The most characteristic manifestation of hypertension is elevated blood pressure.
Usually, high blood pressure in hypertension can be determined by examining the pulse.When palpating the pulse on the radial artery, a hard pulse (p. durus) is determined, which is caused by an increase in intra-arterial pressure and tonic contraction of the artery walls.However, due to the fact that the lumen of the medium-sized artery decreases slightly during hypertension, pulse filling changes little.During the graphic recording of pulse fluctuations (on the sphygmogram), the pulse wave is low, rounded and has a slight rise and fall (pulsus tardus);the dicrotic wave is barely noticeable.
Studying blood pressure using the auscultatory method is still the best way to simultaneously determine systolic, diastolic and pulse pressure.In hypertension, all three values are usually elevated.The systolic increases most significantly;diastolic increases to a lesser extent.
If we compare the percentage increase in systolic and diastolic pressure in hypertension compared to the average values of both pressures in normal conditions, the increase will be almost equal.So, if we take 120 mm Hg as a normal value for systolic pressure, and 70 mm Hg for diastolic pressure.art., then with blood pressure equal to 160 mm Hg.Art.(maximum) and 90 mm Hg.Art.(minimal), the increase from the norm in relation to both values will be almost the same (90 in relation to 70 and 160 in relation to 120).With a reading of 180/100 mmHg.Art.at first sight, the systolic seems to be increased much more significantly than the diastolic (180 vs. 120 and 100 vs. 70);if we compare it with normal ratios, the percentage increase will be almost equal.
Often, in the initial period (I stage) of hypertension, there is an increase in either systolic or diastolic pressure (usually the first, less often the second).Maybe it depends on the baseline level before the disease (each person is individual).
The relationship between diastolic and systolic pressure is influenced by:
- the degree of elasticity of the walls of large arteries,
- contractile force of the heart.
It is known that the decrease in the elasticity of the arteries contributes to the increase in systolic pressure (in its most pronounced form, this occurs in atherosclerosis of the central arteries).
In hypertension, changes in the elasticity of the walls of large blood vessels are observed, which is reflected in an increase in pulse pressure.Under the same conditions, when the heart begins to weaken, the amplitude becomes smaller: systolic pressure decreases, diastolic pressure remains elevated.
Already at the beginning of the disease there is a tendency to pressor reactions.Blood pressure measurement shows that in some patients its level does not exceed the upper limit of the age norm, but the values obtained during the measurement are higher than usual for a given 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, reflex - and remains at an elevated level from several minutes to several hours.
The first measurement usually gives higher numbers (random pressure) than repeated measurements after 5-10-15 minutes.The difference between the value of the accidental and the main pressure is referred to as "additional pressure";its value in people suffering from hypertension is significantly higher than in healthy people.The main pressure is considered the one obtained during the study of basal metabolism (ie in bed, in the morning after sleep, on an empty stomach).The lowest value of the indicator after repeated measurements under normal circumstances is conventionally called "almost 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 that regulates blood pressure.Experience shows that in the prehypertensive period, the amount of additional pressure in patients is usually more significant than in people who have not shown a tendency to develop hypertension.
When comparing the degree of pressor influence of certain nerve influences, it should be noted that the most acute stimulus is the word.Therefore, it will not be an exaggeration to say that the level of high blood pressure in hypertension and in people predisposed to it is mostly influenced by influences through another signaling system.
Tests for high blood pressure in hypertension
They also tried to determine the tendency to hypertension with reflex irritations.In this regard, special attention was paid to the so-calledcold dough.After a short period of rest, the subject's blood pressure is measured in a lying position, and then the hand of the other hand is immersed for a minute in water at a temperature of 4°;at the moment of submersion and then measure the level every 30 seconds until it equalizes.Increase in systolic pressure by more than 20 mmHg.Art., diastolic by more than 15 mm Hg.Art.serves as an indicator of increased pressure reactivity.People who found it were called "hyperreactors" and those who didn't were called "hyporeactors".Among healthy people, hyperreactors make up 15%.
The cold test received mixed reviews.The conditions under which the test is performed play an important role in the pressure effect for a given test.The pressor reaction to cold in a person who is warm, due to the reduced tone of the blood vessels, is lower than in the same person in conditions of lower external temperature.The reflex reaction to cold depends on the usual temperature influences, profession and living conditions.It is known that people become addicted to the temperature factor.In hardened persons the cold test may be weak, but in people sensitive to cold it may be strong.
The cold test is based on the reflex reaction of the vasomotor center in response to a sudden thermal (and partially painful) stimulation in the periphery.Pressor reaction to cold weakens after taking alcohol, bromine and barbiturates.
Sometimes the answers to the cold test turn out to be paradoxical: high blood pressure does not occur in hypertension, and occasionally it even decreases.
It is interesting to compare these data with the results of determining blood pressure after exposure to heat.When warming the hand, people suffering from hypertension often experience not a decrease, but an increase in blood pressure (a hand immersed in warm water does not turn red, but turns pale).Consequently, cold and heat can sometimes produce the same type of pressor vasoconstrictor effect.
