The most characteristic manifestation of hypertension is increased blood pressure.
Typically, high blood pressure in hypertension can be established by examining the pulse.When palpating the pulse in the radial artery, a hard pulse (p. durus) is determined, caused by the increase in intra-arterial pressure and the 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 graphically recording pulse fluctuations (on a sphygmogram), the pulse wave is low, rounded, and has a smooth rise and fall (pulsus tardus);the dicrotic wave is almost imperceptible.
Studying blood pressure using the auscultatory method is still the best way to simultaneously determine systolic, diastolic and pulse pressure.In hypertension, all three values are usually elevated.Systolic increases more significantly;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 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 compared to 70 and 160 compared to 120).With a reading of 180/100 mmHg.Art.at first glance, it appears that systolic increases much more significantly than diastolic (180 versus 120 and 100 versus 70);If we compare 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 basal 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 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 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 decreases: the systolic pressure decreases, the diastolic pressure remains high.
At the beginning of the disease there is a tendency to pressor reactions.Measuring blood pressure shows that in some patients its level does not exceed the upper limit of the age norm, but the values obtained during measurement are higher than normal for a particular person, while in others it exceeds the upper limit of the age norm.The increase in pressure in hypertension is observed under the influence of various influences - mental, emotional, reflex - and remains at a high 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 value of random and main pressure 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 one obtained during the study of the basal metabolic rate (that is, in bed, in the morning after sleeping, on an empty stomach).The lowest value of the indicator after repeated measurements under normal circumstances is conventionally called “almost the main pressure”.
The “additional pressure” undoubtedly expresses the degree of excitement or mental (emotional) tension of the patient at the 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 more significant than in individuals who have not demonstrated a tendency to develop hypertension.
In comparing the degree of pressor influence of certain nervous influences, it should be noted that the sharpest stimulus is the word.Therefore, it will 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 the influences of the second signaling system.
Tests for high blood pressure in hypertension
They also tried to determine the tendency to hypertension through reflex irritations.In this regard, special attention was paid to the so-called cold test.After a short period of rest, the subject's blood pressure is measured in the supine position, then the hand of 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 more than 15 mm Hg.Art.serves as an indicator of increased 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 heated person, due to the decrease in the tone of their blood vessels, is lower than in the same person under conditions of colder external temperature.The reflex reaction to cold depends on the usual influences of temperature, profession and living conditions.It is well known that people get addicted to the temperature factor.In hardened people the cold test may be weak, but in people sensitive to cold it may be strong.
The cold test is based on the reflex reaction of the vasomotor center in response to thermal (and partially painful) stimulation caused suddenly in the periphery.The pressor reaction to cold weakens after ingestion of alcohol, bromine and barbiturates.
Sometimes the responses to a cold test turn out to be paradoxical: high blood pressure does not occur in hypertension and occasionally even decreases.
It is interesting to compare these data with the results of determining blood pressure 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 vasoconstrictive effect.
The effects of temperature can hardly be used as a method of assessing the reactivity of the apparatus that regulates hypertension in hypertension, because they do not reflect the specifics 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 individuals with markedly increased blood pressure due to hypertension.The reduction is especially significant with unstable blood pressure;Sometimes this decrease is seen in persistent hypertension.In the more advanced stages of hypertension (with the development of arteriolosclerotic changes in the kidneys), a nitroglycerin test gives 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 isoamyl nitrite inhalation.Glycerol trinitrate, like isoamyl nitrite, acts mainly through central vasomotor devices, characterizing the increased excitability of these centers in hypertension.
The sodium amytal test has gained some popularity.The subject, who is bedridden, receives sodium amytal 0.2 g every hour, 3 times;blood pressure is measured before taking the medicine 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, sleep usually occurs.Typically, sodium amytal helps lower blood pressure not only in the first few hours, but also in the following days, sometimes up to several days;the patient's well-being improves.However, this effect is not always observed: some patients have intolerance to the drug.
Unlike the nitrite test, which causes a rapid drop in pressure, in the sodium amytal test it gradually decreases.The degree of its decrease after taking sodium amytal 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 in nature, a test with sodium amytal characterizes the state of devices that regulate blood pressure in the 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 nerve centers (sometimes large and small doses give the same effect, or small doses have a depressant effect that is more distinct than large doses).
In addition to tests based on depressant action, many tests have been proposed based on pressor action - with respiratory arrest, inhalation of carbon dioxide, ingestion of phenamine, but they do not fail to have a negative effect on the condition of patients, although they probably no less determine the tendency to hypertension in its initial 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 diagnose hypertension, much less inform the person being examined about this.Under favorable environmental conditions, pressor reactions may disappear completely.
High blood pressure depending on the stage of hypertension
The increase in pressure in early-stage 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 hypertension in hypertension, and the periods of normal levels are shorter and rarer.Treatment measures and adherence to the regimen are of great importance.Under the influence of rest and treatment in the initial transitional phase of hypertension with a benign course, the indicator often returns to normal for a long period.
An increasingly persistent tendency towards an increase in blood pressure during hypertension and the preservation of its pathological level indicates the 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 over a short period of time to a level close to normal, although it does not remain at this level for long.Under the influence of treatment, however, a long-term decrease in the indicator to normal can be achieved.
During the day, blood pressure with hypertension can fluctuate widely.In the morning it is generally lower than in the evening.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 high levels (stage II stage B, stable).It is true that even at this stage there are sometimes periods of decline.Sometimes remission occurs under the influence of prolonged therapy for a fairly long period.However, this phase is generally characterized by persistent and high 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, including, without a doubt, the involvement of the kidneys.However, with a decrease in the excitability of vasopressor centers during strokes or under the influence of heart failure (the occurrence of decompensation due to overload of the contractile function of the hypertrophied heart), a decrease in blood pressure is observed.Moderate heart failure has little effect on the indicator level;sometimes it even increases during this period (stagnation factor).
As for venous pressure in hypertension, it is generally within normal limits and increases only in heart failure.True, in some patients, even in the initial stages of the disease, slightly increased values of venous pressure can be found, which even led to the assumption of excitement 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 by blood).Blood pressure in capillaries is difficult to determine.Capillaroscopically in the nail bed, a narrowing of the arterial curves of the precapillaries and an expansion of the venous curves are generally determined;The variability of the hair pattern (“game”) is typical.