For regenerative and preventive purposes, Supplements Biofiton Healthy Vessels and Healthy Nerves can be used.

Biofiton Healthy Nerves Phytotablets include medicinal plants, the effect of which is aimed at:

  1. RELAXING, CALMING. Motherwort Aerial Parts and Hawthorn Flowers decrease excitability; Valerian Roots, Hop Strobile, Dill Seeds, Linden Flowers and Peppermint Leaves have calming effect and relieve irritation. Combined effect of all plants promotes relieving of manager’s syndrome (constant mental tension), allow emotional state normalization in menopausal women.
  2. SOUND SLEEP. Biological compounds, contained in Valerian Roots, Hop Strobile, Linden and Hawthorn Flowers remove emotional tension, promote falling asleep, making sleep calm and sound, and morning waking becomes easy and joyful.
  3. NORMAL PRESSURE AND HЕALTHY HEART. Combined effect of Motherwort Aerial Parts and Hawthorn Flowers promotes support of normal blood pressure and heart rate.

 

Biofiton Healthy Vessels Phytotablets include medicinal plants, the effect of which is aimed at:

  1. NORMAL PRESSURE. Biologically active substances of Hawthorn Flowers, Birch Leaves and Horsetail Aerial Parts improve heart work and regulate blood pressure.
  2. NORMAL BLOOD FLOW. Hawthorn Flowers, Melilot Aerial Parts, Horse Chestnut Seeds, Horsetail Aerial Parts and Buckwheat Flowers have mild action and favorable effect on blood circulation.
  3. NORMAL CHOLESTEROL LEVEL. Active substances of Alder Buckthorn Bark and Peppermint Leaves prevent fatty deposits on vascular walls and maintain normal blood cholesterol level.
  4. STRENGTHENING AND CLEARANCE. Common Periwinkle and Melilot Aerial Parts, Dog Rose Fruits and Cowberry Leaves clean vessels from various deposits, normalizing their elasticity and flexibility.
  5. NORMAL METABOLISM. Hawthorn Flowers, Horse Chestnut Seeds, Dog Rose Fruits and Buckwheat Flowers activate metabolic processes, providing delivery of nutrients to all body cells, thus normalizing the blood flow.

 

Hypertension, hypertonia, hypertension, AH (from arterial hypertension), HA (from Latin hypertonia arterialis), in the narrower sense, hypertensive disease – a condition of the blood circulation system characterized by periodically or continuously elevated blood pressure, both systolic (upper), as well as diastolic (bottom).
The vast majority (over 90%) of cases of hypertension are primary (spontaneous), i.e. there is no known somatic cause that could be removed by medical intervention. The etiology of essential hypertension has not been fully established. It is believed that genetic and environmental factors play a role in it. Other cases are secondary (symptomatic) when the cause of the disease is well known, for example kidney disease, endocrine disease or brain disease.

EPIDEMIOLOGY
In 2000, 972 million adults in the world suffered from hypertension, of which 639 million in economically developing countries. It is estimated that in 2025 there will be 1.5 billion people with hypertension in the world.
In the NATPOL III PLUS study carried out in 2002, the prevalence of hypertension in Poland was estimated at 29%, in 30% of respondents it was found to be normal, 21% normal and 20% optimal (accepted JNC VI and WHO / ISH 1999 classification, then adopted in the ESH / ESC 2003, PTNT 2003 and ESH / ESC 2007 guidelines).
The detection of hypertension in Poland in 2002 was 67%, the correct control among all patients only 12.5%. For comparison – in the US 31% of people taking antihypertensive drugs have blood pressure <140/90, while in the UK only 9%.
According to the data presented during the conference “Cardiology 2012” by prof. Zbigniew Gacionga from the Medical University of Warsaw has hypertension in 9.5 million adult Poles aged 18-79. However, 17-year-olds need to be added to this number (according to the research – 9% of them have hypertension).

