The most characteristic manifestation of hypertension is an increase in blood pressure.
Usually, high blood pressure in hypertension can be determined by examining the pulse.During palpation of the pulse in the radial artery, a strong pulse (p. durus) is determined, which is caused by the increase in intraarterial pressure and the tonic contraction of the arterial walls.However, due to the fact that the lumen of a middle artery during hypertension is slightly reduced, the filling of the pulse changes slightly.When pulse fluctuations are recorded graphically (on a sphygmogram), the pulse wave is low, rounded, and has a gentle rise and fall (pulsus tardus);the dicrotic wave is hardly 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 increase is more sensitive;diastolic increases to a lesser extent.
If we compare the percentage of increase in systolic and diastolic pressure in hypertension in relation 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 a blood pressure equal to 160 mm Hg.Art.(maximum) and 90 mm Hg.Art.(minimal), the increase versus the norm relative to both values will be almost the same (90 compared to 70 and 160 compared to 120).With a reading of 180/100 mmHg.Art.at first sight it seems that the systolic has increased much more than the diastolic (180 against 120 and 100 against 70);if we compare it with normal ratios, the percentage increase will be almost equal.
Often in the initial period (phase I) of hypertension there is an increase in systolic or diastolic pressure (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 large arteries,
- the contractile force of the heart.
It is well known that a decrease in arterial elasticity contributes to an increase in systolic pressure (in its most pronounced form, this occurs with atherosclerosis of the central arteries).
In hypertension, there are changes in the elasticity of the walls of large vessels, 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 for suppressive 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 certain person, while in others it exceeds the upper limit of the age norm.The increase in pressure in hypertension is observed under the influence of various influences - mental, emotional, reflexive - and remains at an elevated level from several minutes to several hours.
The first measurement usually gives higher numbers (random pressure) than repeated measurements taken 5-10-15 minutes later.The difference between the value of the incidental pressure and the main one is defined as "additional pressure";its value in people suffering from hypertension is significantly greater than in healthy people.The main pressure is considered to be that 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 circumstances is conventionally called "almost main pressure".
"Additional pressure" undoubtedly expresses the degree of arousal or mental (emotional) 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 important than in individuals who have not shown a tendency to develop hypertension.
When we compare the degree of pressure influence of several 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 more affected by influences 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 irritations.In this regard, special attention has been paid to the so-called cold test.After a short period of rest, the subject's blood pressure is measured in a supine position, then the hand of the other hand is 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 it is level.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 reactivity of the pressor.People who found it were called "hyper-reactors", those who didn't were called "hypo-reactors".Among healthy people, hyperreactors account for 15%.
The cold test received mixed reviews.The conditions under which the test is performed play an important role in the suppression effect for a given test.The blood pressure response to cold in a warm person, due to the decrease in blood vessel tone, is lower than in the same person in conditions of a colder outside temperature.The reflex response to cold depends on common temperature influences, occupation and living conditions.It is known that people become addicted to the temperature factor.In hardened people, the cold test may be weak, but in people sensitive to cold, it may be strong.
The cold test is based on the reflex response of the vasomotor center in response to thermal stimulation caused suddenly (and partially painful) in the periphery.The pressor response to cold is weakened after taking alcohol, bromine and barbiturates.
Sometimes the answers to a cold test turn out to be paradoxical: high blood pressure does not appear in 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 you warm your 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 pales).Consequently, cold and heat can sometimes produce the same type of suppressive 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 proposed.One of them is a test with glycerol trinitrate.After taking 2 drops of glycerol trinitrate (under the tongue), blood pressure (systolic and diastolic) decreases significantly.The decline is more pronounced in individuals with high blood pressure due to hypertension.The reduction is especially important with unstable blood pressure;Sometimes such a decrease is observed in persistent hypertension.In the later stages of hypertension (with the development of arteriolosclerotic changes in the kidneys), a nitroglycerin test gives a slight decrease in hypertension, which can be used to diagnose renal forms (or stages) of hypertensive states.
The same results (depressant effect) are obtained from an isoamyl nitrite inhalation test.Glycerol trinitrate, like isoamyl nitrite, acts mainly through central vasomotor equipment, thus characterizing the increased excitability of these centers in hypertension.
The sodium amytal test has gained popularity.The subject, 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 baseline and trough levels 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 few 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, during the sodium amytal test it decreases gradually.The rate of its decrease after taking sodium amytal is especially important at the beginning of the disease.In the late period, in the presence of arteriolosclerotic changes in the kidneys, the decline is usually small or absent.
Since the effect of barbiturates is obviously central in nature, a test with sodium amytal characterizes the state of the devices that regulate blood pressure in cortical and subcortical areas.When using different doses of the drug (small and large), it is possible to judge from the blood pressure the phase states of the vasopressor nerve centers (sometimes large and small doses give the same effect, or small doses have a depressant effect that is more distinct than large doses).
In addition to tests based on depressant action, many tests based on oppressive action have also been proposed - with respiratory arrest, carbon dioxide inhalation, phenamine intake, but they are not without a negative effect on the condition of patients, although perhaps no less they determine the tendency to hypertension in its early stage and in the so-called premorbid state.
Having discovered a tendency to short-term increase in blood pressure in a certain person, you should not immediately make a diagnosis of hypertension, much less inform the person being examined about it.Under favorable environmental conditions, suppressor reactions can disappear completely.
High blood pressure depending on the stage of hypertension
The increase in pressure in the early stage of hypertension occurs only periodically (transient stage).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 rarer.Treatment measures and adherence to the regime 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 for a long period.
A more and more continuous trend towards increasing blood pressure during hypertension and maintaining its pathological level indicates the further development of the disease, moving to stage II.In phase A of phase II, blood pressure is unstable (labile phase).Its level can fluctuate within significant limits.Under the influence of rest, it decreases for a short period of time to a level close to normal, although it 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 with hypertension can fluctuate greatly.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 in hypertensive than in healthy people.
As the disease progresses, blood pressure settles more firmly at a high level (stage B of stage II, stable).True, even at this stage there are sometimes periods of its decline.Sometimes remission occurs under the influence of long-term therapy for a fairly long period.However, this stage is usually characterized by persistent and high hypertension.Depression 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 participation 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 the overload of the contractile function of the 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 the normal range and increases only with heart failure.True, in some patients, even in the early stages of the disease, slightly increased values of venous pressure can be detected, which 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, since intravenous blood pressure is usually measured).Capillary blood pressure is difficult to determine.Capillaroscopically in the nail bed, a narrowing of the arterial bends of the precapillaries and an expansion of the venous bends is usually determined;The variability of the capillary pattern (their "game") is typical.