The most characteristic manifestation of hypertension is an increase in blood pressure.
Usually, high blood pressure in hypertension can be established by checking the pulse.When palpating the pulse on the radial artery, a hard pulse (p. durus) is determined, which is caused by increased intra-arterial pressure and tonic contraction of the arterial wall.However, due to the fact that the lumen of medium-sized arteries during hypertension is slightly reduced, pulse filling changes slightly.When recording pulse fluctuations graphically (on a sphygmogram), the pulse wave is low, round, and has a gentle rise and fall (pulsus tardus);dicrotic waves are almost invisible.
Blood pressure studies using the auscultation method are still the best way to determine systolic, diastolic and pulse pressure simultaneously.In hypertension, all three values are usually elevated.Systolic increased most significantly;diastolic increases to a lower level.
If we compare the percentage increase in systolic and diastolic pressure in hypertension in relation to the average value of both pressures in normal conditions, the increase will be almost the same.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.(minimum), the increase to the norm in relation to both values will be almost the same (90 versus 70 and 160 versus 120).With a reading of 180/100 mmHg.Art.at first glance, it seems that the systolic increases significantly more than the diastolic (180 versus 120 and 100 versus 70);if we compare with the normal ratio, the increase in percentage terms will be almost the same.
Often in the initial period (stage I) of hypertension there is an increase in either systolic or diastolic pressure (usually the first, less often the second).Maybe this depends on the baseline level before the disease (each person is an individual).
The relationship between diastolic and systolic pressure is influenced by:
- the degree of elasticity of the walls of large arteries,
- heart contraction force.
It is well known that a decrease in arterial elasticity contributes to an increase in systolic pressure (in its most significant form, this occurs with atherosclerosis of the central arteries).
In hypertension, changes in the elasticity of the walls of large 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 high.
Already at the beginning of the disease there is a tendency for a pressor reaction.Measuring blood pressure shows that in some patients the level does not exceed the upper limit of the age norm, but the value obtained during the measurement is higher than normal for a certain 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 a high level from several minutes to several hours.
The first measurement usually gives a higher number (random pressure) than a repeat measurement taken 5-10-15 minutes later.The difference between the random value and the main pressure is designated as "additional pressure";its value in people suffering from hypertension is much greater than in healthy people.Primary pressure is considered to be the pressure obtained during the study of the basal metabolic rate (ie in bed, in the morning after sleep, on an empty stomach).The smallest value of the indicator after repeated measurements under normal conditions is conventionally called "near main pressure."
"Additional pressure" certainly expresses the level of mental stimulation (emotion) or tension of the patient at the moment and the level of excitement of his nervous system that controls blood pressure.Experience shows that in the prehypertensive period, the amount of additional stress in patients is usually more significant than in individuals who do not show a tendency to develop hypertension.
When comparing the degree of pressor influence of certain neural influences, it should be noted that the most acute stimulus is the word.Therefore, it is not an exaggeration to say that the level of high blood pressure in hypertension and in people prone to it is most influenced by the influence through the second signaling system.
Tests for high blood pressure in hypertension
They also tried to determine the tendency to hypertension by means of reflex irritation.In this regard, special attention is paid to the so-called cold test.After a short rest period, the subject's blood pressure was measured in a supine position, then the other hand was immersed for one minute in water at a temperature of 4°;at the moment of immersion and then measure the level every 30 seconds until the level comes out.An increase in systolic pressure of more than 20 mmHg.Art., diastolic with more than 15 mm Hg.Art.serves as an indicator of increased pressor reactivity.People who find it are called "hyper-reactors", those who don't are called "hypo-reactors".Among 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 suppressor effect for a particular test.The pressor reaction to cold in a person who is hot, due to a decrease in the tone of his blood vessels, is lower than the same person in colder external temperature conditions.The reflex reaction to cold depends on the influence of normal temperature, profession, and living conditions.It is well known that people become addicted to the temperature factor.In hardy people, the cold test may be weak, but in people sensitive to cold, it can be strong.
The cold test is based on the central vasomotor reflex response in response to a sudden thermal (and partly painful) stimulus in the periphery.The pressor reaction to cold is weakened after taking alcohol, bromine, and barbiturates.
Sometimes the reaction to the cold test is paradoxical: high blood pressure does not occur in hypertension, and sometimes it even decreases.
It is interesting to compare this data with the results of blood pressure determination after exposure to heat.When warming the hands, people suffering from hypertension often do not experience a decrease, but an increase in blood pressure (hands soaked in warm water do not turn red, but turn pale).As a result, cold and heat can sometimes produce the same type of pressor vasoconstrictor effect.
