Arterial hypertension: treatment. Anesthesia in patients with hypertension Intraoperative hypotension in patients with arterial hypertension

Currently, there are no medical procedures that do not have complications. Despite the fact that modern anesthesiology uses selective and safe drugs, and the technique of anesthesia is being improved every year, there are complications after anesthesia.

After anesthesia, there can be unpleasant consequences

When preparing for a planned operation or suddenly faced with its inevitability, each person feels anxiety not only about the surgical intervention itself, but even more because of the side effects of general anesthesia.

Undesirable phenomena of this procedure can be divided into two groups (according to the time of their occurrence):

1. Occur during the procedure.
2. Develop after a different time after the completion of the operation.

During the operation:

1. From the respiratory system: sudden cessation of breathing, bronchospasm, laryngospasm, pathological recovery of spontaneous breathing, pulmonary edema, cessation of breathing after its recovery.
2. From the side of the cardiovascular system: increased (tachycardia), slow (bradycardia) and abnormal (arrhythmia) heart rhythm. Drop in blood pressure.
3. From the nervous system: convulsions, hyperthermia (increase in body temperature), hypothermia (decrease in body temperature), vomiting, tremor (trembling), hypoxia and cerebral edema.

During the operation, the patient is constantly monitored to avoid complications.

All complications during the procedure are controlled by an anesthesiologist and have strict algorithms of medical actions aimed at their relief. The doctor has drugs on hand to treat possible complications.

Many patients describe visions during anesthesia - hallucinations. Hallucinations cause patients to worry about their own mental health. There is no need to worry, as hallucinations are caused by some narcotic drugs used for general pain relief. Hallucinations during anesthesia occur in mentally healthy people and do not recur after the end of the drug.

After completion of the operation

After general anesthesia, a number of complications develop, some of them require long-term treatment:

1. From the respiratory system.

Often appear after anesthesia: laryngitis, pharyngitis, bronchitis. These are the consequences of the mechanical impact of the equipment used and the inhalation of concentrated gaseous drugs. Manifested by coughing, hoarseness, pain when swallowing. Usually pass within a week without consequences for the patient.

Pneumonia. A complication is possible when gastric contents enter the respiratory tract (aspiration) during vomiting. Treatment will require an additional hospital stay after surgery and the use of antibacterial drugs.

1. From the side of the nervous system.

Central hyperthermia- an increase in body temperature that is not associated with an infection. This phenomenon may be a consequence of the body's reaction to the introduction of drugs that reduce the secretion of sweat glands, which are administered to the patient before surgery. The patient's condition is normalized within one or two days after the termination of their action.

Elevated body temperature is a common consequence of anesthesia

Headaches after anesthesia are a consequence of the side effects of drugs for central anesthesia, as well as complications during anesthesia (prolonged hypoxia and cerebral edema). Their duration can reach several months, pass independently.

encephalopathy(impaired cognitive function of the brain). There are two reasons for its development: it is a consequence of the toxic effect of narcotic drugs and a prolonged hypoxic state of the brain with complications of anesthesia. Despite the widespread opinion about the incidence of encephalopathy, neurologists argue that it rarely develops and only in people with risk factors (background brain diseases, old age, previous chronic exposure to alcohol and / or drugs). Encephalopathy is reversible, but requires a long recovery period.

To speed up the process of restoring brain function, doctors suggest prophylaxis before the planned procedure. In order to prevent encephalopathy, vascular drugs are prescribed. Their selection is carried out by the doctor, taking into account the characteristics of the patient and the planned operation. It is not necessary to carry out self-prophylaxis of encephalopathy, since many drugs can change blood clotting, as well as affect susceptibility to anesthetics.

Peripheral neuropathy of the extremities. It develops as a consequence of a long stay of the patient in a forced position. Manifested after anesthesia paresis of the muscles of the extremities. It takes a long time, requires physical therapy and physiotherapy.

