The most characteristic manifestation of hypertension is an increase in pressure.
In general, the increase in 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 walls of the artery.However, due to the fact that the light of the average caliber arteries with hypertension decreases slightly, the filling of the pulse changes little.During the graphic recording of pulse oscillations (in the sphygmogram), the pulse wave is low, rounded, has an emotion of elevation and descent (late pulse);The dicrotic wave is discreet.
The study of blood pressure by auscultic method remains the best way to simultaneously determine the systolic, diastolic and pulse pressure.With hypertension, the three values generally increase.Systolic increases more significantly;The diastolic increases to a lesser extent.
If we compare the percentage of increasing the magnitude of systolic and diastolic pressure for hypertension in relation to the average values of both pressure in the standard, then the increase will be almost the same.So, if we take a normal value for systolic pressure of 120 mm, and for diastolic pressure - 70 mm Hg.Art., Then at blood pressure equal to 160 mm Hg.Art.(maximum) and 90 mm Hg.Art.(minimum), an increase against the norm in relation 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 systolic increases more and more than diastolic (180 versus 120 and 100 versus 70);If compared to normal relations, the increase in the percentage is almost the same.
Often in the initial period (stage I) of hypertension, there is an increase in systolic or diastolic pressure (often the first, less frequently the second).Perhaps it depends on the initial level you have before the disease (each person individually).
The relationship between diastolic and systolic pressure affects:
- The degree of elasticity of the walls of the large arteries,
- Socratic power of the heart.
It is well known that a decrease in the elasticity of the arteries helps increase systolic pressure (in the most pronounced way it 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: systolic pressure decreases, diastolic remains increase.
Already at the beginning of the disease, there is a inclination to press reactions.The measurement of blood pressure shows that in some patients their level does not go beyond the upper limit of the age standard, but is obtained when measuring size is higher than usual for a given person, while in others it exceeds the upper limits of the age standard.A higher pressure with hypertension is observed under the influence of several effects (mental, emotional, reflexes) and is maintained at an increased level of several minutes to several hours.
The first dimension generally provides higher numbers (random pressure) than repeated measurements taken after 5-10-15 minutes.The difference between the amount of random and basic pressure is indicated with "additional pressure";Its value in people suffering from hypertension is much greater than in healthy ones.The main pressure obtained in the conditions of the study of the main exchange is considered the main one (that is, in bed, in the morning after sleep, with an empty stomach).The smallest value of the indicator after repeated measurements in the usual environment is conditionally called "almost the main pressure."
The "additional pressure" undoubtedly expresses the degree of mental excitation (emotional) or patient tension at this time and the degree of excitability of his nervous, which regulates the blood pressure of the device.Experience shows that in the pregnout period 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 presor of certain nerve influences, it should be taken into account that the most acute stimulus is the word.Therefore, it will not be an exaggeration to say that the impact of the second signaling system to the greater extent affects the level of greater pressure for hypertension and in people predisposed to it.
Samples for higher pressure with hypertension
They tried to determine the inclination to hypertension for reflex irritations.In this sense, special attention was paid to the cold sample of SO.In the one studied after a short rest period, blood pressure is measured in a liar position, then the brush of the other hand immerses itself at a temperature of 4 ° for a minute;At the time of immersion and then every 30 seconds, the level is measured until rent.An increase in systolic pressure is more than 20 mm Hg.Art., Diastolic for more than 15 mm Hg.Art.It serves as an indicator of an increase in presor reactivity.The faces that discovered it were called "hyperreactors", who did not find: "hyporeactors."Among healthy people, hyperreactors are 15%.
The cold sample received a contradictory evaluation.In the pressing effect, with this sample, the conditions in which the sample is carried out play an important role.A pressing reaction to cold in a warm person, due to a small tone of their vessels, is less than that of the same person in colder external temperature conditions.The reaction reflects the cold depends on the usual temperature influences, on the profession, the living conditions.It is well known that people are accustomed to the temperature factor.For hardened people, a cold test can be weak, and in cold -sensitive people, it can be expressed strongly.
The cold sample is based on the reflex reaction of the Vasomotor Center in response to an irritation of the thermal periphery (and partially painful).The pressing reaction to the cold weakens after drinking alcohol, bromine, barbiturates.
Sometimes, the responses to the cold sample turn out to be paradoxical: there is no greater pressure in hypertension, and occasionally even decreases.
