What does pulse arterial pressure (PAP) show? Sad mmHg what does it mean

When it comes to pressure in relation to to the human body, there is an association with hypertension, severe complications and unfavorable outcomes of this disease. Moreover, with the invention of Korotkov N.S. device for non-invasive (bloodless) measurement blood pressure, this procedure, along with glucose monitoring, has become routine not only for medical workers, but also for the patients themselves. And everyone understands why they measure their blood pressure. Everyone knows that there is systolic pressure, and there is diastolic pressure, but rarely, even among medical workers, knows about pulse arterial pressure (PAP) - this is also the most important indicator of health status.

So what is it - pulse pressure?

Already in the very name of this phenomenon lies part of the answer. Pulse means it is somehow connected with the pulse. Measuring blood pressure (hereinafter referred to as BP) by determining the pressure in the cuff, when inflated the radial artery is compressed and the pulse disappears, and when the cuff is subsequently deflated, the pulse is detected again. It is the point of restoration of blood flow, when, upon auscultation (listening) of the compressed artery, the first sounds of the pulse are heard and there is systolic blood pressure (hereinafter referred to as SBP).

The moment when sounds (Korotkoff sounds) with further slow deflation of the cuff disappear again will be diastolic blood pressure (DBP), and the difference between them will be pulse pressure. Thus, to know your pulse pressure and how to calculate its value, you just need to take a tonometer, measure your blood pressure, and subtract the lower number (DBP) from the top number (SBP).

Pulse pressure is not just a difference in indicators

The question arises: there are such indicators as SBP and DBP, why do we also need to know about pulse pressure. Until recently, there was an opinion among the scientific medical elite that it was the increase in DBP that had a negative effect on the body. The higher the DBP, the higher the risk of cardiovascular disease (CVD) - and this is a correct opinion. The higher the DBP, the more likely there are problems with blood vessels, kidneys, thyroid gland, heart, etc. It is also true that high SBP is no less dangerous for human health, which is also a risk factor for heart failure, damage to target organs (brain, heart, kidneys) and blood vessels.

Both of these quantities (both SBP and DBP) are integral, i.e. depending on many parameters:

• stroke volume;
• heart rate (HR);
• total peripheral vascular resistance (TPVR);
• circulating blood volume (CBV);
• blood viscosity, etc.,

which in turn are also multicomponent. Therefore, the difference between SBP and DBP, i.e. pulse pressure, is an integral indicator that reflects both the condition of the heart and the true age of the arteries and other parameters of the body’s vital activity.

What pulse pressure value is considered normal?

Normally, the indicator is considered to be 40 + 5 mmHg. Art. You can present the norm of pulse pressure by age in the table (Table 1), but we can say with confidence that in relation to PBP, as in everything that concerns the human body, it is necessary to adhere to the golden rule: the maximum is sufficient and the minimum necessary. That is, the lower the PBP, but it ensures a comfortable (sufficient in all respects) state of the body, the less its wearing effect on all organs and systems. It is important to understand this rule in its entirety, without in any way detracting from its second part – maximum sufficiency.

Table: Pulse pressure - norm by age

In addition, the calculation of the proper SBP and DBP, adjusted for weight, for each age can be calculated using the formulas:

1. SBP = 109+(0.5*Age (in years))+(0.1*Weight (in kg))
2. DBP = 63+(0.1*Age (in years)+(0.15*Weight (in kg))
3. PAD = GARDEN - PAD

So, for example, for a 53-year-old man weighing 85 kg, these indicators will be as follows:

1. SBP = 109+(0.5*53)+(0.1*85) = 144 mmHg.
2. DBP = 63+(0.1*53)+(0.15*85) = 81 mmHg.
3. PBP = 144 – 81 =63 mmHg.

What does pulse pressure reflect?

When PBP is above 50 mmHg. (high pulse pressure) or below 30 mmHg (low pulse pressure) indicate a deviation from the norm. Both a high indicator and a low one indicate cardiovascular risk. In healthy people, an increase may occur during psycho-emotional or physical stress; a decrease may be observed during sleep. Those. Almost always, when the work of the heart increases (stroke volume, heart rate), the blood pressure increases, and vice versa.

High pulse pressure

A systematic increase in pulse pressure negatively affects the condition of target organs and blood vessels. Accordingly, an increased rate at rest indicates the presence of cardiovascular or other pathology.

Low pulse pressure

A decrease in PBP can occur with aortic diseases, myocardial infarction, kidney diseases, shock of various origins, etc. Low pulse pressure means the heart is not functioning well, while increased value Pulse pressure may indicate insufficient closure of the heart valves and backflow of blood into the left ventricle.

It is important to understand that a decrease or increase can occur with seemingly normal blood pressure, and therefore, if there is discomfort in the heart, general malaise and changes in blood pressure, you should consult a specialist.

In a healthy person, the stroke volume received by the vessels with each contraction of the heart muscle causes stretching of these vessels with subsequent elastic recoil at the end of each cycle. With aging, blood vessels lose elasticity, which leads to their rigidity, an increase in pulse wave speed and, accordingly, an increase in blood pressure.

Of course, in to a greater extent this applies to elderly and senile people. But in recent years, CVDs have become younger and are becoming relevant for both older and younger people.

Determining blood pressure standards and the limits of extreme fluctuations in children is challenging task, since blood pressure in children and adolescence is closely related to the influence of gender, height-weight and hormonal “jumps”, hereditary characteristics, physical activity, environmental factors, etc. Currently, standards have been developed for the average values ​​of systolic blood pressure (SBP) and diastolic blood pressure (DBP) in children and adolescents with cut-off points for their percentile distribution depending on age and somatotype.

Higher blood pressure was observed in the group with low physical activity. A very large influence on blood pressure is exerted by constitutional features autonomic nervous system. With a hyperkinetic type of blood circulation, along with a more frequent heart rhythm, a higher level of blood pressure is also observed.

If blood pressure is between the 90th and 95th percentiles, then this condition is regarded as “high normal blood pressure.” Blood pressure values ​​above the 95th percentile of the distribution curve in the pediatric population with a threefold change are taken as “arterial hypertension.”

First- average SBP and/or DBP from those measurements equal to or greater (by less than 10 mm Hg) 95 percentile for a given age group taking into account gender and age.

Second- average SBP and/or DBP from those measurements, equal to or greater than 10 mm Hg. Art. and more than 95 percentiles, for a given age group, taking into account gender and age.

The Pediatric Blood Pressure Working Group, after examining 70,000 children in the United States and Great Britain in 1987, developed criteria for the severity of hypertension for children and adolescents of all age groups.

It has been established that at birth the systolic blood pressure (SBP) of a child is 70-75 mmHg. Art. In the 1st week of life, SBP increases daily by 1-2 mmHg. Art., and then in the next 6 weeks - by 1 - 2 mm Hg. Art. per week and remains stable until approximately 4 years of age. In subsequent years, there is a gradual increase in blood pressure, the level of which depends on height and body weight. The correlation between body weight and blood pressure is especially pronounced in the 2nd decade of life. Growth directly correlates with blood pressure. Considering the report of the II Commission on the Control of Blood Pressure in Children, age-specific blood pressure standards are given that take into account the growth of children and adolescents, which is currently used in the United States and the European Union. A similar approach is beginning to be used in our country.

