The most characteristic manifestation of hypertension is an increase in pressure.
Typically, increased pressure with hypertension can be installed already when examining the pulse.When feeling the pulse on the radial artery, a solid pulse (p. Durus) is determined, due to an increase in intraarterial pressure and the tonic reduction of the walls of the artery.However, due to the fact that the lumen of the average caliber arteries with hypertension decreases slightly, the filling of the pulse changes little.During graphic recording of pulse oscillations (on the sphigmogram), the pulse wave is low, rounded, has an excitement of lifting and descent (Pulsus Tardus);The dicrotic wave is inconspicuous.
The study of blood pressure by auscultative method is still the best way to simultaneously determine systolic, diastolic and pulse pressure.With hypertension, all three values are usually increased.Sistolic is most significantly increased;Diastolic increases to a lesser extent.
If we compare the percentage of increasing the magnitude of systolic and diastolic pressure for hypertension in relation to the average values of both pressure in the norm, then the rise will be almost equal.So, if we take for a normal value for systolic pressure a number of 120 mm, and for diastolic pressure - 70 mm Hg.Art., then at a blood pressure equal to 160 mm Hg.Art.(maximum) and 90 mm Hg.Art.(minimum), an increase against the norm in relation to both values will be almost the same (90 compared with 70 and 160 compared to 120).With an indicator of 180/100 mm Hg.Art.At first glance, it seems that systolic is increasingly increasingly increased than diastolic (180 versus 120 and 100 versus 70);If you compare with normal ratios, then the rise in percentage is almost equal.
Often in the initial period (stage I) of hypertension, there is an increase in either systolic or diastolic pressure (often the first, less often the second).Perhaps it depends on the initial level that has before the disease (each person individually).
The ratio between diastolic and systolic pressure affects:
- The degree of elasticity of the walls of large arteries,
- Socratic power of the heart.
It is well known that a decrease in the elasticity of the arteries helps to increase systolic pressure (in the most pronounced form it is found in atherosclerosis of the central arteries).
With hypertension, changes in the elasticity of the walls of large vessels are observed, which is reflected in an increase in pulse pressure.In the same conditions, when the heart begins to weaken, the amplitude becomes less: systolic pressure decreases, the diastolic remains increased.
Already at the beginning of the disease, an inclination to press reactions is observed.The measurement of arterial pressure shows that in some patients its level does not go beyond the upper limit of the age norm, but obtained when measuring the size is higher than the usual for a given person, while in others it exceeds the upper limits of the age norm.Increased pressure with hypertension is observed under the influence of various effects - mental, emotional, reflex - and is kept at an increased level from several minutes to several hours.
The first dimension usually gives higher numbers (random pressure) than repeated measurements taken after 5-10-15 minutes.The difference between the amount of random and basic pressure is indicated by “additional pressure”;Its value in people suffering from hypertension is much larger than in healthy ones.The main pressure obtained in the conditions of the study of the main exchange is considered the main one (i.e. in bed, in the morning after sleep, on an empty stomach).The smallest value of the indicator after repeated measurements in the usual environment is conditionally 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, which regulates the blood pressure of the apparatus.Experience shows that in the pregypertonic period in patients, the value of additional pressure is usually more significant than in people who have not found a tendency to develop hypertension.
Comparing the degree of pressor influence of certain nervous influences, it should be noted that the most sharp stimulus is the word.Therefore, it will not be an exaggeration to say that the impact of the second signaling system to the greatest extent affects the level of increased pressure for hypertension and in people predisposed to it.
Samples for increased pressure with hypertension
They tried to determine the inclination to hypertension by reflex irritations.In this regard, special attention was paid to the so -called cold sample.In the studied after a short period of rest, blood pressure is measured in a lying position, then the brush of the other hand is immersed in a temperature of 4 ° for a minute;At the time of immersion and then every 30 seconds, the level is measured until it leases.An increase in systolic pressure is more than 20 mm Hg.Art., diastolic by more than 15 mm Hg.Art.serves as an indicator of an increase in pressor reactivity.The faces who discovered it were called "hyperreactors", who did not find - "hyporeactors."Among healthy people, hyperreactors are 15%.
The cold sample received a contradictory assessment.In the pressing effect, with this sample, the conditions in which the sample is performed play a large role.A pressing reaction to the cold in a person who is warm, due to a reduced tone of his vessels is lower than that of the same person in conditions of cooler external temperature.The reflex reaction to the cold depends on the usual temperature influences, on the profession, living conditions.It is well known that people are used to the temperature factor.For hardened people, a cold test can be weak, and in people sensitive to cold, it can be strongly expressed.
The cold sample is based on the reflex reaction of the vasomotor center in response to a suddenly caused thermal (and partly pain) irritation on the periphery.The pressing reaction to the cold weakens after taking alcohol, bromine, barbiturates.
Sometimes the answers to the cold sample turn out to be paradoxical: increased pressure in hypertension does not occur, and occasionally it even decreases.
