Arterial gipertenziya: Versiyalar orasidagi farq

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„Hypertension“ sahifasi tarjima qilib yaratildi
(Farq yoʻq)

23-Sentyabr 2022, 12:18 dagi koʻrinishi

Gipertenziya ( HTN yoki HT ), shuningdek, yuqori qon bosimi ( HBP ) sifatida ham tanilgan, arteriyalarda qon bosimi doimiy ravishda ko'tarilgan uzoq muddatli tibbiy holatdir[1]. Uzoq muddatli yuqori qon bosimi insult, koronar arteriya kasalligi, yurak yetishmovchiligi, atriyal fibrilatsiya, periferik arterial kasalliklar, ko'rish qobiliyatini yo'qotish, surunkali buyrak kasalligi va demans uchun asosiy xavf omilidir[2][3][4][5]. Gipertenziya butun dunyo bo'ylab erta o'limning asosiy sababidir[6].

Yuqori qon bosimi birlamchi (asosiy) yoki ikkilamchi gipertenziya deb tasniflanadi[7]. Taxminan 90-95% holatlar birlamchi bo'lib, o'ziga xos bo'lmagan turmush tarzi va genetik omillar tufayli yuqori qon bosimi sifatida aniqlanadi[7][8]. Kasallik xavfni oshiradigan turmush tarzi omillari orasida dietada ortiqcha tuz, ortiqcha tana vazni, chekish va spirtli ichimliklarni tartibsiz iste'mol qilish natijasida yuzaga keladi[9][7]. Qolgan 5-10% hollarda surunkali buyrak kasalligi, buyrak arteriyalarining torayishi, endokrin kasalliklar yoki tug'ilishni nazorat qilish tabletkalarini qo'llash kabi aniqlanganligi tufayli, yuqori qon bosimi sifatida tavsiflangan ikkilamchi yuqori qon bosimi deb tasniflanadi[7].

Qon bosimi ikkita o'lchov bo'yicha tasniflanadi: sistolik va diastolik bosim. Mos ravishda maksimal va minimal bosimdir[9]. Ko'pgina kattalar uchun dam olishda normal qon bosimi sistolik simob (mmHg) 100-130 millimetr va diastolik 60-80 mmHg oralig'ida yuz beradi[10][11]. Aksariyat kattalar uchun qon bosimi doimiy ravishda 130/80 yoki 140/90 mmHg dan yuqori bo'lsa, yuqori qon bosimi mavjud deb hisoblanadi[7][10]. Bolalar uchun turli raqamlar qo'llaniladi[12].

Turmush tarzini o'zgartirish va dori-darmonlar qon bosimini pasaytirishi va sog'liq uchun asoratlar xavfini kamaytirishi mumkin[13]. Turmush tarzi o'zgarishi vazn yo'qotish, jismoniy mashqlar, tuz iste'molini kamaytirish, spirtli ichimliklarni iste'mol qilishni kamaytirish va sog'lom ovqatlanishni o'z ichiga oladi[7]. Agar turmush tarzini o'zgartirish yetarli bo'lmasa, u holda qon bosimida dori vositalari qo'llaniladi[13]. Bir vaqtning o'zida qabul qilingan uchta dori 90% odamlarda qon bosimini nazorat qila oladi[7]. O'rtacha yuqori arterial qon bosimini (>160/100 mmHg sifatida aniqlanadi) dori vositalari bilan davolash umr ko'rish davomiyligini oshirish bilan bog'liq[14]. Qon bosimini davolashning ta'siri 130/80 orasida mmHg va 160/100 mmHg unchalik aniq emas. Yuqori qon bosimi butun dunyo aholisining 16 dan 37 foizigacha ta'sir qiladi[7]. 2010-yilda 18 foiz o'limga gipertenziya sabab bo'lganligi aniqlandi. Dunyo bo'yicha 9,4 million kishi aynan gipertenziyadan vafot etadi[15].

Video summary (script)

Belgilari va belgilari

Gipertenziya kamdan-kam hollarda alomatlar bilan birga keladi va uni aniqlash odatda skrining orqali yoki bog'liq bo'lmagan muammo uchun tibbiy yordam so'rab murojaat qilganda amalga oshiriladi. Qon bosimi yuqori bo'lgan ba'zi odamlar bosh og'rig'i (ayniqsa , ertalab boshning orqa qismidagi og'rig'i) shuningdek, bosh aylanishi, bosh aylanishi, tinnitus (quloqlarda shovqin yoki shivirlash), ko'rishning o'zgarishi yoki hushidan ketish mumkin[16].

Jismoniy tekshiruvda gipertenziya oftalmoskopiya bilan ko'rilgan optik fundusdagi o'zgarishlar mavjudligi bilan bog'liq bo'lishi mumkin[17]. Gipertenziv retinopatiyaga xos bo'lgan o'zgarishlarning zo'ravonligi I dan IV darajagacha; I va II darajalarni farqlash qiyin bo'lishi mumkin[17].

Ikkilamchi gipertenziya

Ikkilamchi gipertenziya aniqlangan sababga ko'ra gipertenziya bo'lib, ma'lum o'ziga xos qo'shimcha belgilar va alomatlarga olib kelishi mumkin[18]. Gipertiroidizm tez-tez ishtahaning kuchayishi, tez yurak urishi, ko'zlarning shishishi va titroq bilan vazn yo'qotishiga olib keladi. Buyrak arteriyasi stenozi (RAS) o'rta chiziqning chap yoki o'ng tomonida (bir tomonlama RAS) yoki ikkala joyda (ikki tomonlama RAS) mahalliylashtirilgan qorin bo'shlig'i bilan bog'liq bo'lishi mumkin. Aorta koarktatsiyasi ko'pincha qo'llarga nisbatan pastki ekstremitalarda qon bosimining pasayishiga yoki femoral arterial pulslarning kechikishi yoki yo'qligiga olib keladi. Feokromotsitoma bosh og'rig'i, yurak urishi, rangpar ko'rinish va ortiqcha terlash bilan birga keladigan keskin gipertenziya epizodlarini keltirib chiqarishi mumkin[18].

Gipertenziv inqiroz

Asosiy maqola: Pathophysiology of hypertension

Yuqori ko'tarilgan qon bosimi (sistolik 180 yoki diastolik 110 ga teng yoki undan yuqori) gipertenziv inqiroz deb ataladi[19]. Gipertenziv inqiroz mos ravishda oxirgi organlarning shikastlanishi yo'qligi yoki mavjudligiga qarab gipertonik shoshilinch yoki gipertonik favqulodda deb tasniflanadi[20][21].

Shoshilinch gipertenziyada qon bosimining ko'tarilishi natijasida oxirgi organlarning shikastlanishi haqida hech qanday dalil yo'q. Bunday hollarda 24 dan 48 soatgacha qon bosimini bosqichma-bosqich pasaytirish uchun og'iz orqali yuboriladigan dorilargina yordam bera oladi[22].

Gipertenziv favqulodda vaziyatlarda bir yoki bir nechta organlarga bevosita zarar yetkazilishi haqida dalillar mavjud[23][24]. Eng ko'p ta'sirlangan organlarga miya, buyraklar, yurak va o'pka kiradi. Ular chalkashlik, uyquchanlik, ko'krak qafasidagi og'riqlar va nafas qisilishi kabi belgilarni keltirib chiqaradi[22]. Gipertenziya bilan bog'liq favqulodda holatlarda, davom etayotgan organlarning shikastlanishini to'xtatish uchun qon bosimini tezroq pasaytirish kerak[22].

Homiladorlik

Gipertenziya homiladorlikning taxminan 8-10 foizida uchraydi[18]. 140/90 dan yuqori bo'lgan olti soatlik oraliqda ikkita qon bosimi o'lchovi mm Hg homiladorlikdagi gipertenziya diagnostikasi hisoblanadi[25]. Homiladorlikdagi yuqori qon bosimi oldingi gipertenziya, homiladorlik gipertenziyasi yoki preeklampsi sifatida tasniflanishi mumkin[26].

Preeklampsi - homiladorlikning ikkinchi yarmida va tug'ruqdan keyingi davrda qon bosimi ortishi va siydikda protein mavjudligi bilan tavsiflangan jiddiy holatlardan biridir[18]. Bu homiladorlikning taxminan 5 foizida uchraydi va butun dunyo bo'ylab onalar o'limining taxminan 16 foizi uchun javobgardir[18]. Odatda preeklampsida hech qanday alomat yo'q va u muntazam skrining orqali aniqlanadi. Preeklampsi belgilari paydo bo'lganda, bosh og'rig'i, ko'rishning buzilishi (ko'pincha "chiroqlar" miltillaydi), qusish, oshqozon og'rig'i va shish paydo bo'ladi . Preeklampsiya vaqti-vaqti bilan hayot uchun xavfli bo'lgan eklampsiya deb ataladigan holatga o'tishi mumkin, bu favqulodda gipertenziya bo'lib, ko'rishning yo'qolishi, miya shishishi, tutilishlar, buyrak yetishmovchiligi, o'pka shishi va tarqalgan intravaskulyar koagulyatsiya (qon ivishining buzilishi) kabi bir qator jiddiy asoratlar bilan kechadigan asoratlardir[18][27].

Aytib o'tish kerakki, homiladorlik gipertenziyasi siydikda protein bo'lmagan homiladorlik davrida yangi boshlangan gipertenziya sifatida tavsiflanadi[26].

Bolalar

Rivojlanmaslik, tutilishlar, asabiylashish, energiya yetishmasligi va nafas olish qiyinlishuvi[28] yangi tug'ilgan chaqaloqlar va yosh bolalarda ham gipertoniya bilan bog'liq bo'lishi mumkin. Bolalarda gipertenziya bosh og'rig'i, sababsiz asabiylashish, charchoq, rivojlanishning sustlashishi, ko'rishning xiralashishi, burundan qon ketishi va yuz falajiga olib kelishi mumkin[28][29].

Sabablari

Birlamchi gipertenziya

Gipertenziya genlar va atrof-muhit omillarining murakkab o'zaro ta'siridan kelib chiqadi. Qon bosimiga kichik ta'sir ko'rsatadigan ko'plab keng tarqalgan genetik variantlar[30], shuningdek, qon bosimiga katta ta'sir ko'rsatadigan ba'zi noyob genetik variantlar aniqlangan[31]. Shuningdek, genom bo'yicha assotsiatsiya tadqiqotlari (GWAS) qon bosimi bilan bog'liq 35 ta genetik lokusni (joylashuvni) aniqladi. Qon bosimiga ta'sir qiluvchi ushbu genetik lokuslardan 12 tasi yangi topildi[32]. Ushbu sentinel SNP qon tomir silliq mushaklari va buyrak funksiyasi bilan bog'liq genlar ichida joylashgan. DNK metilatsiyasi qaysidir ma'noda umumiy irsiy o'zgaruvchanlikni bir nechta fenotiplarga bog'lashga ta'sir qilishi mumkin. Ushbu tadqiqotda 35 sentinel SNP (ma'lum va yangi) uchun o'tkazilgan yagona variant testi genetik variantlar alohida yoki jami yuqori qon bosimi bilan bog'liq klinik fenotiplar xavfiga hissa qo'shishini ko'rsatadi[32].

G'arbiy ovqatlanish va turmush tarzi bilan bog'liq bo'lsa, qon bosimi qarish bilan ko'tariladi va keyingi hayotda gipertoniya bo'lish xavfi katta bo[33][34] Bir qator atrof-muhit omillari qon bosimiga ta'sir qiladi. Tuzni ko'p iste'mol qilish tuzga sezgir odamlarda qon bosimini oshiradi; jismoniy mashqlar yetishmasligi, markaziy semizlik alohida holatlarda rol o'ynashi mumkin. Kofein iste'moli[35] va D vitamini yetishmovchiligi[36] kabi boshqa omillarning mumkin bo'lgan rollari unchalik aniq emas. Semirib ketishda tez-tez uchraydigan va X sindromining tarkibiy qismi bo'lgan insulin qarshiligi ham gipertenziyaga yordam beradi[37].

