The most characteristic manifestation of hypertension is an increase in pressure.
Usually, increased pressure with hypertension can be installed already when examining the pulse.When it comes to the pulse in the radial artery, the solid pulse (pHowever, due to the fact that the average arterial artery lumen with hypertension decreases slightly, the pulse filling slightly.During the graphic recording of the pulse swing (on the sphigmogram), low pulse waves, round, have the pleasure of lifting and offspring (pulsus tardus);Didrotic waves do not make sense.
The study of blood pressure by auscultative methods is still the best way to simultaneously determine systolic, diastolic and pulse pressure.With hypertension, three -three values usually increase.The most increasing systolic;Diastolic increase to a lower level.
If we compare the percentage of increasing the magnitude of systolic and diastolic pressure for hypertension in relation to the average value of the two pressure in the norm, then the increase will be almost the same.So, if we take normal value to systolic pressure of several 120 mm, and for diastolic pressure - 70 mm Hg.Art., Then on blood pressure equal to 160 mm Hg.Art.(maximum) and 90 mm Hg.Art.(minimum), the increase in the norms in relation to both values will be almost identical (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 increasing from diastolic (180 compared to 120 and 100 compared to 70);If you compare it to a normal ratio, then the percentage increase is almost the same.
Often in the early stages (stage I) hypertension, there is an increase in systolic or diastolic pressure (usually the first, less frequently the second).It may depend on the early stages of the disease (each person individually).
The ratio between diastolic and systolic pressure affects:
- The elasticity of the large artery wall,
- The power of the scratic heart.
It is known that the decrease in arterial elasticity helps to increase systolic pressure (in the most significant form it is found in central arterial atherosclerosis).
With hypertension, changes in large vessel wall elasticity are observed, reflected in increased pulse pressure.In the same situation, as the heart begins to weaken, the amplitude becomes less: the systolic pressure decreases, the diastolic still increases.
Already at the beginning of the disease, the tendency to suppress the reaction was observed.The measurement of arterial pressure shows that in some patients the level does not exceed the limit of age norms, but is obtained when measuring its size higher than normal for certain people, while in others -it exceeds the upper limit of age.Increased stress with hypertension is observed under the influence of various effects - mental, emotional, reflex - and stored at a higher level than a few minutes to several hours.
The first dimension usually gives a higher number (random pressure) than recurrent measurements taken after 5-10-15 minutes.The difference between the amount of random and basic pressure is indicated by "additional pressure";Its value in people suffering from hypertension is much greater than the healthy.The main pressure obtained in the state of the main exchange study is considered the main one (that is, in bed, in the morning after sleep, on an empty stomach).The smallest value of the indicator after repeated measurements in the common environment is called "almost the main pressure."
The "additional stress" is no doubt expressing the level of mental (emotional) or the patient's tension at this time and the level of nerves, which controls the blood pressure of the apparatus.Experience shows that during the pregnancy period in patients, additional pressure values are usually more important than those who do not find a tendency to develop hypertension.
Comparing the level of pressor of certain nerve influences, it should be noted that the sharp stimulation is the word.Therefore, it will not be too much to say that the effect of the second signal system at the largest level affects the level of pressure increases for hypertension and on people exposed to it.
Sample for increased pressure with hypertension
They try to determine the tendency for hypertension by reflex irritation.In this case, special attention has been paid to cold samples.In which it is studied after a short break, blood pressure is measured in a lying position, then the other hand brush is soaked at 4 ° for one minute;At the time of immersion and then every 30 seconds, the level is measured until the lease.Increased systolic pressure is more than 20 mm Hg.Art., Diastolic by more than 15 mm Hg.Art.It acts as an indicator of increased pressure reactivity.The face that found it called "hyperreactors", which could not find - "hyporeactors."Among healthy people, hypertics is 15%.
Cold samples receive conflicting assessments.In an urgent effect, with this sample, the situation in which the sample plays a major role.The urgent reaction to the cold in a warm person, as the tone reduced from his vessel is lower than the same person in cooler temperatures.Reflex reactions to cold depends on the influence of normal temperatures, on the profession, living conditions.It is known that people are used for temperature factors.For hard -working people, cold tests can be weak, and in people who are sensitive to cold, they can be stated strongly.
Cold samples are based on the vasomotor center reflex reaction in response to thermal irritation (and some pain) that arrives on the edge.The urgent reaction to the cold weakens after consuming alcohol, bromin, barbiturates.
Sometimes the answers to cold samples turn into paradox: increased pressure in hypertension does not occur, and sometimes it decreases.
It is interesting to compare this data by determining blood pressure after heat effect.When heating up to people suffering from hypertension, it often does not decrease, but increased blood pressure (hands are lowered into warm water not red, but turn pale).Therefore, cold and heat can sometimes cause the same vasoconstrictor effect.
