The most characteristic manifestation of high blood pressure is a pressure increase.
As a rule, increased pressure with high blood pressure can already be installed when examining the impulse.When the impulse on the radial artery feels, a fixed impulse (S. Durus) is determined due to an increase in the intra -arterial pressure and the tonic reduction of the walls of the artery.Due to the fact that the lumen of the average caliber arteries decreases slightly with high blood pressure, the filling of the impulse changes little.During the graphic recording of pulse soscillations (in the sphigmogram), the impulse shaft is low, rounded, an excitement of the lifting and descent (pulsus tardus);The dicotic wave is inconspicuous.
The examination of the blood pressure according to the exhibition method is still the best way to determine systolic, diastolic and impulse pressure at the same time.In the event of high blood pressure, all three values are usually increased.Sistolic is most clearly increased;The diastolic increase increases to a lesser extent.
If we compare the percentage of increasing the size of the systolic and diastolic pressure for high blood pressure in relation to the average values of both pressure in the standard, the increase is almost the same.So if we occupy a normal value for systolic pressure, there is a number of 120 mm and for diastolic pressure - 70 mm ed. Art., Then with a blood pressure of 160 mm ed.(maximum) and 90 mm ed. Art.(Minimum) an increase in 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 ed. Art.At first glance, it seems that the systolic is increasingly increasingly increased as diastolic (180 compared to 120 and 100 compared to 70);If you compare with normal conditions, the increase in the percentage is almost the same.
In the early days (stage I), high blood pressure is an increase in systolic or diastolic pressure (often the first, less often in the second).Perhaps it depends on the initial level that has before the disease (each person individually).
The relationship between diastolic and systolic pressure influences:
- The degree of elasticity of the walls of large arteries,
- Socratic power of the heart.
It is known that a decrease in the elasticity of the arteries helps to increase the systolic pressure (in the pronounced form it can be found in atherosclerosis of the central arteries).
In the event of high blood pressure, changes in the elasticity of the walls of large vessels are observed, which is reflected in an increase in impulse pressure.Under the same conditions, the amplitude becomes lower when the heart begins to weaken: the systolic pressure decreases, the diastolic remains rise.
A tendency towards press reactions is observed at the beginning of the disease.The measurement of the arterial pressure shows that in some patients the level does not go beyond the upper limit of the age standard, but is higher when measuring the size than that for a specific person, while it exceeds the upper limits of the age norm.An increased pressure with high blood pressure is observed under the influence of different effects - mentally, emotional, reflex - and is increased from several minutes to several hours.
The first dimension usually results in higher numbers (random pressure) than after 5-10-15 minutes of repeated measurements.The difference between the random and basic pressure is displayed by "additional pressure".Its value in people who suffer from high blood pressure is much greater than in healthy people.The main pressure, which is preserved under the conditions of the investigation of the main exchange, is seen as the main pressure (i.e. in bed, in the morning after sleep, on empty stomach).The smallest value of the indicator after repeated measurements in the usual environment is referred to as "almost the main print".
“Additional pressure” undoubtedly expresses the degree of mental (emotional) excitement or tension of the patient at the moment and the degree of excitability of his nerve, which regulates the blood pressure of the apparatus.Experience shows that in the distinctive period in patients the value of the additional pressure is usually more significant than in people who have not found a tendency to develop high blood pressure.
If you compare the degree of the influence of certain nervous influences, it should be noted that the sharp stimulus is the word.Therefore, it is not an exaggeration to say that the effect of the second signal system influences the increased pressure on high blood pressure and in humans.
Samples for increased pressure with high blood pressure
They tried to determine the tendency towards high blood pressure by reflex irritation.In this regard, special attention was paid to the cold sample.In the break examined after a short rest period, the blood pressure is measured in a lying position, then the brush of the other hand is immersed in a temperature of 4 ° for a minute;At the time of immersion and then every 30 seconds, the level is measured until it rented.An increase in systolic pressure is more than 20 mm ed. Art., Diastolic by more than 15 mm ed.serves as an indicator for an increase in pressor reactivity.The faces that discovered it were called "hyperreactors" that did not find "hyporeactors".Hyperreactors are 15%in healthy people.
The cold sample received a contradictory assessment.In the oppressive effect, the conditions under which the sample is carried out play a major role.An urgent reaction to the cold in a person who is warm is lower than that of the same person under the conditions of cooler external temperature due to a reduced tone of its vessels.The reflex reaction on the cold depends on the usual temperature influences, the living conditions.It is known that people are used to the temperature factor.For hardened people, a cold test can be weak and in people who are sensitive to cold, it can be strongly expressed.
The cold sample is based on the reflex reaction of the vasomotor center in response to a suddenly caused thermal (and partly pain) irritation on the periphery.The urgent reaction to the cold weakens after taking alcohol, bromine and barbiturates.
Sometimes the answers to the cold sample prove to be paradoxical: increased pressure in the event of high blood pressure does not occur and occasionally even decreases.
It is interesting to compare this data with the results of the determination of blood pressure after the influence of the heat.If the hands in people who suffer from high blood pressure are often not a decrease, but an increase in blood pressure (a hand that is reduced in warm water, but pale).Therefore, cold and heat can sometimes cause the same oppressive vasoconstrictor effect.