Bolaning kam vaznda tug'ilishi, onaning chekishi va emizishning yetishmasligi kabi erta hayotdagi hodisalar kattalar uchun muhim gipertenziya uchun xavf omillari bo'lishi mumkin. Gipertenziya bilan og'rigan bemorlarda normal qon bosimi bo'lgan odamlarga nisbatan yuqori qon siydik kislotasi darajasining ortishi aniqlangan, ammo birinchisi sababchi rol o'ynaydimi yoki buyrak funksiyasining yomonlashishiga yordam beradimi, bu savollar noaniqligicha qolmoqda[38]. Qishda o'rtacha qon bosimi yozga qaraganda yuqori bo'lishi mumkin[39]. Periodontal kasallik ham yuqori qon bosimi bilan bog'liq[40].

Ikkilamchi gipertenziya

Asosiy maqola: Pathophysiology of hypertension

Ikkilamchi gipertenziya aniqlangan sabablardan kelib chiqadi. Buyrak kasalligi gipertenziyaning eng ko'p uchraydigan ikkinchi darajali sababidir[18]. Gipertenziya, shuningdek, Kushing sindromi, gipertiroidizm, hipotiroidizm, akromegaliya, Kon sindromi yoki giperaldosteronizm, buyrak arteriyasi stenozi ( ateroskleroz yoki fibromuskulyar displazi), giperokrin[18][41]. Ikkilamchi gipertenziyaning boshqa sabablari orasida esa semizlik, uyqu apneasi, homiladorlik, aorta koarktatsiyasi, qizilmiya o'tini ko'p iste'mol qilish, spirtli ichimliklarni ko'p iste'mol qilish, retsept bo'yicha ba'zi dorilar, o'simlik preparatlari va qahva, kokain va metamfetamin kabi stimulyatorlar kiradi[18][42]. Ichimlik suvi orqali mishyak ta'sirining ko'tarilgan qon bosimi bilan bog'liqligi ko'rsatilgan[43][44]. Depressiya ham gipertoniya bilan bog'liq edi[45]. Ko'pincha yolg'izlik ham gepertenziyaga sabab bo'luvchi xavfli omilidir[46].

2018-yilgi tekshiruv shuni ko'rsatdiki, har qanday alkogol erkaklarda qon bosimini oshiradi, bir yoki ikkitadan ortiq ichimliklar esa ayollarda xavfni oshiradi[47].

Patofiziologiya

Asosiy maqola: Pathophysiology of hypertension
Yuqori qon bosimi ta'sirini tasvirlaydigan rasm

O'rnatilgan asosiy gipertenziyasi bo'lgan ko'pchilik odamlarda qon oqimiga qarshilik kuchayishi (umumiy periferik qarshilik) yuqori bosimga olib keladi[48]. Gipertenziyadan oldingi yoki "chegaradagi gipertenziya" bilan og'rigan ba'zi yoshlarda yuqori yurak chiqishi, yurak urish tezligining oshishi va normal periferik qarshilik borligi, giperkinetik chegara gipertenziyasi deb ataladigan dalillar mavjud[49]. Bu odamlar keyingi hayotda o'rnatilgan asosiy gipertenziyaning tipik xususiyatlarini rivojlantiradilar, chunki ularning yurak faoliyati pasayadi va yosh bilan periferik qarshilik kuchayadi[49]. O'rnatilgan gipertenziyada periferik qarshilikning kuchayishi, asosan, mayda arteriyalar va arteriolalarning strukturaviy torayishi bilan bog'liq[50], ammo kapillyarlar soni yoki zichligining kamayishi ham hissa qo'shishi mumkin[51].

Gipertenziya, shuningdek, periferik venoz moslashuvning pasayishi bilan bog'liq[52]. Bu venoz qaytishni oshirishi, yurakning oldingi yukini oshirishi va natijada diastolik disfunktsiyani keltirib chiqarishi mumkin.

Gipertenziya bilan og'rigan keksa odamlarda puls bosimi (sistolik va diastolik qon bosimi o'rtasidagi farq) tez-tez ortadi[53]. Bu sistolik bosimning anormal darajada yuqori ekanligini anglatishi mumkin, ammo diastolik bosim normal yoki past bo'lishi ham mumkin. Bu holat izolyatsiya qilingan sistolik gipertenziya deb ataladi[54]. Gipertenziya yoki izolyatsiya qilingan sistolik gipertenziya bilan og'rigan keksa odamlarda yuqori puls bosimi arterial qattiqlikning oshishi bilan izohlanadi. Bu odatda qarish bilan birga keladi va yuqori qon bosimi bilan kuchayishi mumkin[55].

Gipertenziyada periferik qarshilikning o'sishini hisobga olish uchun ko'plab mexanizmlar taklif qilingan. Ko'pgina dalillar buyraklardagi tuz va suv bilan ishlashning buzilishini (ayniqsa, intrarenal renin-angiotenzin tizimidagi anormalliklarni)[56] yoki simpatik asab tizimining anormalliklarini nazarda tutadi[57]. Bundan tashqari, endotelial disfunktsiya va tomirlarning yallig'lanishi ham periferik qarshilikning kuchayishiga va gipertenziyadagi tomirlarning shikastlanishiga yordam berishi mumkinligi taxmin qilingan[58][59] Interleykin 17 o'simta nekrozi omili alfa, interleykin 1, interleykin 6 va interleykin 8 kabi gipertenziya bilan bog'liq deb hisoblangan boshqa immun tizimining kimyoviy signallarini ishlab chiqarishni ko'paytirishdagi roli uchun qiziqish uyg'otdi[60].

Ratsiondagi ortiqcha natriy yoki kaliyning yetishmasligi ortiqcha hujayra ichidagi natriyga olib keladi. Bu qon tomirlarining silliq mushaklarini qisqartiradi va qon oqimini cheklaydi natijada qon bosimini oshiradi[61][62].

Diagnostika

Amerika yurak assotsiatsiyasi (AHA) kamida ikkita alohida tibbiy tashrifda kamida uchta dam olish o'lchovini tavsiya qiladi[63]. Buyuk Britaniyaning Sog'liqni saqlash va parvarish bo'yicha milliy instituti, agar klinikada qon bosimi 140/90 mmHg yoki undan yuqori bo'lsa, gipertenziya tashxisini tasdiqlash uchun ambulator qon bosimi monitoringini tavsiya qiladi[64].

O'lchash texnikasi

Gipertenziyaning aniq tashxisini qo'yish uchun qon bosimini to'g'ri o'lchash texnikasidan foydalanish kerak[65]. Qon bosimini noto'g'ri o'lchash tez-tez uchraydi va qon bosimi ko'rsatkichini 10 mmHg ga o'zgartirishi mumkin, bu esa noto'g'ri tashxis qo'yish va gipertenziya noto'g'ri tasniflanishiga olib keladi[65]. Qon bosimini to'g'ri o'lchash texnikasi bir necha bosqichlarni o'z ichiga oladi. Qon bosimini to'g'ri o'lchash uchun qon bosimi o'lchanayotgan odam kamida besh daqiqa jim o'tirishni talab qiladi, so'ngra to'g'ri o'rnatilgan qon bosimi manjetini yalang'och yuqori qo'liga qo'yish kerak[65]. Qon bosimi o'lchanayotgan odam bu jarayonda gaplashmaslik yoki harakat qilmaslik kerak[65]. O'lchanayotgan qo'l yurak darajasida tekis yuzada qo'llab-quvvatlanishi kerak[65]. Qon bosimini o'lchash tinch xonada o'tkazilishi kerak, shuning uchun qon bosimini tekshiradigan shifokor qon bosimini aniq o'lchash uchun brakiyal arteriyani stetoskop bilan tinglayotganda Korotkoff tovushlarini eshitishi mumkin[65][66]. Korotkoff tovushlarini tinglashda qon bosimi manjetini sekin tushirish kerak (sekundiga 2-3 mmHg)[66]. Biror kishining qon bosimini o'lchashdan oldin siydik pufagini bo'shatish kerak, chunki bu qon bosimini 15/10 mmHg ga oshirishi mumkin[65]. To'g'riligini ta'minlash uchun bir-biridan 1-2 daqiqa oraliqda bir nechta qon bosimi ko'rsatkichlarini (kamida ikkita) olish kerak[66]. 12-24 soat davomida ambulator qon bosimi monitoringi tashxisni tasdiqlashning eng aniq usuli hisoblanadi[67]. Qon bosimi juda yuqori bo'lganlar bundan mustasno, ayniqsa a'zolar faoliyati yomonlashganda bu xavfli tus olishi mumkin[68].

24 soatlik ambulator qon bosimi o'lchagichlari va uydagi qon bosimi apparatlari mavjudligi tufayli oq xalatli gipertenziya bilan og'riganlarga noto'g'ri tashxis qo'ymaslik muhimligi protokollarning o'zgarishiga olib keldi. Amerika Qo'shma Shtatlarining profilaktika xizmatlari bo'yicha ishchi guruhi, shuningdek, sog'liqni saqlash muhitidan tashqarida o'lchovlarni olishni tavsiya qiladi[67]. Keksa yoshdagi psevdogipertenziya yoki siqilmaydigan arteriya sindromi ham e'tiborni talab qilishi mumkin. Bu holat arteriyalarning kalsifikatsiyasi bilan bog'liq bo'lib, natijada qon bosimi manjeti yordamida g'ayritabiiy yuqori qon bosimi ko'rsatkichlari paydo bo'ladi, qon bosimining arterial ichidagi o'lchovlari normaldir[69]. Ortostatik gipertenziya - bu tik turganda qon bosimining oshishi[70].

Boshqa tekshiruvlar

Amalga oshirilgan odatiy testlar [71][72][73][74][75][76]
Tizim Testlar
Buyrak Mikroskopik siydik tahlili, siydikdagi oqsil, BUN, kreatinin
Endokrin Sarum natriy, kaliy, kaltsiy, TSH
Metabolik Ro'za qon glyukoza, HDL, LDL, umumiy xolesterin, triglitseridlar
Boshqa Gematokrit, elektrokardiogramma, ko'krak qafasi rentgenogrammasi

Gipertenziya tashxisi qo'yilgach, shifokorlar xavf omillar mavjud bo'lsa, boshqa alomatlar asosida asosiy sababni aniqlashga harakat qilishlari kerak. Ikkilamchi gipertenziya o'smirlikdan oldingi bolalarda ko'proq uchraydi. Aksariyat hollarda esa buyrak kasalligi sabab bo'ladi. Birlamchi yoki asosiy gipertenziya o'smirlar va kattalarda ko'proq uchraydi va ko'plab xavf omillariga, jumladan semirish bilan uzviy bog'liqdir[77]. Ikkilamchi gipertenziyaning mumkin bo'lgan sabablarini aniqlash va gipertoniya yurak, ko'z va buyraklarga zarar etkazganligini aniqlash uchun laboratoriya tekshiruvlarini ham o'tkazish mumkin. Qandli diabet va yuqori xolesterin miqdori uchun qo'shimcha testlar o'tkaziladi.

Hipertansif odamlarni dastlabki baholash to'liq tarix va fizik tekshiruvni o'z ichiga olishi kerak. Qon zardobidagi kreatinin miqdori gipertenziya sababi yoki natijasi bo'lishi mumkin bo'lgan buyrak kasalligi mavjudligini aniqlash uchun o'lchanadi. Buyrak kasalliklarida dietani o'zgartirish (MDRD) formulasi kabi qoidali tenglamalardan foydalanishni qo'llab-quvvatlaydi[23]. Bundan tashqari, siydik namunalarini protein uchun tekshirish buyrak kasalligining ikkinchi darajali ko'rsatkichi sifatida ishlatiladi. Elektrokardiogramma (EKG / EKG) yurakning yuqori qon bosimi tufayli zo'riqishining dalillarini tekshirish uchun amalga oshiriladi. Shuningdek, u yurak mushagining qalinlashuvi (chap qorincha gipertrofiyasi) bor-yo'qligini yoki yurakda jim yurak xuruji kabi avvalroq kichik buzilishlarni boshdan kechirganligini ko'rsatishi mumkin. Ko'krak qafasi rentgenogrammasi yoki ekokardiyogramma ham yurakning kengayishi yoki yurakning shikastlanishi belgilarini izlash uchun bajarilishi mumkin[18].

