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2021, vol. 149, br. 11-12, str. 737-740
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Stres i arterijska hipertenzija - od patofiziologije do farmakologije
Stress and arterial hypertension: From pathophysiology to pharmacology
aVojnomedicinska akademija, Klinika za endokrinologiju, Beograd bVojnomedicinska akademija, Klinika za kardiologiju, Beograd cUniverzitet u Beogradu, Medicinski fakultet, Institut za neurologiju i psihijatriju za decu i omladinu dUniverzitet u Beogradu, Medicinski fakultet, Institut za neurologiju i psihijatriju za decu i omladinu + Univerzitet u Beogradu, Medicinski fakultet, Institut za farmakologiju, kliničku farmakologiju i toksikologiju
e-adresa: janko.samardzic@med.bg.ac.rs
Sažetak
Arterijska hipertenzija je danas najmasovnija hronična nezarazna bolest čovečanstva. Može ostati nedijagnostikovana godinama, što izaziva kasnije komplikacije, poput akutne srčane insuficijencije, moždanog udara, infarkta miokarda, bubrežne insuficijencije, hipertenzivne retinopatije ili iznenadne smrti. Primarna arterijska hipertenzija je češća, dok se sekundarna javlja u oko 5-20% slučajeva. Nedavna istraživanja su pokazala da stres kod nekih pacijenata može biti ključni faktor u razvoju esencijalne hipertenzije. Kod pacijenata koji pate od posttraumatskog stresnog poremećaja, stres je dominantni etiološki faktor koji dovodi do bolesti. Dokazano je da hronični stres može da utiče na regulaciju krvnog pritiska, endokrine i metaboličke funkcije putem limbičko-hipotalamičkih centara i samim tim da utiče na razvoj arterijske hipertenzije. Snažna povezanost stresa i arterijske hipertenzije potvrđena je u pretkliničkim studijama i ispitivanjima na životinjama. Za farmakoterapijski pristup najvažniji su beta-adrenergički blokatori, inhibitori enzima koji konvertuje angiotenzin i blokatori receptora AT1 (sartani). Kao druga linija terapije mogu se koristiti blokatori kalcijumovih kanala, diuretici, alfa-adrenergički blokatori i centralni antihipertenzivi. Uvođenje anksiolitika, poput benzodiazepina, treba razmotriti u slučaju hronične anksioznosti i psihosomatskog poremećaja.
Abstract
Currently, arterial hypertension is the most massive chronic non-infectious disease of mankind. It may remain undiagnosed for years, provoking later complications, such as acute heart failure, cerebrovascular stroke, myocardial infarction, renal failure, hypertensive retinopathy, or sudden death. Primary arterial hypertension is more common, while secondary occurs in about 5-20% of cases. The recent studies have shown that stress may be a core factor in the development of essential hypertension in some patients. For the patients suffering from post-traumatic stress disorder, stress is the dominant etiological factor that leads to the disease. It has been proven that chronic stress can affect blood pressure regulation and endocrine-metabolic functions through the limbic-hypothalamic centers; therefore, it can affect the arterial hypertension development. The strong association between stress and arterial hypertension has also been confirmed in preclinical and animal studies. For the pharmacotherapy approach, the most important are beta-adrenergic blockers, angiotensin-converting enzyme (ACE) inhibitors and AT1-receptor blockers (sartans). As a second line treatment, calcium channel blockers, diuretics, alpha-adrenergic blockers, and central antihypertensive agents may be required. The anxiolytics, such as benzodiazepines, should be considered if chronic anxiety and psychosomatic disorders are present.
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