If a 10-year-old boy's blood pressure is 120/80 mmHg. Art., then this should be considered normal for a tall child, but at the same time it is elevated for a short child. If the height is average, then the normal blood pressure value will occupy an intermediate value between the normal values ​​for short and tall children of a given age.

Given the wide variation in BP levels considered elevated by researchers, the WHO suggests a BP value of 140/90 mmHg. Art. as a single universal criterion for hypertension in adolescents starting from the age of 13.

We would like to emphasize the following. It would seem that it is very easy to make a diagnosis of hypertension based on determining blood pressure levels, but in practice, due to the lack of sufficient knowledge or haste when measuring blood pressure, incorrect conclusions are often made, which leads to overdiagnosis of this disease. Assessing many situations is also very difficult. For example, in the case of a difference in blood pressure on both arms, the question arises: which indicator is considered “correct”. With several consecutive measurements, different values ​​of blood pressure are determined. Rhythm disturbances deprive blood pressure levels of stability. Because of this, when measuring blood pressure, you must strictly adhere to the following rules:

The study should be carried out in a quiet, calm and comfortable environment, at a comfortable room temperature;

Blood pressure must be measured after the child has rested for 3-5 minutes while sitting on a chair with a straight back next to the table;

On the day of blood pressure measurement, the child should not drink tea or coffee, or smoke during the last hour before the test;

The cuff must have a pneumatic chamber size corresponding to the circumference of the upper arm; use cuffs of three standard sizes: 5-6, 8-9 and 12-14 cm wide (if a cuff is too small, the measurement results are overestimated, and if too large, the measurement results are underestimated); Taking into account the age of the child, WHO recommends the following cuff width: up to 1 year - 2.5 cm, 1-3 years - 5-6 cm, 4-7 years - 8-8.5 cm, 8-9 years - 9 cm, 10 -13 years - 10 cm, 14-17 years - 13 cm;

The cuff is placed on right hand(at the first measurement, sequentially on both arms) and cover at least 40% of the circumference and at least 80% of the length of the shoulder; the lower edge of the cuff should be 2.5 cm above the cubital fossa;

The arm with the cuff applied should be at the level of the heart, i.e. approximately at the level of the fourth intercostal space in a sitting position;

The hand on which the measurement is taken must be bare;

Blood pressure is measured at the radial artery after air is inflated into the cuff until the pulse disappears; deflation of air from the cuff leads to the appearance of tones, which corresponds to SBP, and the complete disappearance of tones corresponds to DBP;

To achieve the greatest measurement accuracy, it is necessary to inflate air into the cuff quickly and release it at a speed of 2 mmHg. Art. in 1 s before the appearance of Korotkoff sounds, and then at the same speed from beat to beat;

Blood pressure is measured again 1-2 minutes after the first measurement; the average value of several measurements taken on one arm reflects the blood pressure level more accurately than a single measurement;

The SBP level can be monitored by the appearance of a pulse wave on the radial artery, the DBP level can be monitored by a sharp decrease in the fluctuations of the tonometer needle or oscillations of the mercury column.

Often, accurate determination of DBP is associated with some difficulties; Korotkoff sounds in children and adolescents are often heard until the very end of the measurement (the “infinite tone” phenomenon). In this case, you should not press the stethoscope on the brachial artery, but only lightly press it against the skin, which avoids the occurrence of this phenomenon.

It should be borne in mind that the initial measurement of blood pressure, as a rule, gives slightly inflated results, which can only be of approximate value. When re-measuring, the pressure in the cuff should be adjusted to a level slightly higher than that noted during the first measurement. Blood pressure readings are recorded as the pressure in the cuff slowly decreases, sometimes intermittently, re-inflating the cuffs along the way. If it is not possible to accurately record the blood pressure level, a third measurement is taken, adhering to the same rules.

Typically, the lowest blood pressure readings are recorded in the supine position, somewhat higher - in the sitting position and the highest - in the standing position. With the opposite ratio of blood pressure, i.e., a decrease in blood pressure after the patient gets up, this indicates orthostatic syndrome, which is observed with autonomic dysfunction.

However, this method of measuring blood pressure is acceptable only for children over 3 years of age. In newborns and children under 3 years of age, oscillometric principles or Doppler ultrasound are used for measurement. In Doppler measurements, SBP is recorded by the increase in the intensity of reflected sound waves, and DBP by the appearance of muffledness during deflation of air from the cuff. This method is comparable in accuracy to other non-invasive methods of measuring blood pressure.

In the last decade, 24-hour blood pressure monitoring (ABPM) has become widespread for diagnosing hypertension. When using this method in comparison with traditional blood pressure measurement, new opportunities and advantages appear:

Possibility of using the method in the living conditions familiar to children and adolescents (outpatient);

The ability to analyze blood pressure in parallel with heart rate during both wakefulness and sleep, as well as at various specified time intervals;

Safety, simplicity of the method, the possibility of its repeated repetition;

The ability to determine individual daily (circadian) blood pressure rhythms;

Reducing the effect of “placebo” on blood pressure parameters during antihypertensive therapy (AHT);

The ability to carry out differentiated selection of antihypertensive drugs (AGDs), frequency and time of their administration.

ABPM is currently not a mandatory method of examining patients with hypertension. It is most informative in the following cases:

Marked changes in blood pressure during one or more visits;

Suspicions of “white coat hypertension”;

Symptoms that suggest the presence of episodes of hypotension;

Refractory to drug therapy hypertension;

Disturbances of the circadian rhythm of blood pressure.

Along with the obvious advantages of ABPM over “office” blood pressure measurements, it should be recognized that there are also disadvantages:

High cost of research and, as a result, limited availability;

Discomfort due to frequent blood pressure measurements with the device, which may affect the results of the study;

There is still no generally accepted normal suture indicators for ABPM.

Average values ​​of SBP and DBP per day, as well as individual time periods, more objectively reflect the true level of blood pressure and the severity of hypertension than single measurements. In 1997, M. Soergel et al. determined the proper average values ​​of blood pressure in children and adolescents based on 24-hour monitoring data taking into account height (body length).

An important indicator reflecting the severity of hypertension (as with hypertension in adults) is the time index, calculated by the percentage of measurements that exceed normal blood pressure values ​​over 24 hours or individual time intervals. IV SBP more than 25% is considered pathological. With labile hypertension, the AI ​​is in the range of 25-50%, and with stable hypertension it exceeds 50%.

The diagnostic criteria for labile forms of hypertension, according to ABPM data, are:

Increasing the average values ​​of SBP and/or DBP from 90 to 95 percentiles of the distributions of these parameters for the corresponding growth indicators;

IW during the day and/or night period from 25 to 50%;

Increased blood pressure variability.

The criteria for diagnosing stable forms of blood pressure, according to ABPM data, are:

An increase in the average values ​​of SBP and/or DBP above the 95th percentile of the distributions of these parameters for the corresponding growth indicators;

AI during the day and/or night is more than 50%.

The diurnal index (CI) gives an idea of ​​the circadian organization of the daily blood pressure profile in both healthy and sick children and adolescents. SI is calculated as the difference between the average blood pressure values ​​during the day and night periods as a percentage of the average daily value. For most children, both with normal blood pressure and with hypertension, the nighttime decrease in blood pressure is 10-20% of the daytime value. In English-language literature, such persons are classified as “dippers”. If the SI is less than 10%, such individuals are designated as “non-dipper”. With an excessive nighttime decrease in blood pressure, SI is more than 20%, and such patients are classified as “over-dipper”. When blood pressure increases at night, SI is less than 0%, and such patients are designated as “night-peaker”. This type curve occurs most often in patients with symptomatic hypertension. Taking into account the SI index, it is possible to differentiate different forms of hypertension.