Kattalardagi tasnifi

Kattalardagi tasnifi (Turli toifadagi sistolik va diastolik bo'lgan shaxslar yuqori toifaga tayinlanadi. [10] )
Turkum Sistolik, mmHg Diastolik, mmHg
Gipotenziya < 90 < 60
Oddiy 90–119 [10]



</br> 90–129 [78] 		60–79 [10]



</br> 60–84 [78]
Gipertenziya oldidan



</br> (yuqori normal, baland [10] ) 		120–129 [10]



</br> 130–139 [78] [79] 		60–79 [10]



</br> 85–89 [78] [79]
Gipertenziya 1-bosqich 130–139 [10]



</br> 140–159 [78] 		80–89 [10]



</br> 90–99 [78]
Gipertenziya 2-bosqich >140 [10]



</br> 160–179 [78] 		>90 [10]



</br> 100–109 [78]
Gipertenziv inqirozlar ≥ 180 [10] ≥ 120 [10]
Izolyatsiya qilingan sistolik gipertenziya ≥ 140 [10] < 90 [10]
Izolyatsiya qilingan diastolik gipertenziya [80] [81] < 140 ≥ 90

18 yosh va undan katta yoshdagi odamlarda gipertenziya sistolik yoki diastolik qon bosimining doimiy ravishda qabul qilingan me'yordan yuqori bo'lishi (bu 129 yoki 139 dan yuqori) deb ta'riflanadi. Gipertenziya bo'yicha so'nggi xalqaro ko'rsatmalar, shuningdek, normal diapazonda yuqori qon bosimi bilan xavfning uzluksizligini ko'rsatish uchun gipertenziv diapazondan past toifalarni yaratdi. Yuqori qon bosimining oldini olish, aniqlash, baholash va davolash bo'yicha qo'shma milliy qo'mitasining (JNC7) 2003- yilda chop etilgan yettinchi hisobotida[23] 120-139 oralig'ida qon bosimi uchun prehipertenziya atamasi qo'llaniladi.  JNC7 gipertenziya I bosqich, gipertenziya II bosqich va izolyatsiya qilingan sistolik gipertenziyani ajratib turadi. Izolyatsiya qilingan sistolik gipertenziya normal diastolik bosim bilan ko'tarilgan sistolik bosimni anglatadi va bu holatlar eng ko'p qariyalarda keng tarqalgan[23] ESH-ESC ko'rsatmalari (2007)[82] va BHS IV (2004) [83] qo'shimcha ravishda sistolik qon bosimi 179 dan yuqori bo'lgan odamlar uchun uchinchi bosqichni (III bosqich gipertoniya) belgilaydi. mmHg yoki diastolik bosim 109 dan yuqori mmHg. Agar dorilar qon bosimini normal darajaga tushirmasa, gipertoniya "chidamli" deb tasniflanadi[23]. 2017-yil noyabr oyida Amerika yurak assotsiatsiyasi va Amerika kardiologiya kolleji JNC7 hisobotining tavsiyalarini yangilaydigan qo'shma yo'riqnomani nashr etdi[84]. Xalqaro Gipertenziya Jamiyatining 2020-yilgi ko'rsatmalari gipertoniyanining ofis qon bosimi ≥140/90 ga asoslangan holda belgilaydi. mmHg yoki uy nazorati qon bosimi ≥135/85 mmHg yoki 24 soatlik ambulator qon bosimi o'rtacha ≥130/80 mmHg (kunduzi o'rtacha ≥135/85 mmHg yoki tungi o'rtacha BP ≥120/70 mmHg)[85] etib belgilangan.

Bolalar

Gipertenziya yangi tug'ilgan chaqaloqlarning 0,2 dan 3% gacha; ammo sog'lom yangi tug'ilgan chaqaloqlarda qon bosimi muntazam ravishda o'lchanmaydi[29]. Gipertenziya yuqori xavfli yangi tug'ilgan chaqaloqlarda ko'proq uchraydi. Yangi tug'ilgan chaqaloqlarda qon bosimi normal yoki yo'qligini aniqlashda homiladorlik davri, kontseptsiyadan keyingi yosh va tug'ilish vazni kabi turli omillarni hisobga olish kerak[29].

Bolalikda qon bosimi yoshga qarab ko'tariladi va bolalarda gipertoniya o'rtacha sistolik yoki diastolik qon bosimining uch yoki undan ko'p marta bolaning jinsi, yoshi va bo'yi uchun mos keladigan 95 foizga teng yoki undan yuqori bo'lishi deb ta'riflanadi. Yuqori qon bosimi bolani gipertenziya bilan tavsiflashdan oldin takroriy tashriflarda tasdiqlanishi kerak[86]. Bolalardagi gipertenziya o'rtacha sistolik yoki diastolik qon bosimi 90 foizdan yuqori yoki unga teng, lekin 95 foizdan past bo'lgan qon bosimi deb ta'riflangan[86]. O'smirlarda gipertenziya va oldingi gipertenziya kattalardagi kabi bir xil mezonlar bo'yicha tashxis qo'yilishi va tasniflanishi taklif qilingan[86].

2004-yilda Milliy yuqori qon bosimi bo'yicha ta'lim dasturi 3 yosh va undan katta yoshdagi bolalarga har bir tibbiy muassasaga tashrif buyurganida kamida bir marta qon bosimini o'lchashni tavsiya qildi[86]. Milliy yurak, o'pka va qon instituti va Amerika pediatriya akademiyasi shunga o'xshash tekshiruvni o'tkazdi. tavsiya[87]. Biroq, Amerika Oila shifokorlari akademiyasi[88] AQSh profilaktika xizmatlari ishchi guruhining alomatlari bo'lmagan bolalar va o'smirlarda gipertenziya skriningining foydalari va zararlari muvozanatini aniqlash uchun mavjud dalillar yetarli emas degan fikrini qo'llab-quvvatlaydi[89][90].

Kasallikning oldini olish

Yuqori qon bosimining oqibatlarini kamaytirish va antihipertenziv dorilarga bo'lgan ehtiyojni kamaytirish uchun aholi strategiyalari talab qilinadi. Dori-darmonlarni qabul qilishni boshlashdan oldin, qon bosimini pasaytirish uchun turmush tarzini o'zgartirish tavsiya etiladi. Britaniya Gipertenziya Jamiyatining 2004-yilgi ko'rsatmalari[83] gipertenziyaning birlamchi oldini olish uchun 2002-yilda AQSh Milliy yuqori qon bosimi bo'yicha ta'lim dasturi[91] tomonidan belgilangan hayot tarzini o'zgartirishni taklif qildi:

  • kattalar uchun normal tana vaznini saqlang (masalan, tana massasi indeksi 20-25 kg/m 2 )
  • dietada natriy miqdorini <100 gacha kamaytiring mmol/kun (<6 g natriy xlorid yoki kuniga <2,4 g natriy)
  • tez yurish kabi muntazam aerobik jismoniy faoliyat bilan shug'ullaning (kuniga ≥30 daqiqa, haftaning ko'p kunlari)
  • spirtli ichimliklarni iste'mol qilishni erkaklarda kuniga 3 birlikdan, ayollarda esa 2 birlikdan ko'p bo'lmagan miqdorda cheklash
  • meva va sabzavotlarga boy parhezni iste'mol qiling (masalan, kuniga kamida beshta porsiya);
  • Stressni kamaytirish[92].

Stressdan saqlanish va uni boshqarishni o'rganish qon bosimini nazorat qilishga yordam beradi.

Stressdan xalos bo'lishga yordam beradigan bir nechta yengillik texnikasi:

  • meditatsiya
  • issiq vannalar
  • yoga
  • uzoq yurish[92]

Samarali turmush tarzini o'zgartirish qon bosimini individual antihipertenziv dori kabi kamaytirishi mumkin. Tuzni iste'mol qilishni kamaytirish qon bosimini pasaytiradi, degan ko'plab dalillar mavjud, ammo bu o'lim va yurak-qon tomir kasalliklarining kamayishiga olib keladimi yoki yo'qmi noaniq[93]. Taxminiy natriy iste'moli kuniga ≥6 g va <3 g / kun ikkalasi ham o'lim yoki katta yurak-qon tomir kasalliklari xavfi bilan bog'liq, ammo natriyni yuqori iste'mol qilish va salbiy oqibatlar o'rtasidagi bog'liqlik faqat gipertenziyasi bo'lgan odamlarda kuzatiladi[94]. Shunday qilib, randomizatsiyalangan nazorat ostida bo'lgan sinovlar natijalari yo'qligi sababli, dietada tuz iste'mol qilish darajasini kuniga 3 g dan pastga tushirishning donoligi shubha ostiga qo'yilgan[93]. ESC ko'rsatmalarida periodontit yurak-qon tomir tizimining yomon holati bilan bog'liq[95].

Boshqaruv

2003-yilda chop etilgan bir sharhga ko'ra, qon bosimining 5 ga pasayishi mmHg insult xavfini 34% ga kamaytirar ekan. Ishemik yurak kasalligi xavfini 21% ga va demans, yurak etishmovchiligi va yurak- qon tomir kasalliklaridan o'lim ehtimolini kamaytirishi mumkin[96].

Maqsadli qon bosimi

Turli xil ekspert guruhlari gipertenziya bilan davolanayotgan odamda qon bosimining maqsadi qanchalik past bo'lishi kerakligi haqida ko'rsatmalar ishlab chiqdi. Ushbu guruhlar umumiy aholi uchun 140-160 / 90-100 mmHg oralig'idan pastroq maqsadni tavsiya qiladi[11][12][97][98] Cochrane sharhlari qandli diabet[99] va ilgari yurak-qon tomir kasalliklari bo'lgan odamlar kabi kichik guruhlar uchun shunga o'xshash maqsadlarni tavsiya qiladi[100]. O'rtacha yoki yuqori yurak-qon tomir xavfi bo'lgan keksa odamlar uchun standart qon bosimining past ko'rsatkichiga (140/90 mmHg yoki undan past) erishishga urinishning foydasi aralashuv bilan bog'liq xavfdan ustundir[101]. Bu topilmalar boshqa populyatsiyalar uchun qo'llanilmasligi mumkin[101].

Ko'pgina ekspert guruhlari 60 dan 80 yoshgacha bo'lganlar uchun 150/90 mmHg dan biroz yuqoriroq maqsadni tavsiya qiladi[97][98][102] JNC-8 va Amerika shifokorlar kolleji 60 yoshdan oshganlar uchun 150/90 mmHg maqsadini tavsiya qiladi[12][103], ammo bu guruhlardagi ba'zi ekspertlar bu tavsiyaga qo'shilmaydi[104]. Ba'zi ekspert guruhlari, shuningdek, diabet[11] yoki siydikda protein yo'qolishi bilan surunkali buyrak kasalligi bo'lganlar uchun bir oz pastroq maqsadlarni tavsiya qilgan[105], ammo boshqalar umumiy aholi uchun bir xil maqsadni tavsiya qiladi[12][99]. Eng yaxshi maqsad nima va yuqori xavf ostida bo'lgan odamlar uchun maqsadlar farq qilishi kerakmi yoki yo'qligi masalasi hal etilmagan[106].

Hech qachon yurak-qon tomir kasalliklarini boshdan kechirmagan va 10 yil davomida yurak-qon tomir kasalliklari xavfi 10% dan kam bo'lgan odamlar uchun Amerika yurak assotsiatsiyasining 2017-yilgi ko'rsatmalari sistolik qon bosimi > 140 mmHg yoki diastolik qon bosimi > 90 bo'lsa, dori-darmonlarni tavsiya qiladi[10]. Yurak-qon tomir kasalliklariga duchor bo'lgan yoki 10 yil davomida yurak-qon tomir kasalliklari xavfi 10% dan yuqori bo'lgan odamlar uchun sistolik qon bosimi > 130 mmHg yoki diastolik qon bosimi >80 mmHg bo'lsa, dori-darmonlarni tavsiya qiladi[10].