Complications of local anesthesia

Spinal and epidural anesthesia

Spinal and epidural anesthesia replaces anesthesia. These types of anesthesia are completely devoid of the side effects of anesthesia, but their implementation has its own complications and consequences:

Often after anesthesia the patient suffers from a headache

1. Headache and dizziness. A frequent side effect, which manifests itself in the first days after surgery, ends with recovery. Rarely, headaches are persistent and continue for a long time after surgery. But as a rule, such a psychosomatic state, that is, due to the patient's suspiciousness.
2. Paresthesia(tingling, tingling sensation on the skin of the lower extremities) and loss of sensation in the skin of the legs and torso. It does not require treatment and resolves on its own within a few days.
3. Constipation. Often occur during the first three days after surgery as a consequence of anesthesia of the nerve fibers innervating the intestine. After restoring the sensitivity of the nerve, the function is restored. In the early days, mild laxatives and folk remedies help.
4. Neuralgia of the spinal nerves. The consequence of nerve injury during the puncture. A characteristic manifestation is pain in the innervated area, which persists for several months. Physiotherapy exercises and physiotherapy help to speed up the process of its recovery.
5. Hematoma (bleeding) at the puncture site. Accompanied by pain in the damaged area, headaches and dizziness. During resorption of the hematoma, there are increases in body temperature. As a rule, the condition ends with recovery.

Stem and infiltration anesthesia

1. Hematomas (hemorrhages). Occur as a result of damage to small vessels in the area of ​​anesthesia. They present with bruising and pain. They go away on their own within a week.
2. Neuritis (inflammation of the nerve). Pain along the nerve fiber, impaired sensitivity, paresthesia. You should consult with a neurologist.
3. Abscesses (suppurations). Their occurrence requires additional treatment with antibiotics, most likely in a hospital setting.

A complication of any type of anesthesia, from superficial to anesthesia, may be the development of allergic reactions. Allergies come in varying degrees of severity, from flushing and rash to the development of anaphylactic shock. These kinds of side effects can happen to any drug and food. They cannot be predicted if the patient has not previously used the drug.

When going for an operation, it is worth remembering that the qualifications of anesthesiologists will allow you to cope with any difficult and unforeseen situations. The hospital has the necessary equipment and medicines to maintain the health of the patient. Cases of death and disability from anesthesia are rare in world practice.

24.07.2007, 11:08

At the dentist's appointment, anesthesia was made, the pressure rose sharply 180/110. I see a cardiologist. I drink egilok, preduktal and tritace. You need to go to the dentist soon. What to tell the doctor, what kind of anesthesia can I do? Can I get tested for intolerance? My cardiologist says that I can't take adrenaline.

24.07.2007, 18:44

Blood pressure during local anesthesia does not always increase due to the adrenaline contained in the anesthetic. The excitement of a patient suffering from hypertension may affect. Some of the patients, for some incomprehensible reasons, decide not to take antihypertensive drugs before visiting the dentist, which they drink daily - this is another reason for the rise in blood pressure. And much less common is such a complication as the introduction of the drug into the vascular bed - when the doctor accidentally enters the vessel with the tip of the needle. Sometimes - if a non-carpool (ready-made) anesthetic is used - the solution may be incorrectly prepared, with a higher concentration of adrenaline.
A vasoconstrictor (adrenaline) greatly increases the effectiveness of a local anesthetic, significantly increases its duration. Insufficient pain relief is more likely to lead to an increase in blood pressure than adrenaline itself.
The vast majority of anesthetic substances used in practice has the property of dilating blood vessels. This leads to their rapid absorption into the bloodstream and destruction - and, accordingly, to a shorter duration and effectiveness of anesthesia. Mepivacaine does not dilate blood vessels. There are also carpool anesthetics with a lower content of adrenaline (ultracaine-DS for example).

Tests are carried out to detect allergies to any substance, therefore, in the case of adrenaline, this is meaningless, and an increase in blood pressure for adrenaline is not even a side effect, but a direct effect due to its properties.