ETHIOLOGY AND PATHOGENESIS
About 90% of cases of the disease are primary hypertension (idiopathic or idiopathic), and therefore without a perceptible cause. Pathogenesis is probably multifactorial, and the presence of physiological disorders of blood pressure control processes is environmentally and genetically determined. During a normal heart cycle, we distinguish between its contraction (systole) and diastole (diastole). Within a minute, the heart shrinks about 60-80 times and with each blow ejects blood into the arteries. During the ejection of blood from the left ventricle to the aorta (the main artery), the pressure is greatest and gradually decreases in the smaller arteries, capillaries and veins. Thanks to this, it is possible to transport blood in the direction of pressure drop and supply all organs with oxygen and nutrients (sugar, fats and others). During diastole, blood pressure reaches the lowest value. Then the venous system returning blood is pumped from the right atrium to the right ventricle, from where it is transported to the lungs to enrich oxygen again. Blood pressure during diastole never drops to zero. This is due to the elasticity of the arterial walls, which take the force of a stroke of blood during contraction and give it away during relaxation. The amount of pressure, i.e. the pressure on the arterial walls, varies and varies between maximum (contraction) and minimum (diastolic) values. A short-term increase in pressure is a natural phenomenon and can happen, for example, during physical exertion, in a stressful situation, when pressure is measured by medical personnel (so-called “white coat” overpressure), then the pressure rises, but the body as a whole remains in equilibrium. However, too high blood pressure values, which persist in several subsequent measurements, already indicate hypertension. This indicates that one or more risk factors have led to a permanent increase in blood pressure.
In the remaining 10% of people, hypertension is secondary, but perhaps this percentage is actually higher. The most common causes of secondary hypertension include chronic renal disease (5% of all HA), others include renal stenosis (<1%), Cushing’s syndrome, pheochromocytoma, Conna syndrome (all <0.2%). American Association of Clinical Endocrinologists (AACE) expressed in their 2006 guidelines the view that only Conn’s syndrome (primary hyperaldosteronism) alone accounts for 15% of all hypertension cases.

Primary hypertension
According to Folkov’s hypothesis, genetic predisposition to adapt arteries to frequent sympathetic arousals is responsible for primary hypertension. Remodeling the walls of the resistance arteries leads to an increase in peripheral vascular resistance (TPR) and forces the heart to work more.
Guyton’s theory explains hypertension with a genetic kidney defect that retains more sodium, resulting in increased blood circulation. Maintaining the correct sodium concentration requires more perfusion of the kidneys, which is the cause of hypertension.

Secondary hypertension
Causes of secondary hypertension:

1. kidney-related diseases
• parenchymal diseases
 – acute and chronic glomerulonephritis
 – polycystic kidney disease
 – hydronephrosis
 – diabetic kidney disease
• renal artery disease
 – renal artery stenosis
 – other causes of kidney ischemia
• renin-secreting tumors
• primary sodium retention syndromes (Liddle syndrome, Gordon syndrome)

2. endocrine gland diseases
• adrenal diseases
 – primary hyperaldosteronism caused by adenoma or adrenal hyperplasia
 – phaeochromocytoma of the adrenal gland (also paragons)
 – Cushing’s syndrome
• acromegaly
• thyroid disease (especially hyperthyroidism, sometimes underactive)
• hyperparathyroidism
• carcinoid syndrome

3. Neurological
• Guillain-Barré syndrome
• tetraplegia
• increased intracranial pressure
• a brain tumor
• brain injury
• family dysautonomy

4. cardiovascular disease
• coarctation of the aorta
5. pregnancy-induced hypertension
6. obstructive sleep apnea syndrome
7. acute stress (burns, alcohol abstinence in addicts, psychogenic hyperventilation, hypoglycemia, perioperative period)
8. hypervolemia
9. drugs – exogenous hormones (estrogens, corticosteroids, erythropoietin, sympathomimetics, cyclosporine, tacrolimus, MAO inhibitors)
10. toxic substances: amphetamine, cocaine, heavy metals
11. benign prostatic hyperplasia

Causes of isolated systolic hypertension:
• excessive stiffness of the arteries (especially in the elderly)
• increased cardiac output (aortic regurgitation, arteriovenous fistula).
Hypertension and oral contraceptives
Hypertension is more common in women using oral contraceptives than in those who prevent pregnancy in a different way or do not use any method of contraception. The cause of this phenomenon is unknown. Probably the underlying is the effect of the components of contraceptives on the mechanisms of blood pressure control. Genetic factors are also taken into account. The appearance of hypertension in a woman taking contraception is an indication to change the way contraception. In women with prior hypertension, the use of such agents may worsen its course.