It is interesting to compare this data with the results of the determination of blood pressure after the influence of heat.By heating 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 pressing vasoconstrictor.
The effects of temperature can hardly be used as a method to evaluate the reactivity of the apparatus that regulates the increase in hypertension pressure, because they do not reflect the details of the disorders that underlie hypertension.Vascular samples were offered with pharmacological agents.One of them 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 abruptly greater pressure in hypertension.Particularly decreasing significantly with unstable blood pressure;Sometimes, such decrease is observed with persistent hypertension.In the last stages of hypertension (with the development of arteriological changes in the kidneys), a nitroglycerin test gives a slight decrease in the hypertension indicator, which can be used to diagnose renal forms (or stages) of hypertensive conditions.
The same results (the depressing effect) give an isoamilnitrito inhalation test.Glycerin trinitrate, such as isoamilnitrite, acts mainly through central vascular devices, thus characterizing the greatest excitability of these centers for hypertension.
A sodium test spread something.The person studied in bed gives him an amyl of sodium 0.2 g every hour 3 times;The blood pressure is measured before the preparation of the medication and every half hour after taking it (within 3 hours).The difference between the initial and smaller level determines the value of the depressing effect.After taking the second dust, a dream is usually produced.In general, amital sodium helps reduce blood pressure not only in the first hours, but also in the following days, sometimes even several days;The patient's well improves.However, this effect is not always observed: some patients have medication intolerance.
Unlike nitrite test, which causes a violent fall in pressure, when sodium sodium is sodium, gradually decreases.The degree of decrease in its intake 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, without a doubt, is central, a sodium test with an ammal is characterized by the status of the regulatory pressure of the instrument in the cortical and subcortical regions.When using several doses of the drug (small and large), it is possible to judge the phase conditions of the nerve centers vasopressors due to blood pressure (sometimes large and small doses give the same effect, or small doses have a depressive effect, more different than large doses).
In addition to the samples based on the action of the depressor, there are many samples based on the action pressured: with a respiratory stop, carbon dioxide inhalation, taking phenamine, but they do not lack negative effects in the condition of patients, although probably not less than determine the inclination of hypertension in its early stage and in the predication state thus initiated thus.
Having discovered an inclination to the increase in short -term blood pressure in a particular person, one should not diagnose hypertension immediately, and even more to inform those examined about it.In favorable environmental conditions, instant reactions can pass completely.
Greater pressure depending on the hypertension stage
The increase in pressure in the initial stage can only be periodically (transient phase).The more difficult in neuropsychiatric terms the patient conditions, the deeper and more frequent are periods of higher pressure in hypertension and periods of the normal level of its shortest and most rare.Of great importance are therapeutic measures, compliance with the regime.Under the influence of rest and treatment in the initial transitory phase of hypertension with a benign course, the indicator often decreases to 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 (labile phase) is instructed.Its level can fluctuate in large limits.Under the influence of rest, it is reduced in 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 decrease in the standard indicator can be achieved.
During the day, blood pressure with hypertension can vary widely.In the morning it is usually lower than at night.After eating, it increases slightly, then gives a significant decrease.During night sleep, it decreases with the hypertension more abruptly than in the healthy.
As the disease progresses, blood pressure is established more firmly at a high level (phase B II, stable).It is true, at this stage, periods of decreases are sometimes observed.Sometimes, remission occurs under the influence of prolonged therapy for a long time.However, in general, this phase differs stubborn and high hypertension.Depressor tests at this stage indicate the functional nature of the increase in hypertension pressure.
In stage III, blood pressure is usually resistant.Hypertension is backed by a series of factors, among which there is undoubtedly 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 appearance of decompensation in the soil of the contractile function of a hypertrophied heart), a decrease in blood pressure is observed.Moderate heart failure is not much reflected at the indicator level;Sometimes it even increases during this period (stagnant factor).
As for venous pressure in hypertension, it is generally to be within normal limits, it increases only with heart failure.It is true that some patients can also be found at the early stage of the disease, several augmented values of venous pressure, which even led to the assumption of the "venomotor center", as a result of which the tone of the venous walls increases (however, we cannot judge the latter, since generally the interetnosis pressure is measured with a bloody shape).Blood pressure on capillaries is inaccessible for definition.Capillarcopically in the bed of the nail, the narrowing of the arterial knees of the presmapillary and the expansion of the venous knees are generally determined;Typical variability of the image of the capillaries (their "game").