The most characteristic manifestation of hypertension is an increase in pressure.
Usually, increased hypertension pressure can already be installed when examining the pulse.When feeling the pulse in the radial artery, a solid pulse (p. Durus) is determined, due to an increase in intra -arterial pressure and the tonic reduction of the artery walls.However, due to the fact that the lumen of the medium -caliber arteries with hypertension decreases slightly, the pulse filling changes little.During the graphical recording of pulse fluctuations (in the sphigmogram), the pulse wave is low, rounded, has an emotion of elevation and descent (pulsus tardus);The dichrotic wave is discreet.
The study of blood pressure by the auscultative method is still the best way to simultaneously determine systolic, diastolic and pulse pressure.With hypertension, all three values usually increase.The systolic increases significantly;Diastolic increases to a lesser extent.
If we compare the percentage of increasing the magnitude of systolic and diastolic pressure to hypertension in relation to the average pressure values in the norm, the increase will be almost equal.Therefore, if we consider a normal value for systolic pressure a number of 120 mm and for diastolic pressure - 70 mm hg.Art., Then to a blood pressure equal to 160 mm hg.Art.(maximum) and 90 mm hg.Art.(Minimum), an increase against the standard compared to both values will be almost the same (90 compared to 70 and 160 compared to 120).With an indicator of 180/100 mm hg.Art.At first glance, it seems that the systolic is increasingly increased than the diastolic (180 versus 120 and 100 versus 70);If you compare with normal proportions, the increase in the percentage will be almost the same.
Often, in the initial period (stage I) of hypertension, there is an increase in systolic or diastolic pressure (usually the first, less often the second).Perhaps it depends on the initial level it has before the disease (each person individually).
The proportion between diastolic and systolic pressure affects:
- The degree of elasticity of the walls of great 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, is found in atherosclerosis of the central arteries).
With hypertension, changes in the elasticity of the walls of the 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 lower: the systolic pressure decreases, the remaining diastolic ones increased.
At the beginning of the disease, a inclination for press reactions is observed.Blood pressure measurement shows that in some patients their level does not go beyond the upper limit of age, but obtained by measuring the size is higher than the usual for a particular person, while in others it exceeds the upper limits of the age standard.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 provides higher numbers (random pressure) than repeated measurements performed after 5-10-15 minutes.The difference between the amount of random and basic pressure is indicated by "additional pressure";Its value in people who suffer from hypertension is much higher than in healthy.The main pressure obtained under the conditions of the main exchange study is considered the main (ie in bed, in the morning after sleep, with an empty stomach).The lowest indicator value after repeated measurements in the usual environment is conditionally called "almost the main pressure".
“Additional pressure”, no doubt, expresses the degree of excitement or mental tension (emotional) of the patient at the moment and the degree of excitability of his nervous, which regulates the blood pressure of the device.Experience shows that, in the pre -stagepertonic period in patients, the additional pressure value is generally more significant than in people who have not found a tendency to develop hypertension.
Comparing the degree of influence of the presidingman of certain nerve influences, it should be noted that the clearest stimulus is the word.Therefore, it will not be an exaggeration to say that the impact of the second signaling system mostly affects the level of increased pressure for hypertension and the people predisposed to it.
Samples for increased pressure with hypertension
They tried to determine the inclination of hypertension by reflex irritation.In this sense, special attention was paid to the cold and so cold sample.In the studied after a short rest period, blood pressure is measured in a lying position, so the brush of the other hand is immersed at a temperature of 4 ° by one minute;At the time of immersion and then every 30 seconds, the level is measured until renting.An increase in systolic pressure is greater than 20 mm hg.Art., Diastolic in more than 15 mm Hg.Art.Serves as an indicator of an increase in pressing reactivity.The faces that discovered him were called "hyper -rearators", which they did not find - "hypermakers".Among healthy people, hyper -shares are 15%.
The cold sample received a contradictory evaluation.In the pressing effect, with this sample, the conditions under which the sample is performed play an important role.A pressing reaction to the cold in a hot person due to a small tone of their vessels is lower than that of the same person in colder outdoor conditions.The reflex reaction to the cold depends on the usual influences of temperature, in the profession, on 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 cold -sensitive people, can be strongly expressed.
The cold sample is based on the reflex reaction of the vasomotor center in response to a thermal (and partially pain) irritation caused in the periphery.The pressing reaction to the cold weakens after taking alcohol, bromine and barbiturgical.
Sometimes the answers to the cold sample end up being paradoxical: increased pressure in hypertension does not occur and occasionally decreases.