DIAGNOSTICS
Examination of a patient with hypertension should include, apart from blood pressure measurement, an accurate interview and physical examination.
Among the data from clinical history, the current course of HA, co-occurrence of kidney diseases (also in the family), symptoms of pheochromocytoma and hyperaldestoronism, medication (oral contraceptives, steroids, antihypertensive drugs), presence of other cardiovascular risk factors, complications are of particular importance. organ.
Ancillary examinations are intended to detect additional risk factors, possible causes of secondary hypertension and organ damage. The minimum scope of necessary supporting research remains debatable. Basic research according to PTNT: blood count, fasting glucose, sodium and potassium, uric acid, creatinine, lipidogram, urinalysis, ECG. The recommended tests include: echocardiogram, fundus examination, chest X-ray, belly and carotid ultrasound, microalbuminuria, calcium concentration, CRP and glucose load test (in non-diabetic subjects). The recommended tests should be performed in patients in whom a potentially positive result may change the rules of conduct or other indications. PTNT negates the indications for the routine performance of genetic tests in patients with hypertension, evaluation of endothelial dysfunction or stiffness of large arteries or other laboratory tests.
Compared to PTNT, ESC recommendations do not include C-reactive protein (CRP), but emphasize the importance of subclinical organ changes (recommend routine determination of microalbuminuria, as well as creatinine clearance (using the Cockroft and Gaulda formula) or glomerular filtration (equation MDRD).

Pressure measurement technology
Blood pressure measurement in the doctor’s office should be done after providing the patient with a few minutes of rest in a sitting position. Two measurements are made with a two-minute break, and as a result, the arithmetic mean value is recorded. At the first visit, the measurement on both arms is indicated. In patients with shoulder circumference 22-32 cm, a standard cuff is used, in others the mockups are appropriate to the size of their arm. Using a too narrow cuff may falsely inflate the pressure.
At home, patients should take 2 readings in the morning and evening for 3 days a week. Self-pressure control avoids the “white coat effect” (raising pressure when contacting a doctor). The average pressure from several measurements less than 135/85 is accepted as the norm in this method.

In special circumstances, it may be advisable to:

24-hour pressure monitoring (ABPM) – recommended mainly for patients over 65 years of age,
conducting a one-time pulse wave analysis – recommended mainly for younger patients, without additional risk factors, not suffering from white coat syndrome,
24-hour pulse wave analysis – recommended for patients of all ages. This is a study combining both of the above. From the patient’s point of view, it is no different from classic 24-hour monitoring, but after each measurement, a pulse wave analysis is also performed. This combination provides the physician with incomparably more information than the two above-mentioned studies carried out separately.

RISK ASSESSMENT
Hypertension is one of the most important cardiovascular risk factors. His assessment is made in relation to the next 10 years of life comparing the values ​​of blood pressure, the presence of risk factors other than hypertension, organ complications and comorbidities.
Several general cardiovascular risk assessment systems are currently available based on large population studies – these include the American Framingham scale and the European SCORE.
In 2003, the results of the SCORE (Systematic COronary Risk Evaluation) project were announced. This system, based on data from cohort studies conducted in 12 European countries, was developed in two versions – for countries with a low and high risk of death caused by a cardiovascular incident. Poland was included in the second group. As part of the project, risk assessment tables were prepared, also available in the form of the network HeartScore® program.
It is worth noting that the SCORE scale is unsuitable for risk assessment in patients whose cardiovascular risk is by definition high, i.e. in all patients diagnosed with cardiovascular disease, diabetes and also in persons with a very strong single risk factor . The risk is also actually higher for obese people who have a family history of cardiovascular disease and are approaching the next age category. SCORE does not take into account other risk factors.

OVERPRESSURE DISEASE
Hypertension usually goes on secretly until the onset of complications. Elevated blood pressure values ​​are detected as a result of routine medical examination or incidental measurement.
For many years, existing hypertension may not be accompanied by any symptoms. If they do occur, they are not very characteristic: headaches, excessive excitability, insomnia, easy fatigue, sometimes a feeling of palpitations, redness of the face, neck and chest (especially when the pressure rises). In the case of secondary hypertension, symptoms of the underlying disease may be present.
In some patients, hypertension may be unstable and does not cause organ complications for a long time, while in others it is permanent from the time of diagnosis and leads to these complications early.

COMPLICATIONS
The complication is primarily kidney damage (chronic renal failure, up to the need for dialysis), cardiovascular system (heart failure, heart attack) and complications from the nervous system (ischemic stroke, dementia syndrome).
Hypertension clinics according to WHO:
And – no changes in organs
II – left ventricular hypertrophy or hypertensive retinopathy I ° / II ° or proteinuria
III – hypertensive damage to the heart (left ventricular failure), kidney (renal failure), brain and eye (retinopathy III ° / IV °)

