The most characteristic manifestation of hypertension is an increase in pressure.
Usually increased pressure with hypertension can now be installed during the pulse examination.When you feel the pulse on the radial artery, a solid impulse (p. Duru) is determined due to an increase in intra -arterial pressure and the tonic decrease in the walls of the artery.However, due to the fact that the lumen of the middle arteries of caliber with hypertension slightly decreases, the filling of the impulse changes slightly.During a graphical recording of pulse vibrations (the sphygmograms), the pulse wave is low, rounded, there is excitement from lifting and lowering (Pulsus tardus);The dracotic wave is imperceptible.
A blood pressure study by an auscultative method is still the best way to simultaneously determine systolic, diastolic and pulse pressure.In hypertension, all three values usually increase.The systolic is the most significantly enlarged;The diastolic increases to a smaller degree.
If we compare the rate of increase in the magnitude of systolic and diastolic pressure for hypertension in connection with the average values of the two pressure in normal, then the rise will be almost equal.So if we accept normal systolic pressure value, 120 mm number and 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 in relation to the two 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 systolic is increasingly increasing than diastolic (180 vs 120 and 100 against 70);If you compare with normal ratios, then the increase in the percentage is almost equal.
Often in the initial period (stage I) of hypertension there is an increase in systolic or diastolic pressure (often the first, less often the second).Maybe it depends on the original 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 force of the heart.
It is well known that reducing the elasticity of the arteries helps to increase systolic pressure (in the most pronounced form it is found with atherosclerosis of the central arteries).
In hypertension, changes in the elasticity of the walls of large vessels are reflected in an increase in impulse pressure.In the same conditions, when the heart begins to weaken, the amplitude becomes less: the systolic pressure decreases, the diastolic remains increased.
Already at the onset of the disease, there is a tendency to press reactions.Measurement of blood pressure indicates that in some patients its level does not exceed the upper limit of the age rate, but obtained by size measurement is higher than usual for a person, while in others it exceeds the upper limits of the age rate.Increased pressure with hypertension is observed under the influence of various effects - mental, emotional, reflex - and maintained at an elevated level of several minutes to several hours.
The first dimension usually gives higher numbers (random pressure) than multiple measurements made after 5-10-15 minutes.The difference between the amount of accidental and basic pressure is indicated by "additional pressure";Its value in people suffering from hypertension is much more than healthy ones.The main pressure obtained in the conditions of examination of the basic exchange is considered to be the main (ie 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 called "almost basic 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 nerve, which regulates the blood pressure of the apparatus.Experience has shown that in patients 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 influence of the press of certain nervous influences, it should be noted that the most urban stimulus is the word.Therefore, it will not be exaggeration to say that the impact of the second signaling system to the largest extent affects the level of high pressure for hypertension and in the people predisposed to it.
Hypertension's high pressure samples
They tried to determine the tendency to hypertension by reflex irritation.In this regard, special attention was paid to the so -called cold sample.In the study after a short rest period, the blood pressure is measured in a supine position, then the brush on the other hand is immersed at 4 ° per minute;During the immersion and then every 30 seconds the level is measured while for rent.The increase in systolic pressure is more than 20 mm Hg.Art., Diastolic with more than 15 mm Hg.Art.Serves as an indicator for increasing the reactivity of the press.The persons who found it were called "hyperreactions" who did not find - "Hippoorectors".Healthy people are 15%hyperreactors.
The cold sample received a controversial assessment.In the pressing effect with this sample, the conditions under which the sample is performed play a big role.The pressing reaction of the cold in a person who is warm due to a decreased tone of his vessels is a lower than that of the same person in conditions of a cool outside temperature.The reflex reaction to the cold depends on the usual temperature influences, the profession, the living conditions.It is well known that people are used to the temperature factor.For hardened people, the cold test can be weak and in cold people, it can be strongly pronounced.
The cold sample is based on the reflex reaction of the vasomotor center in response to a sudden thermal (and partial pain) irritation of the periphery.The cold reaction of the cold weakens after drinking alcohol, bromine, barbiturates.
Sometimes the answers to the cold sample are paradoxical: increased pressure in hypertension does not appear and sometimes even decreases.
It is interesting to compare this data to the results of blood pressure determination after the influence of heat.When you warm your hands in people suffering from hypertension, it is often not a decrease, but an increase in blood pressure (a hand lowered in warm water does not blush, but becomes pale).Therefore, cold and heat can sometimes cause the same vasoconstrictor effect.