Let us dwell on one more aspect of blood pressure measurement. Currently, many recommendations from societies for the study of hypertension contain provisions that provide for the use of self-monitoring of blood pressure (SMB) as an important addition for diagnosing and monitoring the effectiveness of antihypertensive therapy. Involving patients and their relatives in the treatment process increases “adherence” to the treatment. However, along with the positive aspects of using home blood pressure measurements, some difficulties may arise. These primarily include methodological errors when measuring blood pressure with sphygmomanometers. In this regard, it is advisable to use electronic semi-automatic or automatic devices when measuring blood pressure at home, which is not always possible due to the lack of the required width of the cuff used. These devices are easy to use and require skills in auscultatory determination of blood pressure. It is necessary to use devices in which the cuff is attached to the forearm. The use of devices that allow you to measure blood pressure on the wrist or finger is unacceptable, since the results obtained are not reliable.

To adequately control blood pressure at home, measurements should be taken in the morning (within 1 hour after waking up, before breakfast) and in the evening (before dinner or at least 2 hours after dinner) in a sitting position after a 5-minute rest.

Remember that only a methodically correct determination of blood pressure allows you to make a timely diagnosis of hypertension and prescribe an adequate amount of various rehabilitation measures.

For cardiac cycle BP levels are constantly changing, increasing at the beginning of ejection and decreasing during diastole. At the moment of cardiac ejection, part of the blood located in the proximal segment of the ascending aorta receives significant acceleration, while the rest of the blood, which has inertia, does not accelerate immediately. This leads to a short-term increase in pressure in the aorta, the walls of which are somewhat stretched. As the rest of the blood accelerates under the influence of the pulse wave, the pressure in the aorta begins to fall, but still remains higher at the end of systole than at the beginning. During diastole, the pressure decreases uniformly, but blood pressure does not drop to zero, which is due to elastic properties of arteries and quite tall peripheral resistance.

The level of blood pressure depends on several factors: the magnitude of cardiac output; arterial system capacity; intensity of blood outflow; elastic wall stress arterial vessels.

There are systolic, diastolic, pulse, mean and lateral blood pressure (Fig. 2.9 a).

Systolic blood pressure (SBP)- this is the maximum pressure in the arterial system developed during left ventricular systole. It is caused mainly by the stroke volume of the heart and the elasticity of the aorta and large arteries.

Diastolic blood pressure (DBP)- this is the minimum pressure in the artery during diastole of the heart. It is largely determined by the tone of the peripheral arterial channels.

Pulse blood pressure (BP) is the difference between systolic and diastolic blood pressure.

Mean blood pressure (BP cp) is the resultant of all variable blood pressure values ​​throughout the cardiac cycle, calculated by integrating the curve of pulse pressure fluctuations over time

(Fig. 2.9 b):

Рср = (Pi + Р2 + ... + Pn)/n,

where Рср - average blood pressure, Pi.....Pn - variable pressure values

throughout the cardiac cycle, n is the number of pressure measurements throughout the cardiac cycle.

In the clinic, the average blood pressure for peripheral arteries is usually calculated using the formula:

BPsr = (DBP + (GARDEN - DBP))/3.

Rice. 2.9. Scheme for determining systolic, diastolic, pulse (a) and average blood pressure (b). Explanation in the text

For the central arteries, another formula is more suitable: BPav = (DBP + (SBP - DBP))/2.

Thus, the average blood pressure for peripheral arteries is equal to the sum of diastolic and 1/3 pulse pressure, and for central arteries - the sum of diastolic and 1/2 pulse pressure.

Mean blood pressure is the most important integral hemodynamic characteristic of the circulatory system. This is the one average value pressure, which would be capable, in the absence of pulse pressure fluctuations, to give the same hemodynamic effect as is observed with the natural, oscillating movement of blood in large arteries.

Lateral systolic blood pressure- this is the pressure acting on the side wall of the artery during ventricular systole.

Methods for determining blood pressure

Blood pressure can be measured by direct and indirect methods. Direct methods used primarily in surgical practice; they are associated with arterial catheterization and the use of low-inertia strain gauges.

The most common of indirect methods is auscultatory method N.S. Korotkova. Most often, this method determines blood pressure at the brachial artery. The measurement is carried out with the patient lying on his back or sitting, after 10-15 minutes of rest. When measuring blood pressure, the subject should lie or sit quietly, without tension, and not talk.

The sphygmomanometer cuff is placed tightly on the patient's bare shoulder. A pulsating brachial artery is found in the cubital fossa and a stethoscope is applied to this place. After this, air is pumped into the cuff slightly above (about 20 mm Hg) the moment of complete cessation of blood flow in the brachial (or radial) artery, and then the air is slowly released, reducing the pressure in the cuff and thereby reducing compression of the artery.

When the pressure in the cuff decreases just below systolic, the artery begins to transmit the first pulse waves into systole. In this regard, the elastic arterial wall comes into a short oscillatory movement, which is accompanied by sound phenomena

(Fig. 2.10). The appearance of initial soft tones (phase I) corresponds to SBP.

Rice. 2.10. The principle of measuring systolic and diastolic blood pressure using the Korotkoff method. Explanation in the text

A further decrease in pressure in the cuff causes the artery to open more and more with each pulse wave. In this case, short systolic compression noises appear (phase II), which are subsequently replaced by loud tones (phase III). When the pressure in the cuff decreases to the level of DBP in the brachial artery, the latter becomes completely passable for blood not only in systole, but also in diastole. At this moment, vibrations of the arterial wall are minimal and the sounds sharply weaken (phase IV). This moment corresponds to the DBP level. A further decrease in pressure in the cuff leads to the complete disappearance of Korotkoff sounds (phase V).

Blood pressure is determined using the described method three times with an interval of 2-3 minutes. It is advisable to determine blood pressure in both arms.

Thus, when measuring blood pressure using the Korotkov method, SBP is recorded when the first quiet tones appear above the radial artery (phase I), and DBP is recorded at the moment of a sharp weakening of the tones (phase IV). It is also advisable to determine the level of pressure in the cuff at the moment of complete disappearance of Korotkoff sounds (phase V).

Sometimes, when measuring blood pressure using the auscultatory method, a doctor may encounter two practically important phenomena: “infinite Korotkoff tone” and the phenomenon of “auscultatory failure.”

"The Infinite Tone of Korotkov" can be recorded with a significant increase in cardiac output and/or decrease in vascular tone. In these cases, Korotkoff sounds are detected even after the pressure in the cuff has decreased below diastolic (sometimes to zero). The endless Korotkoff sound is caused by either a significant increase in pulse blood pressure (aortic valve insufficiency) or a sharp drop in vascular tone, especially with increased cardiac output (thyrotoxicosis, neurocirculatory dystonia) and is better detected against the background of physical activity. It is clear that in neither case is the true diastolic blood pressure in the vessel equal to zero.