Subclinical organ damage
The subclinical organ damage is demonstrated by:
heart – features of left ventricular hypertrophy (LVH) in ECG (Sokołów-Lyon index> 38 mm, Cornell product> 2440 mm * ms) or in echocardiography (LVMI ≥ 125 g / m² in men and ≥ 110 g / m² in women)
kidneys – slight increase in serum creatinine (1.3-1.5 mg / dl in men, 1.2-1.4 mg / dl in women), microalbuminuria (excretion 30-300 mg / 24 h, ratio albumin / creatinine ≥ 22 mg / gu male, ≥ 31 mg / gu female), reduced estimated glomerular filtration rate (<60 ml / min / 1.73 m²), low creatinine clearance (<60 ml / min)
blood vessels – atherosclerotic plaque or thickening of the intima-media complex (IMT) of the carotid arteries> 0.9 mm (measured by ultrasound), ankle-brachial index lower than 0.9, pulse wave speed between carotid and femoral artery> 12 m / p.

Hypertensive retinopathy

Hypertensive changes in fundus examination (Keith, Wagener and Barker classification):

I ° moderate stenosis or hardening of small retinal arteries, abnormal ratio of arterial diameters to diameters of veins
II ° Moderate or severely hardening of the arteries (arteries with the appearance of copper wire), positive symptom of Gunn
III ° edema, retinal exudate and haemorrhage, hardened and narrowed arteries
IV ° symptoms of III ° and additionally swelling of the optic disc
I ° and II ° changes are now considered to be so unspecific that (not counting young people) they should not be attributed to prognostic value.

Malignant hypertension
Malignant hypertension is a severe form of hypertension with high blood pressure (usually 120-140 mm Hg diastolic, systolic usually above 200 mm Hg), damage to small vessels in the retina and acute, rapidly progressive renal and heart failure, as well as other organs. It is a life-threatening condition and, if left untreated, leads to death within a few days to several months. A typical symptom of rapidly developing hypertension is headache, usually located in the occiput, occurring mainly in the morning. He is often accompanied by visual disturbances. There may also be disorders of thinking, orientation, consciousness, paraesthesia, convulsions, coma. They are symptoms of severe hypertensive encephalopathy. Systemic symptoms may include: abdominal pain, weakness, shortness of breath, polyuria, nykturia, weight loss.
Treatment of malignant hypertension should take place in a hospital setting in a ward that allows continuous monitoring of pressure.

PRESSURE PREVENTION – CHANGE OF LIFE
A change in lifestyle significantly reduces blood pressure values ​​in people with elevated pressure and may probably prevent the development of the disease in people who have genetically conditioned inclinations to it. Elements of non-pharmacological treatment include: normalization of body weight, adherence to a proper diet, including non-abuse of alcohol and salt, reduction of fat intake, especially saturated fat, smoking cessation and increase of physical activity.
In total, non-pharmacological interventions reduce the 5-year incidence of hypertension by 50%.

Normalization of body weight
In the Western world, 30-65% of patients suffering from hypertension are obese. On average, for every 10 kg body weight above the normal, systolic blood pressure increases by 2-3 mm Hg (and even 5-20 mm Hg) and diastolic blood pressure increases by 1-3 mm Hg. It has been proved that the loss of excessive body weight is effective not only as a method of lowering the already increased pressure, but also as primary prevention (ie preventing the occurrence of hypertension in previously healthy people). The combination of low-calorie diet and exercise gives better results than each of these interventions separately.
Because in middle-aged people the body mass increases gradually (by 0.5-1.5 kg / year), the target can be taken for stabilization.

Limiting salt intake
Epidemiological studies indicate a relationship between excessive sodium intake and hypertension. In randomized trials, for every 100 mmol (2.3 g) of reduced daily sodium intake, systolic blood pressure is reduced by 4-6 mm Hg. As recommended by AACE, patients with high blood pressure or high normal pressure should limit their daily sodium intake to less than 3 g per day. PTNT recommends consuming up to 6 g of table salt per day (equivalent to 2.3 g of sodium) and ESC / ESH <3.8 g of sodium chloride (1.5 g of sodium) or at least <5 g of NaCl (<2 g of sodium) During the reduction of salt intake, one should especially watch out for the “hidden” salt in ready-made food products, eg bread, powdered soups, stock cubes, dairy products. After 48 hours, the body gets used to less salty dishes, and after 2 weeks you can completely give up salt, replacing it with e.g. herbs.

