The most typical manifestation of hypertension is elevated blood pressure.
Often, high blood pressure, which is high blood pressure, can be determined by checking your pulse.When palpating the pulse on the radial artery, a hard pulse (p. durus) can be identified, which is caused by increased intra-arterial pressure and tonic contraction of the arterial wall.However, because the lumen of medium-sized arteries is slightly reduced during hypertension, the filling of the pulse does not change much.When pulse fluctuations are recorded graphically (on a blood pressure chart), the pulse waves are low, rounded, and have a gentle rise and fall (bradypulse); dicrotic waves are barely noticeable.
Studying blood pressure using auscultation remains the best method for determining systolic, diastolic and pulse pressure simultaneously.In hypertension, all three values are usually elevated.Systolic blood pressure increased most significantly; diastolic blood pressure increased to a smaller extent.
If we compare the percentage increase in systolic and diastolic blood pressure in hypertensive patients with the average of both pressures under normal conditions, the increases are almost equal.Therefore, if we take 120 mmHg as the normal value for systolic blood pressure and 70 mmHg as the normal value for diastolic blood pressure.Art., then the blood pressure equals 160 mm Hg.Art.(maximum) and 90 mmHg.Art.(minimum), both values increase almost identically from the standard (90 compared to 70, 160 compared to 120).The reading is 180/100 mmHg.Art.At first glance, the increase in systolic blood pressure appears to be much more significant than that of diastolic blood pressure (180 vs. 120 and 100 vs. 70); if we compare it with the normal ratio, the percentage increases will be almost equal.
Typically, during the initial stages of hypertension (stage 1), either systolic or diastolic blood pressure increases (usually stage 1, less commonly stage 2).Maybe it depends on the baseline level before onset (everyone is an individual).
The relationship between diastolic and systolic blood pressure is affected by:
- The elasticity of the aortic wall,
- The contractility of the heart.
Decreased arterial elasticity is known to lead to increased systolic blood pressure (most notably in the form of central atherosclerosis).
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 blood pressure decreases and diastolic blood pressure remains elevated.
There is a tendency for a pressor response already early in the disease.Measuring blood pressure shows that some patients have blood pressure levels that do not exceed the upper limit of the age standard, but the values obtained during the measurement are higher than the usual levels for that particular person, while other patients have blood pressure levels that exceed the upper limit of the age standard.An increase in pressure in hypertension is observed under the influence of various influences (mental, emotional, reflex) and remains at an elevated level from minutes to hours.
The first measurement will usually give a higher number than a repeated measurement after 5-10-15 minutes (random pressure).The difference between the random pressure value and the main pressure value is called "additional pressure"; its value is significantly higher for patients with hypertension than for healthy people.Primary stress was considered to be the stress obtained during the basal metabolic rate study (i.e. in bed, in the morning after sleep, on an empty stomach).Generally, the minimum value of this indicator after repeated measurements is customarily called "almost main pressure".
"Additional pressure" undoubtedly expresses the patient's mental (emotional) arousal or tension at this time and the excitement of the nervous system that regulates blood pressure.Experience has shown that in prehypertension, the additional stress experienced by patients is usually more significant than in individuals who do not exhibit a tendency to become hypertensive.
When comparing the magnitude of the pressor effects of certain neural influences, it should be noted that the most intense stimuli were words.Therefore, it is no exaggeration to say that the high blood pressure levels of patients with hypertension and those prone to hypertension are most affected by the second signaling system.
Blood pressure check for patients with hypertension
They also attempted to determine the tendency to develop high blood pressure through reflex stimulation.In this regard, special attention is paid to so-called cold tests.After a short rest, the subject's blood pressure was measured in the supine position, and then the other hand was immersed in water at a temperature of 4°C for one minute; at the moment of immersion, the fluid level was then measured every 30 seconds until the level was stable.Systolic blood pressure increases by more than 20 mmHg.Art, diastolic blood pressure exceeds 15 mm Hg.Art.As an indicator of increased pressor responsiveness.Those who discovered it are called "super reactors" and those who did not discover it are called "sub-reactors".Among healthy people, overreactors account for 15%.
Cold testing received mixed reviews.The conditions under which the test is conducted play an important role in the boosting effect of a given test.Due to reduced vascular tone, the pressor response to cold is lower in warm individuals than in cooler external temperatures.The reflex response to cold depends on the usual temperature effects, occupation and living conditions.People are known to be addicted to the temperature factor.The cold test may be weak for someone with an aloof personality, but may be strong for someone who is sensitive to cold.
The cold test is based on the reflex response of the vasomotor center to a sudden thermal (and partly painful) stimulus evoked in the periphery.The pressor response to cold is diminished after administration of alcohol, bromine, and barbiturates.
Sometimes the results of the reaction to the cold test are contradictory: high blood pressure does not occur in high blood pressure, and sometimes it even decreases.
It is interesting to compare these data with the results of measuring blood pressure after exposure to heat.When people with high blood pressure warm their hands, their blood pressure often rises instead of falling (hands immersed in warm water do not turn red, but turn pale).Thus, cold and heat can sometimes produce the same type of pressor vasoconstrictive effect.