A lot of bukof turned out ...

25.07.2007, 10:56

The excitement of a patient suffering from hypertension may affect. Some of the patients, for some incomprehensible reasons, decide not to take antihypertensive drugs before visiting the dentist, which they drink daily - this is another reason for the rise in blood pressure.

Thank you.
There was no excitement, because I went to the dentist for six months already, once a week. like home. came that time, they pricked, they say let's go have a cup of tea, and you Tanya, if you want, read a magazine. I read, I smell - one eye is taken away and does not see, then the brain seems to have become cotton-wool and then the second eye. and then the nurse accidentally looked in, and I was completely sick. Before taking any medication, she did not take it for pressure (and a month before that she started taking Eutirox), because before that she did not suspect that she had high blood pressure. It turns out then that it was elevated for me. This has never happened before with anesthesia. Endocrinologists tell me that an increase in blood pressure cannot be associated with taking thyroxine, but somehow everything started synchronously with taking euthyrox.
In short, I already got all the doctors here .....

25.07.2007, 14:44

25.07.2007, 15:32

You mentioned the eye. I conclude that you have been treated for one of your maxillary molars. When these teeth are anesthetized, an anesthetic is injected into a place with a dense venous plexus. The risk of getting the anesthetic into the bloodstream is quite high. Probably, in this case there was a vascular reaction to the vasoconstrictor.

Nope, lower jaw, penultimate tooth (in terms of location, not in general)))))

25.07.2007, 15:35

Before that, anesthesia was injected in the same place, then my eye also became numb and did not close, that is, it was generally like a dead one, the eyelid did not obey ... I closed the eyelid with my fingers so that the eye would not dry out. Some kind of horror. It lasted about 6 hours then.

25.07.2007, 16:06

hmm..interesting

25.07.2007, 21:43

26.07.2007, 09:19

Tatyana, this sometimes happens when not only sensitive, but also motor branches of nerves are involved in the area of ​​​​action of the anesthetic. Uncomfortable, but goes away with the action of anesthesia
With the anesthesia that you did, it is also possible to get a needle into the vessel. For example, this happened in my experience. Was there a feeling that a hot wave ran over your face?

I don’t remember about the hot wave, to be honest ..
It turns out that if they get into the vessel again - the same situation can happen? Do they do all the teeth at once under general anesthesia? I woke up and all my teeth were cured))))

26.07.2007, 10:20

26.07.2007, 11:22

Tatyana, tell me, how long did it take you to treat that lower tooth, when it was necessary to perform anesthesia?

When the pressure jumped, then the tooth had not even begun to be treated, she came - they immediately gave an injection.
And the one when the eye could not move away for a long time - about an hour, in my dentistry, any appointment lasts an hour. I hope I understood your question correctly.

26.07.2007, 11:39

26.07.2007, 11:48

Yes, right. Do you think that each tooth will be treated for an hour under anesthesia?

Then I'll have to lie there for a day.

According to the unified international criteria (adopted in 1999), arterial hypertension (AH) is a condition in which systolic blood pressure is 140 mm Hg. Art. or higher, and/or diastolic blood pressure - 90 mm Hg. Art. or higher in people not currently receiving antihypertensive treatment.

Depending on the level of blood pressure, there are degree of arterial hypertension, which are listed in the table below.

Perioperative arterial hypertension

Preoperative period

Arterial hypertension is found very often, especially among elderly patients - more than 40%. Hypertension of the first or second degree slightly increases the risk of cardiovascular complications during anesthesia. Higher pressure values ​​are accompanied by an indication that there may be more complications and they are more serious.

In elective patients with grade 3 hypertension (systolic pressure greater than 180 mm Hg and/or DBP > 110 mm Hg), deferral of intervention should be considered to optimize hypertension therapy.