Temperature effects can hardly be used as a method for evaluating the reactivity of the apparatus that regulates high blood pressure in hypertension, because they do not reflect the specifics of the disorders underlying hypertension.Vascular tests using pharmacological agents have been suggested.One of them is the glycerol trinitrate test.After taking 2 drops of glycerol trinitrate (under the tongue), blood pressure (systolic and diastolic) decreases significantly.The decrease is more pronounced in people with suddenly elevated blood pressure due to hypertension.The reduction is particularly significant in unstable blood pressure;Sometimes such a reduction is observed in persistent hypertension.In the later stages of hypertension (with the development of arteriolosclerotic changes in the kidneys), the nitroglycerin test gives a slight drop in hypertension, which can be used to diagnose renal forms (or stages) of hypertensive conditions.
The same results (depressant effect) were obtained with the isoamyl nitrite inhalation test.Glycerol trinitrate, like isoamyl nitrite, acts mainly through central vasomotor devices, thus characterizing the increased excitability of these centers in hypertension.
The sodium amytal test has gained some popularity.The subject who is in bed is given sodium amytal 0.2 g every hour 3 times;blood pressure is measured before administration of the drug and every half hour after administration (3 hours).The difference between the initial and the lowest level determines the magnitude of the depressant effect.After taking the second powder, sleep usually occurs.Typically, sodium amytal helps to lower blood pressure not only in the first hours, but also in the following days, sometimes even for several days;the patient's condition is improving.However, this effect is not always observed: some patients have intolerance to the drug.
Unlike the nitrite test, which causes a rapid drop in pressure, when testing with sodium amytal it decreases gradually.The degree of its reduction after taking sodium amytal is especially significant at the beginning of the disease.In the late period, in the presence of arteriolosclerotic changes in the kidneys, the reduction is usually small or absent.
Given that the action of barbiturates is undoubtedly of a central nature, the amytal sodium test characterizes the condition of the devices that regulate blood pressure in cortical and subcortical areas.When different doses of the drug (small and large) are used, it is possible to assess the phase states of vasopressor nerve centers according to blood pressure (sometimes large and small doses have the same effect, or small doses have a more pronounced depressant effect than large doses).
In addition to tests based on the depressor effect, numerous tests based on the pressor effect have been proposed - with stopping breathing, inhaling carbon dioxide, taking phenamine, but they are not without a negative impact on the patient's condition, although they probably no less determine the tendency to hypertension in its early phase and in the so-calledpremorbid condition.
Having discovered a tendency for a short-term increase in blood pressure in a certain person, one should not immediately make a diagnosis of hypertension, and even less inform the person being examined about it.Under favorable environmental conditions, pressor reactions can disappear completely.
High blood pressure depending on the stage of hypertension
Increased pressure in the early phase of hypertension occurs only periodically (transient phase).The more difficult the patient's living conditions are in the neuropsychological sense, the longer and more frequent the periods of high blood pressure in hypertension, and the shorter and less frequent periods of normal blood pressure.Treatment measures and adherence to the regimen are of great importance.Under the influence of rest and treatment in the initial transitory phase of hypertension with its benign course, the indicator often decreases to normal over a long period.
An increasingly persistent tendency to increase blood pressure during hypertension and preserve its pathological level indicates the further development of the disease, moving into stage II.In phase A II, blood pressure is unstable (labile phase).Its level can vary within significant limits.Under the influence of rest, it decreases for a short time to a level close to normal, although it is not maintained at that level for a long time.Under the influence of treatment, however, a long-term reduction of indicators to normal can be achieved.
During the day, blood pressure in hypertension can vary significantly.It is usually lower in the morning than in the evening.After eating, it increases slightly and then gives a significant decrease.During the night's sleep, it decreases sharply in hypertensives than in healthy people.
As the disease progresses, blood pressure becomes more firmly established at a high level (stage B stage II, stable).True, even at this stage there are sometimes periods of his decline.Sometimes remission occurs under the influence of long-term therapy over a fairly long period.However, this phase is usually characterized by persistent and high hypertension.Depressor tests at this stage indicate the functional nature of high blood pressure in hypertension.
In stage III, blood pressure is usually constantly elevated.Hypertension is maintained by a number of factors, among which the kidneys are undoubtedly involved.However, with a decrease in the excitability of vasopressor centers during cerebral strokes or under the influence of heart failure (the occurrence of decompensation due to overstrain of the contractile function of a hypertrophied heart), a decrease in blood pressure is observed.Moderate heart failure has little effect on the indicator level;sometimes it even increases during this period (stagnation factor).
As for venous pressure in hypertension, it is usually within normal limits and increases only in heart failure.True, in some patients, even in the early stages of the disease, slightly elevated values of venous pressure can be found, 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 are not able to judge the latter, because intravenous pressure is usually measured).Blood pressure in the capillaries is difficult to determine.Capillaroscopy in the nail bed usually reveals the narrowing of the arterial bends of the precapillaries and the widening of the venous bends;The variability of the capillary pattern ("playing" them) is typical.