The most characteristic manifestation of hypertension is increased blood pressure.
High blood pressure in hypertension can usually be established by examining the pulse.When palpating the pulse in the radial artery, a hard pulse (p. durus) is determined, which is caused by an increase in intra-arterial pressure and tonic contraction of the arterial walls.However, due to the fact that the lumen of a medium-sized artery during hypertension decreases slightly, the filling of the pulse changes little.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 barely noticeable.
The study of blood pressure using the auscultatory method remains the best way to simultaneously determine systolic, diastolic and pulse pressure.In hypertension, all three values are usually elevated.Systolic increases more significantly;The diastolic increases to a lesser extent.
If we compare the percentage increase in systolic and diastolic pressure in hypertension in relation to the average values of both pressures under normal conditions, the increase will be almost equal.So if we take 120 mm Hg as 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.(minimum), the increase compared to the norm in relation to both values will be almost the same (90 versus 70 and 160 versus 120).With a reading of 180/100 mmHg.Art.At first glance, it seems that the systolic increases much more significantly than the diastolic (180 vs. 120 and 100 vs. 70);If we compare it with normal ratios, the increase in percentage terms 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 this depends on the initial level before the disease (each person is individual).
The relationship between diastolic and systolic pressure is influenced by:
- degree of elasticity of the walls of the large arteries,
- Contractile force of the heart.
It is well known that a decrease in the elasticity of the arteries contributes to an increase in systolic pressure (in its most pronounced form, this occurs with atherosclerosis of the central arteries).
In hypertension, changes in the elasticity of the walls of the great vessels are observed, which is reflected in an increase in pulse pressure.Under the same conditions, when the heart begins to weaken, the amplitude decreases: the systolic pressure decreases, the diastolic pressure remains elevated.
Already at the beginning of the disease there is a tendency to pressor reactions.Measurement of blood pressure 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 given person, while in others it exceeds the upper limit of the age norm.Increased pressure in hypertension is observed under the influence of various influences (mental, emotional, reflex) 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 random and main pressure value is called “additional pressure”;Its value in people suffering from hypertension is significantly higher than in healthy people.The main pressure is considered to be the pressure obtained during the basal metabolic rate study (i.e., in bed, in the morning after sleeping, on an empty stomach).The smallest value of the indicator after repeated measurements under normal circumstances is conventionally called "near-main pressure".
The “additional pressure” undoubtedly expresses the degree of mental (emotional) excitement or tension of the patient at this 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 greater than in individuals who have not shown a tendency to develop hypertension.
When comparing the degree of pressor influence of certain nervous influences, it should be noted that the most acute stimulus is the word.Therefore, it would not be an exaggeration to say that the level of high blood pressure in hypertension and in people predisposed to it is more influenced by influences through the second signaling system.
Testing for high blood pressure in hypertension.
They also tried to determine the tendency to hypertension through reflex irritations.In this sense, special attention was paid to the so-called cold test.After a short rest period, the subject's blood pressure is measured in the supine position, then the other hand is immersed for one minute in water at a temperature of 4°;at the time of immersion and then measure the level every 30 seconds until level.An increase in systolic pressure of more than 20 mmHg.Art., diastolic in more than 15 mm Hg.Art.It serves as an indicator of greater pressor reactivity.The people who discovered it were called “hyperreactors”, those who did not find it were called “hyperreactors”.Among healthy people, hyperreactors represent 15%.
The cold test received mixed reviews.The conditions under which the test is performed play an important role in the pressor effect of a given test.The pressor reaction to cold in a person who is hot, due to the decreased tone of his blood vessels, is less than in the same person in conditions of colder outside temperature.The reflex reaction to cold depends on the usual influences of temperature, profession and living conditions.It is well known that people become addicted to the temperature factor.In hardened people, the cold test may be weak, but in cold-sensitive people it may be strong.
The cold test is based on the reflex reaction of the vasomotor center in response to thermal (and partly painful) stimulation suddenly provoked in the periphery.The pressor reaction to cold is weakened after taking alcohol, bromine and barbiturates.
Sometimes responses to a cold test are paradoxical: high blood pressure does not occur in hypertension and sometimes even decreases.