It is interesting to compare this data with the results of the determination of blood pressure after the influence of heat.When heating hands on people who suffer from hypertension, it is often not a decrease, but an increase in blood pressure (a hand down in warm water does not run but pale).Therefore, cold and heat can sometimes cause the same pressing vasoconstricient effect.
The effects of temperature can hardly be used as a method for assessing the reactivity of the device that regulates increased pressure on hypertension, because they do not reflect the specificities of disorders that are underlying hypertension.Vascular samples were offered using pharmacological agents.One is a sample with a glycerol trinitrate.After taking 2 drops of glycerol trinitrate (under the tongue), the pressure (systolic and diastolic) decreases significantly.The decrease is more pronounced in people with markedly increased pressure on hypertension.Significantly decrease significantly with unstable blood pressure;Sometimes this decrease is observed with persistent hypertension.In the late stages of hypertension (with the development of arteriolosclerotic changes in the kidneys), a nitroglycerin test offers a slight decrease in the hypertension indicator, which can be used to diagnose (or stages) for shapes of hypertensive conditions.
The same results (the depressing effect) provide a test with isoamylnitrito inhalation.Glycerin trinitrate, such as isoamyllnitritra, acts mainly through central vascular devices, thus characterizing the increased excitability of these hypertension centers.
A sodium test was a little spread.The person studied in bed provides a 0.2 g sodium amilio every hour 3 times;Blood pressure is measured before the drug preparation and every half an hour after taking it (within 3 hours).The difference between the initial and lower level determines the value of the depressing effect.After taking the second powder, a dream usually occurs.Normally, sodium amaters helps reduce blood pressure not only in the early hours, but also in the following days, sometimes until several days;The good -giving of the patient improves.However, this 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 is sodium, gradually decreases.The degree of decrease in its ingestion 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 is undoubtedly central, a sodium test with an Ammal is characterized by the state of the instrument regulatory pressure in the cortical and subcortical regions.By using various doses of the drug (small and large), it is possible to judge the phase conditions of the vasopressive nerve centers for blood 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 the samples based on depressing action, there are many samples based on pressing action - with respiratory arrest, inhalation of carbon dioxide, taking phenamine, but are not devoid of negative effects on patients' condition, although they are probably no less than determining the slope of hypertension at their early stages and more parallel state.
Having discovered an inclination to increase the short term in blood pressure in a particular person, it should not immediately diagnose hypertension, and even more to inform the examination over it.Under favorable environmental conditions, instant reactions can completely pass.
Increased pressure, depending on the hypertension stage
Increased pressure at the early stage can be periodically (transient phase).The harder in the neuropsychiatric terms of the patient conditions, the longer and the more frequent are periods of increased pressure in hypertension and periods of the normal level of their lower and the rare.Of great importance are therapeutic measures, compliance with the regime.Under the influence of rest and treatment on the initial transient phase of hypertension with a benign course, the indicator usually decreases for a long time.
An increasingly stubborn inclination to increase pressure during hypertension and preservation of its pathological level indicates the additional development of the disease that goes to the second stage.In phase A of stage II, blood pressure is instructed (Labil phase).Its level can float into large limits.Under the influence of rest, it is shortly reduced 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 for the norm can be achieved.
During the day, hypertension blood pressure can vary widely.In the morning, it is usually smaller than at night.After eating, it increases a little, then gives a significant decrease.During night sleep, it decreases with hypertension more sharply than in healthy.
As the disease advances, blood pressure is more firmly defined at a high level (stage of stable phase B II).It is true that at this stage, periods of decrease are sometimes observed.Sometimes remission occurs under the influence of prolonged therapy for a long time.However, usually this phase differs stubborn and high hypertension.Depressing tests at this stage indicate the functional nature of increased pressure on hypertension.
In stage III, blood pressure is usually resistant.Hypertension is supported by several factors, among which there is no doubt 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 soil decompensation of the contractile function of a hypertrophied heart), a decrease in blood pressure is observed.Moderate heart failure is not very reflected at the level of the indicator;Sometimes it even increases during this period (stagnant factor).
As for venous pressure on hypertension, it usually stays within normal limits, increases only with heart failure.It is true that some patients can also be found at the early stage of the disease, several increased values of venous pressure, which even led to the supposition of the “venomotor center” as a result of which venous wall tone increases (however, we are unable to judge the latter, since usually interettnosis pressure is measured in bloodstream).Blood pressure in capillaries is inaccessible for definition.Capillary in the nail bed, the narrowing of the pre -chapillar arterial knees and the expansion of venous knees are generally determined;Typical variability of the image of the capillaries ("game").