The most characteristic manifestation of hypertension is increased blood pressure.
High blood pressure can usually be diagnosed by examining the pulse.When palpating the pulse on the radial artery, a hard pulse (S. durus) is detected, which is caused by an increase in intra-arterial pressure and a tonic contraction of the arterial walls.However, due to the fact that the lumen of a medium-sized artery decreases slightly in hypertension, the filling of the pulse hardly changes.When graphically recording pulse fluctuations (in the blood pressure image), the pulse wave is low, rounded, and has a smooth rise and fall (pulsus tardus);the dicrotic wave is barely noticeable.
Examining blood pressure using the auscultatory method remains the best way to simultaneously determine systolic, diastolic and pulse pressure.If you have high blood pressure, all three values are usually increased.The systolic increase is most noticeable;The diastolic rise increases to a lesser extent.
If we compare the percentage increase in systolic and diastolic pressure in hypertension relative to the average values of both pressures under normal conditions, the increase will be almost the same.So let's take 120 mm Hg as the normal value for systolic pressure and 70 mm Hg for diastolic pressure.Art., then with a blood pressure of 160 mm Hg. Art.Art.(maximum) and 90 mm Hg. Art.Art.(minimal) the increase over the norm will be almost the same in relation to both values (90 versus 70 and 160 versus 120).With a reading of 180/100 mmHg.Art.At first glance it seems that the systolic value is much more elevated than the diastolic (180 versus 120 and 100 versus 70);If we compare it with normal conditions, the percentage increase will be almost the same.
In the initial phase (stage I) of hypertension, there is often an increase in systolic or diastolic pressure (usually the first, less often the second).This may depend on the baseline before the illness (each person is individual).
The relationship between diastolic and systolic pressure is influenced by:
- degree of elasticity of the walls of large arteries,
- Contraction force of the heart.
It is known that a decrease in the elasticity of the arteries contributes to an increase in systolic pressure (in its most pronounced form this occurs with atherosclerosis of the central arteries).
With hypertension, changes in the elasticity of the walls of large vessels are observed, which are reflected in an increase in pulse pressure.Under the same conditions, as the heart weakens, the amplitude becomes smaller: systolic pressure decreases, diastolic pressure remains increased.
Even at the beginning of the disease, there is a tendency to have blood pressure-lowering reactions.The measurement of blood pressure shows that in some patients its value does not exceed the upper limit of the age norm, but the values obtained when measuring are higher than usual for a particular person, while in others it exceeds the upper limit of the age norm.Increased pressure in hypertension is observed under the influence of various influences - mental, emotional, reflexive - and remains at an elevated level from several minutes to several hours.
The first measurement usually gives higher values (random pressure) than repeated measurements taken 5-10-15 minutes later.The difference between the value of the random pressure and the main pressure is called “additional pressure”;its value is significantly higher in people with high blood pressure than in healthy people.The main pressure is that which is determined when examining the basal metabolic rate (i.e. in bed, in the morning after sleep, on an empty stomach).The smallest value of the indicator after repeated measurements under normal circumstances is usually called “almost the main pressure”.
“Additional pressure” undoubtedly expresses the degree of mental (emotional) excitement or tension of the patient at the moment and the degree of excitability of his nervous system, which regulates blood pressure.Experience shows that in the prehypertensive phase the additional pressure in patients is usually greater than in people who do not show a tendency to develop hypertension.
When comparing the extent of the pressor effect of certain nerve influences, it should be noted that the sharpest stimulus is the word.Therefore, it is no exaggeration to say that the level of hypertension in hypertensive patients and in people predisposed to it is most influenced by influences via the second signaling system.
Tests for high blood pressure for high blood pressure
They also tried to determine the tendency to high blood pressure using reflex stimuli.Particular attention was paid to the so-called cold test.After a short rest period, the subject's blood pressure is measured in the supine position, then the hand of the other hand is dipped in 4°C warm water for one minute;at the moment of immersion and then measure the level every 30 seconds until it levels off.An increase in systolic pressure of more than 20 mmHg.Art., diastolic by more than 15 mm Hg. Art.Art.serves as an indicator of increased pressure reactivity.People who discovered it were called “hyperreactors,” those who did not find it were called “hyporeactors.”In healthy people, hyperreactors account for 15%.
The cold test received mixed reviews.The conditions under which the test is conducted play an important role in the pressure effect of a particular test.The pressure response to cold in a warm person is lower than in the same person at cooler outside temperatures due to the reduced tone of their blood vessels.The reflex reaction to cold depends on the usual temperature influences, the job and the living conditions.It is known that people become addicted to the temperature factor.In hardy people the cold test can be weak, but in people sensitive to cold it can be strong.
The cold test is based on the reflex reaction of the vasomotor center in response to sudden thermal (and sometimes painful) stimuli in the periphery.The antihypertensive response to cold weakens after taking alcohol, bromine and barbiturates.
Sometimes the reactions to a cold test turn out to be paradoxical: high blood pressure does not occur with high blood pressure, and occasionally it even drops.
It is interesting to compare these data with the results of blood pressure determination after exposure to heat.When the hand is warmed, people with hypertension often experience an increase rather than a drop in blood pressure (a hand dipped in warm water does not turn red, but pale).Consequently, cold and heat can sometimes produce the same type of hypotensive, vasoconstrictor effect.