Drugs that are used to treat hypertension and anesthetic agents, when interacting, can lead to the development of resistant hypotension and other intraoperative complications. The criterion for a properly selected antihypertensive drug therapy for planned surgical intervention is the normal age level of blood pressure in a patient with a deviation within ± 20%.

The important conditions for the safe conduct of anesthesia also include the time during which blood pressure returned to normal. The patient's body needs a lot of time to adapt to the low blood pressure. For example, in a patient with arterial hypertension of the third degree, using intravenous vasodilators, it is possible to “normalize” pressure in a few tens of minutes. And if such a patient begins to undergo, for example, epidural anesthesia, then the likelihood of developing a stroke, uncontrolled hypotension, heart attack will increase rapidly.

Physicians should pay attention to the fact that it is unacceptable to carry out forced correction of arterial hypertension of the 2nd-3rd degree before a planned operation in one or two days. And even more so - for 3-4 hours. It takes at least two to three weeks to find the optimal antihypertensive therapy. We also note that the standards for the treatment of arterial hypertension set aside at least a month (30 days) for these purposes.

The question is posed Do I need to stop taking antihypertensive drugs before surgery?? Among experienced professionals, there is no consensus on whether or not to interrupt medication on the eve of the intervention. For example, some experts believe that patients should continue taking antihypertensive drugs as usual until the hour of surgical treatment. And basically, there are no special problems during the implementation of anesthesia in connection with such a tactic of managing the patient.

But today, more specialists highlight a different approach, which, in their opinion, provides better hemodynamic stability of the patient during anesthesia:

• ACE inhibitors or angiotensin II antagonists should not be discontinued if patients are receiving this drug for heart failure or left ventricular dysfunction;
• ACE inhibitors or angiotensin II antagonists prescribed for hypertension should be temporarily canceled exactly one day before the start of the operation;
• Diuretics are not prescribed on the day of surgery. Patients should continue taking beta-blockers as usual.

Perioperative period in patients with arterial hypertension

The main task is to maintain an optimal level of blood pressure during the operation. If there are no special indications, then doctors are guided by the "working" level of pressure of the sick patient ± 20%. In patients over 80 years of age, SBP should preferably not be reduced to less than 150 mm Hg. Art.

Arterial pressure in patients with hypertension can fluctuate significantly. It can not only rise sharply, but also decline sharply. For prevention, there are such methods:

If controlled ventilation is planned, then 2-3 minutes before intubation, it is recommended to administer an increased dose of analgesic (fentanyl at a dose of 3-5 mcg / kg works well) and induce with a drug that does not increase blood pressure (propofol, sodium thiopental, diazepam and etc.). An increase in blood pressure during intubation is a separate anesthetic problem.

When conducting intravenous anesthesia, sodium thiopental should be chosen as an anesthetic, because these are drugs that do not increase blood pressure in humans. It is not necessary to reduce medical pressure before epidural and spinal anesthesia. It is enough to increase sedation (midazolam, propofol, diazepam).

When blocking peripheral nerves, it is recommended to add to the anesthetic (as an adjuvant), which improves the quality of anesthesia and at the same time slightly reduces the patient's pressure. But, in the vast majority of cases, it is enough to add ataractics to premedication (diazepam and midazolam give a good effect in this regard).

Intraoperative hypotension in patients with arterial hypertension

A sharp decrease in blood pressure in a patient can lead to various complications that are associated with insufficient blood supply to various organs - myocardial ischemia, stroke, renal failure, and so on.

Physicians should remember that against the background of antihypertensive therapy, vasopressors traditionally used to correct hypotension - ephedrine and phenylephrine - may not have the desired effect. In this case, hypotension is treated with (Noradrenaline), epinephrine (Adrenaline), or vasopressin.

Intraoperative arterial hypertension

It is generally accepted to consider perioperative arterial hypertension a condition in a person when systolic blood pressure during surgery, and in the post-anesthesia awakening ward, corresponds to one of the following conditions:

• is higher than 200 mm Hg. st;
• exceeds the preoperative level by 50 mm Hg. st;
• requires intravenous administration of antihypertensive drugs.

