Лечение Эссенциальной Гипертензии – Essential hypertension treatment

Болезненные изменения в организме, возникающие вследствие первичного повышения артериального давления, называются гипертонической болезнью. В определении заболевания подчеркивается именно первичная гипертония, в отличие от вторичной гипертонии -повышения давления при таких болезнях, как воспаление почек, поражение клапанного аппарата сердца, заболевания щитовидной железы, придатка головного мозга и др. Повышенное давление в этих случаях является одним из признаков страдания. При выздоровлении или улучшении состояния больного вторичная гипертония исчезает или становится менее выраженной.

Вместе с тем, при гипертонической болезни также возможны изменения в почках, сердце и других органах, но это уже не причина, а следствие первичного повышения артериального давления.

Какое давление можно считать нормальным и каковы пределы его колебания?

Артериальное давление подвержено существенным колебаниям даже и в норме. Оно зависит от возраста, пола, характера питания и даже от географических и социально-экономических условий жизни. В младшем возрасте средняя цифра колеблется: максимальное (систолическое) — 110-130, минимальное (диастолическое) — 70-80 мм ртутного столба.

Предлагается формула для определения нормального артериального давления:

- для максимального давления 120+(0,6Xчисло лет);

- для минимального давления 63+ (0,4Xчисло лет).

В разные дни показатели давления бывают неодинаковыми. Колебания возможны и в течение суток. Иногда бывает неодинаковое давление на правой и левой руке. В этих случаях более высокое давление чаще находят на правой руке.

Многие больные постоянно с тревогой ожидают, каковы будут результаты измерения кровяного давления. Такое тревожное состояние само по себе может его повысить. Этим больным полезно знать, что высокие цифры кровяного давления далеко не всегда соответствуют тяжести заболевания: иногда высокое давление находят больных, общее состояние и самочувствие которых остаются вполне удовлетворительными. И у совершенно здоровых людей при некоторых условиях, например, при волнении, во время бега или при пребывании на холоде, кровяное давление может временно значительно повыситься, но потом быстро снижается.

Замечено, что у некоторых давление легко «подскакивает». На сравнительно незначительные физические или психические раздражения они реагируют значительным повышением кровяного давления, которое дольше держится на высоких цифрах, чем при тех же условиях у большинства людей. Таких людей нельзя считать больными, но при одинаковых условиях они легче и быстрее, чем другие, могут заболеть гипертонической болезнью. Однако они могут и не заболеть, если вовремя принять соответствующие меры.

Если же такие меры не будут приняты, то при неблагоприятных условиях может развиться гипертоническая болезнь, и тогда кровяное давление все реже и реже падает до нормальных цифр, но может установиться на нормальном уровне после полного покоя в постели.

Reintroduce one item each week, for example:

week 1 – food containing additives

week 2 – tea

week 3 – coffee

week 4 – beer

week 5 – white wine

week 6 – red wine

week 7 – spirits

week 8 – chocolate Take some of the test food or drink every day, starting with a small amount and continuing for a week. If there is a reaction, then stop immediately. Wait until you are better, then go on to the next item. If there is no reaction then give it up again after a week, and test the next item. At the end of the testing period, you can reintroduce all the things that produced no reaction.

If you react to food containing additives, then leave these out again for a while, while you test other items. Then test them again individually – see pp305-6 for details of the different groups of additives. If you react to one member of a group, you may well react to others in that group too.

Try to continue your good eating habits after the diet is finished – don’t go back to eating a lot of salt and sugar, or drinking huge quantities of tea, coffee or alcohol (even if these didn’t cause any specific symptoms). Keep eating fresh foods, particularly green vegetables, and stay away from junk food.

Once you have established which items cause your symptoms, you will probably need to avoid these entirely for some considerable time, although you might be able to consume a small amount occasionally. Try them out from time to time, to see whether your reaction has abated.

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Our digestive tract is home to a great many bacteria and other microbes, which do not cause any disease, and are actually important for good health. They are known as the gut flora. Some doctors believe that the gut flora may become ‘disturbed’, causing the beneficial bacteria such as Lactobacillus to become less abundant, and other, more damaging microbes, to take their place. This might then lead on to food intolerance.-

The main evidence for this has been gathered by Dr John Hunter of Adden-brooke’s Hospital in Cambridge. Dr Hunter noticed that many of his patients with irritable bowel syndrome or IBS, dated their illness back to a bout of diarrhoea caused by an infection, or to a long course of antibiotics. Both these things are known to disturb the gut flora . Some women patients had first suffered from IBS after having a hysterectomy operation. This seemed puzzling, until Dr Hunter discovered that antibiotics were always given before such operations, to help prevent infections. An experiment followed in which some hysterectomy patients had the antibiotic treatment while others did not -11 per cent of those in the first group developed IBS but none of the second group did. In a further experiment, Dr Hunter looked at the bacteria found in the stools of IBS patients, and detected some differences from the bacteria of healthy people.