Temperature effects can hardly be used as a method for assessing the reactivity of the apparatus regulating hypertension in hypertension, since they do not reflect the specifics of the diseases underlying hypertension.Vascular testing with pharmacological agents has been suggested.One of them is a test with glycerol trinitrate.After taking 2 drops of glycerol trinitrate (under the tongue), blood pressure (systolic and diastolic) drops significantly.The decline is more pronounced in people with severely elevated blood pressure due to hypertension.The reduction is particularly noticeable in unstable blood pressure;Sometimes such a decrease is observed with persistent hypertension.In the later stages of hypertension (with the development of arteriolosclerotic changes in the kidneys), a nitroglycerin test reveals a slight decrease in hypertension, which can be used to diagnose renal forms (or stages) of hypertensive diseases.
The same results (depressor effect) are obtained in a test with inhalation of isoamyl nitrite.Glycerol trinitrate, like isoamyl nitrite, acts mainly through central vasomotor devices, which characterizes the increased excitability of these centers in hypertension.
The sodium amytal test is becoming increasingly popular.The bedridden subject is given 0.2 g of sodium amytal three times an hour;Blood pressure is measured before administration of the drug and every half hour after administration (for 3 hours).The difference between the initial and lowest levels determines the extent of the dampening effect.Sleep usually occurs after taking the second powder.Typically, sodium amytal helps reduce blood pressure not only in the first few hours but also in the following days, sometimes even several days;the patient's well-being improves.However, this effect is not always observed: some patients experience intolerance to the drug.
Unlike the nitrite test, which causes a rapid drop in pressure, the amytal sodium test causes the pressure to drop gradually.The degree of its decrease after taking sodium amytal is especially significant at the beginning of the disease.In the late phase, when there are arteriolosclerotic changes in the kidneys, the decrease is usually small or absent.
Since the action of barbiturates is undoubtedly of a central nature, a test with amytal sodium characterizes the state of the blood pressure regulating devices in the cortical and subcortical areas.When using different doses of the drug (small and large), it is possible to judge the phase states of the vasopressor nerve centers based on blood pressure (sometimes large and small doses have the same effect, or small doses have a more noticeable depressant effect than large doses).
In addition to tests based on the depressant effect, many tests based on the hypotensive effect have been proposed - with respiratory arrest, inhalation of carbon dioxide, intake of phenamine, but they do not remain without negative effects on the condition of patients, although they are no less likely to determine the tendency to hypertension in the early stages and in the so-called premorbid state.
If you notice a tendency to short-term increases in blood pressure in a particular person, you should not immediately diagnose high blood pressure, let alone inform the person being examined about it.Under favorable environmental conditions, pressure reactions can disappear completely.
High blood pressure depending on the stage of hypertension
Increased pressure in the early stages of hypertension only occurs periodically (transitional phase).The more difficult the patient's living conditions are neuropsychically, the longer and more frequent are the periods of high blood pressure in hypertension, and the periods of normal values are shorter and less frequent.Treatment measures and adherence to the regime are of great importance.Under the influence of rest and treatment in the initial transitional phase of hypertension with its benign course, the indicator often decreases to normal for a long period of time.
An increasingly persistent tendency to increased blood pressure in hypertension and the preservation of its pathological level indicates the further development of the disease, moving to stage II.In phase A of stage II, blood pressure is unstable (labile phase).Its level can fluctuate within significant limits.Under the influence of rest, it drops to a level close to normal for a short time, but is not maintained at this level for a long time.However, under the influence of treatment, a long-term reduction in the indicator to normal can be achieved.
Blood pressure can fluctuate significantly during the day if you have high blood pressure.It is usually lower in the morning than in the evening.After eating it increases slightly and then decreases significantly.During nighttime sleep, it decreases more in people with high blood pressure than in healthy people.
As the disease progresses, blood pressure stabilizes at a high level (phase B of stage II, stable).Even at this stage there are sometimes phases of decline.Sometimes remission occurs under the influence of long-term therapy over a long period of time.However, this phase is usually characterized by persistent and high high blood pressure.Depressor tests at this stage indicate the functional nature of hypertension in hypertension.
In stage III, blood pressure is usually persistently elevated.Hypertension is maintained by a number of factors, including undoubtedly the involvement of the kidney.However, with a decrease in the excitability of vasopressor centers during strokes or under the influence of heart failure (occurrence of decompensation due to overload of the contractile function of the hypertrophied heart), a decrease in blood pressure is observed.Moderate heart failure has little influence on the level of the indicator;sometimes it even increases during this period (stagnation factor).
Venous pressure in high blood pressure is usually within the normal range and only increases in heart failure.True, in some patients, even in the early stages of the disease, slightly increased values of venous pressure can be detected, which even led to the assumption of excitation of the "venomotor center", as a result of which the tone of the venous walls increases (however, we cannot judge the latter, since intravenous pressure is usually measured using blood).The blood pressure in the capillaries is difficult to determine.Capillaroscopy usually reveals a narrowing of the arterial arches of the precapillaries and an expansion of the venous arches in the nail bed;The variability of the capillary pattern (“play”) is typical.