The most common cause of perioperative hypertension is activation of the sympathetic nervous system, combined with insufficient depth of blockade of nociceptive stimulation during anesthesia and surgery. Therefore, the traditional method of stopping intraoperative hypertension is the deepening of anesthesia with the help of narcotic analgesics, inhalation anesthetics and benzodiazepines.

It is recommended to take for these purposes (a bolus of 25-50 mg until the effect is obtained, after which, if necessary, you can switch to continuous administration). The drug acts quickly, has a short half-life, goes well with almost all drugs that are used for anesthesia.

In many cases, magnesium sulfate can be prescribed to a patient with a dose of 2-5 g per administration, it is administered not immediately, but in 10-15 minutes. This medicine not only gently reduces blood pressure, but significantly reduces the need for analgesics during surgery, and in the early postoperative period, improves the quality of anesthesia. In cases resistant to this therapy, as well as when the pressure needs to be reduced in a short time, doctors use antihypertensive drugs with a short half-life.

Postoperative hypertension

Doctors must take into account that if the patient has been taking beta-blockers or alpha-adrenergic agonists for a long time, such as clonidine (clophelin), then taking these drugs should be continued after the operation, otherwise a withdrawal syndrome may develop with a sharp increase in blood pressure.

First of all, attending physicians pay attention to maintaining adequate analgesia. As soon as possible, you need to resume taking those antihypertensive drugs that were effective in this person before the operation. In choosing a drug, experts sometimes use a special table. But physicians do not recommend the routine appointment of calcium antagonists, as this is associated with an increased risk of postoperative vascular complications.

Choice of antihypertensive therapy

Low doses of antihypertensive drugs should be used at the initial stage of treatment, starting with the minimum dosage of the drug (the goal is to reduce adverse side effects). If there is a good response to a low dose of this drug, but blood pressure control is still insufficient, it is recommended to increase the dosage of this drug if it is well tolerated.

Effective low-dose combinations of antihypertensive agents should be used to maximize BP reduction with minimal side effects. This means that when one drug is ineffective, the addition of a small dose of a second drug is preferred, rather than increasing the dosage of the primary drug used.

It is necessary to carry out a complete replacement of one class of drugs with another class of drugs: with a low effect or poor tolerance, without increasing the dosage or adding another drug.

1. Angiotensin II receptor antagonists + diuretic;

2. Angiotensin II receptor antagonists + calcium antagonist;

3. Angiotensin-converting enzyme inhibitors + diuretic;

4. Angiotensin-converting enzyme inhibitors + calcium antagonist;

5. Calcium antagonist + diuretic.

Emergency conditions for arterial hypertension

All situations in which a rapid decrease in blood pressure is required in that case are divided into 2 large groups:

• The first is a group of diseases and conditions that require an emergency (over 1-2 hours) lowering of blood pressure.

The same group includes a complicated (with damage to target organs) hypertensive crisis - a sudden (several hours) and significant increase in blood pressure in relation to the usual level for a person. An increase in blood pressure leads to the appearance or worsening of symptoms from the target organs:

• unstable angina;
• about a dissecting aortic aneurysm;
• system of left ventricular failure;
• hemorrhagic stroke;
• eclampsia;
• in case of injury or damage to another genesis of the central nervous system;
• swelling of the nipple of the optic nerve;
• in patients during surgery and in the postoperative period with a threat of bleeding and in some other cases.

For emergency blood pressure lowering used parenteral drugs such as:

• nitroglycerin (it is preferred for myocardial ischemia in a patient);
• sodium nitropruside (suitable for most cases of resistant hypertension);
• magnesium sulfate (preferred for eclampsia);
• (it is chosen mainly for CNS lesions);
• enalapril (preference is given to him in the presence of heart failure in a patient);
• furosemide (preferred for hypervolemia, acute LV insufficiency);
• phentolamine (if pheochromocytoma is suspected).