Temperature effects can hardly be used as a method of assessing the reactivity of the apparatus, which regulates the increased pressure in hypertension, as they do not reflect the specifics of the disorders that underlie hypertension.Vascular samples are available using pharmacological agents.One of them is a trinitrate glycerol sample.After taking 2 drops of trinitrate glycerol (under tongue), pressure (systolic and diastolic) decreases significantly.The reduction is more pronounced in people with a sharp high pressure in hypertension.It is particularly significantly reduced by unstable blood pressure;Sometimes such a decrease in persistent hypertension is observed.In the late stages of hypertension (with the development of arteriolosclerotic changes in the kidney), the nitroglycerin test gives a slight reduction in the hypertension indicator that can be used to diagnose kidney forms (or stages) of hypertonic conditions.
The same results (the effect of the depressor) give a test with inhalation of isamillenetrite.Glycerin Trinitrate, like isamillenetrite, acts mainly through central vascular devices, thus characterizing the increased excitability of these hypertension centers.
Sodium test was somewhat widespread.The studied person in bed gives amil sodium 0.2 g every hour 3 times;The blood pressure is measured before the drug is obtained and every half hour after taking it (within 3 hours).The difference between the original and the lowest level determines the value of the depressor effect.After taking the second powder, sleep usually occurs.Usually sodium amital helps reduce blood pressure not only in the first hours, but also in the coming days, sometimes even a few days;The patient's ability is improving.However, such an effect is not always observed: some patients have an intolerance to the drug.
Unlike the nitrite test, which causes a violent pressure drop when sodium sodium is sodium, it gradually decreases.The degree of decrease in its intake is particularly significant at the onset of the disease.In the late period, in the presence of arteriolosclerotic changes in the kidney, the decrease is usually small or absent.
As the effect of the barbiture is undoubtedly the central, the sodium test with amal is characterized by the condition of the instrument -regulatory pressure in the cortical and subcortical regions.When using different doses of the drug (small and large), it is possible to evaluate the phase conditions of vasopressor nerve centers in blood pressure (sometimes large and small doses give the same effect, or small doses have a depressive effect, more reported by large doses).
In addition to the samples based on the action of the depressor, there are many prescription samples -with breathing stopping, inhalation of carbon dioxide, taking phenamin, but they are not deprived of negative effects on the condition of the patients, although they are probably less than determining the inclination of hypertension in the early stage and in its early stage.
After finding a tendency to have a short -term increase in blood pressure in a particular person, one should not immediately diagnose hypertension and even more so to inform the studies of it.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 (transitional phase).The more difficult in the neuropsychiatric conditions are the conditions of the patient, the more prolonged and more frequent are periods of increased pressure in hypertension and periods of normal level of the shorter and more.Of great importance are therapeutic measures, compliance with the regime.Under the influence of rest and treatment in the original transition phase of hypertension with a benign course, the indicator often decreases to a long time.
Increasingly, the increasing tendency to increase pressure during hypertension and the maintenance of its pathological level shows the more current development of the disease, which passes into the second stage.In Phase A, a phase II is instructed blood pressure (labile phase).Its level can hesitate in large limits.Under rest, it is reduced by a short 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 prolonged reduction of the indicator to the norm can be achieved.
During the day, blood pressure with hypertension can vary significantly.In the morning it is usually more nine than in the evening.After eating it increases slightly, and then gives a significant reduction.During the night's sleep decreases with hypertension sharper than in healthy ones.
As the disease progresses, blood pressure is more healthy at a high level (phase B II stage, stable).It is true that at this stage there are periods of reduction of moments.Sometimes remission occurs under the influence of prolonged therapy for a very long time.Usually this phase differs with stubborn and high hypertension.Depressor tests at this stage show the functional nature of high pressure in hypertension.
In Stage III, blood pressure is usually resistant.Hypertension is supported by a number of factors, among which the kidney participation is undoubtedly.However, with a decrease in the excitability of vasopressor centers in brain strokes or under the influence of heart failure (the appearance of decompensation on the soil of the contractile function of the hypertrophied heart) is noted a decrease in blood pressure.Moderate heart failure does not affect the level of the indicator much;Sometimes it even increases during this period (stagnant factor).
As for venous pressure in hypertension, it usually turns out to be normal, increases only in heart failure.It is true that some patients can also be detected in the early stages of the disease, several elevated venous pressure values, which even led to the assumption of the "center of the abnormal", resulting in the tone of the venous walls (however, we are unable to judge the latter, since the interethnic pressure is usually measured.The blood pressure in the capillaries is inaccessible to the definition.Capillaroscopic in the nails, narrowing the arterial knees of the premapillars and the expansion of the venous knees is usually determined;Typical volatility of capillaries ("play" from them).