Increased potassium intake
People with normal kidney function AACE are suggested a daily potassium intake of 3.5 g, preferably in the form of fresh fruit and vegetables. It was shown that supplementation of 2.34-3.9 g of potassium results in a mean reduction of systolic arterial pressure by 4.4 mm Hg and diastolic by 2.5 mm Hg. Potassium regulates the work of the myocardium and nervous system. The diet should also take into account the supply of magnesium, which affects the strength and frequency of heart contractions. It is also a natural calcium channel blocker. The daily requirement for magnesium is 250-350 mg.

Moderate alcohol consumption
A linear relationship has been demonstrated between the amount of alcohol consumed and the incidence of hypertension in the population, with adverse effects usually seen among those who regularly consume more than 20-30 g of ethyl alcohol per day. Therefore, men with hypertension who drink alcohol are advised not to reach a maximum of 20-30 g, while women and people with low body weight 10-20 g ethanol per day.
Some people should not drink alcohol at all. This applies especially to people with problems with self-control, women planning pregnancy, pregnant and lactating women, children and adolescents, people taking medications that may interact with alcohol, people with liver disease, people who have complications associated with alcohol consumption (including pathological hypertensive reaction and alcohol-induced arrhythmia), and people in special medical situations.
In diabetics, alcohol intake should be limited to small amounts, included in the caloric content of the meal and consumed with the meal (oral antidiabetic drugs generally exclude alcohol consumption). Sweet and high-calorie alcohols (e.g. beer, liqueurs, spirits) are not allowed.
Alcohol is an active chemical that reacts easily with drugs – including medicines for hypertension. It may in an uncontrolled way weaken or strengthen the effect of medicines and exacerbate side effects. In combination with some medications, it can also be a cause of life-threatening intoxication of the body, paroxysmal anxiety and depression, and even suicidal thoughts.

Smoking cessation
PTNT, ESC / ESH and AACE agree on smoking cessation as a very strong cardiovascular risk factor. AACE indicates a 3-fold higher risk of heart attack in smokers compared to people who never smoked. Tobacco addiction causes: an increase in the risk of stool, heart failure and stroke; weakening the effectiveness of hypertension treatment; permanent increase in blood pressure; increasing the risk of hypertension complications; faster development of atherosclerosis.
The same organization is of the opinion that smoking does not cause hypertension. A different position is presented by PTNT, ESC and ESH.
Smoking cessation is probably the most effective single lifestyle change in preventing cardiovascular disease.

Physical activity
Physical activity has been shown to reduce systolic blood pressure by 4–9 mm Hg. Increasing physical activity also helps reduce overweight, improve overall body function and reduce mortality.
Moderate, regular aerobic exercise is recommended, such as brisk walking, swimming, and cycling for at least 30-45 minutes on most days of the week. Intensive isometric exercises (such as weightlifting) can cause a large increase in pressure and are contraindicated. This procedure is safe in most hypertensive patients. People with severe hypertension or accompanying diseases should increase physical activity under medical supervision.
AACE emphasizes that physically active people also have less age-related increase in blood pressure.

Calming down the lifestyle
The “speed of life” also influences the amount of pressure. People who lead a quiet life have lower blood pressure. People who are constantly busy, rushing from one place to another, constantly sleepless and tired have higher pressure. An important role in the prevention and treatment of hypertension also plays ensuring an adequate dose of sleep. During sleep, the pressure drops by 10-20 mm Hg. Lack of sufficient sleep (less than 5 hours a day), difficulty in falling asleep, interrupted sleep, shallow or sleep apnea may accelerate the development of hypertension.

Dietary recommendations
It is known that people who eat less red meat, processed cereal products and sweets, and more vegetables and fruits, fish and whole-grain cereal products are less likely to have a stroke. Adding olive oil and wine (Mediterranean diet) to the diet causes the so-called life expectancy.
The beneficial effect of red wine is attributed to the flavonoids contained in it. This effect, without conducting appropriate tests, is also trying to extend to other products containing flavonoids – including in ginkgo, cranberry, hawthorn inflorescence, chokeberry, chamomile.
The hypotensive effect of fish oil has been proven. Increased intake of fish, fish oil (also in the form of supplementation of polyunsaturated fatty acids ω-3) also reduces the incidence of coronary heart disease.
Fiber is responsible for the beneficial effect of fruits, vegetables and whole grains. Vegetarians have lower blood pressure compared to people on a non-vegetarian diet. In addition, a diet rich in vegetables and fruits is associated with a high content of magnesium. Magnesium supplementation is not recommended in any other way.
It seems controversial that antioxidant preparations (such as vitamin C, E, coenzyme Q10) have a beneficial effect on the course of hypertension. Although vegetables and fruits contain large amounts of vitamins, it has been proven that vitamin E can even increase the total mortality in the group taking its supplement. The results of research on vitamin C remain ambiguous. A rich source of natural vitamin E are walnuts, vitamin C – e.g. black currants.
It has been confirmed that powdered garlic can lower blood pressure, although there is a criticism of the research methodology. Steviosides – compounds from the stevia plant have a hypotensive effect by stopping the influx of Ca2 + ions.
There is no need for calcium supplementation (if there are no specific indications). Increasing the supply of calcium, especially in patients with hypertension, can lead to kidney stones.
In a 12-day study of a group of 500 people who introduced a strictly vegetarian diet, controlled stress, and performed moderate intensity exercise, there was a significant reduction in blood pressure in people with hypertension (over 140/90 mm Hg), an average of 17/13 mm Hg.