The phenomenon of “auscultatory failure”. Sometimes in patients with hypertension, when measuring blood pressure by auscultation, after the appearance of the first sounds corresponding to systolic blood pressure, Korotkoff sounds completely disappear, and then, after the pressure in the cuff decreases by another 20-30 mm Hg, they appear again. It is believed that the phenomenon of “auscultatory failure” is associated with a sharp increase in the tone of the peripheral arteries. The possibility of its occurrence should be taken into account when measuring blood pressure in patients with arterial hypertension, focusing on the initial inflation of air into the cuff not on the auscultatory picture, but on the disappearance of pulsation in the radial or brachial artery (by palpation). Otherwise, erroneous determination of SBP values ​​by 20-30 mmHg is possible. lower than true systolic blood pressure.

In patients with vascular pathology(for example, with obliterating atherosclerosis of the arteries lower limbs) mandatory determination of blood pressure in both upper and lower extremities is indicated. For this purpose, blood pressure is determined not only in the brachial, but also in the femoral arteries with the patient in the prone position. Korotkoff sounds are heard in the popliteal fossa.

Among other indirect methods for determining blood pressure, oscillography, tachooscillography and ultrasound methods of studying blood vessels are most often used, which are not only distinguished by higher accuracy in measuring SBP and DBP, but also allow one to determine mean and lateral blood pressure.

Daily blood pressure monitoring. In recent years, cardiology clinics have increasingly used various automatic systems for long-term monitoring of daily fluctuations in blood pressure. They use different methods pressure determinations based either on recording using microphones of sound phenomena over the area of ​​​​the compressed vessel, or on assessing changes in local blood flow that occur during programmed compression and decompression of the vessel.

In these latter cases, changes in blood flow are recorded using ultrasound sensors, rheographic electrodes, or the oscillometric or tachooscillometer method. In this case, blood pressure is automatically measured at certain intervals, for example every 30 minutes.

Automatic blood pressure monitoring systems are used to study the dynamics of pressure changes over a long time:

In order to clarify the etiology and pathogenesis of hypertension;

At emergency conditions to assess basic hemodynamic parameters;

When individually selecting medications for patients with hypertension.

It should be remembered that the use of monitoring systems for measuring blood pressure, based on the auscultatory or oscillometric method, is not recommended in patients with arrhythmia, in particular atrial fibrillation, since significant variability in cardiac output makes accurate monitoring determination of blood pressure very difficult.

Interpretation of blood pressure measurement results

Normally, systolic blood pressure at the brachial artery does not exceed 139 mm Hg, and diastolic blood pressure does not exceed 89 mm Hg. According to the recommendations of the US National Committee on Arterial Hypertension (1993), the normal level of blood pressure in the brachial artery should include SBP figures not exceeding 129 mm Hg. and DBP - 84 mm Hg. SBP level is from 130 to 139 mm Hg. and DBP from 85 to 89 mmHg. assessed as “high normal blood pressure.”

Increased blood pressure (140/90 mm Hg and above) is called arterial hypertension (AH).

Its causes may be hypertension (essential hypertension) or numerous variants of symptomatic hypertension (see below). Among people with hypertension, a special group of patients with borderline AG, whose blood pressure levels fluctuate in the so-called border zone: 140-159 (SBP) and 90-94 mmHg. (DBP). This group usually includes relatively young patients with a high risk of developing hypertension, for example, patients with neurocirculatory dystonia of the hypertensive type.

To characterize the severity of hypertension and individual selection of antihypertensive therapy, the classification of the US National Committee on the Study of Hypertension (1996) is useful, taking into account the level of blood pressure, regardless of the specific cause of its increase (hypertension, symptomatic hypertension). According to this classification there are:

1) Mild hypertension with a SBP level from 140 to 159 mm Hg. and DBP - from 90 to 99 mm Hg. This group can include both patients with hypertension and symptomatic hypertension, and patients with borderline hypertension (SBP - 140-159 mm Hg and DBP - 90-94 mm Hg);

2) Moderate hypertension - with SBP fluctuations from 160 to 179 mm Hg. and DBP from 100 to 109 mm Hg;

Note:* if SBP and DBP fall within different categories, is assigned a higher category

These recommendations provide for the identification of optimal (less than 120/80 mm Hg), normal (less than 130/85 mm Hg) and high normal blood pressure (SBP - 130-139 mm Hg and/or DBP - 85 -89 mm Hg), as well as subgroups with so-called borderline hypertension (SBP - 140-149 mm Hg and/or DBP - 90-94 mm Hg). Depending on the degree of increase in blood pressure, there are “mild” (I degree), “moderate” (II degree) and “severe” (III degree) hypertension. There are also systole-diastolic and isolated systolic hypertension with corresponding divisions into degrees of blood pressure increase.

Unfortunately, the JNC-VI classification (1997) does not take into account other important signs characterizing the severity of the condition of patients with essential hypertension, in particular target organ damage.

it, which largely determines the prognosis of the disease. Despite the fact that higher blood pressure levels are associated with a greater risk of target organ damage, a direct correlation between blood pressure levels and structural and functional changes in these organs is not always found. Moreover, in recent years it is mild hypertension that has attracted much attention.

Nevertheless, the use of the JNC-VI classification in everyday medical practice turns out to be very useful, since it provides a single unified system for quantitative assessment of the level of elevated blood pressure, which the practicing physician always focuses on when selecting appropriate treatment for a patient with hypertension.

Decreased blood pressure (arterial hypotension) occurs in many pathological conditions:

Essential arterial hypotension ( hypotension), caused by disturbances in the regulation of vascular tone;

Acute and chronic vascular insufficiency, including shock, collapse, fainting, etc.;

Acute and chronic adrenal insufficiency and other diseases.

There are still no generally accepted strict criteria for arterial hypotension in the literature. Most authors consider it possible to diagnose primary or secondary arterial hypotension, if blood pressure drops to 100/60 mm Hg. and below.

The most valuable information about changes in blood pressure throughout the day can be obtained using modern automatic monitoring systems 24-hour (or 48-hour) blood pressure dynamics. This method makes it possible to objectively assess the effect of antihypertensive drugs at different periods of the day, including at night. Daily blood pressure profile is usually assessed according to several quantitative indicators:

Average daily systolic blood pressure (SADav);

Average daily diastolic blood pressure (DABP;

Daily maximum SBP (SADmax);

Daily maximum DBP (DBPmax);

Average SBP and DBP during the day and night hours;

“daily pressure load” - an indicator characterizing the frequency of blood pressure increases above 140/90 mm Hg. as a percentage of the total number of blood pressure measurements;

Blood pressure variability during the day and other indicators. When analyzing the daily blood pressure profile, it should be remembered that even

In a healthy person, significant fluctuations in both systolic and diastolic blood pressure occur throughout the day. It changes under the influence of physical activity, psycho-emotional and mental stress, as well as as a result of the existence of biological daily (circadian) rhythms. IN daytime two peaks of higher blood pressure levels are observed: between 9 and 11 a.m. and around 6 p.m. In the evening and at night, blood pressure decreases, reaching a minimum between 2 and 5 a.m. In the morning, an increase in blood pressure is observed again. Such a daily blood pressure profile can occur both in patients with hypertension and in healthy patients, differing only in the level of blood pressure rises.

Other options for the daily blood pressure profile are possible. For example, in some patients with hypertension (including those with renal symptomatic hypertension) maximum blood pressure values ​​are recorded in the evening hours of the day, and the nighttime decrease in blood pressure is weakly expressed.

The results of 24-hour blood pressure monitoring are used for individual selection of antihypertensive therapy.