Turmush tarzi o'zgarishlari

Gipertenziyani davolashning birinchi qatori turmush tarzini o'zgartirish, jumladan, dietani o'zgartirish, jismoniy mashqlar va vazn yo'qotishdir. Tekshiruv tana vazni va qon bosimining pasayishini aniqladi[107]. Ularning potentsial samaradorligi bitta doriga o'xshaydi va ba'zida ulardan oshadi[11]. Agar gipertenziya dori-darmonlarni darhol qo'llashni oqlash uchun yetarli darajada yuqori bo'lsa, turmush tarzini o'zgartirish hali ham dori-darmonlar bilan birgalikda tavsiya etiladi.

Qon bosimini pasaytirish uchun ko'rsatilgan parhez o'zgarishlariga past natriyli dietalar[108][109] DASH dietasi (Gipertenziyani to'xtatish uchun parhez yondashuvlari)[110] va o'simlikka asoslangan parhezlar kiradi. [111] Yashil choyni iste'mol qilish qon bosimini pasaytirishi mumkinligi haqida ba'zi dalillar mavjud, ammo bu uni davolash sifatida tavsiya qilish uchun yetarli emas[112]. Randomize qilingan, ikki marta ko'r, platsebo nazorati ostida bo'lgan klinik tadkikotlar, Hibiskus choyini iste'mol qilish sistolik qon bosimini (-4,71 mmHg, 95% CI [-7,87, -1,55]) va diastolik qon bosimini (-4,08 mmHg, 95) sezilarli darajada kamaytirishi haqida dalillar mavjud[113][114]. Lavlagi sharbatini iste'mol qilish ham qon bosimi yuqori bo'lgan odamlarning qon bosimini sezilarli darajada pasaytiradi[115][116][117].

Ratsiondagi kaliyni ko'paytirish gipertenziya xavfini kamaytirish uchun potentsial foyda keltiradi[118][119]. Biroq, ba'zi antihipertenziv dorilarni (masalan, ACE inhibitörleri yoki ARBlar) qabul qiladigan odamlar kaliyning yuqori darajasi xavfi tufayli kaliy qo'shimchalarini yoki kaliy bilan boyitilgan tuzlarni qabul qilmasliklari kerak[120].

Qon bosimini pasaytirishi ko'rsatilgan jismoniy mashqlar rejimlariga izometrik qarshilik mashqlari, aerob mashqlari, qarshilik mashqlari va bilan boshqariladigan nafas olish kiradi[121].

O'z-o'zini nazorat qilish va uchrashuvni eslatish qon bosimi nazoratini yaxshilash uchun boshqa strategiyalardan foydalanishni qo'llab-quvvatlashi mumkin.

Dori-darmonlar

Gipertenziya uchun birinchi darajali dorilar orasida tiazid-diuretiklar, kaltsiy kanallari blokerlari, angiotensinga aylantiruvchi ferment inhibitörleri (ACE inhibitörleri) va angiotensin retseptorlari blokerlari (ARB) mavjud[122][12]. Ushbu dori-darmonlarni alohida yoki birgalikda qo'llash mumkin (ACE inhibitörleri va ARBlarni birgalikda ishlatish tavsiya etilmaydi); oxirgi variant qon bosimi qiymatlarini davolashdan oldingi darajaga qaytarish uchun harakat qiluvchi qarshi tartibga solish mexanizmlarini minimallashtirishga xizmat qilishi mumkin[12][123]. Qon bosimini nazorat qilish uchun dori-darmonlar maqsadli darajalarga erishilmaganda bosqichma-bosqich davolash usuli bilan amalga oshirilishi kerak[124].

Ilgari atenolol kabi beta-blokerlar gipertenziya uchun birinchi darajali terapiya sifatida ishlatilganda xuddi shunday foydali ta'sirga ega deb hisoblangan. Biroq, 13 ta sinovni o'z ichiga olgan Cochrane tekshiruvi shuni ko'rsatdiki, beta-blokerlarning ta'siri yurak-qon tomir kasalliklarining oldini olishda boshqa antihipertenziv dorilar ta'siridan past[125].

Gipertenziyaga chidamli

Rezistent gipertenziya turli xil ta'sir mexanizmlari bilan bir vaqtning o'zida uchta yoki undan ortiq antihipertenziv dorilar buyurilganiga qaramay, maqsadli darajadan yuqori bo'lgan yuqori qon bosimi deb ta'riflanadi[126]. Belgilangan dori-darmonlarni ko'rsatmalarga muvofiq qabul qilmaslik chidamli gipertenziyaning muhim sababidir[127]. Chidamli gipertenziya, shuningdek, otonomik asab tizimining surunkali yuqori faolligidan kelib chiqishi mumkin, bu ta'sir neyrojenik gipertenziya deb ataladi[128].

Chidamli gipertenziyaning ba'zi umumiy ikkinchi darajali sabablari orasida obstruktiv uyqu apnesi, feokromositoma, buyrak arteriyasi stenozi, aorta koarktasyonu va asosiy aldosteronizm kiradi[129]. Gipertenziyaga chidamli bo'lgan har beshinchi odamda birlamchi aldosteronizm mavjud bo'lib, bu davolash mumkin bo'lgan va ba'zida davolanadigan kasallikdir[130].

Refrakter gipertenziya

Refrakter gipertenziya turli toifadagi besh yoki undan ortiq antihipertenziv vositalar, jumladan, uzoq muddatli ta'sir qiluvchi tiazidga o'xshash diuretik, kaltsiy kanallari blokeri va renin-angiotensin tizimining blokerlari tomonidan nazoratsiz ko'tarilgan qon bosimi bilan tavsiflanadi[131]. O'tga chidamli gipertenziyasi bo'lgan odamlar odatda simpatik asab tizimining faolligini oshiradilar va yurak-qon tomir kasalliklari va har xil sabablarga ko'ra o'lim xavfi yuqori hisoblanadi[131][132].

Epidemiologiya

2014-yilda erkaklarda ko'zatiladigan gipertoniya darajasi [133].
Gipertenziv yurak kasalligi uchun nogironlikka moslashtirilgan hayot yili 100 000 kishiga 2004-yilda aholi[134].


Evropada gipertenziya -Missing required parameter 1=month!, 2013-yil(2013-Missing required parameter 1=month!-00) holatiga koʻra ko'ra odamlarning 30-45 foizida uchraydi[11]. 1995-yilda Qo'shma Shtatlarda 43 million kishi (aholining 24%) gipertoniya bilan og'rigan yoki antihipertenziv dori-darmonlarni qabul qilgan[135]. 2004- yilga kelib, bu 29% [136][137] ga va yana 32% ga (76) oshdi. 2017-yilda gipertoniya ta'riflarining o'zgarishi bilan Qo'shma Shtatlardagi odamlarning 46 foizi ta'sir ko'rsatdi[10]. Qo'shma Shtatlardagi afro-amerikalik kattalar dunyodagi eng yuqori gipertenziya darajasiga ega - 44%[138]. Bundan tashqari, u Filippin amerikaliklarida tez-tez uchraydi va AQSh oq tanlilari va meksikalik amerikaliklarda kamroq tarqalgan[8] [139] Gipertenziya darajasidagi farqlar ko'p omilli va o'rganilmoqda[140].

Bolalar

Qo'shma Shtatlarda so'nggi 20 yil ichida bolalar va o'smirlarda yuqori qon bosimi ko'rsatkichlari oshdi[141]. Bolalikdagi gipertenziya, ayniqsa o'smirlikdan oldingi davrda, kattalarga qaraganda ko'proq ikkinchi darajali kasallikdir. Buyrak kasalligi bolalar va o'smirlarda gipertenziyaning eng ko'p uchraydigan ikkinchi darajali sababidir. Shunga qaramay, ko'p hollarda asosiy yoki asosiy gipertenziya hisoblanadi[142].

Prognoz

Doimiy yuqori qon bosimining asosiy asoratlarini ko'rsatadigan diagramma.

Gipertenziya butun dunyo bo'ylab erta o'limning oldini olish mumkin bo'lgan eng muhim xavf omilidir[143]. Bu yurak ishemik kasalligi[144] insult[18], periferik qon tomir kasalligi[145] va boshqa yurak-qon tomir kasalliklari, jumladan yurak etishmovchiligi, aorta anevrizmasi, diffuz ateroskleroz, surunkali buyrak kasalligi, atriyal fibrilatsiya, saraton va leykemiya xavfini oshiradi. O'pka emboliyasi[5][18]. Gipertenziya, shuningdek, kognitiv buzilish va demans uchun xavf omilidir[18]. Boshqa asoratlar orasida hipertansif retinopatiya va hipertansif nefropati mavjud[23].

Tarixi

Harveyning Animalibusdagi Exercitatio Anatomica de Motu Cordis et Sanguinisdan olingan tomirlar tasviri.

O'lchov

Yurak-qon tomir tizimini zamonaviy tushunish shifokor Uilyam Garvining (1578-1657) " De motu cordis " kitobida qon aylanishini tasvirlab bergan ishidan boshlangan. Ingliz ruhoniysi Stiven Xeyls 1733-yilda birinchi marta qon bosimini o'lchashni amalga oshirdi[146] [147]. Biroq, gipertoniya klinik ko'rinish sifatida 1896-yilda Scipione Riva-Rocci tomonidan manjetli sfigmomanometr ixtirosi bilan paydo bo'ldi[148]. Bu klinikada sistolik bosimni oson o'lchash imkonini berdi. 1905-yilda Nikolay Korotkoff sfigmomanometr manjeti tushirilganda arteriya stetoskop bilan auskultatsiya qilinganida eshitiladigan Korotkoff tovushlarini tasvirlab, texnikani takomillashtirdi[147]. Bu sistolik va diastolik bosimni o'lchash imkonini beradi.

Identifikatsiya

Gipertenziv inqiroz bilan og'rigan bemorlarning alomatlariga o'xshash alomatlar o'rta asrlardagi Fors tibbiy matnlarida "to'liqlik kasalligi" bo'limida muhokama qilinadi[149]. Alomatlar orasida bosh og'rig'i, boshdagi og'irlik, sust harakatlar, umumiy qizarish va tananing teginish uchun issiqligi, ko'zga ko'ringan, kengaygan va taranglashgan tomirlar, pulsning to'liqligi, terining kengayishi, rangli va zich siydik, ishtahaning yo'qolishi, zaif ko'rish, fikrlashning buzilishi, esnash, uyquchanlik, qon tomirlarining yorilishi va gemorragik insult[150].

Gipertenziyaning kasallik sifatida tavsifi 1808-yilda Tomas Yang va ayniqsa 1836-yilda Richard Bright tomonidan berilgan[146]. Buyrak kasalligi bo'lmagan odamda qon bosimining ko'tarilishi haqida birinchi hisobot Frederik Akbar Mahomed (1849-1884) tomonidan qilingan[151].

Davolash

Tarixda "qattiq puls kasalligi" deb ataladigan kasallikni davolash qon quyish yoki zuluklarni qo'llash orqali qon miqdorini kamaytirishdan iborat edi[146]. Buni Xitoyning Sariq imperatori Korniliy Tsels, Galen va Gippokrat qo'llab-quvvatlagan[146]. Qattiq yurak urishi kasalligini davolashning terapevtik yondashuvi turmush tarzini o'zgartirish (g'azab va jinsiy aloqadan uzoqlashish) va bemorlar uchun parhez dasturini ( sharob, go'sht va xamir ovqatlarini iste'mol qilmaslik, ovqatdagi oziq-ovqat hajmini kamaytirish, ovqatlanishni saqlash) o'z ichiga oladi. kam energiyali parhez va ismaloq va sirkadan parhez foydalanish).

19-20-asrlarda, gipertenziyani samarali farmakologik davolash mumkin bo'lgunga qadar, uchta davolash usuli qo'llanilgan, ularning barchasi ko'p yon ta'sirga ega: natriy miqdorini qattiq cheklash (masalan, guruch dietasi[146]), simpatektomiya (qon tomirlarining qismlarini jarrohlik yo'li bilan olib tashlash simpatik asab tizimi ) va pirogen terapiyasi (isitmani keltirib chiqaradigan, bilvosita qon bosimini pasaytiradigan moddalarni kiritish)[146][152].