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Main sources of yeast

Bread, including pitta bread and pizza, but excluding soda bread, matzos

and chapattis. Buns and cakes made with yeast eg doughnuts Yeast extract (Marmite, Vegemite etc)

Oxo cubes and most other stock cubes

Anything labelled ‘hydrolysed vegetable protein’ Beer, wine and cider Vinegar and pickles Sauerkraut

Vitamin tablets containing B vitamins, unless labelled ‘yeast-free’

Secondary sources of yeast

Dried fruit

Over-ripe fruit

Any unpeeled fruit

Commercial fruit juices

Anything labelled ‘malt’

Yoghurt, buttermilk and sour cream

Synthetic cream

Soy sauce

Tofu

Any leftover food, unless eaten within 24 hours, or 48 hours if in a refrigerator

Whiskey, vodka, gin, brandy and other spirits

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The discovery of IgE was a breakthrough for classical allergists. Laboratory tests showed raised levels of total IgE in most patients displaying classical allergic symptoms..If the patient knew what antigen caused their symptoms, then a radioallergosorbent test or RAST (described on p79) could be applied to measure IgE for that specific antigen. The RAST result usually confirmed that there was an excessive amount of IgE antibody that would bind the incriminated antigen. In a very short space of time, IgE became the touchstone of respectability for classical allergists. Some even changed the definition of allergy, yet again, to mean reactions involving IgE only. This definition is still used by a few allergists.

When immunologists tried RASTs on patients diagnosed as food-allergic, they found a basic division. Those like Jane, with immediate, violent reactions, even to a very small amount of the offending food, almost always had high levels of IgE for that food, confirming the status of such reactions as classical allergies. Those like Susan, with ‘delayed’ or ‘masked’ reactions to foods, rarely produced positive RAST results for their culprit foods. More recently, some studies have shown that a small IgE reaction in the gut wall could be a contributing factor in people, but IgE is certainly not the major cause of the problem.

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Corn-free diet

Corn may be a gift from the Aztecs. But if you have corn allergy, it’s a nuisance. Perhaps it’s easy enough to avoid corn meal, corn-starch, corn flour, corn syrup and maybe even corn oil. But a glance at Table 5 shows how easily corn can creep into practically every meal, obvious or disguised, unless you plan your diet carefully. As with milk-free and wheat-free diets, you have to learn the tricks of the food trade when it comes to hidden sources of corn. Oil added to peanut butter, for instance, isn’t peanut oil at all, but corn oil.

Sometimes the corn problem is in the container. ‘You think you’re avoiding corn, but then you drink from a paper cup, and that may be coated with cornstarch,’ says Dr Failiers. ‘Or your milk carton may have cornstarch. I know people who get their milk in glass containers for that reason.’

The less processed and sugar laden your diet, the easier it will be to avoid corn in its many guises. In addition, follow these general rules.

1. Read labels carefully. Avoid any food listing not only corn, cornflour, corn oil and com syrup, but the sugars: glucose, dextrose, dextrin, dextrimaltose and fructose. Corn is also a major source of sugar. Any sugar not specifically marked ‘cane sugar’ or ‘beat sugar’ may contain corn.

2. Cough syrups, cough drops, lozenges, pills, tablets and suppositories often contain corn. ‘If your allergy pills contain cornstarch,’ Dr Failiers told us, ‘they may actually make you sicker.’ If you must take medication, ask your pharmacist for a corn-free product. Consult your doctor before changing or stopping any medication.

3. Vitamin and mineral supplements may also be corn based. See the Appendix for a list of corn-free nutritional supplements.

4. Arrowroot or tapioca may be substituted in recipes calling for cornflour as a thickener.

If you’re puzzled because you can eat corn on the cob but not commercial canned or frozen corn, you may be allergic to the sulphur dioxide used in corn processing rather than the corn itself.

Yeast-free diet

Yeasts are wondrous little one-celled plants that turn dough into bread and cider into vinegar. Like moulds, yeasts are a fungus – and just as apt to cause allergies in people sensitive to fungus. To avoid yeast (and mould) in your diet, you’ll need to steer clear of not only the obvious foods – mushrooms, bread and vinegar – but also certain cheeses, condiments, drugs and nutritional supplements. It’s a lot easier to eliminate a food ingredient of any kind if you avoid commercial packaged foods and stick to whole, unprocessed food.