It is interesting to compare these data with the results of determining blood pressure after the influence of heat.When warming the hands in people suffering from hypertension, it is often not a decrease, but an increase in blood pressure (a hand lowered into warm water does not blush, but turns pale).Therefore, cold and heat can sometimes cause the same pressing vasoconstrictor effect.
The temperature effects can hardly be used as a method for assessing the reactivity of the apparatus that regulates increased pressure in hypertension, because they do not reflect the specifics of the disorders that underlie hypertension.Vascular samples using pharmacological agents were offered.One of them is a sample with a glycerol trinitrate.After taking 2 drops of glycerol trinitrate (under the tongue), pressure (systolic and diastolic) decreases significantly.The decrease is more pronounced in people with sharply increased pressure in hypertension.Particularly significantly decrease with unstable blood pressure;Sometimes such a decrease is observed with persistent hypertension.In the late stages of hypertension (with the development of arteriolosclerotic changes in the kidneys), a nitroglycerin test gives a slight decrease in the indicator of hypertension, which can be used to diagnose renal forms (or stages) of hypertensive conditions.
The same results (the depressor effect) gives a test with inhalation of isoamilnitrite.Glycerin trinitrate, like isoamilnitrite, acts mainly through the central vascular devices, thereby characterizing the increased excitability of these centers for hypertension.
A sodium test was somewhat spread.The studied person in bed give an amyl of sodium 0.2 g every hour 3 times;Arterial pressure is measured before the preparation of the drug and every half hour after taking it (within 3 hours).The difference between the initial and smallest level determines the value of the depressor effect.After taking the second powder, a dream usually occurs.Typically, sodium amital helps to reduce 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, such an effect is not always observed: some patients have intolerance to the drug.
Unlike a nitrite test, which causes a violent drop in pressure, when sodium sodium is sodium, it decreases gradually.The degree of decrease in its intake is especially significant at the beginning of the disease.In the late period, in the presence of arteriolosclerotic changes in the kidneys, the decrease is usually small or absent.
Since the effect of barbiturates, undoubtedly, is central, a sodium test with an ammal is characterized by the state of the instrument -regulatory pressure in the cortical and subcortical regions.When using various doses of the drug (small and large), it is possible to judge the phase conditions of vasopressor nerve centers by arterial pressure (sometimes large and small doses give the same effect, or small doses have a depressive effect, more distinct than large doses).
In addition to samples based on depressor action, there are many samples based on pressing action - with breathing stop, inhalation of carbon dioxide, taking phenamine, but they are not devoid of negative effects on the condition of the patients, although they probably no less than determine the inclination of hypertension in its early stage and in the so -called premorbid state.
Having discovered an inclination to short -term rise in blood pressure in a particular person, one should not immediately diagnose hypertension, and even more so to inform the examined about him.Under favorable environmental conditions, instant reactions can pass completely.
Increased pressure depending on the stage of hypertension
Increased pressure in the initial stage can only be periodically (transient phase).The harder in the neuropsychiatric terms the conditions of the patient, the more prolonged and more frequent are periods of increased pressure in hypertension, and periods of the normal level of its shorter and more rare.Of great importance are therapeutic measures, compliance with the regime.Under the influence of rest and treatment in the initial transient phase of hypertension with a benign course, the indicator often decreases to a long time.
An increasingly stubborn inclination to increased pressure during hypertension and the preservation of its pathological level indicates the further development of the disease that goes to the second stage.In phase A of stage II, arterial pressure is instructed (labile phase).Its level can fluctuate in large limits.Under the influence of rest, it is reduced by a short time to a level close to normal, although it is not kept at this level for a long time.Under the influence of treatment, however, a prolonged decrease in the indicator to the norm can be achieved.
During the day, blood pressure with hypertension can vary 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 with hypertension more sharply than in healthy ones.
As the disease progresses, blood pressure is more firmly set at a high level (phase B II stage, stable).True, in this stage, periods of decrease are observed at times.Sometimes remission occurs under the influence of prolonged therapy for a rather long time.However, usually this phase differs stubborn and high hypertension.Depressor tests in this stage indicate the functional nature of increased pressure in hypertension.
In stage III, blood pressure is usually resistant.Hypertension is supported by a number of factors, among which there is undoubtedly the participation of the renal.However, with a decrease in the excitability of vasopressor centers in brain strokes or under the influence of heart failure (the occurrence of decompensation on the soil of the contractile function of a hypertrophied heart), a decrease in blood pressure is noted.Moderate heart failure is not much reflected at the level of the indicator;Sometimes it even increases during this period (stagnant factor).
As for venous pressure in hypertension, it usually turns out to be within normal limits, increases only with heart failure.True, some patients can also be found in the early stage of the disease, several increased values of venous pressure, which even led to the assumption 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, since usually interethnosis pressure is measured with a bloody way).Blood pressure in the capillaries is inaccessible to the definition.Capillaryoscopically in the nail bed, the narrowing of the arterial knees of the premapillaries and the expansion of venous knees are usually determined;Typical variability of the picture of the capillaries (“game” of them).