Gipertenziya uchun birinchi kimyoviy, natriy tiosiyanat 1900-yilda ishlatilgan, ammo ko'p yon ta'sirga ega va mashhur emas edi[146] Ikkinchi jahon urushidan keyin bir qancha boshqa vositalar ishlab chiqildi, ulardan eng ommabop va samarali bo'lganlari tetrametilamoniy xlorid, geksametonium, hidralazin va reserpin (Rauvolfia serpentina dorivor o'simlikidan olingan) edi. Bularning hech biri yaxshi muhosaba qilinmadi[153][154]. Birinchi yaxshi muhosaba qilinadigan og'iz orqali qabul qilinadigan vositalarning kashf etilishi bilan katta yutuqga erishildi. Birinchisi xlorotiyazid bo'lib, birinchi tiazidli diuretik bo'lib, 1958- yilda mavjud bo'lgan sulfanilamid antibiotikidan ishlab chiqilgan[146][155] Keyinchalik antihipertenziv vositalar sifatida beta-blokerlar, kaltsiy kanallari blokerlari, angiotensinga aylantiruvchi ferment (ACE) inhibitörleri, angiotensin retseptorlari blokerlari va renin inhibitörleri ishlab chiqildi[152].

Jamiyat va madaniyat

Ogohlik

NHANESning to'rtta tadqiqoti o'rtasidagi taqqoslaganda, gipertenziya haqida xabardorlik, davolash va nazoratning tarqalishi, grafik ko'rsatilgan[136]

Jahon sog'liqni saqlash tashkiloti gipertoniya yoki yuqori qon bosimini yurak- qon tomir kasalliklaridan o'limning asosiy sababi sifatida aniqladi[156]. 85 milliy gipertoniya jamiyatlari va ligalarini o'z ichiga olgan Butunjahon Gipertenziya Ligasi ( WHL ) butun dunyo bo'ylab gipertoniya bilan og'rigan aholining 50% dan ortig'i ularning ahvolidan bexabar ekanligini tan oldi[156]. Ushbu muammoni hal qilish uchun WHL 2005-yilda gipertoniya bo'yicha global xabardorlik kampaniyasini boshladi va har yili 17-mayni Butunjahon gipertoniya kuni (WHD) sifatida nishonladi. So'nggi uch yil ichida ko'proq milliy jamiyatlar WHD bilan shug'ullanishdi va bu xabarni jamoatchilikka etkazish uchun o'z faoliyatida innovatsion bo'ldi. 2007-yilda WHLga a'zo 47 ta mamlakatdan rekord darajadagi ishtirok etdi. WHD haftaligida ushbu mamlakatlarning barchasi o'zlarining mahalliy hukumatlari, professional jamiyatlari, nodavlat tashkilotlari va xususiy sanoat korxonalari bilan hamkorlikda bir nechta ommaviy axborot vositalari va ommaviy mitinglar orqali aholi o'rtasida gipertenziya haqida xabardorlikni oshirishdi. Internet va televideniye kabi ommaviy axborot vositalaridan foydalangan holda xabar 250 milliondan ortiq kishini qamrab oldi.

Iqtisodiyot

Yuqori qon bosimi AQShdagi birlamchi tibbiy yordam ko'rsatuvchi provayderlarga tashrif buyurishni talab qiladigan eng keng tarqalgan surunkali tibbiy muammodir. Amerika yurak assotsiatsiyasi 2010-yilda yuqori qon bosimining bevosita va bilvosita xarajatlarini 76,6 milliard dollar deb baholadi[138]. AQShda gipertoniya bilan og'rigan odamlarning 80 foizi o'z holatidan xabardor, 71 foizi antihipertenziv dori-darmonlarni qabul qiladi, ammo faqat 48 foiz odamlar gipertoniya bilan kasallanganligini bilishadi[138]. Gipertenziyani etarli darajada boshqarishga yuqori qon bosimini tashxislash, davolash yoki nazorat qilishning yetarli emasligi to'sqinlik qilishi mumkin[157]. Sog'liqni saqlash xodimlari qon bosimini nazorat qilishda ko'plab to'siqlarga duch kelishadi, shu jumladan qon bosimi maqsadlariga erishish uchun bir nechta dori-darmonlarni qabul qilishga qarshilik. Odamlar, shuningdek, dori-darmonlar jadvaliga rioya qilish va turmush tarzini o'zgartirish kabi qiyinchiliklarga duch kelishadi. Shunga qaramay, qon bosimi maqsadlariga erishish mumkin, va eng muhimi, qon bosimini pasaytirish yurak xastaligi va qon tomirlari tufayli o'lim xavfini, boshqa zaiflashuvchi sharoitlarning rivojlanishini va ilg'or tibbiy yordam bilan bog'liq xarajatlarni sezilarli darajada kamaytiradi[158][159].

Boshqa hayvonlar

Mushuklardagi gipertenziya 150 dan ortiq sistolik qon bosimi bilan ko'rsatiladi mm Hg, amlodipin bilan odatdagi birinchi darajali davolash [160].

Itlardagi normal qon bosimi zotlar orasida sezilarli darajada farq qilishi mumkin, ammo sistolik qon bosimi 160 dan yuqori bo'lsa, gipertenziya ko'pincha tashxis qilinadi. Renin-angiotensin tizimining ingibitorlari va kaltsiy kanal blokerlari ko'pincha itlarda gipertenziyani davolash uchun ishlatiladi, ammo boshqa dorilar yuqori qon bosimiga olib keladigan muayyan sharoitlarda ko'rsatilishi mumkin[161].

Manbalar

 

Qo'shimcha manbalar

 