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Bread was so basic to the Roman diet that the word was synonymous with food. Most of us today still eat bread or a similar grain food at least two or three times a day. Cereal or toast for breakfast. A sandwich for lunch. Noodles, pasta or breaded fish or chicken for dinner. Plus crackers, biscuits and cakes. And a flaky-crusted pie or quiche now and then.

Wheat is by far the most popular grain in the West, where people put a premium on light, springy baked goods and pasta. However, gluten – the elastic protein in wheat that makes baked goods springy and light – is a prime cause of wheat allergy. Some people are sensitive not only to wheat but to grains low in gluten like barley, rye and oats. Symptoms commonly caused by wheat or gluten allergy are: eczema; abdominal problems like indigestion, cramps, colitis, bloating, gas and diarrhoea; and respiratory problems like asthma and hay fever. Wheat and gluten sensitivity is now being recognized as a possible cause of headaches, depression and even symptoms resembling neurosis and schizophrenia. (Coeliac disease, a food-related illness that responds to the elimination of grain from the diet, is not an allergy.)

Much of the problem can be solved by cooking foods yourself rather than buying prepared foods. To sidestep wheat or gluten completely, however, you have to know a few tricks. Commercial bread and baked goods labelled ‘wheat-free’ or ‘gluten-free’ don’t always hold to their word. Getting bread to rise without gluten is like trying to make a fluffy souffl? with too few egg whites. So some bakeries add just a little wheat anyway. Other bakers and food manufacturers may list wheat in a disguised form. Look out for products that list not only the obvious – flour, wheat flour, wheat starch, gluten flour or cracked wheat – but also monosodium glutamate, hydrolyzed vegetable protein or durum flour.

Malt is derived from barley or other grains and is a hidden source of gluten. Most dry breakfast cereals and baked goods contain malt in some form.

Start a wheat-free diet by eliminating just wheat. If you still experience symptoms, eliminate wheat plus barley, oats and rye.

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The cheese stands alone

You may find you can tolerate every other milk product except cheese, not even lactose-free varieties. The trouble may stem from the mould-type fermentation that turns milk into cheese. Cottage cheese is mould-free. Dr Breneman told us that some cheese-sensitive people can tolerate farmer’s cheese and homemade cheese, which are often mould-free.

If moulds aren’t your problem, but cheese still makes you miserable, you may be sensitive to tyramine, a natural substance in cheese and other foods — notably chocolate, yoghurt, beer, red wine, gin, bourbon and vodka – that tends to trigger migraine headaches. If that’s the case, you may be able to eat only a tiny sliver of cheese, as long as you don’t eat any other tyramine-containing food or drink along with it.

Egg-free diet

We tend to forget that a lot of foods contain eggs. They show up in all kinds of goodies. Puddings, cakes, pancakes and waffles all contain eggs. And eggs are the stuff noodles, custards and mayonnaise are made of. Eggs show up in ice cream and marshmallows. Occasionally, eggs are even used to make root beer foam.

Like those allergic to milk, people allergic to eggs may be sensitive to only a part of the food: in this case, either the white or the yolk. (Whites are usually the problem.) The method of cooking also makes a difference. Some people can tolerate hard-boiled eggs, but not soft-boiled. Others can cook their eggs until they’re tough as golf balls and still be allergic. Very rarely, a person is so sensitive to eggs that he or she can’t tolerate chicken either. Another egg-related product – vaccines grown on egg cultures – should also be approached cautiously if you’re allergic to eggs. (Ask your doctor about a vaccine’s base if you are allergic to eggs.)

So what can you eat, if not eggs? Plenty. Practically all meats and vegetables. Potatoes. Rice. Fruit. Watch out for code words for eggs on food labels: vitellin, ovotellin, livetin, ovomucin and albumin.

A word about egg substitutes: so many of these products contain other highly allergic substances and additives – notably yellow food dye – that we can’t recommend them. You may end up trading one allergy for another.

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Still others cannot digest lactose, the main carbohydrate (or sugar) in milk. Normally, fingerlike projections along the intestinal wall, called villi, secrete lactase, an enzyme specifically designed to digest lactose. But lactose-intolerant people produce little or no lactase. So the milk passes through undigested, producing one heck of a belly-ache: abdominal discomfort, bloating, gas pains and often diarrhoea.