The effect of temperature should not be used as a method to evaluate the reactivity of apparatus that controls increased pressure in hypertension, as it does not reflect the specific disorders of hypertension.Vascular samples use pharmacological agents offered.One of them is a sample with trinitrate glycerol.After taking 2 dots of trinitrate glycerol (under the tongue), pressure (systolic and diastolic) decreases significantly.This decline is more significant in people with increasing pressure in hypertension.Mainly decreases with unstable blood pressure;Sometimes such a decline is observed with persistent hypertension.In the final stages of hypertension (with the development of arteriolosclerotic changes in the kidneys), nitroglycerin tests give a slight decrease in hypertension indicators, which can be used to diagnose kidney form (or stage) hypertension.
The same result (depressor effect) provides tests with inhalation of isoamilnitrite.Glycerin trinitrate, such as isoamilnitrite, acts primarily through central vascular devices, thus characterizing the central excitement of these centers for hypertension.
The sodium test is a bit spread.The person studied on the bed gives the sodium amil 0.2 g every hour 3 times;Arterial pressure is measured before the drug preparation and every half hour after taking it (within 3 hours).The difference between the early and the smallest level determines the value of the depressor.After taking the second powder, dreams usually occur.Usually, amital sodium helps reduce blood pressure not only in the first time, but also in the next day, sometimes even a few days;The well -being of the patient improved.However, such effects are not always observed: some patients are intolerant of drugs.
Unlike nitrite tests, which causes pressure drop, when sodium sodium is sodium, it decreases gradually.The degree of decrease in its intake is very important 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.
Due to the effects of barbiturates, there is no doubt, is the center, the sodium test with the ammal is characterized by pressure -pressure in the cortical and subcortical areas.When using a variety of doses of the drug (small and large), it is possible to evaluate the vasopressor nerve central phase condition with arterial pressure (sometimes large and small doses have the same effect, or small doses have depression effects, different from large doses).
In addition to samples based on depressor action, there are many samples based on urgent actions - with stopping stops, carbon dioxide inhalation, taking phenamine, but they have no negative effect on the patient's condition, although they may be less than determining the tendency of hypertension in the early stages and in the absorbed premorbid state.
After discovering a tendency for short blood pressure increases in a particular person, one cannot immediately diagnose hypertension, and more to inform them of it.Under favorable environmental conditions, immediate reactions can be completely passed.
Increased pressure depends on the level of hypertension
Increased pressure in the early stages can only be periodically (temporary phase).The more difficult in the term neuropsychiatric conditions of the patient, the more and more frequent is the period of increased pressure in hypertension, and the shorter and rare normal period of normal.The most important is the therapeutic step, compliance with the regime.Under the influence of rest and treatment in the temporary phase of early hypertension with benign courses, indicators often decrease to a long time.
The increasingly stubborn tendency to increase stress during hypertension and the preservation of its pathological level indicates further development of the disease that occurs to the second stage.In phase A stage II, arterial pressure is directed (phase labil).The level can change in large limits.Under the influence of rest, it is reduced by a short time to a nearly normal level, though it has not been stored at this level for a long time.Under the influence of treatment, however, prolonged decline in the indicator to the norm can be achieved.
During the day, blood pressure with hypertension can vary.In the morning it is usually lower than in the evening.After eating, it increases slightly, then provides a significant decrease.During the night's sleep, it decreases with sharper hypertension than healthy.
As the disease progresses, stronger blood pressure is prescribed at a high level (phase B II level, stable).True, at this stage, the decline period is observed at time.Sometimes forgiveness occurs under the influence of prolonged therapy for a long time.However, this phase is usually different from stubborn and high hypertension.Depressor tests in this stage show the functional properties of increased pressure in hypertension.
In stage III, blood pressure is usually resistant.Hypertension is supported by several factors, including no doubt in the participation of kidney.However, with a decrease in the joy of the vasopressor center in the brain stroke or under the influence of heart failure (the decomposition of the soil of the hypertrophy of heart contraction), a decrease in blood pressure is observed.Moderate heart failure is not much reflected at the indicator level;Sometimes it increases during this period (stagnant factors).
For vein pressure in hypertension, it usually turns out to be within normal limit, only increases with heart failure.True, some patients are also available in the early stages of the disease, some increased vein pressure value, which even leads to the assumption of "venomotor center", resulting in increased vein wall tone (however, we cannot evaluate the last, as usually interethnosis pressure is measured by bleeding).The blood pressure in the capillaries is not accessible by the definition.Capillaryoscopically in the nail bed, narrowing of the premapillaries artery and venous knee development is usually determined;Typical variability of capillaries (their "games").