In patients with vascular pathology (for example, with obliterating atherosclerosis of the arteries of the lower extremities), blood pressure must be measured in both upper and lower extremities. Normally, systolic blood pressure in the lower extremities is approximately 20 mmHg. higher than on the upper ones, and ranges from 140-160 mm Hg.

Asymmetry of systolic blood pressure in the upper and lower extremities, exceeding 10-15 mm Hg, often indicates a violation of the patency of one of the branches of the aortic arch. The reasons for this change may be:

Atherosclerosis or aortoarteritis of the subclavian artery, or brachiocephalic trunk;

Embolism or acute thrombosis of the subclavian or brachial artery;

Dissecting aortic aneurysm with extension of the lesion to the bracheocephalic branches of the aorta;

Coarctation of the aorta and anomalous origin of the right subclavian artery from the poststenotic segment of the aorta.

If blood pressure in the lower extremities is lower than in the upper extremities by at least 20 mm Hg, one should think about a violation of the patency of the abdominal aorta or arteries of the lower extremities. Moreover, a symmetrical decrease in blood pressure in both legs most often (though not always!) indicates damage to the abdominal aorta, while asymmetry of blood pressure in the right and left legs indicates damage to the iliac or femoral artery.

The causes of impaired patency of the abdominal aorta and vessels of the lower extremities are almost the same as lesions of the aortic arch and its branches:

Obliterating atherosclerosis; aortoarteritis;

Embolism and thrombosis;

Coarctation of the aorta,

Traumatic occlusions, etc.

Thus, asymmetry of systolic blood pressure in the upper extremities most often indicates a violation of the patency of one of the branches of the aortic arch (subclavian artery, brachiocephalic trunk) or brachial artery. Symmetrical decrease in systolic blood pressure in both lower extremities in most cases it is caused by obstruction of the abdominal aorta. Asymmetric decrease in systolic blood pressure in one of the lower extremities indicates a corresponding unilateral lesion of the iliac or femoral artery.

- this is the blood pressure in the arterial system, the level of which depends on the amount of blood entering the arteries at the time of LV systole, the volume of blood flowing from the arteries of the BCC through the capillaries into the venous bed, the capacity of the vascular bed and the tension of the walls of the arterial vessels that offer resistance to the moving flow of blood .

Systemic blood pressure is the pressure that blood exerts on the BCC arteries, as opposed to the pressure on the MCC arteries (not traditionally measured). The value of systemic blood pressure is directly proportional to the IOC and TPSS.

BP = MOC*OPSS

IOC = SV*HR

SV is the volume of blood that the LV ejects during systole in one contraction.

TPSS is the value of resistance to the outflow of blood from arterioles into the capillary network.

The greater the stroke volume and heart rate, the higher the blood pressure.

The blood pressure level reflects the state of central (heart) and peripheral (vessels) hemodynamics. During the cardiac cycle, blood pressure changes synchronously with the phases of the cardiac cycle.

During LV systole, when a new portion of blood enters the arterial bed, the blood pressure level is maximum. This is the so called maximum (systolic) pressure, which depends on the magnitude of cardiac output and the speed of blood movement from the left ventricle to the aorta; expresses the entire reserve of kinetic energy of the blood column during systole; is the sum of the lateral and impact pressures. Depends on the volume of blood, the rate of maximum expulsion of blood and the distensibility of the aortic walls. The magnitude of cardiac output (the portion of blood that enters the aorta during LV systole) depends on the force of contraction, and the speed of blood movement into the aorta depends on the speed of LV contraction. Hence, The level of systolic pressure is determined by the strength and speed of LV contraction. Normally it is 100-130 mmHg.

During diastole (towards the end) of the LV, the blood pressure level is minimal, which is associated with the cessation of blood flow into the aorta and its continued movement through the arteries and veins of the BCC. This is the so called minimum (diastolic) pressure, the level of which depends mainly on the peripheral vascular resistance, as well as on heart rate, bcc and elastic-viscous properties of blood. Normally it is 60-90 mmHg.

A more constant (stable) value is average dynamic pressure, reflecting the pressure value of a continuous blood flow on the arterial wall, regardless of the phases of the cardiac cycle (in the absence of pulse fluctuations), i.e. the average dynamic pressure reflects the energy of a continuous flow of blood directed from the arterial to the venous system of the BCC. Normally it is 80-100 mmHg. The most accurate calculation is using the oscillographic method. In practice, it is calculated using the Hickam formula:

BPavg. = DBP + (SBP – DBP) / 3

Lateral (true) systolic pressure reflects the blood pressure on the walls of blood vessels at the time of LV systole. Normally it is 90-110 mmHg.

True pulse pressure– the difference between lateral and diastolic pressure (when measured by the cuff method - between systolic and diastolic), reflects the degree of fluctuation of the vascular wall under the influence of pulsating blood flow. Normally it is 40-50 mmHg.

Blood pressure is the simplest and relatively accurate indicator of hemodynamics (both central and peripheral), and therefore determination of blood pressure is mandatory every time you visit a therapist, because allows you to identify early forms of arterial hypo- and hypertension and begin timely treatment and prevention.

SBP clearly correlates with the risk of developing complications of arterial hypertension: the higher the SBP, the higher the risk of developing myocardial infarction.

Blood pressure indicators are normal and pathological.

Normally, fluctuations in SBP are allowed from 90 to 140 mmHg, DBP - from 60 to 90 mmHg.

Depending on age, the approximate blood pressure standards are:

up to 15 years: 90-110 / 60-70

15-30 years: 110-120 / 70-75

30-45 years: 120-130 / 75-80

from 45 years old: 130-139 / 80-89

On the brachial artery: 90-140 / 60-90; on the femoral artery: 120-170 / 90-120.

Modern classification of blood pressure levels for persons over 18 years of age

optimal blood pressure – more than 120/80

normal blood pressure – more than 130/85

normal increased 130-140 / 85-90

In hypersthenics, blood pressure is on average 10-15 mmHg. higher than that of asthenics.

Basic (basal) blood pressure is the lowest, determined in the morning, on an empty stomach.

Arterial hypertension (arterial hypertension syndrome)

A short-term increase in blood pressure can be observed with psycho-emotional and physical stress, intense pain, fluctuations in atmospheric pressure, hypothermia, after drinking coffee, tea, alcohol, and excessive smoking.

White coat hypertension- the phenomenon of increasing blood pressure by 10-40 mmHg. due to psycho-emotional stress due to stay in a health care facility, therefore, overdiagnosis of hypertension may occur. In this regard, hypertension is diagnosed after at least 3 visits to the doctor with an interval of 2 weeks. Arterial hypertension is an increase in SBP above 140 mmHg, and DBP above 90 mmHg.

There are 3 degrees arterial hypertension:

I 140-160 / 90-100

II 160-180 / 100-110

III 180 or more / 110 or more

A persistent increase in blood pressure is observed with:

hypertension (essential or primary hypertension);

symptomatic (secondary) forms of arterial hypertension:

for diseases of the kidneys (nephritis), renal vessels (vascular nephrosclerosis);

in case of hemodynamic disorders;

for endocrine diseases (pheochromocytoma, thyrotoxicosis, centrogenic form - for brain tumors, meningitis, encephalitis);

due to taking medications or toxic substances (GC, NSAIDs, cocaine).

