prevalence of arterial hypertension in the European part of the Russian Federation
Federation. Data from the EPOA study, 2003;
2. Shlyakhto EV, Belousov Yu.B., Kirichenko AA Arterial hypertension in postmenopausal women. Cardiology. 2003;
3. Kobalava Zh.D., Tolkacheva VV, Moryleva О.N. Clinical features and treatment of arterial hypertension in women.
A heart. 2004;
4. Kuban scientific medical bulletin Clinical and functional features of the cardiovascular system in women with arterial hypertension. 2011;
5. Prohorovich EA, 2006; Tkacheva ON, 2010; Oganov RG, 2007; Anikin SG, 2009; Yakushin SS, 2010.