Tashqi havolalar

  • Quotations related to Hypertension at Wikiquote
  1. ↑ Medical sciences, 2, 2014 — 562 bet. ISBN 9780702052491. 
  2. ↑ "Global burden of cardiovascular disease and stroke: hypertension at the core". The Canadian Journal of Cardiology 31 (5): 569–571. May 2015. doi:10.1016/j.cjca.2015.01.009. PMID 25795106. 
  3. ↑ Global atlas on cardiovascular disease prevention and control, 1st, Geneva: World Health Organization in collaboration with the World Heart Federation and the World Stroke Organization, 2011 — 38 bet. ISBN 9789241564373. 
  4. ↑ "Treatment options and considerations for hypertensive patients to prevent dementia". Expert Opinion on Pharmacotherapy 18 (10): 989–1000. July 2017. doi:10.1080/14656566.2017.1333599. PMID 28532183. 
  5. ↑ 5,0 5,1 "Modifiable Risk Factors and Atrial Fibrillation". Circulation 136 (6): 583–596. August 2017. doi:10.1161/CIRCULATIONAHA.116.023163. PMID 28784826. 
  6. ↑ „Hypertension“ (en). www.who.int. Qaraldi: 2022-yil 13-may.
  7. ↑ 7,0 7,1 7,2 7,3 7,4 7,5 7,6 7,7 "Hypertension". Lancet 386 (9995): 801–812. August 2015. doi:10.1016/s0140-6736(14)61468-9. PMID 25832858.  Manba xatosi: Invalid <ref> tag; name "Lancet2015" defined multiple times with different content
  8. ↑ 8,0 8,1 "Essential hypertension. Part I: definition and etiology". Circulation 101 (3): 329–335. January 2000. doi:10.1161/01.CIR.101.3.329. PMID 10645931. 
  9. ↑ 9,0 9,1 „High Blood Pressure Fact Sheet“. CDC (2015-yil 19-fevral). 2016-yil 6-martda asl nusxadan arxivlangan. Qaraldi: 2016-yil 6-mart.
  10. ↑ 10,00 10,01 10,02 10,03 10,04 10,05 10,06 10,07 10,08 10,09 10,10 10,11 10,12 10,13 10,14 10,15 10,16 10,17 10,18 "2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines". Hypertension 71 (6): e13–e115. June 2018. doi:10.1161/HYP.0000000000000065. PMID 29133356.  Manba xatosi: Invalid <ref> tag; name "AHA2017" defined multiple times with different content
  11. ↑ 11,0 11,1 11,2 11,3 11,4 "2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)". European Heart Journal 34 (28): 2159–2219. July 2013. doi:10.1093/eurheartj/eht151. PMID 23771844. 
  12. ↑ 12,0 12,1 12,2 12,3 12,4 12,5 "2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8)". JAMA 311 (5): 507–520. February 2014. doi:10.1001/jama.2013.284427. PMID 24352797. 
  13. ↑ 13,0 13,1 „How Is High Blood Pressure Treated?“. National Heart, Lung, and Blood Institute (2015-yil 10-sentyabr). 2016-yil 6-aprelda asl nusxadan arxivlangan. Qaraldi: 2016-yil 6-mart.
  14. ↑ "Pharmacotherapy for hypertension in adults 60 years or older". The Cochrane Database of Systematic Reviews 6: CD000028. June 2019. doi:10.1002/14651858.CD000028.pub3. PMID 31167038. PMC 6550717. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=6550717. 
  15. ↑ "Using the Global Burden of Disease study to assist development of nation-specific fact sheets to promote prevention and control of hypertension and reduction in dietary salt: a resource from the World Hypertension League". Journal of Clinical Hypertension 17 (3): 165–167. March 2015. doi:10.1111/jch.12479. PMID 25644474. PMC 8031937. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=8031937. 
  16. ↑ „Hypertensive vascular disease“,Harrison's Principles of Internal Medicine, 16th, New York: McGraw-Hill, 2005 — 1463–1481 bet. ISBN 978-0-07-139140-5. 
  17. ↑ 17,0 17,1 "The eye in hypertension". Lancet 369 (9559): 425–435. February 2007. doi:10.1016/S0140-6736(07)60198-6. PMID 17276782. 
  18. ↑ 18,00 18,01 18,02 18,03 18,04 18,05 18,06 18,07 18,08 18,09 18,10 18,11 18,12 ABC of hypertension. London: BMJ Books, 2007. ISBN 978-1-4051-3061-5. 
  19. ↑ Research, Center for Drug Evaluation and (2021-01-21). "High Blood Pressure – Understanding the Silent Killer" (en). FDA. https://www.fda.gov/drugs/special-features/high-blood-pressure-understanding-silent-killer. 
  20. ↑ "Hypertensive crisis". Cardiology in Review 18 (2): 102–107. 2010-04-01. doi:10.1097/CRD.0b013e3181c307b7. PMID 20160537. https://semanticscholar.org/paper/7b520e1ed4cee360c275ebf52da27dccb0c6bfe8. 
  21. ↑ „Hypertensive Crisis“. www.heart.org. 2015-yil 25-iyulda asl nusxadan arxivlangan. Qaraldi: 2015-yil 25-iyul.
  22. ↑ 22,0 22,1 22,2 "Hypertensive crises: challenges and management". Chest 131 (6): 1949–1962. June 2007. doi:10.1378/chest.06-2490. PMID 17565029. Archived from the original on 2012-12-04. https://archive.today/20121204174126/http://chestjournal.chestpubs.org/content/131/6/1949.long. 
  23. ↑ 23,0 23,1 23,2 23,3 23,4 23,5 "Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure". Hypertension 42 (6): 1206–1252. December 2003. doi:10.1161/01.HYP.0000107251.49515.c2. PMID 14656957. 
  24. ↑ "Pharmacological interventions for hypertensive emergencies". The Cochrane Database of Systematic Reviews (1): CD003653. January 2008. doi:10.1002/14651858.CD003653.pub3. PMID 18254026. PMC 6991936. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=6991936. 
  25. ↑ Harrison's principles of internal medicine., 18th, New York: McGraw-Hill, 2011 — 55–61 bet. ISBN 9780071748896. 
  26. ↑ 26,0 26,1 „Management of hypertension in pregnant and postpartum women“. www.uptodate.com. 2016-yil 4-martda asl nusxadan arxivlangan. Qaraldi: 2015-yil 30-iyul.
  27. ↑ „Hypertension and Pregnancy“. eMedicine Obstetrics and Gynecology. Medscape (2009-yil 30-iyul). 2009-yil 24-iyulda asl nusxadan arxivlangan. Qaraldi: 2009-yil 16-iyun.
  28. ↑ 28,0 28,1 „Hypertension“. eMedicine Pediatrics: Cardiac Disease and Critical Care Medicine. Medscape (2010-yil 6-aprel). 2009-yil 15-avgustda asl nusxadan arxivlangan. Qaraldi: 2009-yil 16-iyun.
  29. ↑ 29,0 29,1 29,2 "Hypertension in infancy: diagnosis, management and outcome". Pediatric Nephrology 27 (1): 17–32. January 2012. doi:10.1007/s00467-010-1755-z. PMID 21258818. 
  30. ↑ "Genetic variants in novel pathways influence blood pressure and cardiovascular disease risk". Nature 478 (7367): 103–109. September 2011. doi:10.1038/nature10405. PMID 21909115. PMC 3340926. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3340926. 
  31. ↑ "Molecular mechanisms of human hypertension". Cell 104 (4): 545–556. February 2001. doi:10.1016/S0092-8674(01)00241-0. PMID 11239411. 
  32. ↑ 32,0 32,1 "Trans-ancestry genome-wide association study identifies 12 genetic loci influencing blood pressure and implicates a role for DNA methylation". Nature Genetics 47 (11): 1282–1293. November 2015. doi:10.1038/ng.3405. PMID 26390057. PMC 4719169. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4719169. 
  33. ↑ "Residual lifetime risk for developing hypertension in middle-aged women and men: The Framingham Heart Study". JAMA 287 (8): 1003–1010. February 2002. doi:10.1001/jama.287.8.1003. PMID 11866648. 
  34. ↑ "The western diet and lifestyle and diseases of civilization" (English). Research Reports in Clinical Cardiology 2: 15–35. 2011-03-09. doi:10.2147/RRCC.S16919. https://www.dovepress.com/the-western-diet-and-lifestyle-and-diseases-of-civilization-peer-reviewed-article-RRCC. Qaraldi: 2021-02-09. Arterial gipertenziya]]
  35. ↑ "The effect of coffee on blood pressure and cardiovascular disease in hypertensive individuals: a systematic review and meta-analysis". The American Journal of Clinical Nutrition 94 (4): 1113–1126. October 2011. doi:10.3945/ajcn.111.016667. PMID 21880846. 
  36. ↑ "Vitamin D and hypertension: current evidence and future directions". Hypertension 56 (5): 774–779. November 2010. doi:10.1161/HYPERTENSIONAHA.109.140160. PMID 20937970. 
  37. ↑ "Obesity hypertension in children: a problem of epidemic proportions". Hypertension 40 (4): 441–447. October 2002. doi:10.1161/01.HYP.0000032940.33466.12. PMID 12364344. 
  38. ↑ "Pharmacotherapy for hyperuricaemia in hypertensive patients". The Cochrane Database of Systematic Reviews 2020 (9): CD008652. September 2020. doi:10.1002/14651858.CD008652.pub4. PMID 32877573. PMC 8094453. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=8094453. 
  39. ↑ "Winter Hypertension: Potential mechanisms". International Journal of Health Sciences 7 (2): 210–219. June 2013. doi:10.12816/0006044. PMID 24421749. PMC 3883610. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3883610. 
  40. ↑ "Periodontitis is associated with hypertension: a systematic review and meta-analysis". Cardiovascular Research 116 (1): 28–39. January 2020. doi:10.1093/cvr/cvz201. PMID 31549149. 
  41. ↑ „Endocrine hypertension“,Williams textbook of endocrinology, 9th, Philadelphia; Montreal: W.B. Saunders, 1998 — 729–749 bet. ISBN 978-0721661520. 
  42. ↑ "Drug-induced hypertension: an unappreciated cause of secondary hypertension". The American Journal of Medicine 125 (1): 14–22. January 2012. doi:10.1016/j.amjmed.2011.05.024. PMID 22195528. 
  43. ↑ "Association between Arsenic Exposure from Drinking Water and Longitudinal Change in Blood Pressure among HEALS Cohort Participants". Environmental Health Perspectives 123 (8): 806–812. August 2015. doi:10.1289/ehp.1409004. PMID 25816368. PMC 4529016. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4529016. 
  44. ↑ "Arsenic exposure and hypertension: a systematic review". Environmental Health Perspectives 120 (4): 494–500. April 2012. doi:10.1289/ehp.1103988. PMID 22138666. PMC 3339454. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3339454. 
  45. ↑ "Depression increases the risk of hypertension incidence: a meta-analysis of prospective cohort studies". Journal of Hypertension 30 (5): 842–851. May 2012. doi:10.1097/hjh.0b013e32835080b7. PMID 22343537. 
  46. ↑ "Loneliness matters: a theoretical and empirical review of consequences and mechanisms". Annals of Behavioral Medicine 40 (2): 218–227. October 2010. doi:10.1007/s12160-010-9210-8. PMID 20652462. PMC 3874845. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3874845. 
  47. ↑ "Sex-Specific Associations Between Alcohol Consumption and Incidence of Hypertension: A Systematic Review and Meta-Analysis of Cohort Studies". Journal of the American Heart Association 7 (13): e008202. June 2018. doi:10.1161/JAHA.117.008202. PMID 29950485. PMC 6064910. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=6064910. 
  48. ↑ "Hemodynamic aspects of essential hypertension in humans". Physiological Reviews 64 (2): 617–660. April 1984. doi:10.1152/physrev.1984.64.2.617. PMID 6369352. 
  49. ↑ 49,0 49,1 "The role of cardiac autonomic function in hypertension and cardiovascular disease". Current Hypertension Reports 11 (3): 199–205. June 2009. doi:10.1007/s11906-009-0035-4. PMID 19442329. 
  50. ↑ "Physiological aspects of primary hypertension". Physiological Reviews 62 (2): 347–504. April 1982. doi:10.1152/physrev.1982.62.2.347. PMID 6461865. 
  51. ↑ "The microcirculation and hypertension". Journal of Hypertension Supplement 10 (7): S147–156. December 1992. doi:10.1097/00004872-199212000-00016. PMID 1291649. 
  52. ↑ "Arterial and venous compliance in sustained essential hypertension". Hypertension 10 (2): 133–139. August 1987. doi:10.1161/01.HYP.10.2.133. PMID 3301662. 
  53. ↑ Steppan, Jochen; Barodka, Viachaslau; Berkowitz, Dan E.; Nyhan, Daniel (2011-08-02). "Vascular Stiffness and Increased Pulse Pressure in the Aging Cardiovascular System". Cardiology Research and Practice 2011: 263585. doi:10.4061/2011/263585. ISSN 2090-8016. PMID 21845218. PMC 3154449. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3154449. 
  54. ↑ "Clinical practice. Isolated systolic hypertension in the elderly". The New England Journal of Medicine 357 (8): 789–796. August 2007. doi:10.1056/NEJMcp071137. PMID 17715411. https://semanticscholar.org/paper/3b8606161db9ebd3b7ea4868afe68e5a104336af. 
  55. ↑ "Mechanisms, pathophysiology, and therapy of arterial stiffness". Arteriosclerosis, Thrombosis, and Vascular Biology 25 (5): 932–943. May 2005. doi:10.1161/01.ATV.0000160548.78317.29. PMID 15731494. 
  56. ↑ "Counterpoint: Activation of the intrarenal renin-angiotensin system is the dominant contributor to systemic hypertension". Journal of Applied Physiology 109 (6): 1998–2000; discussion 2015. December 2010. doi:10.1152/japplphysiol.00182.2010a. PMID 21148349. PMC 3006411. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3006411. 
  57. ↑ "Point: Chronic activation of the sympathetic nervous system is the dominant contributor to systemic hypertension". Journal of Applied Physiology 109 (6): 1996–1998; discussion 2016. December 2010. doi:10.1152/japplphysiol.00182.2010. PMID 20185633. https://semanticscholar.org/paper/7fb165b65dc597989dea16aeef0da7ab62797210. 
  58. ↑ "Endothelium-dependent contractions and endothelial dysfunction in human hypertension". British Journal of Pharmacology 157 (4): 527–536. June 2009. doi:10.1111/j.1476-5381.2009.00240.x. PMID 19630832. PMC 2707964. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2707964. 
  59. ↑ "Role of the renin-angiotensin system in vascular inflammation". Trends in Pharmacological Sciences 29 (7): 367–374. July 2008. doi:10.1016/j.tips.2008.05.003. PMID 18579222. 