Arterial hypotension

Blood pressure 100 or less / 60 or less. Observed in acute and chronic vascular insufficiency. Causes:

a constitutional feature in persons of asthenic physique, especially in an upright position (orthostatic hypotension) - an essential form;

symptomatic forms:

acute and chronic infections;

chronic intoxication (atropine, chloral hydrate);

tuberculosis;

endocrine diseases (Addison's disease, hypothyroidism);

shock, collapse, heavy blood loss, myocardial infarction - a sharp drop in blood pressure.

Measuring blood pressure is of great diagnostic importance, as it allows you to determine the state of the central and peripheral hemodynamics, determine the nature and degree of disruption of the neuroregulatory mechanisms that determine the level of blood pressure both normally and in pathology of the cardiovascular system and extracardiac pathology. Blood pressure is measured using method of Nikolai Sergeevich Korotkov using a cuff tonometer.

Normally, SBP, measured on the brachial artery, ranges from 110–130 mmHg, DBP – from 60–90, pulse – from 40 to 60, the average hemodynamic is 80–100 mmHg.

Significant increase in pulse pressure as a result of increased systolic and sharp fall Diastolic pressure is observed in aortic regurgitation, which is associated with a sharp and rapid decrease in blood volume and pressure in the aorta as a result of the flow of diastolic aortic regurgitation. A slight increase in pulse pressure is detected in thyrotoxicosis, aortic AS - due to a decrease in arterial tone.

Venous pressure(blood pressure in venous system BCC) is determined by the volume of circulating venous blood and the tone of the venous vessels. Venous pressure is measured using a direct (bloody) method using apparatusWaldman. The principle of the method is that venous blood, filling the manometric tube, moves a column of sterile liquid (saline), the level of which indicates the value of the measured venous pressure (in mm of water column). Venous pressure is determined by puncture of the ulnar or subclavian vein, the zero mark of the scale is set approximately at the PP level.

Normally, the level of venous pressure fluctuates between 60–120 mm of water column, increasing with physical stress and decreasing at rest and during night sleep.

In case of right heart failure, venous pressure increases significantly, especially high in case of tricuspid valve insufficiency, which is associated with an increase in the volume of blood in the BCC; in case of vascular failure, it decreases significantly as a result of a decrease in OPSS and a decrease in the volume of blood volume (in vascular insufficiency of any origin, part of the blood is deposited in the blood depots).

Sdarterial hypertension includes diseases in which there is an episodic or persistent increase in blood pressure.

By origin Arterial hypertension can be:

primary (essential, hypertension - as defined by domestic authors) - occurs regardless of the state of the organs involved in the regulation of vascular tone;

secondary (symptomatic) - arterial hypertension is one of the symptoms of the underlying disease.

ESSENTIAL ARTERIAL HYPERTENSION (HYPERTENSION).

Hypertension is one of the so-called diseases of civilization, since its prevalence in economically developed countries is much higher than in developing countries.

Pathogenesis primary arterial hypertension is quite complex, and it can be divided into 2 links: breakdown of central regulatory mechanisms and breakdown of peripheral regulatory mechanisms.

Central regulatory mechanisms.

Inhibitory GABAergic system of the brain. GABA reduces the activity of excitation processes in the SGM and prevents the development of stagnant foci of excitation.

1. Subcortical structures of the brain.

Adrenergic system of the brain (catecholamines).

Cholinergic system of the brain (acetylcholine)

Endorphin synthesis system (endogenous opioids).

Biological synthesis system active amines (serotonin, etc.)

The releasing system (releasing hormones that regulate the synthesis of tropic hormones by the pituitary gland).

Pituitary.

System of synthesis of tropic hormones (ADH, ACTH, TSH, STH

Peripheral regulatory mechanisms.

Sympathetic nervous system.

Tissue depots of norepinephrine (cardiac muscle and vascular wall)

Circulating catecholamines.

Parasympathetic nervous system.

Acetylcholine.

Vascular wall.

Volume receptors.

Osmoreceptors.

Chemoreceptors.

Peripheral endocrine organs.

Adrenal glands (GCS, mineralocorticoids, adrenaline - medulla and paravertebral chromaffin tissue).

Thyroid gland (T3, T4).

Kidneys.

YUGA (renin, angiotensin, PG).

Press influence the vascular wall is affected by: circulating CA; serotonin; vasopressin (ADH); ACTH; TSH; STG; T3 and T4; GCS; aldosterone; renin, AT II; PG F2a (produced in large quantities in the SGA of the kidneys).

Depressor effect on the vascular wall: GABA; Oh; endorphins; PG 12.

The basis for the increase in blood pressure is psycho-emotional stress, which is a violation of the body’s adequate response to situationally determined influence. The reaction to external stimuli, as a rule, becomes with a “-” sign. More often this is due to the genetic basic properties of the personality. Primary arterial hypertension is classified as a psychosomatic disease (repressed emotions - "disease of unreacted emotions"). The emerging autoaggression is directed towards target organs (LV and vascular wall). Adrenaline mainly affects the myocardium of the left ventricle and, to a lesser extent, the vascular wall. This is realized by LV hyperfunction with an increase in heart rate, LV contraction rate, SV, and VO, which leads to a significant increase in vascular filling in systole and is realized by an increase in SBP.

1. Formation or activation of a stagnant focus of excitation in the brainstem (weakness of the GABAergic system of the brain).

2. Activation of central and peripheral pressor mechanisms.

3. Increased levels of circulating KA, vasopressin, pituitary tropic hormones, glucocorticoids.

4. LV hyperfunction, increased vascular tone.

5. Tachycardia, systolic or diastolic arterial hypertension.

In later stages of the disease, along with an increase in adrenaline levels, the level of circulating norepinephrine also increases, which mainly has a vasopressor effect and, to a lesser extent, affects the heart muscle. This is accompanied by an increase in OPSS. The combination of increased vascular tone and increased cardiac output leads to an increase in both SBP and DBP ( systolic and diastolic hypertension).

An increase in the level of circulating catecholamines activates renal JGA, which is accompanied by increased synthesis of renin, angiotensin and aldosterone. The next stage in the progression of arterial hypertension is connected - saline mechanism. The reabsorption of Na and sodium-dependent H2O in the distal tubules of the kidneys increases. This leads to an increase in BCC. The retention of Na and H2O in the vascular wall leads to an increase in its sensitivity to the vasopressor effect of circulating catecholamines.

An increase in the synthesis of angiotensin II during hyperreninemia has a powerful direct vasopressor effect on the vascular wall. At the same time, the content of Ca ions in the SMC of blood vessels increases, which stimulates their contraction and further increases vascular tone and peripheral vascular resistance.

Systolic blood pressure is maintained by increasing SV and IOC. A further increase in vascular tone determines a further increase in diastolic blood pressure. Persistent systolic and diastolic arterial hypertension with systolic and volume overload of the LV is formed. Systolic overload is associated with an increase in peripheral vascular resistance, and volume overload is associated with an increase in blood volume. This is accompanied by remodeling resistive vessels and compensatory LV hypertrophy. Clinically manifested by bradycardia with an increase in the duration of systole and diastole of the left ventricle, which works against increased peripheral vascular resistance.

With overwork of the LV myocardium, dystrophic changes develop in it, especially in the subendocardial parts of the heart muscle due to the emerging relative coronary insufficiency. This leads to left ventricular decompensation with a decrease in cardiac output and a decrease in systolic blood pressure. Developing "decapitated" (diastolic) arterial hypertension.