Diet DASH (Dietary Approaches to Stop Hypertension)
Based on the research of the American National Institutes of Health (NIH), a diet was developed consisting of eating large amounts of fruit, vegetables and low-fat products. The DASH diet is recommended by experts of the Polish Society of Hypertension and the Polish Forum for the Prevention of Cardiovascular Diseases.
An important effect of its use, in addition to reducing pressure by about 8–14 mm Hg, is a simultaneous reduction in total cholesterol, LDL cholesterol and triglycerides, and thus an additional reduction in cardiovascular risk.
Polymeal diet
In response to the concept of Polypill, the treatment of hypertension with combined preparations containing several active substances, in 2004 a diet was proposed to result in a 75% reduction in cardiovascular incidents.
The Polymeal scheme assumes eating 114 g of fish for 4 days a week and every day:
400 g of fruit and vegetables (and 2.7 g of garlic in addition)
100 g of dark (bitter) chocolate
68 g of almonds
150 ml of red wine.

Biofiton dietary supplements
In order to alleviate the effects of stress and calming the body, it is recommended to use the Healthy Nerves nutritional supplement. The Healthy Vessels supplement should be used to normalize blood pressure, blood circulation, cholesterol normalization and metabolism. Taking supplements should alleviate or even eliminate the causes leading to high blood pressure.

TREATMENT
The decision on the time and method of treatment inclusion is made after taking into account the value of blood pressure and general cardiovascular risk. The need for a flexible approach to starting pharmacotherapy in people with BPs is also emphasized. Lowering the systolic pressure below 130 mmHg reduces the risk in people suffering from coronary heart disease, diabetes and chronic kidney disease.

Drug-free
The change in lifestyle described above is an indispensable part of chronic therapy for hypertension. Not only is it an intervention sufficient to control hypertension, it reduces the overall cardiovascular risk, but it also improves the response to some medications.

pharmacological
In the treatment of hypertension, a wide range of antihypertensive drugs are used, differing in terms of chemical structure and mechanism of action. Most often they are:
• ACE inhibitors (ACE-I) – they inhibit angiotensin-converting enzyme activity and thus have a hypotensive effect. This group includes active substance zofenopril, which is highly effective in lowering blood pressure and beneficial effects on the cardiovascular system. It was demonstrated, among others cardioprotective, anti-atherosclerotic and protective effects on the kidneys (reduces proteinuria and progression of renal failure), which has a high degree of recommendation of the European Society of Cardiology (ESC). Zofenopril is characterized by a long-lasting hypotensive effect, a mild onset of action and the absence of reflex tachycardia. Clinical observations to date indicate the appropriateness of its administration in a single daily dose, facilitating the systematic conduct of pharmacotherapy. Conditions co-occurring with hypertension, especially for the use of ACE inhibitors (ESH / ESC recommendations from 2007) include heart failure, left ventricular dysfunction, after myocardial infarction, atrial fibrillation, nephropathy, proteinuria / microalbuminuria.
• angiotensin receptor antagonists (sartans, ARBs)
• β-blockers (β-blockers) – in 2006 doubts were published as to whether β-blockers should be used as first-line drugs in the treatment of hypertension, due to the unacceptable risk of developing diabetes with long-term use.
calcium channel blockers (calcium channel blockers) – block the penetration of calcium into the muscles of the arteries, causing them to shrink. The development of the newest drugs in this class (e.g. lercanidipine) went towards the elimination of side effects, and thus increased patient persistence in the continuation of therapeutic therapy. For lercanidipine, symptoms such as headache and ankle swelling have been reduced. Calcium antagonists together with thiazide diuretics are first-line drugs in the treatment of hypertension – especially in older 60+ patients.
• thiazide and thiazide-like diuretics (a group of diuretics) – stimulate the kidneys to excrete water and the sodium it contains from the body. By reducing water management, they reduce blood pressure and prevent vasoconstriction.
• other antihypertensive drugs gradually losing their importance (methyldopa, reserpine).
They all reduce the incidence of hypertension complications.
When you need to start treatment for high blood pressure, you usually use one medicine (monotherapy) or a combination of two drugs at low doses in one tablet (called polypill). In most cases, however, two or more antihypertensive drugs (polytherapy) are required to normalize the pressure. If you have a condition caused by hypertension, it is necessary to treat complications at the same time. During the pharmacotherapy, periodic checks of treatment effects are necessary (mainly blood pressure measurements, but also blood and urine tests, as well as a specific ECG time, fundus examination).
In the vast majority of cases, treatment of hypertension is provided as part of primary care.