Recommendations. To avoid ischemia of the central nervous system, kidneys and myocardium, it is not necessary to reduce blood pressure too quickly. Systolic pressure should be reduced by 25% of baseline in the first two hours, and to 160/100 mm Hg. Art. - over the next 2-6 hours. In the first 2 hours after the start of antihypertensive treatment, blood pressure should be monitored every 15-30 minutes. Doctors select the dosage of the drug individually. Preference is given to drugs (in the absence of contraindications in each case) with a short half-life.

• The second group, where experts include all other cases of increased blood pressure, when it should be normalized in a few hours.

In itself, a sharp increase in blood pressure, without the manifestation of symptoms from other organs, requires mandatory, but not so urgent intervention. It can be stopped by oral administration of relatively fast-acting drugs (calcium antagonists (nifedipine), beta-blockers, short-acting ACE inhibitors, clonidine, loop diuretics).

It should be noted that the parenteral route of taking antihypertensive drugs should be the exception rather than the rule. That is, in most cases it is not used.

Oral medications for urgent blood pressure lowering

Examples of assignment in such cases:

• moxonidine (Physiotens) 0.4 mg should be given to the patient by mouth. It is effective in increasing blood pressure in patients with high sympathetic activity;
• captopril 25-50 mg gab to the patient by mouth. Indications: moderate increase in blood pressure in patients without high sympathetic activity;
• 10-20 mg sublingually (they give the patient to chew), if there is no effect, repeat the dose after half an hour. It is indicated with a moderate increase in pressure in patients without high sympathetic activity;
• propranolol 40 mg is taken sublingually (or orally with a glass of warm water). It is used when arterial hypertension is combined with tachycardia.

Before starting treatment and even examination, dentists ask their patients a number of standard questions: are there any allergies to drugs, what are the concomitant diseases. Doctors are especially interested in the presence of hypertension. If the pressure is increased, then any treatment of caries and its complications, as well as the extraction of teeth, will have their own characteristics, which relate to anesthesia and further rehabilitation. In addition, hypertension will affect the condition of the oral cavity, which can cause complications of already existing changes. MedAboutMe will tell you how patients with hypertension are treated and how to prepare for this process.

With prolonged existence of hypertension in the sky, the mucous membrane of the tongue, single blisters may appear, which contain bloody contents. In medicine, this condition is called "vesical syndrome".

Bubbles located under the mucosa can maintain their integrity from several hours to 1-2 days. After opening them, an eroded surface remains, bringing a lot of inconvenience and pain to the patient. The addition of bacterial flora can result in complications - bacterial inflammation.

Even in the initial stages of the development of hypertension, the dentist may notice that the mucous membrane is pale, cyanotic, and the papillae of the tongue are changing. Patients may complain of burning, cracked lips.

Also, for patients with hypertension in 91% of cases, periodontal diseases are detected: gingivitis, periodontitis, periodontal disease is diagnosed in 11% of patients. Therefore, hypertension is a risk factor for the development of serious periodontal disease.

Anesthesia for hypertension

The first difficulties of dental treatment are associated with anesthesia. Patients with concomitant diseases require an individual approach already at the very beginning of treatment - when choosing anesthesia.

In order to cope with pain, with a disease or already directly during treatment and prolonging the action of anesthesia, a vasoconstrictor is introduced into its composition: adrenaline, norepinephrine. All doctors' fears are related to the fact that vasoconstrictors can increase blood pressure, which in case of hypertension is dangerous for the development of a hypertensive crisis.

Therefore, for local anesthesia, it is recommended to use anesthetics with minimal doses of vasoconstrictors. Among dentists, the drug Mepivakin, which has a vasodilating effect, has become popular, so it does not require additional administration of a vasoconstrictor.

With the introduction of bupivacaine, anesthesia persists for a long time, and therefore it is considered one of the most powerful anesthetics.