The temperature effects can hardly be used as a method to assess the reactivity of the apparatus, which regulates increased pressure in high blood pressure because they do not reflect the peculiarities of the diseases that are based on high blood pressure.Vascular samples with pharmacological active ingredients were offered.One of them is a rehearsal with a glycerin trinitrate.After 2 drops of glycerin trinitrate (under the tongue), the pressure (systolic and diastolic) decreases significantly.The acceptance is more pronounced in people with greatly increased pressure in high blood pressure.Particularly significantly decreases with unstable blood pressure;Sometimes such a decrease is observed with persistent hypertension.In the late stages of hypertension (with the development of arteriolosclerotic changes in the kidneys), a nitroglycerin test results in a slight decrease in the indicator for high blood pressure, which can be used to diagnose kidney forms (or stages) of hypertensive states.
The same results (the depressor effect) result in a test with inhalation of isoamamnitrit.Glycerin -Trinitrate such as ISOAMALNITRIT is mainly through the central vascular devices, which characterizes the increased excitability of these centers for high blood pressure.
A sodium test was somewhat distributed.The examined person in bed gives an amyl sodium three times a hour with 0.2 g;The arterial pressure is measured before the drug and every half hour after ingestion (within 3 hours).The difference between the initial and smallest level determines the value of the depression effect.After the second powder there is usually a dream.As a rule, sodium -amital helps to lower blood pressure not only in the first few hours, but also in the following days, sometimes even in several days.The patient's fountain improves.However, such an effect is not always observed: some patients have intolerance to the drug.
In contrast to a NIETETESTEST, which causes a violent drop in pressure, it gradually decreases with sodium sodium.The degree of acceptance of its admission is particularly significant at the beginning of the disease.In the late time, in the presence of arteriolosclerotic changes in the kidneys, the decrease is usually or is missing.
Since the impact of barbiturates is undoubtedly central, a sodium test is characterized by an invisible pressure in the cortical and subcortical regions.When using different doses of the drug (small and large), it is possible to assess the phase conditions of the nasopressorner nerve centers according to arterial pressure (sometimes large and small doses result in the same effect, or small doses have a depressive effect, more clearly than large doses).
In addition to rehearsals based on depression effect, there are many samples based on pressing -with a breath stop, inhaling carbon dioxide, phenamine, but they have no negative effects on the condition of the patients, although they probably determine no less than the tendency of hypertension in the early stage and in the so -called premorbide state.
After discovering a tendency to short -term blood pressure in a specific person, you should not immediately diagnose high blood pressure and even more to inform the examined about him.Immediate reactions can be made entirely under favorable environmental conditions.
Increased pressure depending on the phase of high blood pressure
An increased pressure in the initial stages can only be regular (transient phase).The more difficult the patient's conditions are in the neuropsychiatric conditions, the longer and more often periods with increased pressure in high blood pressure and periods of the normal level of its loser and rarer are.Therapeutic measures are of great importance, compliance with the regime.Under the influence of calm and treatment in the initial transient phase, high blood pressure with a benign course, the indicator often decreases for a long time.
An increasingly stubborn tendency to increased pressure during high blood pressure and maintaining its pathological level shows the further development of the disease that leads to the second stage.In phase A of stage II, arterial pressure is instructed (unstable phase).Its level can fluctuate within large borders.Under the influence of the calm, it is reduced to a level near normality for a short time, although it is not kept at this level for long.However, under the influence of the treatment, a longer decrease in the indicator to the norm can be achieved.
During the day, blood pressure can vary greatly with high blood pressure.In the morning it is usually lower than in the evening.After eating, it rises slightly and then results in a significant decline.During the night sleep, it decreases with high blood pressure than in healthy people.
In the course of the disease, blood pressure is determined at a high level (phase B II stadium, stable).A acceptance period are observed at times at this stage.Sometimes remission occurs for a long time under the influence of longer therapy.However, this phase usually differs stubbornly and high hypertension.Depression tests at this stage show the functional nature of increased pressure in high blood pressure.
In stage III, blood pressure is usually resistant.Hypertension is supported by a number of factors under which there is undoubtedly the kidney participation.However, with a decrease in vasopressor centers in brain blows or under the influence of heart failure (the occurrence of decompensations on the floor of the contractile function of a hypertrophic heart), a reduction in blood pressure is determined.A moderate heart failure is not very reflected at the level of the indicator.Sometimes it increases even during this period (stagnating factor).
As for venous pressure in the event of high blood pressure, it usually turns out that it is within normal limits and only increases with heart failure.It is also that some patients can also be found in the early stage of the disease, several increased values of venous pressure, which even led to the acceptance of the "venomotor center", according to which the tone of the vein walls increases (we cannot judge the latter, since the interethnose pressure is usually measured in a bloody way).The blood pressure in the capillaries is not accessible to the definition.Capillaryoscopic in the nail bed, the narrowing of the arterial knees of the premapillary cars and the expansion of venous knees are usually determined.Typical variability of the image of the capillaries ("game" from them).