The most characteristic manifestation of hypertension is increased blood pressure.
Usually, high blood pressure in hypertension can be established by examining the pulse.When palpating the pulse on 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 artery 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 recording pulse fluctuations graphically (on a sphygmogram), the pulse wave is low, rounded, and has a gentle rise and fall (pulsus tardus);the dicrotic wave is hardly noticeable.
The study of 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 most 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 a 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.(minimal), the increase against 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 seems that the systolic is increased much more significantly than the diastolic (180 versus 120 and 100 versus 70);if we compare it with normal ratios, the increase in percentage terms will be almost equal.
Often in the initial period (stage I) of hypertension there is an increase in either systolic or diastolic pressure (usually the first, less often the second).Perhaps this depends on the baseline 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 becomes smaller: systolic pressure decreases, diastolic pressure remains elevated.
Already 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 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 value of random and main pressure is designated “additional pressure”;its value in people suffering from hypertension is significantly greater than in healthy people.The main pressure is considered to be the one obtained during the study of the basal metabolic rate (i.e. in bed, in the morning after sleep, on an empty stomach).The smallest value of the indicator after repeated measurements in normal circumstances is conventionally called “almost the main pressure.”
“Additional pressure” undoubtedly expresses the degree of mental (emotional) arousal or 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 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 will not be an exaggeration to say that the level of high blood pressure in hypertension and in persons predisposed to it is most influenced by influences through the second signaling system.
Tests for high blood pressure in hypertension
They also tried to determine the tendency to hypertension by means of 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 a supine position, then the hand of the other hand is immersed for a minute in water at a temperature of 4°;at the moment of immersion and then measure the level every 30 seconds until it levels out.An increase in systolic pressure of more than 20 mmHg.Art., diastolic by more than 15 mm Hg.Art.serves as an indicator of increased pressor reactivity.Persons who discovered it were called “hyper-reactors”, those who did not find it were called “hypo-reactors”.Among healthy people, hyperreactors account for 15%.
The cold test received mixed reviews.The conditions in which the test is performed play an important role in the pressor effect for a given test.The pressor reaction to cold in a person who is warm, due to the decreased tone of his blood vessels, is lower than in the same person in conditions of a cooler external temperature.The reflex reaction to cold depends on the usual temperature influences, 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 people sensitive to cold, it can be strong.
The cold test is based on the reflex reaction of the vasomotor center in response to suddenly caused thermal (and partly painful) stimulation in the periphery.The pressor reaction to cold weakens after taking 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 it 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 turns pale).Consequently, cold and heat can sometimes produce the same type of pressor vasoconstrictor effect.
Temperature effects can hardly be used as a method for assessing the reactivity of the apparatus that regulates high blood pressure in hypertension, because they do not reflect the specifics of the disorders that underlie 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 sharply increased blood pressure due to hypertension.The reduction is especially significant with unstable blood pressure;Sometimes such a decrease is observed in persistent hypertension.In the later 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 (depressor effect) are obtained by a test with inhalation of isoamyl nitrite.Glycerol trinitrate, like isoamyl nitrite, acts mainly through central vasomotor devices, thereby characterizing the increased excitability of these centers in hypertension.
The sodium amytal test has gained some popularity.The subject, who is in bed, is given sodium amytal 0.2 g every hour 3 times;blood pressure is measured before giving the drug and every half hour after taking it (for 3 hours).The difference between the initial and lowest levels determines the magnitude of the depressor effect.After taking the second powder, sleep usually occurs.Typically, sodium amytal helps lower blood pressure not only in the first hours, but also in the following days, sometimes even several days;the patient's well-being improves.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 testing with amytal sodium it decreases gradually.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 amytal sodium characterizes the state of the devices regulating 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 depressor effect that is more distinct than large doses).
In addition to tests based on depressor action, many tests have been proposed based on pressor action - with stopping breathing, inhaling carbon dioxide, taking phenamine, but they are not without a negative effect on the condition of patients, although they 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 person being examined about it.Under favorable environmental conditions, pressor reactions can completely disappear.
High blood pressure depending on the stage of hypertension
Increased 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 high blood pressure in hypertension are, 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 transient phase of hypertension with its benign course, the indicator often decreases to normal for a long period.
An increasingly persistent tendency towards increased blood pressure during hypertension and the preservation of its pathological level indicates the further development of the disease, passing into 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 is not maintained at this level for any long time.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 usually lower than in the evening.After eating, it increases slightly, then gives a significant decrease.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 (phase B of stage II, stable).True, even at this stage there are sometimes periods of its 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 high hypertension.Depressor 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 number of factors, among which undoubtedly the participation of the kidney.However, with a decrease in the excitability of vasopressor centers during cerebral strokes or under the influence of heart failure (the occurrence of decompensation due to overstrain of 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 are not able to judge the latter, since intravenous pressure is usually measured by blood).Blood pressure in the capillaries is difficult to determine.Capillaroscopically in the nail bed, a narrowing of the arterial bends of the precapillaries and an expansion of the venous bends are usually determined;The variability of the capillary pattern (“play” of them) is typical.