  60. ↑ "Targeting the immune system to treat hypertension: where are we?". Current Opinion in Nephrology and Hypertension 23 (5): 473–479. September 2014. doi:10.1097/MNH.0000000000000052. PMID 25036747. 
  61. ↑ "Sodium and potassium in the pathogenesis of hypertension". The New England Journal of Medicine 356 (19): 1966–1978. May 2007. doi:10.1056/NEJMra064486. PMID 17494929. https://semanticscholar.org/paper/04fb7e2e8715e9540f1845b26f925b14aaf8e3cf. 
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  63. ↑ "ACCF/AHA 2011 expert consensus document on hypertension in the elderly: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents developed in collaboration with the American Academy of Neurology, American Geriatrics Society, American Society for Preventive Cardiology, American Society of Hypertension, American Society of Nephrology, Association of Black Cardiologists, and European Society of Hypertension". Journal of the American Society of Hypertension 5 (4): 259–352. 2011. doi:10.1016/j.jash.2011.06.001. PMID 21771565. 
  64. ↑ „Hypertension in adults: diagnosis and management | Guidance and guidelines | NICE“. www.nice.org.uk. 2017-yil 9-aprelda asl nusxadan arxivlangan. Qaraldi: 2018-yil 11-noyabr.
  65. ↑ 65,0 65,1 65,2 65,3 65,4 65,5 65,6 "Screening for Hypertension and Lowering Blood Pressure for Prevention of Cardiovascular Disease Events". The Medical Clinics of North America 101 (4): 701–712. July 2017. doi:10.1016/j.mcna.2017.03.003. PMID 28577621. 
  66. ↑ 66,0 66,1 66,2 Principles of Blood Pressure Measurement – Current Techniques, Office vs Ambulatory Blood Pressure Measurement, 2017 — 85–96 bet. DOI:10.1007/5584_2016_49. ISBN 978-3-319-44250-1. 
  67. ↑ 67,0 67,1 "Screening for high blood pressure in adults: U.S. Preventive Services Task Force recommendation statement". Annals of Internal Medicine 163 (10): 778–786. November 2015. doi:10.7326/m15-2223. PMID 26458123. 
  68. ↑ National Clinical Guidance Centre „7 Diagnosis of Hypertension, 7.5 Link from evidence to recommendations“,. Hypertension (NICE CG 127). National Institute for Health and Clinical Excellence, August 2011 — 102 bet. 
  69. ↑ "Unusual hypertensive phenotypes: what is their significance?". Hypertension 59 (2): 173–178. February 2012. doi:10.1161/HYPERTENSIONAHA.111.182956. PMID 22184330. 
  70. ↑ "Orthostatic hypertension: a measure of blood pressure variation for predicting cardiovascular risk". Circulation Journal 73 (6): 1002–1007. June 2009. doi:10.1253/circj.cj-09-0286. PMID 19430163. 
  71. ↑ Harrison's principles of internal medicine. McGraw-Hill Medical, 2008. ISBN 978-0-07-147691-1. 
  72. ↑ "The 2009 Canadian Hypertension Education Program recommendations for the management of hypertension: Part 1 – blood pressure measurement, diagnosis and assessment of risk". The Canadian Journal of Cardiology 25 (5): 279–286. May 2009. doi:10.1016/S0828-282X(09)70491-X. PMID 19417858. PMC 2707176. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2707176. 
  73. ↑ "The 2008 Canadian Hypertension Education Program recommendations for the management of hypertension: Part 1 – blood pressure measurement, diagnosis and assessment of risk". The Canadian Journal of Cardiology 24 (6): 455–463. June 2008. doi:10.1016/S0828-282X(08)70619-6. PMID 18548142. PMC 2643189. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2643189. 
  74. ↑ "The 2007 Canadian Hypertension Education Program recommendations for the management of hypertension: part 1 – blood pressure measurement, diagnosis and assessment of risk". The Canadian Journal of Cardiology 23 (7): 529–538. May 2007. doi:10.1016/S0828-282X(07)70797-3. PMID 17534459. PMC 2650756. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2650756. 
  75. ↑ "The 2006 Canadian Hypertension Education Program recommendations for the management of hypertension: Part I – Blood pressure measurement, diagnosis and assessment of risk". The Canadian Journal of Cardiology 22 (7): 573–581. May 2006. doi:10.1016/S0828-282X(06)70279-3. PMID 16755312. PMC 2560864. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2560864. 
  76. ↑ "The 2005 Canadian Hypertension Education Program recommendations for the management of hypertension: part 1 – blood pressure measurement, diagnosis and assessment of risk". The Canadian Journal of Cardiology 21 (8): 645–656. June 2005. PMID 16003448. 
  77. ↑ "Hypertension in children and adolescents". American Family Physician 73 (9): 1558–1568. May 2006. PMID 16719248. 
  78. ↑ 78,0 78,1 78,2 78,3 78,4 78,5 78,6 78,7 „Guideline for the diagnosis and management of hypertension in adults“ 12. Heart Foundation (2016). 2017-yil 14-yanvarda asl nusxadan arxivlangan. Qaraldi: 2017-yil 12-yanvar.
  79. ↑ 79,0 79,1 „AAFP Decides to Not Endorse AHA/ACC Hypertension Guideline“. AAFP (2017-yil 12-dekabr). 2018-yil 7-yanvarda asl nusxadan arxivlangan. Qaraldi: 2017-yil 15-dekabr.
  80. ↑ "[Isolated diastolic hypertension : do we still have to care about it ? [Isolated diastolic hypertension: do we still have to care about it?]"]. Revue Médicale Suisse 14 (618): 1607–1610. September 2018. doi:10.53738/REVMED.2018.14.618.1607. PMID 30226658. Archived from the original on 22 May 2020. https://web.archive.org/web/20200522074708/https://www.revmed.ch/contentrevmed/download/239609/2274674. 
  81. ↑ "Isolated diastolic hypertension". Journal of Clinical Hypertension (Wiley) 5 (6): 411–413. 2003. doi:10.1111/j.1524-6175.2003.02840.x. PMID 14688497. PMC 8099308. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=8099308. 
  82. ↑ "2007 ESH-ESC Practice Guidelines for the Management of Arterial Hypertension: ESH-ESC Task Force on the Management of Arterial Hypertension". Journal of Hypertension 25 (9): 1751–1762. September 2007. doi:10.1097/HJH.0b013e3282f0580f. PMID 17762635. https://semanticscholar.org/paper/a2927bb59360cf2b97944eb7fa53e393d2f94c36. 
  83. ↑ 83,0 83,1 "Guidelines for management of hypertension: report of the fourth working party of the British Hypertension Society, 2004-BHS IV". Journal of Human Hypertension 18 (3): 139–185. March 2004. doi:10.1038/sj.jhh.1001683. PMID 14973512. 
  84. ↑ "2017 Guideline for High Blood Pressure in Adults". American College of Cardiology. Archived from the original on 19 November 2017. https://web.archive.org/web/20171119220007/http://www.acc.org/latest-in-cardiology/ten-points-to-remember/2017/11/09/11/41/2017-guideline-for-high-blood-pressure-in-adults. Qaraldi: 21 November 2017. Arterial gipertenziya]]
  85. ↑ "2020 International Society of Hypertension Global Hypertension Practice Guidelines". Hypertension 75 (6): 1334–1357. June 2020. doi:10.1161/HYPERTENSIONAHA.120.15026. PMID 32370572. 
  86. ↑ 86,0 86,1 86,2 86,3 National High Blood Pressure Education Program Working Group on High Blood Pressure in Children Adolescents (August 2004). "The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents". Pediatrics 114 (2 Suppl 4th Report): 555–576. doi:10.1542/peds.114.2.S2.555. PMID 15286277. 
  87. ↑ Expert Panel on Integrated Guidelines for Cardiovascular Health Risk Reduction in Children Adolescents; National Heart, Lung, and Blood Institute (December 2011). "Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report". Pediatrics 128 (Suppl 5): S213–256. doi:10.1542/peds.2009-2107C. PMID 22084329. PMC 4536582. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4536582. 
  88. ↑ „Hypertension - Clinical Preventive Service Recommendation“. 2014-yil 1-noyabrda asl nusxadan arxivlangan. Qaraldi: 2013-yil 13-oktyabr.
  89. ↑ "Screening for primary hypertension in children and adolescents: U.S. Preventive Services Task Force recommendation statement". Annals of Internal Medicine 159 (9): 613–619. November 2013. doi:10.7326/0003-4819-159-9-201311050-00725. PMID 24097285. https://semanticscholar.org/paper/d0a86414897610041b6739fd63edd3d7134a1a99. 
  90. ↑ „Document | United States Preventive Services Taskforce“. www.uspreventiveservicestaskforce.org. 2020-yil 22-mayda asl nusxadan arxivlangan. Qaraldi: 2020-yil 22-aprel.
  91. ↑ "Primary prevention of hypertension: clinical and public health advisory from The National High Blood Pressure Education Program". JAMA 288 (15): 1882–1888. October 2002. doi:10.1001/jama.288.15.1882. PMID 12377087. https://semanticscholar.org/paper/71186674bbfaa53fe340dad1f1f94f1a8a72baa1. 
  92. ↑ 92,0 92,1 „Hypertension: Causes, symptoms, and treatments“ (en). www.medicalnewstoday.com (2021-yil 10-noyabr). Qaraldi: 2022-yil 27-aprel.
  93. ↑ 93,0 93,1 "Evidence-based policy for salt reduction is needed". Lancet 388 (10043): 438. July 2016. doi:10.1016/S0140-6736(16)31205-3. PMID 27507743. 
  94. ↑ "Associations of urinary sodium excretion with cardiovascular events in individuals with and without hypertension: a pooled analysis of data from four studies". Lancet 388 (10043): 464–475. July 2016. doi:10.1016/S0140-6736(16)30467-6. PMID 27216139. https://ecommons.aku.edu/pakistan_fhs_mc_chs_chs/331. "The results showed that cardiovascular disease and death are increased with low sodium intake (compared with moderate intake) irrespective of hypertension status, whereas there is a higher risk of cardiovascular disease and death only in individuals with hypertension consuming more than 6 g of sodium per day (representing only 10% of the population studied)" 
  95. ↑ "European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts)". European Heart Journal 33 (13): 1635–1701. July 2012. doi:10.1093/eurheartj/ehs092. PMID 22555213. 
  96. ↑ "Lowering blood pressure to prevent myocardial infarction and stroke: a new preventive strategy". Health Technology Assessment 7 (31): 1–94. 2003. doi:10.3310/hta7310. PMID 14604498. 
  97. ↑ 97,0 97,1 "The 2015 Canadian Hypertension Education Program recommendations for blood pressure measurement, diagnosis, assessment of risk, prevention, and treatment of hypertension". The Canadian Journal of Cardiology 31 (5): 549–568. May 2015. doi:10.1016/j.cjca.2015.02.016. PMID 25936483. https://escholarship.mcgill.ca/concern/articles/rb68xh61n. 
  98. ↑ 98,0 98,1 „Hypertension: Recommendations, Guidance and guidelines“. NICE. 2006-yil 3-oktyabrda asl nusxadan arxivlangan. Qaraldi: 2015-yil 4-avgust.
  99. ↑ 99,0 99,1 "Blood pressure targets for hypertension in people with diabetes mellitus". The Cochrane Database of Systematic Reviews (10): CD008277. October 2013. doi:10.1002/14651858.cd008277.pub2. PMID 24170669. 
  100. ↑ "Blood pressure targets for the treatment of people with hypertension and cardiovascular disease". The Cochrane Database of Systematic Reviews 2020 (9): CD010315. September 2020. doi:10.1002/14651858.CD010315.pub4. PMID 32905623. PMC 8094921. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=8094921. 
  101. ↑ 101,0 101,1 "Blood pressure targets in adults with hypertension". The Cochrane Database of Systematic Reviews 2020 (12): CD004349. December 2020. doi:10.1002/14651858.CD004349.pub3. PMID 33332584. PMC 8094587. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=8094587. 
  102. ↑ "Pharmacologic Treatment of Hypertension in Adults Aged 60 Years or Older to Higher Versus Lower Blood Pressure Targets: A Clinical Practice Guideline From the American College of Physicians and the American Academy of Family Physicians". Annals of Internal Medicine 166 (6): 430–437. March 2017. doi:10.7326/M16-1785. PMID 28135725. 
  103. ↑ "Pharmacologic Treatment of Hypertension in Adults Aged 60 Years or Older to Higher Versus Lower Blood Pressure Targets: A Clinical Practice Guideline From the American College of Physicians and the American Academy of Family Physicians". Annals of Internal Medicine 166 (6): 430–437. March 2017. doi:10.7326/m16-1785. PMID 28135725. 
  104. ↑ "Evidence supporting a systolic blood pressure goal of less than 150 mm Hg in patients aged 60 years or older: the minority view". Annals of Internal Medicine 160 (7): 499–503. April 2014. doi:10.7326/m13-2981. PMID 24424788. 
  105. ↑ "KDIGO Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease". Kidney International Supplements. December 2012. Archived from the original on 16 June 2015. https://web.archive.org/web/20150616063812/http://www.kdigo.org/clinical_practice_guidelines/pdf/KDIGO_BP_GL.pdf. 
  106. ↑ "Lower blood pressure targets: to whom do they apply?". Lancet 387 (10017): 405–406. January 2016. doi:10.1016/S0140-6736(15)00816-8. PMID 26559745. https://zenodo.org/record/896834. 
  107. ↑ "Long-term effects of weight-reducing diets in people with hypertension". The Cochrane Database of Systematic Reviews 2021 (2): CD008274. February 2021. doi:10.1002/14651858.CD008274.pub4. PMID 33555049. PMC 8093137. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=8093137. 