Uncomplicated primary hypertension
There are no definitive opinions as to the first choice drug. It is only known that hypertension must be treated, of course, taking into account contraindications to specific drugs.
ESC and ESH emphasize the benefits of hypotension alone, regardless of the choice of drug from those mentioned above. PTNT and PFP present a similar position, indicating the need for individualization of therapy.
The American JNC recommends starting treatment with thiazide diuretic as a single agent or in combination with one other drug (ACE inhibitor, angiotensin receptor antagonist, beta-blocker or calcium channel blocker) as standard.
The most systematic treatment algorithm was presented in 2006 by the British National Institute of Clinical Excellence (NICE) in cooperation with the British Society of Hypertension (BHS).
The NICE / BHS guidelines assume the use of a calcium antagonist or thiazide diuretic in all black patients and other patients aged 55 or over. Younger people should be given the first-line treatment of ACE-I or ARB. In the case of ineffectiveness of such therapy, the British propose combination therapy: ACE-I or ARB together with a diuretic or calcium blocker. If this approach turns out to be ineffective, ACE-I / ARB should be combined with a calcium channel antagonist and thiazide. It is only for people who do not respond to such therapy that inclusion of β-blocker, α-blocker and possible specialist consultation is envisaged.
Systolic hypertension isolated
In elderly patients with isolated systolic hypertension, the possibility of systolic blood pressure below 140 mmHg can be limited due to the risk of excessive reduction of diastolic pressure (60-70 mmHg). Patients with this type of hypertension should maintain the lowest well-tolerated systolic pressure. Intensive treatment to reduce systolic blood pressure to 120 mmHg has been found to significantly reduce the incidence of heart attacks and circulatory failure by almost a third and the risk of death by a quarter compared to patients with a systolic blood pressure target of 140 mmHg.

Diabetes
Type 2 diabetes and hypertension often coexist. Due to the beneficial effect on renal function (protective effect in patients with nephropathy in the course of type 1 and 2 diabetes mellitus and non-diabetic nephropathy) and possible increase in insulin sensitivity in the treatment of hypertension in patients with diabetes, ACE-I or ARB is preferable (or combined ACE treatment -I and ARB). In view of the need to add additional drugs, a diuretic (at the lowest effective dose and with potassium supplementation or a potassium-sparing drug), a calcium antagonist or a third generation ß-blocker (such as nebivolol) or any combination of these drugs is recommended.
Treatment should be aggressive to achieve a target pressure of <130/80 mm Hg and even ≤ 120/75 (AACE), especially in patients with proteinuria (> 1 g / d).

Treatment of secondary hypertension
In secondary hypertension, treatment is introduced to eliminate its cause.
The treatment of primary hyperaldosteronism is also the treatment of hypertension. Depending on the cause of the excess aldosterone it is adrenal resection, administration of spironolactone, exceptionally – glucocorticosteroid treatment.
Surgery is performed for Cushing’s syndrome, but as many as 33% of patients have systolic hypertension after surgery, and 75% have diastolic hypertension. Before removing the adrenal tumor, ketoconazole, a cortisol synthesis inhibitor, more commonly known as an antifungal drug, is used. Thiazide diuretics, ACE inhibitors and calcium channel blockers are considered to be the drugs of choice in pharmacotherapy.
Treatment of hyperthyroidism or hypothyroidism usually also leads to a reduction in hypertension.
In pheochromocytoma, resection of the tumor leads to resolution of hypertension in 75% of patients. Preoperative pressure control as well as treatment of residual disease is carried out with the help of α-blockers and additionally, if necessary, using β-blockers or calcium channel blockers.
The renin-secreting renal tumors are usually operable due to their superficial location.

Rare Liddle syndrome responds to treatment with amiloride and triamterene.