It is interesting to compare these data with the results of blood pressure determination after exposure to heat.When warming the 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 pale).Consequently, cold and heat can sometimes produce the same type of pressor vasoconstrictor effect.
Temperature effects can hardly be used as a method to assess the reactivity of the apparatus that regulates high blood pressure in hypertension, because they do not reflect the specific characteristics 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 decrease is more pronounced in people with very high blood pressure due to hypertension.The reduction is especially significant in case of unstable blood pressure;Such a decrease is sometimes observed in persistent hypertension.In the later stages of hypertension (with the development of arteriolosclerotic changes in the kidneys), a nitroglycerin test produces a slight decrease in hypertension, which can be used to diagnose renal forms (or stages) of hypertensive conditions.
The same results (depressant effect) are obtained by a test with inhalation of isoamyl nitrite.Glycerol trinitrate, like isoamyl nitrite, acts mainly through central vasomotor devices, characterizing increased excitability of these centers in hypertension.
The sodium amytal test has gained some popularity.The subject, who is in bed, is administered sodium amytal 0.2 g every hour 3 times;Blood pressure is measured before administering the medication and every half hour after taking it (for 3 hours).The difference between the initial and lowest levels determines the magnitude of the depressant effect.After taking the second powder, you usually fall asleep.Normally, sodium amytal helps reduce blood pressure not only in the first few hours, but also in the following days, sometimes even for several days;improves patient well-being.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, when tested with sodium amytal it decreases gradually.The degree of decrease after taking sodium amytal is especially significant at the beginning of the disease.In the latter 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 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 by blood pressure the phase states of the vasopressor nervous centers (sometimes large and small doses produce the same effect, or small doses have a more different depressing effect than large doses).
In addition to tests based on depressant action, many tests based on pressor action have been proposed: stopping breathing, inhaling carbon dioxide, taking phenamine, but they do not cease to have a negative effect on the condition of patients, although probably no less determine the tendency to hypertension in its early stage and in the so-called premorbid state.
Having discovered a tendency to short-term increases in blood pressure in a particular person, you should not immediately make a diagnosis of hypertension, much less inform the examinee about it.Under favorable environmental conditions, pressor reactions can disappear completely.
High blood pressure according to the stage of hypertension.
The increase in pressure in the early stages of hypertension occurs only periodically (transient phase).The more difficult the patient's living conditions are in neuropsychic terms, the longer and more frequent the periods of high blood pressure in hypertension are, and the periods of normal levels are shorter and rarer.Treatment measures and compliance with the regimen are of great importance.Under the influence of rest and treatment in the initial transient phase of hypertension with its benign course, the indicator often decreases to normal over a long period.
An increasingly persistent tendency to increase blood pressure during hypertension and the preservation of its pathological level indicates further development of the disease, moving to stage II.In phase A of stage 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 does not remain at this level for a long time.However, under the influence of treatment, a long-term decrease in the indicator can be achieved until it normalizes.
During the day, blood pressure with hypertension can fluctuate widely.In the morning it is usually lower than in the afternoon.After eating, it increases slightly and then decreases significantly.During night sleep, it decreases more sharply in hypertension than in healthy people.
As the disease progresses, blood pressure becomes more firmly established at a high level (stage II phase B, stable).It is true that even at this stage there are sometimes periods of decline.Sometimes remission occurs under the influence of long-term therapy for a fairly long period.However, this phase is usually characterized by persistent and elevated hypertension.Depressant tests at this stage indicate the functional nature of high blood pressure in hypertension.
In stage III, blood pressure is usually persistently elevated.Hypertension is maintained by a series of factors, among which the involvement of the kidney undoubtedly stands out.However, with a decrease in the excitability of the vasopressor centers during a stroke or under the influence of heart failure (the appearance of decompensation due to excessive strain on the contractile function of the hypertrophied heart), a decrease in blood pressure is observed.Moderate heart failure has little effect on the level of the indicator;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 found, which even led to the assumption of excitation of the "venomotor center", as a result of which the tone of the venous walls increases (however, we cannot judge the latter, since intravenous pressure is usually measured in blood).Blood pressure in the capillaries is difficult to determine.Capillaroscopically, a narrowing of the arterial curves of the precapillaries and an expansion of the venous curves are usually determined in the nail bed;Hair pattern variability (“game” of them) is typical.