  108. ↑ "Effect of longer-term modest salt reduction on blood pressure". The Cochrane Database of Systematic Reviews 30 (4): CD004937. April 2013. doi:10.1002/14651858.CD004937.pub2. PMID 23633321. https://semanticscholar.org/paper/a188970ba1b87724a3db6995f550fc48ca3348ac. 
  109. ↑ "Effect of dose and duration of reduction in dietary sodium on blood pressure levels: systematic review and meta-analysis of randomised trials". BMJ 368: m315. February 2020. doi:10.1136/bmj.m315. PMID 32094151. PMC 7190039. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=7190039. 
  110. ↑ "Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group". The New England Journal of Medicine 344 (1): 3–10. January 2001. doi:10.1056/NEJM200101043440101. PMID 11136953. 
  111. ↑ "Plant-Based Diets and Hypertension". American Journal of Lifestyle Medicine 14 (4): 397–405. 2020. doi:10.1177/1559827619875411. PMID 33281520. PMC 7692016. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=7692016. 
  112. ↑ "Effect of green tea supplementation on blood pressure: A systematic review and meta-analysis of randomized controlled trials". Medicine 99 (6): e19047. February 2020. doi:10.1097/MD.0000000000019047. PMID 32028419. PMC 7015560. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=7015560. 
  113. ↑ "The efficacy of sour tea (Hibiscus sabdariffa L.) on selected cardiovascular disease risk factors: A systematic review and meta-analysis of randomized clinical trials". Phytotherapy Research 34 (2): 329–339. February 2020. doi:10.1002/ptr.6541. PMID 31943427. https://onlinelibrary.wiley.com/doi/abs/10.1002/ptr.6541. 
  114. ↑ "Hibiscus sabdariffa L. tea (tisane) lowers blood pressure in prehypertensive and mildly hypertensive adults". The Journal of Nutrition 140 (2): 298–303. February 2010. doi:10.3945/jn.109.115097. PMID 20018807. 
  115. ↑ „Beetroot juice lowers high blood pressure, suggests research“. British Heart Foundation.
  116. ↑ "Inorganic nitrate and beetroot juice supplementation reduces blood pressure in adults: a systematic review and meta-analysis". The Journal of Nutrition 143 (6): 818–826. June 2013. doi:10.3945/jn.112.170233. PMID 23596162. 
  117. ↑ "The Nitrate-Independent Blood Pressure-Lowering Effect of Beetroot Juice: A Systematic Review and Meta-Analysis". Advances in Nutrition 8 (6): 830–838. November 2017. doi:10.3945/an.117.016717. PMID 29141968. PMC 5683004. https://doi.org/10.3945/an.117.016717. 
  118. ↑ "Effect of increased potassium intake on cardiovascular risk factors and disease: systematic review and meta-analyses". BMJ 346: f1378. April 2013. doi:10.1136/bmj.f1378. PMID 23558164. PMC 4816263. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4816263. 
  119. ↑ "Potassium Intake, Bioavailability, Hypertension, and Glucose Control". Nutrients 8 (7): 444. July 2016. doi:10.3390/nu8070444. PMID 27455317. PMC 4963920. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4963920. 
  120. ↑ "Hyperkalemia associated with use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers". Cardiovascular Therapeutics 30 (3): e156–166. June 2012. doi:10.1111/j.1755-5922.2010.00258.x. PMID 21883995. 
  121. ↑ "Beyond medications and diet: alternative approaches to lowering blood pressure: a scientific statement from the american heart association". Hypertension 61 (6): 1360–1383. June 2013. doi:10.1161/HYP.0b013e318293645f. PMID 23608661. 
  122. ↑ "First-line drugs for hypertension". The Cochrane Database of Systematic Reviews 2018 (4): CD001841. April 2018. doi:10.1002/14651858.CD001841.pub3. PMID 29667175. PMC 6513559. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=6513559. 
  123. ↑ "Blood pressure lowering efficacy of diuretics as second-line therapy for primary hypertension". The Cochrane Database of Systematic Reviews (4): CD007187. October 2009. doi:10.1002/14651858.CD007187.pub2. PMID 19821398. https://semanticscholar.org/paper/f9716a5d3dd5ced9d989746ed7ffbae48b42fd1c. 
  124. ↑ "Interventions used to improve control of blood pressure in patients with hypertension". The Cochrane Database of Systematic Reviews (3): CD005182. March 2010. doi:10.1002/14651858.cd005182.pub4. PMID 20238338. Archived from the original on 12 April 2019. https://web.archive.org/web/20190412075644/http://researchonline.lshtm.ac.uk/10814/1/Fahey_et_al-2006-The_Cochrane_library.pdf. Qaraldi: 11 February 2019. Arterial gipertenziya]]
  125. ↑ "Beta-blockers for hypertension". The Cochrane Database of Systematic Reviews 1: CD002003. January 2017. doi:10.1002/14651858.CD002003.pub5. PMID 28107561. PMC 5369873. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=5369873. 
  126. ↑ "Resistant hypertension: a review of diagnosis and management". JAMA 311 (21): 2216–2224. June 2014. doi:10.1001/jama.2014.5180. PMID 24893089. Archived from the original on 20 April 2018. https://web.archive.org/web/20180420074038/https://pdfs.semanticscholar.org/71f3/dfb73fa198d6adfa8a623bda34826fb59426.pdf. Qaraldi: 19 April 2018. Arterial gipertenziya]]
  127. ↑ "Electronic monitors of drug adherence: tools to make rational therapeutic decisions". Journal of Hypertension 27 (11): 2294–2295; author reply 2295. November 2009. doi:10.1097/hjh.0b013e328332a501. PMID 20724871. 
  128. ↑ "Autonomic-immune-vascular interaction: an emerging concept for neurogenic hypertension". Hypertension 57 (6): 1026–1033. June 2011. doi:10.1161/HYPERTENSIONAHA.111.169748. PMID 21536990. PMC 3105900. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3105900. 
  129. ↑ Sarwar, M.; Islam, M.; Al Baker, S.M.; Hasnat, A. (22 March 2013). "Resistant Hypertension: Underlying Causes and Treatment". Drug Research 63 (5): 217–223. doi:10.1055/s-0033-1337930. PMID 23526242. 
  130. ↑ Young, W. F. (February 2019). "Diagnosis and treatment of primary aldosteronism: practical clinical perspectives" (en). Journal of Internal Medicine 285 (2): 126–148. doi:10.1111/joim.12831. PMID 30255616. https://onlinelibrary.wiley.com/doi/10.1111/joim.12831. 
  131. ↑ 131,0 131,1 "Treatment of resistant and refractory hypertension". Circulation Research 124 (7): 1061–1070. March 2019. doi:10.1161/CIRCRESAHA.118.312156. PMID 30920924. PMC 6469348. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=6469348. 
  132. ↑ "Refractory hypertension: A novel phenotype of antihypertensive treatment failure". Hypertension 67 (6): 1085–1092. June 2016. doi:10.1161/HYPERTENSIONAHA.116.06587. PMID 27091893. PMC 5425297. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=5425297. 
  133. ↑ „Blood Pressure“. World Health Organization. 2017-yil 18-aprelda asl nusxadan arxivlangan. Qaraldi: 2017-yil 22-aprel.
  134. ↑ „WHO Disease and injury country estimates“. World Health Organization (2009). 2009-yil 11-noyabrda asl nusxadan arxivlangan. Qaraldi: 2009-yil 11-noyabr.
  135. ↑ "Prevalence of hypertension in the US adult population. Results from the Third National Health and Nutrition Examination Survey, 1988–1991". Hypertension 25 (3): 305–313. March 1995. doi:10.1161/01.HYP.25.3.305. PMID 7875754. https://semanticscholar.org/paper/020ec657d9f9b890bafb80756909e1123fcbf796. 
  136. ↑ 136,0 136,1 "Trends in the prevalence, awareness, treatment, and control of hypertension in the adult US population. Data from the health examination surveys, 1960 to 1991". Hypertension 26 (1): 60–69. July 1995. doi:10.1161/01.HYP.26.1.60. PMID 7607734. Archived from the original on 2012-12-20. https://archive.today/20121220113643/http://hyper.ahajournals.org/cgi/pmidlookup?view=long&pmid=7607734. 
  137. ↑ "Trends in hypertension prevalence, awareness, treatment, and control in older U.S. adults: data from the National Health and Nutrition Examination Survey 1988 to 2004". Journal of the American Geriatrics Society 55 (7): 1056–1065. July 2007. doi:10.1111/j.1532-5415.2007.01215.x. PMID 17608879. https://zenodo.org/record/1230667. 
  138. ↑ 138,0 138,1 138,2 "Heart disease and stroke statistics – 2010 update: a report from the American Heart Association". Circulation 121 (7): e46–e215. February 2010. doi:10.1161/CIRCULATIONAHA.109.192667. PMID 20019324. 
  139. ↑ „Culture-Specific of Health Risk Health Status: Morbidity and Mortality“. Stanford (2014-yil 16-mart). 2016-yil 15-fevralda asl nusxadan arxivlangan. Qaraldi: 2016-yil 12-aprel.
  140. ↑ "Epidemiological issues are not simply black and white". Hypertension 58 (4): 546–547. October 2011. doi:10.1161/HYPERTENSIONAHA.111.178541. PMID 21911712. 
  141. ↑ "Hypertension in children and adolescents: epidemiology and natural history". Pediatric Nephrology 25 (7): 1219–1224. July 2010. doi:10.1007/s00467-009-1200-3. PMID 19421783. PMC 2874036. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2874036. 
  142. ↑ "Hypertension in children and adolescents". American Family Physician 73 (9): 1558–1568. May 2006. PMID 16719248. Archived from the original on 26 September 2007. https://web.archive.org/web/20070926230038/http://www.aafp.org/afp/20060501/1558.html. 
  143. ↑ „Global health risks: mortality and burden of disease attributable to selected major risks“. World Health Organization (2009). 2012-yil 14-fevralda asl nusxadan arxivlangan. Qaraldi: 2012-yil 10-fevral.
  144. ↑ "Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies". Lancet 360 (9349): 1903–1913. December 2002. doi:10.1016/S0140-6736(02)11911-8. PMID 12493255. 
  145. ↑ "Management of hypertension in peripheral arterial disease: does the choice of drugs matter?". European Journal of Vascular and Endovascular Surgery 35 (6): 701–708. June 2008. doi:10.1016/j.ejvs.2008.01.007. PMID 18375152. 
  146. ↑ 146,0 146,1 146,2 146,3 146,4 146,5 146,6 146,7 "From blood pressure to hypertension: the history of research". Journal of the Royal Society of Medicine 84 (10): 621. October 1991. doi:10.1177/014107689108401019. PMID 1744849. PMC 1295564. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1295564. 
  147. ↑ 147,0 147,1 "Historical trends and milestones in hypertension research: a model of the process of translational research". Hypertension 58 (4): 522–38. October 2011. doi:10.1161/HYPERTENSIONAHA.111.177766. PMID 21859967. 
  148. ↑ A century of arterial hypertension 1896–1996 Postel-Vinay N: . Chichester: Wiley, 1996 — 213 bet. ISBN 978-0-471-96788-0. 
  149. ↑ "The medieval origins of the concept of hypertension". Heart Views 15 (3): 96–98. July 2014. doi:10.4103/1995-705X.144807. PMID 25538828. PMC 4268622. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4268622. 
  150. ↑ "Avicenna's doctrine about arterial hypertension". Acta Medico-Historica Adriatica 12 (1): 157–162. 2014. PMID 25310615. 
  151. ↑ Manual of hypertension Swales JD: . Oxford: Blackwell Science, 1995 — xiii bet. ISBN 978-0-86542-861-4. 
  152. ↑ 152,0 152,1 "Controlling hypertension. A research success story". Archives of Internal Medicine 156 (17): 1926–1935. September 1996. doi:10.1001/archinte.156.17.1926. PMID 8823146. 
  153. ↑ "Experiences with tetraethylammonium chloride in hypertension". Journal of the American Medical Association 136 (9): 608–613. February 1948. doi:10.1001/jama.1948.02890260016005. PMID 18899127. 
  154. ↑ "The evolution of antihypertensive therapy: an overview of four decades of experience". Journal of the American College of Cardiology 14 (7): 1595–1608. December 1989. doi:10.1016/0735-1097(89)90002-8. PMID 2685075. 
  155. ↑ "Benzothiadiazine dioxides as novel diuretics". J. Am. Chem. Soc. 79 (8): 2028–2029. 1957. doi:10.1021/ja01565a079. 
  156. ↑ 156,0 156,1 "Impact of World Hypertension Day". The Canadian Journal of Cardiology 23 (7): 517–519. May 2007. doi:10.1016/S0828-282X(07)70795-X. PMID 17534457. PMC 2650754. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2650754. 
  157. ↑ "Hypertension, a health economics perspective". Therapeutic Advances in Cardiovascular Disease 2 (3): 147–155. June 2008. doi:10.1177/1753944708090572. PMID 19124418. 
  158. ↑ "The economic impact of hypertension". Journal of Clinical Hypertension 5 (3 Suppl 2): 3–13. October 2003. doi:10.1111/j.1524-6175.2003.02463.x. PMID 12826765. PMC 8099256. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=8099256. 
  159. ↑ "Economic benefits of treating high-risk hypertension with angiotensin II receptor antagonists (blockers)". Clinical Drug Investigation 28 (4): 211–220. 2008. doi:10.2165/00044011-200828040-00002. PMID 18345711. 
  160. ↑ "ISFM Consensus Guidelines on the Diagnosis and Management of Hypertension in Cats". Journal of Feline Medicine and Surgery 19 (3): 288–303. March 2017. doi:10.1177/1098612X17693500. PMID 28245741. 
  161. ↑ "ACVIM consensus statement: Guidelines for the identification, evaluation, and management of systemic hypertension in dogs and cats". Journal of Veterinary Internal Medicine 32 (6): 1803–1822. November 2018. doi:10.1111/jvim.15331. PMID 30353952. PMC 6271319. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=6271319.  
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