Anesthesia, its characteristics, the choice of the drug depend on the stage of hypertension. If in the first two stages the exclusion of a vasoconstrictor is decided on an individual basis, then in the third stage the use of vasoconstrictors is absolutely contraindicated.

Pain is a universal reaction of the body that accompanies most dental diseases: deep caries, its complications and some gum diseases. In hypertension, pain is a risk factor for the development of complications, including hypertensive crisis. Dentists forbid to endure severe pain and recommend promptly seeking help from specialists.

Moreover, inadequate pain relief may be more dangerous in dental treatment than the administration of vasoconstrictors. Therefore, the decision on the choice of anesthesia depends on the specific numbers of pressure, the patient's well-being.

An important role in the prevention of hypertensive crisis is given to the timely sanitation of the oral cavity and the prevention of dental diseases.

Features of tooth extraction in hypertension

Surgical treatment for hypertension is more often planned, with preliminary preparation and mandatory premedication. Dentists find out the maximum values ​​​​and pressure figures that are "working".

Before anesthesia, the level of blood pressure is determined, which should always be monitored. If the figures of the usual pressure are fixed, then the doctors strive for an even greater decrease, after which they perform a surgical operation.

Premedication is carried out under strict control of blood pressure, antihypertensive drugs are included in its schemes.

If the patients had increased pressure figures, then before the direct treatment, even the introduction of anesthesia, the doctors repeatedly measure the pressure, reduce it with medication and control its values ​​throughout the procedure.

In one of the issues of the scientific journal Journal of Periodontology, a study was published proving that poor oral hygiene is a risk factor and can increase the likelihood of developing a hypertensive crisis.

The study involved 19.5 thousand participants, more than 5 thousand were diagnosed with hypertension. The level of oral hygiene was determined using special dental tests. Analysis of the data obtained showed that satisfactory hygiene is associated with a reduced prevalence of hypertensive crisis. Patients who neglect oral hygiene were several times more likely to suffer a hypertensive crisis.

According to the authors of the study, periodontitis, which is typical for 73% of patients and occurs with concomitant diseases and poor hygiene, is associated with hypertension. Inflammation can be a trigger for high blood pressure. Accordingly, hygiene care is considered as an independent factor that increases the possibility of developing hypertension.

If you have recently had surgery, your doctor may advise you to try to lower your blood pressure. You can do this by making changes to your diet and lifestyle. Be sure to check with your doctor before making any changes. He will advise you on the best options.

Steps

Dietary changes for low physical activity

Eat less sodium. Sodium is found in salt, so limit your intake. The taste for salty food is acquired, that is, it is not inherent in a person from birth, but is formed as a habit. Some people who are accustomed to salting their food abundantly can consume up to 3.5 grams of sodium (as part of salt) daily. If you have high blood pressure after surgery and need to lower it, your doctor will recommend that you limit the amount of salt in your diet. In this case, you should consume no more than 2.3 grams of sodium daily. Do the following:

• Be careful what you snack on. Instead of salty snacks like chips, crackers, or nuts, switch to apples, bananas, carrots, or bell peppers.
• Choose canned foods that are low in salt or no salt at all, paying attention to the ingredients listed on the package.
• Use much less salt when cooking, or don't add it at all. Instead of salt, use other seasonings such as cinnamon, paprika, parsley, or oregano. Remove the salt shaker from the table so as not to add salt to ready meals.

1. Boost your health with whole grain foods. They contain more nutrients and dietary fiber than white flour and are easier to fill up. Try to get most of your calories from whole grains and other foods that contain complex carbohydrates. Eat six to eight servings a day. One serving may consist, for example, of half a glass of boiled rice or a piece of bread. Increase your intake of whole grains in the following ways:

   • Eat oatmeal or whole grain cereal for breakfast. To sweeten porridge, add fresh fruits or raisins to it.
   • Study the composition of the bread you buy, giving preference to whole grains.
   • Switch from white flour to whole grain flour. The same applies to pasta.

