Лечение Эссенциальной Гипертензии – Essential hypertension treatment

Back in biblical times, longevity wasn’t such a big deal. Heck, Moses lived 120 years without missing a step, according to the Bible. Noah kept trekking 350 years after the flood-living a colossal 950 years. And we hardly need mention Methuselah’s claim to fame. At 969 years of age, he’s credited with being the oldest man in history.

How’d they do it?

With all due respect, they most likely didn’t. Theologians have mulled this question for years. By considering traditions of the time, they have developed very human explanations for what appear to be superhuman life spans.

«No one really has the answer, but there are two very plausible explanations,» says the Reverend Glenn Asquith Jr., Ph.D., professor of pastoral theology at Moravian Theological Seminary in Bethlehem, Pennsylvania. «One is that the Israelites counted time differently. Some have theorized that they followed a lunar rather than a solar calendar.»

An even better explanation is that the Israelites loved their heroes much in the way we do-by making them larger than life. It’s like all of the embellishment surrounding George Washington, the Reverend Dr. Asquith says. «Most of these stories were passed down orally. So, with each telling, they likely became embellished. Since longevity was a sign of God’s blessing to the ancient Israelites, it makes sense that they would make their heroes out to be ancient.»

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Although a physical examination and detailed medical history can tell a great deal about the likelihood of OSA, confirmation of the syndrome can only be done in properly equipped sleep laboratories which are now established in many large public hospitals and some private institutions. Formal sleep studies (technically referred to as polysomnography) make it possible to observe the patient in a clinical setting under the supervision of trained personnel.

Many of the functional and physiological changes mentioned previously, such as airway obstruction, hypoxaemia and irregularities of heart rate, are monitored during the study, giving investigators enough information to decide on the best course of action for the hapless snorer. Most people are apprehensive about the need for hospital admission and comprehensive testing procedures, and it is important that they be informed and reassured of the non invasive nature of these procedures. A nervous patient is likely to have a poor night’s sleep from which little useful information can be extracted.

Oxygen saturation

Probably the single most important measure of the severity of OSA is the level to which blood oxygen falls. Blood oxygen concentration, or saturation, can be estimated quite accurately by attaching a probe to either a finger or ear lobe. A special light emitted from the probe is able to detect oxygen saturation in the blood supply of the site to which it is attached, which in turn reflects the circulating oxygen level.

Sleep states

Airway obstruction is more pronounced in deep sleep, particularly during REM, and it is therefore important to document sleep stages to confirm that the patient slept soundly, preferably with several episodes of REM. Sleep states are monitored via several electrodes which are glued to various sites on the head which detect electrical activity °f the brain, eye movements and muscle tone, all of which help to define sleep states.

Chest wall movement: Obstructive and Central

The two broad categories of sleep apnoea, central and obstructive, are defined by the type of respiratory efforts made. One way of measuring this is to look at the movement of the chest wall as it expands and contracts with each breath, in conjunction with a detector of airflow at the opening of the nasal passage. When the upper airway collapses in obstructive sleep apnoea, the chest wall continues to move but there will be no detectable airflow through the nose. Falling oxygen levels stimulate the patient to take bigger breaths resulting in ever increasing signals from the monitor of chest wall movement. Eventually, the obstruction is overcome, airflow is again detected and breathing returns to normal until the next obstructive event. With central apnoea, the chest wall shows little or no sign of movement, indicating an absence of respiratory effort. This is also accompanied by a cessation of airflow.

Heart monitoring

The final obligatory assault comes in the form of a heart monitor (or ECG), the electrodes of which are attached to the chest. The ECG records the heart rate and provides information about the electrical impulses which stimulate the heart to beat regularly.

The process of «wiring up» for a sleep study can be an intimidating experience for those with an innate fear of hospitals and high technology. A small percentage of patients never relax enough to get a good night’s sleep, but most adapt quickly to the novel circumstances and sleep soundly enough for the purpose of the investigation. In this respect, patients with advanced OSA have no problems, often falling asleep while being attached to their monitoring equipment.

The capacity to measure oxygen saturation, sleep states, chest wall movement, nasal airflow and heart rate is a minimum requirement for a unit specializing in sleep-related breathing disorders. Some units, however, are capable of measuring other parameters of sleep and breathing and have the resources to screen several patients on the same night.

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The large differences in health and illness behaviour between groups and cultures suggest that it must be learned. Research shows that Jews and Italians claim that their mothers were over-protective and over-concerned about their children’s health and participation in sports and that they were constantly warned to avoid colds, fights and other threatening situations. Perhaps this kind of upbringing fosters a type of personality which is particularly concerned and even anxious about illness.

First-born and only children are more likely to want the company of another person when they face stress in adult life-probably because they are so much more psychologically dependent than later-born children. This is interesting in the light of studies which show that early-born children use more medical services than do later-borns (in whatever size of family).

We have already seen that psychological manoeuvres that are going on, usually quite unconsciously, are much more complex. Illness behaviour is part of a well-defined social pattern and we all have our views of how doctors (them) and patients (us) behave. I firmly believe, to paraphrase Shakespeare, that, ‘All the world’s a surgery and all the doctors and patients merely role-players.’ It is my view that many of those going to their doctors are quite unconsciously playing a role-the sick role. Studies suggest that only about four out of ten people going to a general practitioner have anything physically wrong with them and that about 80 per cent of all ailments are self-limiting. So what are we all playing at?

Illness behaviour (adopting the sick role) is a very effective way of being relieved from social expectations, and is an excuse for failure, a way of obtaining privileges and sympathy, and so on. For those who have few social ties, poor support and feel isolated, the medical system is a well-recognized and comfortable way of obtaining at least some of these. Thirty or more years ago perceptive doctors realized that what their patients came to them for was often quite unimportant but what it did was to establish a relationship with the doctor who would then confirm them in the sickness role. Doctors need people like this to make them feel wanted so that they, the doctors, can live out their role as health-givers. Unfortunately, many doctors do not understand this role-playing and as a result go along with their patients’ endless demands for medical care. This results in numerous return visits, many if not most of which would be unnecessary if the patient’s real problems and motivations had been perceived and adequately dealt with by the doctor at the first consultation.

Just as certain people unconsciously retreat into the sickness role because it is a release from unpleasant or unacceptable situations, others sacrifice their health to ambition, expediency or the good of others. Young parents overwork in the full knowledge of what they are doing, sometimes also going without things ‘because of the children’ and so on. The health of general practitioners is perhaps a good example. British GPs have alarmingly high rates of alcoholism, drug abuse, broken marriages, coronary artery disease and suicide, yet they presumably know all the answers. To some extent at least, they are choosing to sacrifice their own health in favour of that of their patients.

But closely allied to all this illness and sickness behaviour is society’s concept of what is normal, and how it defines ill health. Mental illness for example, has been seen, at different times over the centuries, as demonic power, witchcraft and madness. The labels, the treatments and the social attitudes are all different and yet the ‘reality’ of the illness in question may well have been the same. Alcoholism is another example. When does social drinking become an illness? Sexual deviations and hypochondriasis or malingering are especially difficult to define yet somewhere along the line is a point beyond which sufferers could be said to be ‘ill’. Certainly fashions and fads are all-important when trying to define behaviour of any kind, let alone illness behaviour. Forty years ago oral sex was a ‘perversion’-today it is a fashionable pursuit that raises few eyebrows. Today we accept the fact that 30 per cent of the population has backache-it is ‘nor-mal’-and that thousands are killed on the roads every year. In developing countries parasitic diseases, infectious diseases, civil war or poverty may be similarly accepted as ‘normal’.

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