Temperature effects are difficult to use as a method of assessing the responsiveness of hypertensive regulatory devices because they do not reflect the specifics of hypertensive disease.Vascular testing using drugs has been proposed.One of these is a test with glyceryl trinitrate.Blood pressure (systolic and diastolic) decreased significantly after taking 2 drops of glyceryl trinitrate (sublingually).This decrease was more pronounced in individuals with acutely elevated blood pressure due to hypertension.This decrease is particularly pronounced when blood pressure is unstable; it is sometimes observed in persistent hypertension.In the later stages of hypertension (as arteriosclerotic changes develop in the kidneys), a nitroglycerin test shows a slight decrease in high blood pressure, which can be used to diagnose the renal form (or stage) of hypertensive disease.
The same results (inhibitory effect) were obtained with tests on inhalation of isoamyl nitrite.Like isoamyl nitrite, glyceryl trinitrate acts primarily through the central vasomotor apparatus, thus characterizing the increased excitability of these centers in hypertension.
The sodium amytal test has gained some popularity.The subjects were in bed and given sodium amytal 0.2g three times every hour; their blood pressure was measured before and every half hour after taking the medicine (for 3 hours).The difference between the initial level and the lowest level determines the strength of the inhibitory effect.After taking the second powder, sleep usually occurs.Typically, sodium amytal helps lower blood pressure not only in the first few hours, but also over the next several days, and sometimes even several days.The patient's health improves.However, this effect is not always observed: some patients are intolerant to the drug.
The nitrite test causes a rapid drop in pressure, while the pressure drop is gradual when tested with sodium amytal.The degree of reduction after taking sodium amytal is particularly significant in the early stages of the disease.In the later stages, when arteriosclerotic changes occur in the kidneys, there is usually little or no reduction.
Since the effect of barbiturates is undoubtedly important, tests with sodium amytal allow to characterize the status of the apparatus that regulates blood pressure in cortical and subcortical areas.When using different doses (small and large doses) of drugs, the phase state of the pressor nerve center can be judged by blood pressure (sometimes large and small doses produce the same effect, or small doses have a more obvious antihypertensive effect than large doses).
In addition to tests based on the antihypertensive effect, many tests based on the pressor effect have been proposed - stopping breathing, inhaling carbon dioxide, taking pheniramine, but they are not without a negative impact on the patient's condition, although they may equally identify the tendency to hypertension in the early stages and in the so-called premorbid state.
You should not make a diagnosis of hypertension immediately after discovering that someone has a tendency to have short-term elevated blood pressure, let alone inform the person being examined.Under favorable environmental conditions, the pressor response can disappear completely.
High blood pressure depends on the stage of hypertension
The pressure increases in early hypertension occur only periodically (transitional phases).From a neuropsychological perspective, the more difficult the patient's living conditions, the longer and more frequent the hypertensive episodes of hypertension, and the shorter and less common the episodes of normal levels.Treatment measures and adherence to the treatment plan are very important.In the early stages of a benign course of hypertension, under the influence of rest and treatment, this indicator often declines to normal over a long period of time.
The continued trend of increased blood pressure during hypertension and the maintenance of its pathological levels indicate further progression of the disease, entering the second stage.During phase A of the second phase, blood pressure is unstable (unstable period).Its levels can fluctuate within wide limits.Under the influence of rest, it will drop to near-normal levels for a short period of time, although it will not remain at this level for long periods of time.However, under the influence of treatment, this indicator can decrease to normal over the long term.
People with high blood pressure may have large fluctuations in blood pressure during the day.Temperatures are usually lower in the morning than in the evening.After eating, there is a slight increase and then a significant decrease.During nighttime sleep, people with high blood pressure experience a faster decline than healthy people.
As the disease progresses, blood pressure becomes more firmly maintained at high levels (stage II B, stable).Granted, even at this stage it sometimes goes through periods of decline.Sometimes remission occurs under the influence of long-term treatment over a considerable period of time.However, this stage is often characterized by persistent hypertension.This phase of antihypertensive drug testing demonstrates the functional nature of hypertension in hypertension.
In stage three, blood pressure usually continues to rise.Hypertension is maintained by many factors, among which the kidneys are undoubtedly involved.However, during cerebral stroke or under the influence of heart failure (decompensation due to overstraining of the systolic function of the hypertrophic heart), the excitability of the vasopressor center decreases and a decrease in blood pressure is observed.Moderate heart failure has little effect on this level; sometimes it even increases during this period (stagnation factor).
As for venous pressure in patients with hypertension, it is usually within the normal range and only increases in heart failure.Indeed, in some patients, even in the early stages of the disease, slightly elevated venous pressure values can be found, which even leads to the hypothesis of excitement of the "venomotor center" and thus an increase in the tension of the venous walls (however, we cannot judge the latter, since venous pressure is usually measured in blood).Capillary blood pressure is difficult to determine.Capillaroscopy on the nail bed often identifies narrowing of the arterial curvatures and dilation of the venous curvatures of the precapillaries; variability in capillary patterns (their "play") is typical.