The effect of temperature can hardly be used as a method to evaluate the reactivity of the apparatus that controls high blood pressure in hypertension, because it does not reflect the specifics of the disorder underlying hypertension.Vascular testing using pharmacological agents has been suggested.One of them is the test with glycerol trinitrate.After taking 2 drops of glycerol trinitrate (under the tongue), blood pressure (systolic and diastolic) decreased significantly.This decrease is more noticeable in individuals who experience a sudden increase in blood pressure due to hypertension.This reduction is particularly noticeable with unstable blood pressure;Sometimes such a decrease is observed in persistent hypertension.In the late stages of hypertension (with the development of arteriolosclerotic changes in the kidneys), the nitroglycerin test gives a slight decrease in hypertension, which can be used to diagnose the renal form (or stage) of the hypertensive state.
The same result (depressor effect) was obtained by testing with inhalation of isoamyl nitrite.Glycerol trinitrate, like isoamyl nitrite, acts mainly through the central vasomotor apparatus, thereby characterizing the increased excitability of this center in hypertension.
The sodium amytal test has gained some popularity.The subject, who was in bed, was given sodium amytal 0.2 g every hour 3 times;blood pressure is measured before giving the medicine and every half hour after taking it (for 3 hours).The difference between the initial and lowest levels determines the magnitude of the suppressor effect.After taking the second powder, sleep usually occurs.Usually, sodium amytal helps lower blood pressure not only in the first hour, 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 develop intolerance to the drug.
Unlike the nitrite test, which causes a rapid decrease in pressure, when tested with sodium amytal it decreases gradually.The level of its decrease after taking sodium amytal is especially noticeable at the beginning of the disease.In the late period, with the presence of arteriolosclerotic changes in the kidneys, the decrease is usually small or absent.
Since the effects of barbiturates are undoubtedly central, the test with sodium amytal characterizes the state of the apparatus that regulates blood pressure in cortical and subcortical areas.When using different doses of the drug (small and large), it is possible to evaluate with blood pressure the state of the vasopressor nerve center phase (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 depressor action, many tests have been proposed based on pressor action - by stopping breathing, inhaling carbon dioxide, taking phenamine, but they are not without negative effects on the patient's condition, although they may no less determine the tendency to hypertension in the early stages and in the so-called premorbid conditions.
Having discovered a short-term tendency to increase blood pressure in a certain person, you should not immediately make a diagnosis of hypertension, let alone tell the person being examined about it.Under favorable environmental conditions, the pressor response can disappear completely.
High blood pressure depends on the level of hypertension
Increased pressure in early stage hypertension occurs only periodically (temporary phase).The more difficult the patient's life in neuropsychic terms, the longer and more frequent the period of high blood pressure in hypertension, and the period of normal level is shorter and rarer.Treatment measures and adherence to the regimen are very important.Under the influence of rest and treatment in the initial transient phase of hypertension with its benign course, indicators often decrease to normal for a long period.
The continuing tendency towards an increase in blood pressure during hypertension and the preservation of its pathological level indicate the further development of the disease, beyond stage II.In phase A stage II, blood pressure is unstable (labile phase).The level can vary within significant limits.Under the influence of rest, it decreases for a short time to an almost normal level, although it is not maintained at this level for a long time.Under the influence of treatment, however, a long-term decrease in indicators to normal can be achieved.
During the day, blood pressure with hypertension can fluctuate widely.In the morning it is usually lower than in the evening.After eating, it increases slightly, then gives a significant decrease.During night sleep, it decreases more sharply in hypertensive than in healthy people.
As the disease progresses, the blood pressure becomes stronger at a high level (phase B stage II, stable).True, even at this stage there are sometimes periods of decline.Sometimes remission occurs under the influence of long-term therapy for a relatively long period of time.However, this phase is usually characterized by persistent and high hypertension.The depressor test at this stage shows the functional nature of high blood pressure in hypertension.
In stage III, blood pressure usually rises continuously.Hypertension is maintained by a number of factors, among which is undoubtedly the participation of the kidneys.However, with a decrease in the excitability of the vasopressor center during a cerebral stroke or under the influence of heart failure (occurrence 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 indicator levels;sometimes it also increases during this period (stagnation factor).
As for venous pressure in hypertension, it is usually in the normal range and increases only with heart failure.True, in some patients, even in the early stages of the disease, a slightly increased value of venous pressure can be found, which even leads to the assumption of excitation of the "venomotor center", as a result of which the tone of the venous wall increases (however, we cannot evaluate the latter, because intravenous pressure is usually measured with blood).Blood pressure in capillaries is difficult to determine.Capillaroscopically in the nail bed, the narrowing of the precapillary arterial bend and the expansion of the venous bend are usually determined;The variability of the capillary pattern ("game" of it) is typical.