Hypertension in pregnancy
Hypertension in pregnancy is a serious threat to both the fetus and the pregnant woman. Hypertension increases from 5 to 10% of pregnancies in Poland.
Hypertension in pregnancy is diagnosed at values ​​≥ 140 or 90 mm Hg.
Changes in arterial blood pressure are a physiological phenomenon. In the I and II trimesters, a decrease in blood pressure is observed, with the lowest values ​​reaching around the 23rd week of pregnancy. From this moment, the blood pressure increases again and up to 6 weeks after the dissolution returns to the state before pregnancy.
Therefore, PTNT adopted the following breakdown of gestational hypertension:
• chronic hypertension – occurring before pregnancy or before 20 weeks of pregnancy (and persisting over 42 days after delivery)
• pregnancy-induced hypertension – developing after week 20
• unspecified hypertension (symptomatic or asymptomatic) – diagnosed after the 20th week of pregnancy (requires re-evaluation after at least 42 days after termination, which allows it to be included in one of the two types mentioned above).
Hypertension during pregnancy predisposes to the development of preeclampsia, eclampsia and HELLP syndrome. Occurrence in pregnant hypertension is also associated with a threat to the fetus: its growth, intrauterine hypoxia and even death may be inhibited. There is also an increased risk of premature detachment of the placenta and prematurity.
Treatment, depending on needs, may include non-pharmacological management, use of methyldopa, calcium channel blockers, and sometimes β-blockers to reduce pressure and administration of low doses of acetylsalicylic acid (prevention of pre-eclampsia). ACE inhibitors and sartans are contraindicated.
Hypertension in children
Blood pressure in children can be considered high normal if its value is between 90 and 95 percentile, but it meets the criteria for hypertension when it reaches or exceeds the 95 percentile for a given age and sex. The proper cuff selection is necessary. Hypertension in children is rare (approximately 1%). In younger children it is almost always secondary, and only after 10 years of age is more likely to reveal primary hypertension. The finding of hypertension in every child is an indication for in-depth specialist diagnosis to rule out secondary hypertension (especially caused by aortic coarctation, renal artery stenosis, renal failure, renal nephropathy or hormonal disorders). Elevated pressure may be caused by the use of anabolic hormones or drugs. Treatment of hypertension in children is similar to that in adults. The same groups of drugs are used in correspondingly lower doses. Children with hypertension who do not have organ complications should not have limited physical activity.

Biofiton Healthy Nerves Phytotablets include medicinal plants, the effect of which is aimed at:

  1. RELAXING, CALMING. Motherwort Aerial Parts and Hawthorn Flowers decrease excitability; Valerian Roots, Hop Strobile, Dill Seeds, Linden Flowers and Peppermint Leaves have calming effect and relieve irritation. Combined effect of all plants promotes relieving of manager’s syndrome (constant mental tension), allow emotional state normalization in menopausal women.
  2. SOUND SLEEP. Biological compounds, contained in Valerian Roots, Hop Strobile, Linden and Hawthorn Flowers remove emotional tension, promote falling asleep, making sleep calm and sound, and morning waking becomes easy and joyful.
  3. NORMAL PRESSURE AND HЕALTHY HEART. Combined effect of Motherwort Aerial Parts and Hawthorn Flowers promotes support of normal blood pressure and heart rate.

 

Biofiton Healthy Vessels Phytotablets include medicinal plants, the effect of which is aimed at:

  1. NORMAL PRESSURE. Biologically active substances of Hawthorn Flowers, Birch Leaves and Horsetail Aerial Parts improve heart work and regulate blood pressure.
  2. NORMAL BLOOD FLOW. Hawthorn Flowers, Melilot Aerial Parts, Horse Chestnut Seeds, Horsetail Aerial Parts and Buckwheat Flowers have mild action and favorable effect on blood circulation.
  3. NORMAL CHOLESTEROL LEVEL. Active substances of Alder Buckthorn Bark and Peppermint Leaves prevent fatty deposits on vascular walls and maintain normal blood cholesterol level.
  4. STRENGTHENING AND CLEARANCE. Common Periwinkle and Melilot Aerial Parts, Dog Rose Fruits and Cowberry Leaves clean vessels from various deposits, normalizing their elasticity and flexibility.
  5. NORMAL METABOLISM. Hawthorn Flowers, Horse Chestnut Seeds, Dog Rose Fruits and Buckwheat Flowers activate metabolic processes, providing delivery of nutrients to all body cells, thus normalizing the blood flow.