One of the main causes of rupture of the thoracic aorta is considered to be chronic arterial hypertension - a disease that still few people, except the doctors themselves, take seriously
This is a good reason to talk again about its insidiousness and about the methods of treatment, which today (and here is the big paradox!) are enough. And the threat is not getting any smaller.
Prof. Shevchenko, why is world medicine so worried exactly about hypertension?
- Only nine risk factors account for 95% of premature disability and death of the human organism.
These are arterial hypertension, smoking, obesity, diabetes, low physical activity, alcohol, some psychosocial factors, stress. And what is most interesting - all of them can be avoided!
Cardiology (responsible for the treatment of arterial hypertension) is today the most depressing speci alty in medicine, because: until the age of 30, everyone is afraid of acne, then of cancer, and they die mainly of cardiovascular diseases.
This is also confirmed by the forecast published a few months ago in the magazine "Lancet" - one of the most authoritative medical publications in the world. In order to answer the question: "What will we die of in 2040?", scientists have analyzed a huge amount of data from 195 countries.
Their conclusion is extremely interesting: in 2040, coronary heart disease will continue to be the leading cause of death worldwide. Second place will be taken by stroke.
The number of deaths caused by various infections and by oncology will decrease because the doctors of the world will have already learned how to treat cancer.
Another problem is that when we treat the cancer, the patient develops heart failure… Anticancer drugs, as well as radiation, often cause cardiomyopathy. And the patients treated for oncology come to us, the cardiologists.
According to statistics, people in the world more often die from heart attacks than from strokes. Nevertheless, and regardless of sound logic, people are not afraid not only of strokes, but also of heart attacks, apparently hoping for the well-known phrase in our country:
“This can't happen to me…”
A clear example of this is the sensational list of the best-selling (and therefore purchased) drugs published in the media. The warm leaves lead the drugs, as we say "for the head" (pain relievers) and the widely advertised preparations "for the stomach".
There is not a single antihypertensive drug that regulates blood pressure - ie. that which actually affects life expectancy and prevents death. And the prevalence of hypertension is extremely high, even huge!
For example, according to the 2018 statistics, every second person has a blood pressure higher than 140/90 - this means that at least half of the able-bodied, working population has hypertension and therefore lives with all the potential risks of premature death.
Why do you define hypertension as a paradoxical disease?
- Hypertension is indeed an extremely paradoxical disease. To diagnose it, you don't need complicated and high-tech methods - you just take the device and measure your blood pressure.
However, the majority of patients with hypertension do not even know they have it. At the same time, it is extremely easy to keep blood pressure under control - antihypertensive drugs are cheap and sold literally in every pharmacy.
The treatment algorithm is also clear: you take the pill every day (you should not stop taking the medicine even when the blood pressure in the morning is like that of an athlete!) and continue to live in peace and tranquility - the risks are gone.
It is also a paradox, for example, that a large number of patients do not take their medication, even if they know about their diagnosis. Or, without consulting a doctor, they take the "wrong" drugs - as a result, the treatment becomes ineffective.
Are there disagreements among you cardiology specialists about the treatment of hypertension?
- Today there is no disagreement among us cardiologists regarding the assessment of hypertension as one of the most dangerous diseases - the "silent killer" whose number of victims continues to grow.
We can only argue about the thresholds for starting treatment - at what blood pressure values we should start taking medication and most importantly - how to better motivate our patients to adhere strictly to their prescribed treatment.
We all know what happens in practice: a person starts taking his pills - felt better - throws them away…
By the way, in 2017, new criteria were adopted in the USA, according to which the treatment of arterial hypertension should be started already at blood pressure indicators of 130 over 80.
This decision was supported by an absolute majority of the American medical community.
And how are things in our country, in Europe?
- The threshold blood pressure values for Americans - 130/80 corresponds to our normal or high normal pressure. The European signal for starting treatment is at blood pressure 140/90. But a specific problem arises here.
If with a blood pressure of 130 I say to the patient: "You have high normal pressure", he only hears the word "normal" and reacts accordingly, i.e. no cure.
If the patient hears: "You have hypertension, you have reached the bottom", only then the serious relationship between the doctor and the patient begins and there is hope that he will change his attitude to his he alth, start treatment. This is the psychological point of view…
Why does blood pressure rise?
- Question from the eternal category. According to us, the specialists, hypertension is polyetiological. I.e. hypertension is not a separate disease, but a syndrome that usually has a whole bunch of causes.
It can be hereditary, it can be provoked by excessive consumption of sodium (s alt), excess body water, edema or several factors at the same time.
By the way, one-time increases in pressure (from overexcitement, for example) are not as dangerous as chronic increases in blood pressure in a calm state, which can develop secretly for years, slowly destroying our vital organs - kidneys, heart, brain, etc.
What is the proper treatment for hypertension?
- For treatment, we have a proven arsenal of non-drug remedies.
These are: enough sleep, adequate physical activity (not shopping!), weight control, limiting s alt that attracts water (you can easily replace it with soy sauce or use spices); limiting fats, carbohydrates and alcohol, stopping smoking.
I.e. optimal way of work and rest - simple, but requiring some effort and willpower "method of treatment".
By the way, the positive effect on hypertension of aerobic exercise has been proven: 3-5 times a week for 30-40 minutes for patients with blood pressure over 120 over 70.
But yoga as well as acupuncture does not work against hypertension - it has been verified in many serious studies.
And, of course, non-drug therapy cannot replace drug treatment. The trend in modern therapy is the combination in one tablet of two or even three preparations, in a dose that is individually selected by the doctor for each patient.
Such "simplification" not only does not reduce the effectiveness of the drug, but is also convenient, because the patient will have to take it for life. And if the hypertensive has a high risk of heart attack, it can be added to the same pill with antihypertensives and a statin.
Today there are such combinations.
Aerobic exercises are:
► Walking and hiking
► Running or jogging
► Skiing (especially cross-country skiing)
► Running in place
► Climbing stairs