Lactase activity is generally highest at birth and slows down as we grow into adults. Many of the world’s peoples – including blacks, Mexicans, Indians, Asians and those of Mediterranean descent – lose lactase in childhood. Others, particularly whites from northern or western Europe and their descendants, lose lactase later. Also, a bout with the flu or another virus can shut down anyone’s lactase activity for several days. When the intestines are inflamed the tips of the villi are broken off and produce little or no lactase. That’s why a milk-loving child may spurn the drink – or get a tummyache from it – after a stomach virus.

Many lactase-deficient people find they can tolerate milk if they simply cut down on milk and milk products, or consume small amounts throughout the day. Others can drink milk that’s been treated with Lactobacillus acidophilus, special (and perfectly safe) bacteria that breaks down the lactose, doing the work their intestines can’t.

Lactobacillus, incidentally, is the same bacteria that turns milk into yoghurt. In Mediterranean, Asian and African countries, where people are frequently lactase deficient, yoghurt is the most widely used milk product.

Some cheeses, such as Cheddar and Cheshire, are very low in lactose, while aged Gouda and Edam are lactose-free. Cottage cheese has 86 per cent less lactose than milk.

You can also try adding Lact-Aid powder, a lactose-digesting enzyme product, to milk. (All these products, incidentally, are available in most health food stores and many supermarkets.)

Until recently, milk allergy and lactose intolerance were regarded as totally separate problems. If you had both, it was considered a coincidence. Now, some doctors are convinced that, in many people, lactase deficiency actually develops as the result of an allergic reaction to either milk or some other food. That’s because food allergy usually causes intestinal inflammation, which mows down the villi and creates lactose intolerance. Doctors who advance this theory believe that 95 per cent of the people who experience stomach distress after drinking milk have lactose intolerance secondary to an allergy of some kind. Of course, you can be allergic to milk without developing lactose intolerance.

In any case, many people with food allergies – children and adults alike – will have to eliminate milk in all forms if they’re ever going to feel better. ‘If a child comes in with a stomach ache, leg aches and a stuffy or runny nose, and they’re also drinking a lot of milk, we take them off milk,’ Dr Stigler told us.

For parents who are concerned that growing children will miss out on much-needed calcium without milk in their diet, Dr Stigler has some reassuring words. ‘Many of us working in the field of allergy feel that allergic people don’t absorb a lot of the calcium in milk. If you’re sensitive to milk, the intestines reject it. So allergic kids aren’t necessarily using the calcium in milk anyway.’ Take away the milk, says Dr Stigler, and as with most people who give up a food to which they are allergic, a child will probably feel worse for the first couple of days.

‘But their symptoms will start to clear up after the first three or four days,’ Dr Stigler predicts. ‘In a week’s time, if milk was the cause of the stomach aches and the leg aches and the runny nose or whatever, it will all go away.’

Dr Stigler also told us that, when milk is eliminated, children may eat ravenously for three or four days, whereas before they were just picking at their food. ‘Take away the quart and a half or two quarts of milk a day – the average amount an allergic kid will drink – and they’ll then make up for milk calories with other food. They’ll eat extra of something else to make up the difference.’

Milk allergy, like simple lactose intolerance, may be dose related, Dr Stigler adds, especially when it causes digestive or respiratory upset. ‘It may take half a pint or more to cause the stomach ache. But if you have a child who has eczema – a skin rash often caused by milk allergy – very often as little as a teaspoon of milk will cause the reaction.’

Avoiding milk may sound easy at first, but you have to stay on your guard against hidden sources.

‘You think you’re staying away from milk. But if you eat a hot dog or spaghetti, they may contain milk,’ pointed out Constantine J. Falliers, an allergist and asthma specialist in Denver, Colorado.

So you’ll need to read labels carefully – advice that applies to any allergy elimination plan. Look for the code words ‘caseinate’, ‘lactose’ or ‘whey’ – all are milk additives. As we mentioned before, most ‘non-dairy’ creamers contain just such milk additives. (Non-dairy creamers also contain ingredients from other foods – corn, soya, animal and vegetable fats; flavour additives; and petroleum-based chemicals – which may trigger allergy on their own.)

You can confidently buy bread, margarine and other foods marked pareve or parve – those are made without a trace of milk to conform to kosher food laws. And if you’re anywhere in the neighborhood of an ethnic bakery, drop in and stock up. Kosher bread (challah) is free of milk, as are some French, Italian and Syrian breads.

If you’re allergic to penicillin, check to find out if your dairy supplier uses penicillin before you reintroduce milk to your diet.

To cook without milk, experiment by substituting water, soya milk or fruit juice in your family’s favourite recipes.

By the way, a small number of people with milk allergy are also allergic to soya, so switching to soya milk may not clear up their symptoms. Some people can tolerate goat’s milk as a substitute; others cannot. Only trial and error will tell.

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