2. Eat more vegetables and fruits. It is recommended to eat four to five servings of fruits and vegetables per day. One serving is about half a cup. Vegetables and fruits contain micronutrients such as potassium and magnesium, which help regulate blood pressure. You can increase your intake of fruits and vegetables by:

   • Start your meal with a salad. By eating a salad first, you will muffle the feeling of hunger. Don't leave the salad for last - once you're full, you're unlikely to want to eat it. Diversify salads by adding various vegetables and fruits to them. Add as little salty nuts, cheese or sauces as possible to salads, as they contain a lot of salt. Dress salads with vegetable oil and vinegar, which contain almost no sodium.
   • For a quick snack, keep ready-to-eat fruits and vegetables on hand. When you go to work or school, bring peeled carrots, sweet pepper slices, or an apple with you.

3. Limit your fat intake. A diet high in fat can lead to clogged arteries and high blood pressure. There are many attractive ways to reduce your fat intake while still getting all the nutrients you need to recover from surgery.

   Limit the amount of sugar you eat. Processed sugar contributes to overeating because it does not contain the nutrients your body needs to feel full. Try to eat no more than five sweets a week.

   • While artificial sweeteners like sucralose or aspartame can satisfy your sugar cravings, try replacing sweets with healthier snacks like vegetables and fruits.

   Maintaining a healthy lifestyle after surgery

   1. Quit smoking . Smoking and/or chewing tobacco constricts blood vessels and reduces their elasticity, leading to an increase in blood pressure. If you live with a smoker, ask him not to smoke in your presence so that you do not breathe tobacco smoke. This is especially important during the recovery period after surgery. If you smoke yourself, try to give up this bad habit. To do this, you can do the following:

   2. Don't drink alcohol. If you've recently had surgery, you're most likely taking medication to help you recover faster. Alcohol interacts with many medications.

      • In addition, your doctor may advise you to lose weight, and alcoholic beverages are high in calories, making it difficult for you.
      • If you find it difficult to stop drinking alcohol, talk to your doctor who can prescribe the appropriate treatment for you and recommend where you can go for support.

   3. Try to reduce stress. Recovery after surgery is not easy, both physically and psychologically. Try these popular relaxation techniques that you can practice even with limited mobility:

      • Music or art therapy;
      • visualization (presentation of soothing pictures);
      • progressive tension and relaxation of individual muscle groups.

   4. If your doctor allows, exercise. This is a great way to reduce stress and lose weight. However, in the process of recovery after surgery, it is important to observe the measure and not overload your body.

      • Walking every day is completely safe after many types of surgeries, so check with your doctor to see if they are appropriate for you and when you can start.
      • Talk to your doctor and physical therapist about a safe exercise program. Continue to see your doctor and physical therapist regularly so they can monitor your condition and see if exercise is still doing you good.

   Consultations with a doctor

   1. If you think you have high blood pressure, call your doctor. In most cases, people don't realize they have high blood pressure because it often doesn't come with noticeable symptoms. However, the following signs may indicate high blood pressure:

      • labored breathing;
      • headache;
      • nosebleeds;
      • blurred or double vision.

   2. Take blood pressure medication prescribed by your doctor. While you are recovering from surgery, your doctor may prescribe medications to lower your blood pressure. Because they can interact with other medicines, tell your doctor about all medicines you take, including over-the-counter medicines, supplements, and herbal remedies. Your doctor may prescribe the following drugs for you:

      • ACE inhibitors. These drugs cause the blood vessels to relax. They often interact with other medications, so tell your doctor about all medications you are taking.
      • calcium antagonists. This type of drug dilates the arteries and lowers the heart rate. Do not drink grapefruit juice while taking them.
      • Diuretics. These drugs increase the frequency of urination, thereby lowering the salt content in the body.
      • Beta blockers. Drugs of this type reduce the frequency and strength of the heartbeat.