LV dilatation (LVD) and remodeling of the vascular wall determines the disruption of blood supply to internal organs: the brain, retina, kidneys and heart muscle. Damage to target organs is clinically manifested:

angina pectoris and a high risk of developing myocardial infarction;

chronic cerebrovascular insufficiency with the development of stroke;

intracranial hypertension with a risk of developing eclampsia;

decreased visual acuity, high risk of developing retinal hemorrhages and retinal detachment;

renal ischemia resulting in hypertensive nephrosclerosis with a high risk of developing renal infarction and chronic renal failure with corresponding clinical symptoms.

Based on blood pressure indicators, there are 3 types of arterial hypertension:

hyperkinetic (systolic hypertension) - pulse pressure increases to 60 mmHg. and more. Corresponds to the adrenergic pathogenetic variant of hypertension.

eukinetic (systole-diastolic hypertension") - pulse pressure does not change significantly. Corresponds to the noradrenergic pathogenetic variant of hypertension.

hypokinetic (“decapitated” hypertension) - pulse pressure indicators are reduced. Corresponds to the salt pathogenetic variant of hypertension against the background of developing left ventricular failure.

Pathogenetic variants of hypertension.

Adrenergic arterial hypertension.

The main pathogenetic factor is an increase in the level of circulating adrenaline. This is situationally determined arterial hypertension in hyperreactors. Characterized by an unstable flow with periodic increase systolic blood pressure. It is realized due to the activation of the central link of hemodynamics with hyperfunction of the left ventricle. This is predominantly systolic arterial hypertension with adrenergic crises (first order crises): hypercatecholaminemia, severe autonomic symptoms, tachycardia. As a rule, they are not complicated by vascular accidents and are easily treated with sedatives, psychotropic drugs, and, to a lesser extent, with β-blockers. They can be observed throughout life, worsening in the premenopausal period (hormonal changes) and in older people (development of atherosclerotic vascular lesions).

Noradrenergic arterial hypertension

The main pathogenetic factor is an increase in the level of circulating norepinephrine, activation of motor centers and peripheral hemodynamics. Most often induced by medications that destroy adrenaline or reduce the sensitivity of tissue receptors to circulating adrenaline (Raunatin, Adelfan, Dopegit, Clonidine, etc.). The level of norepinephrine increases gradually and persists for a long time. Develops against the background of left ventricular hyperfunction and increased vascular tone. This is predominantly systolic and diastolic arterial hypertension with noradrenergic crises (second order crises). They are characterized by a slower increase in systolic and diastolic blood pressure, which persists for several hours and days. Poorly corrected with medications. Pathogenic drugs are used. A high TPR determines a decrease in heart rate with an increase in the duration of the cardiac cycle. The risk of developing vascular complications is extremely high: stroke, acute myocardial infarction, renal infarction, retinal hemorrhages and retinal detachment. The risk of developing ALVF up to pulmonary edema increases.

Saline arterial hypertension.

The main pathogenetic factor is primary (genetically determined) or secondary (as a result of the first 2 mechanisms) activation of the RAAS. Water-salt metabolism is disrupted, blood volume increases, and vascular tone increases. This is predominantly diastolic hypertension with salt (cerebral) crises against the background of systolic and volume overload of the left ventricle. The symptoms of crises are associated with an increase in blood pressure and ICP (due to an increase in the volume of cerebrospinal fluid). Brain symptoms are detected with a high risk of developing eclampsia and stroke. The development of crises is provoked by improper water-salt regime. Characteristic ring syndrome. This hypertension does not manifest itself clinically for a long time.

Main clinical symptoms.

Symptoms are associated with hemodynamic disturbances and target organ damage. 1. Intracranial hypertension Pain in the back of the head.

Nausea, vomiting at elevated ICP.

2. Disturbance of cerebral blood flow. Dizziness.

Balance imbalance.

Memory loss.

Astheno-neurotic symptoms.

Depressive states.

Focal or persistent neurological symptoms.

3. Impaired blood supply to the retina. Decreased visual acuity.

Hypertensive retinopathy (narrowing of arterioles and dilation of venules in the fundus). The degree of hypertension can be determined by the degree of angiopathy. The number of microvessels is significantly reduced; angiopathy is systemic in nature and is directly related to the deterioration of blood supply to all organs and tissues of the body. Hemorrhages in the retina of the eyes.

4. Retinal detachment (partial, total). Partial or complete loss of vision.

5. Relative coronary insufficiency. Attacks of angina pectoris at heights of increased blood pressure

Acute myocardial infarction Sudden death

It develops due to a discrepancy between the capacity of the coronary vessels and the mass of the hypertrophied myocardium. The strength and duration of systolic compression of the coronary vessels in the subendocardial layer increases, because The left ventricle works against high peripheral resistance. In addition, vasospasm develops, induced by adrenaline during an increase in blood pressure.

6. LVH with a tendency to CLVI. Dyspnea.

Attacks of cardiac asthma

Alveolar pulmonary edema

The severity of ALV increases with ischemic heart disease, post-infarction cardiosclerosis and heart rhythm disturbances. Develop more often

intraventricular blockades.

7. Total heart failure Edema (addition of symptoms of stagnation in the BCC). Ascites, hydrothorax, hydrocele.

Hepato- and splenomegaly.

8. Impaired blood supply to the kidneys. Non-specific. symptoms (dull, intermittent bilateral pain). Dysuria.

Renal infarction (clinically, it resembles renal colic + gross hematuria).

A prolonged increase in blood pressure leads to nephrosclerosis, which further aggravates the course of hypertension and increases the risk of developing vascular complications.

9. Chronic renal failure is the outcome of hypertensive nephrosclerosis. Encephalopathy, weakness, drowsiness, anorexia, nausea, vomiting.

Oligouria, up to anuria.

Peripheral edema, ascites, hydrothorax, nephrogenic pulmonary edema.

Uremic pericarditis, pleurisy.

Algorithm for diagnosing primary arterial hypertension.

The diagnosis is established by excluding pathologies of the brain, spine, kidneys and other organs.

Functional tests (Zimnitsky, Reberg, Nechiporenko test).

Biochemical research.

Immunological, serological and bacteriological studies.

Determination of hormone levels.

ECG, MT-tape, EEG,

R-logical studies of the skull, spine, coronary angiography, excretory urography.

Ultrasound (EchoCS, EchoEG, ultrasound of the kidneys).

Radioisotope renography.

Morphological study.

Daily blood pressure monitoring.

Sdheart failure (HF)

I. acute heart failure

1. cardiac (LPN, LVN, PZHN)

2. vascular (collapse, fainting, shock)

II. chronic heart failure

1. cardiac (LPN, LVN, RVN, total HF)

2. vascular (chronic hypotension)

3. mixed (cardiovascular)

Classification of CHF according to Vasilenko-Strazhesko. 3 stages:

Initial (hidden, latent). Hemodynamics at rest are not disturbed, asymptomatic LV dysfunction. With significant physical exertion - shortness of breath, palpitations

Clinically pronounced stage.

A. Hemodynamic disturbances in one of the blood circulation circles. Clinical signs of circulatory failure.

B. Severe circulatory disorders (hemodynamic disturbances in both circles)

An important indicator of human health is normal blood pressure. Over time, the numbers change. And what was unacceptable for young people is the ultimate dream for older people.

Currently, generally accepted standards are used that apply to all ages. But there are also averaged optimal pressure values ​​for each age group. Deviation from them is not always a pathology. Everyone can have their own norm.

