The most characteristic manifestation of hypertension is increased blood pressure.
High blood pressure in hypertension can usually be detected by examining the pulse.When palpating the pulse of the radial artery, a hard pulse (p. Durus) is determined, which is due to an increase in intra-arterial pressure and tonic contraction of the walls of the arteries.However, due to the fact that the lumen of a medium-sized artery during hypertension slightly decreases, pulse filling changes little.When graphically recording the pulse fluctuations (on a sphygmogram), the pulse wave is low, rounded and has a slight rise and fall (pulsus tardus);the dicrotic wave is barely noticeable.
Examination of 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.Systolic increases most significantly;diastolic increases to a lesser extent.
If we compare the percentage increase in systolic and diastolic pressure in hypertension with respect to the average values of the two pressures under 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 over the norm in terms of both values will be almost the same (90 vs. 70 and 160 vs. 120).With a reading of 180/100 mmHg.Art.at first glance it appears that the systolic is increased much more significantly than the diastolic (180 vs. 120 and 100 vs. 70);if we compare it to the normal ratios, the increase in percentage terms will be almost equal.
Often, in the initial period (stage I) of hypertension, an increase in systolic or diastolic pressure is observed (usually the first, less often the second).Perhaps 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 the large arteries,
- contractile force of the heart.
It is well known that a decrease in arterial elasticity contributes to an increase in systolic pressure (in the most pronounced form, this occurs in atherosclerosis of the central arteries).
In hypertension, there are changes in the elasticity of the walls of the large vessels, which is expressed 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 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 values (random pressure) than repeated measurements taken 5-10-15 minutes later.The difference between the value of the accidental and the basic pressure is referred to as "additional pressure";its value in people suffering from hypertension is significantly greater than in healthy people.The basal pressure is considered to be the one obtained during the study of the basal metabolism (ie, in bed, in the morning after sleep, on an empty stomach).The smallest value of the indicator after repeated measurements under normal circumstances is conventionally called "almost basic 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 period, the amount of additional pressure in patients is usually more significant than in individuals who have not shown a tendency to develop hypertension.
When comparing the degree of pressor influence of certain nervous influences, it should be noted that the most acute stimulus is the word.Therefore, it would not be an exaggeration to say that the level of high blood pressure in hypertension and in those predisposed to it is most affected by effects through the second signaling system.
High blood pressure tests for hypertension
They also tried to determine the tendency to hypertension using reflex irritations.In this regard, special attention was paid to the so-called cold test.After a short period of rest, the patient's blood pressure is measured in a supine position, after which the arm of the other arm is immersed for a minute in water at a temperature of 4°;at the time of immersion and then measure the level every 30 seconds until leveling off.An increase in systolic pressure of more than 20 mmHg.art., diastolic by more than 15 mm Hg.Art.serves as an indicator of increased pressor reactivity.People who discovered it were called "hyperreactors", those who didn't discovered it were called "hyporeactors".Among healthy people, hyperreactors are 15%.
The cold test received mixed reviews.The conditions under which the test is conducted play an important role in the pressor effect for a given test.The pressor response to cold in a warm person, due to the reduced tone of his blood vessels, is lower than in the same person under conditions of lower external temperature.The reflex reaction to cold depends on the usual temperature influences, occupation and living conditions.It is well known that people get addicted to the temperature factor.In hardened persons the cold test may be weak, but in those sensitive to cold it may be strong.
The cold test is based on the reflex response of the vasomotor center in response to a sudden thermal (and partly painful) stimulation in the periphery.The pressor response to cold is weakened after taking alcohol, bromine and barbiturates.
Sometimes the answers to the cold test turn out to be paradoxical: high blood pressure does not appear with hypertension, and sometimes it even decreases.
It is interesting to compare these data with the results of determination of 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).Therefore, 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 device regulating high blood pressure in hypertension, since they do not reflect the specificity of the disorders that are the basis of hypertension.Vascular testing using pharmacological agents has 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 reduction is more pronounced in individuals with sharply increased 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 reduction in hypertension, which can be used to diagnose renal forms (or stages) of hypertensive conditions.
The same results (depressant effect) are obtained in 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 patient, who is in bed, is given sodium amytal 0.2 g every hour 3 times;blood pressure is measured before giving the drug and every half hour after taking it (for 3 hours).The difference between the baseline and the lowest level determines the magnitude of the depressant effect.After taking the second powder, sleep usually occurs.Usually, sodium amytal helps to lower blood pressure not only in the first 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, in the sodium amytal test 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 weak or absent.
Since the effect of barbiturates is undoubtedly central in nature, the sodium amytal test characterizes the state of the devices regulating blood pressure in the cortical and subcortical areas.When different doses of the drug (small and large) are used, it is possible to judge the phase states of the vasopressor nerve centers by blood pressure (sometimes large and small doses give the same effect, or small doses have a depressant effect that is more pronounced than large doses).
In addition to the tests based on the depressant effect, many tests based on the depressant effect have been proposed - with cessation of breathing, inhalation of carbon dioxide, intake of phenamine, but they are not without a negative effect on the condition of patients, although they probably no less determine the tendency to hypertension in its early stage and in the so-called pre-morbid state.
Having discovered a tendency to a short-term increase in blood pressure in a particular person, you should not immediately make a diagnosis of hypertension, much less inform the person being examined about it.Under favorable environmental conditions, pressor reactions can completely disappear.
High blood pressure depending on the stage of hypertension
Increased pressure in the early stage of hypertension occurs only periodically (transitional phase).The more difficult the patient's living conditions are in terms of neuropsychology, the longer and more frequent are the periods of high blood pressure in hypertension, and the periods of normal levels are shorter and less frequent.Of great importance are treatment measures and compliance with the regimen.Under the influence of rest and treatment in the initial transitional phase of hypertension with a benign course, the indicator often decreases to the norm for a long period of time.
The increasingly persistent tendency to increase blood pressure during hypertension and the preservation of its pathological level indicates the further development of the disease, passing into the II stage.In phase A of stage II, blood pressure is unstable (labile phase).Its level can vary widely.Under the influence of rest, it decreases for a short period of time to a level close to normal, but is not maintained at this level for a long time.However, under the influence of treatment, a long-term reduction of the indicator to normal can be achieved.
During the day, blood pressure in hypertension can vary significantly.In the morning it is usually lower than in the evening.After a meal, it slightly increases, then significantly decreases.During night sleep, it decreases more sharply in hypertensive than in healthy people.
As the disease progresses, blood pressure settles more firmly at a high level (phase B of stage II, stable).It is true that even at this stage there are sometimes periods of its decline.Sometimes remission occurs under the influence of prolonged therapy for a fairly long period of time.However, this phase is usually characterized by persistent and high hypertension.Depressant tests at this stage show the functional nature of high blood pressure in hypertension.
In stage III, blood pressure is usually persistently elevated.Hypertension is maintained by a number of factors, among which undoubtedly the involvement of the kidneys.However, with a decrease in the excitability of the vasopressor centers during cerebral strokes or under the influence of heart failure (the appearance of decompensation due to overstrain of the contractile function of the hypertrophied heart), a decrease in blood pressure is observed.Moderate heart failure has little effect on the level of the indicator;sometimes it even increases during this period (stagnation factor).
As for venous pressure in hypertension, it is usually within the normal range and increases only in heart failure.It is true that 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 assess the latter, since intravenous pressure is usually measured with blood).It is difficult to determine the blood pressure in the capillaries.Capillaroscopically in the nail bed, narrowing of the arterial bends of the precapillaries and widening of the venous bends is usually determined;The variability of the capillary pattern (their "game") is characteristic.