Modern classification

There are three options for normal blood pressure in an adult:

• optimal – less than 120/80;
• normal – from 120/80 to 129/84;
• high normal – from 130/85 to 139/89 mm Hg. Art.

Everything that fits into these numbers is absolutely normal. It is not specified only bottom line. Hypotension is a condition in which the blood pressure monitor produces values ​​less than 90/60. That is why, depending on individual characteristics, everything above this limit is acceptable.

At this point online calculator you can look at blood pressure norms by age.

Pressure measurement must be carried out in compliance with certain rules:

1. 30 minutes before the intended procedure, you should not play sports or experience other physical activity.
2. To determine true rates, the study should not be performed under stress.
3. For 30 minutes, do not smoke, do not consume food, alcohol, coffee.
4. Do not talk during the measurement.
5. Measurement results obtained on both hands should be evaluated. The highest indicator is taken as a basis. A difference of 10 mm Hg is allowed. Art.

Individual norm

The ideal pressure is one at which a person feels great, but at the same time it corresponds to the norm. Has the meaning hereditary predisposition to hypertension or hypotension. Numbers may change during the day. At night they are lower than during the day. During wakefulness, blood pressure can increase with physical activity and stress. Trained people and professional athletes often show indicators below the age norm. Measurement results are affected by medications and the use of stimulants such as coffee and strong tea. Fluctuations within 15–25 mm Hg are acceptable. Art.

With age, indicators begin to gradually shift from optimal to normal, and then to normal high. This is due to the fact that certain changes occur in the cardiovascular system. One of these factors is an increase in the rigidity of the vascular wall due to age-related characteristics. So, people who have lived their whole lives with numbers of 90/60 may find that the tonometer begins to show 120/80. And that's okay. A person feels good, since the process of increasing pressure occurs unnoticed, and the body gradually adapts to such changes.

There is also the concept of working pressure. It may not correspond to the norm, but the person feels better than with the one that is considered optimal for him. This is relevant for older people suffering from arterial hypertension. The diagnosis of hypertension is established if blood pressure is 140/90 mm Hg. Art. and higher. Many older patients feel better with numbers of 150/80 than with lower values.

In such a situation, you should not achieve the recommended norm. With age, cerebral vascular atherosclerosis develops. Higher systemic pressure is required to ensure satisfactory blood flow. Otherwise, signs of ischemia appear: headaches, dizziness, possible nausea, etc.

Another situation is a young hypotensive person who has lived with the numbers 95/60 all his life. Sudden rise pressure even up to “space” 120/80 mm Hg. Art. may cause a deterioration in health, reminiscent of a hypertensive crisis.

White coat hypertension is possible. Wherein correct pressure The doctor cannot determine it, since it will be higher at the appointment. And at home normal indicators are recorded. Decide on individual norm Only regular monitoring at home will help.

Methods for determining the norm

Each person is individual. This is determined not only by age, but also by other parameters: height, weight, gender. That is why calculation formulas were created that take into account age and weight. They help determine what pressure will be optimal for a particular individual.

The Volynsky formula is suitable for this. Used in people aged 17–79 years. Systolic (SBP) and diastolic (DBP) pressure indicators are calculated separately.

SBP = 109 + (0.5 × number of years) + (0.1 × weight in kg)

DBP = 63 + (0.1 × years of life) + (0.15 × weight in kg)

There is another formula that is applicable for an adult 20–80 years old. Weight is not taken into account here:

SBP = 109 + (0.4 × age)

DBP = 67 + (0.3 × age)

Approximate calculations for those who don’t want to count:

Another reference table can be used to determine the norm:

The indicators here differ from what can be obtained using calculation formulas. Studying the numbers, you will notice that they become higher with age. In people under 40 years of age, rates are higher in men. After this milestone, the picture changes, and women’s blood pressure becomes higher. This is related to hormonal changes V female body. The numbers for people over 50 are noteworthy. They are higher than those currently defined as normal.

Conclusion

When assessing the tonometer indicators, the doctor always focuses on the accepted classification, regardless of how old the person is. The same blood pressure norm should be taken into account during home monitoring. Only with such values ​​does the body function fully and do not suffer vital important organs, the risk is reduced cardiovascular complications.

The exception is for elderly people or those who have had a stroke. In this situation, it is better to keep the numbers no higher than 150/80 mmHg. Art. In other cases, any significant deviations from the standards should be a reason to consult a doctor. This may hide diseases that require treatment.

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Arterial pressure- this is the blood pressure in the large arteries of a person. There are two indicators of blood pressure:

• Systolic (upper) blood pressure is the level of blood pressure at the moment of maximum contraction of the heart.
• Diastolic (lower) blood pressure is the level of blood pressure at the moment of maximum relaxation of the heart.

Blood pressure is measured in millimeters of mercury, abbreviated mmHg. Art. A blood pressure value of 120/80 means that the systolic (upper) pressure is 120 mmHg. Art., and the value of diastolic (lower) blood pressure is 80 mm Hg. Art.

Elevated numbers on the blood pressure monitor are associated with serious diseases, for example, the risk of cerebral circulation, heart attack. In case of chronic high blood pressure, the risk of stroke increases by 7 times, chronic heart failure by 6 times, heart attack by 4 times and peripheral vascular disease by 3 times.

What is normal blood pressure? What are its indicators at rest and during physical activity?

Blood pressure is divided into: optimal - 120 to 80 mm Hg. Art., normal - 130 to 85 mm Hg. Art., high, but still normal - from 135-139 mm Hg. Art., at 85-89 mm Hg. Art. High blood pressure is considered to be 140 to 90 mmHg. Art. and more. With physical activity, blood pressure increases in accordance with the needs of the body, an increase of 20 mm Hg. Art. indicates an adequate response of the cardiovascular system. If there are changes in the body or risk factors, then blood pressure changes with age: diastolic pressure increases until age 60, and systolic pressure increases throughout life.

For accurate results, blood pressure should be measured after 5-10 minutes of rest, and one hour before the examination you should not smoke or drink coffee. During measurement, your hand should lie comfortably on the table. The cuff is attached to the shoulder so that its lower edge is 2-3 cm above the fold of the elbow. In this case, the center of the cuff should be above the brachial artery. When the doctor finishes pumping air into the cuff, he begins to gradually deflate it, and we hear the first sound - systolic.
To assess blood pressure levels, the World Health Organization classification adopted in 1999 is used.

* If systolic and diastolic blood pressure are in different categories, select highest category.
** Optimal in relation to the risk of developing cardiovascular complications and mortality

The terms “mild”, “borderline”, “severe”, “moderate” given in the classification characterize only the level of blood pressure, and not the severity of the patient’s disease.
In everyday life clinical practice The World Health Organization classification of arterial hypertension has been adopted, based on damage to the so-called target organs.

Normal blood pressure in newborns is 70 mm Hg.

Normal blood pressure in a child who is one year old: for boys - 96/66 (upper/lower), for girls - 95/65.

Normal blood pressure in a 10-year-old child: 103/69 in boys and 103/70 in girls.

What is the normal blood pressure for an adult?
Normal blood pressure in young people 20 years old: for boys - 123/76, for girls - 116/72.

Normal blood pressure in young people who are about 30 years old: in young men - 126/79, in young women - 120/75.

What is normal blood pressure for a middle-aged person? In 40-year-old men it is 129/81, in 40-year-old women it is 127/80.

For fifty-year-old men and women, blood pressure is considered normal: 135/83 and 137/84, respectively.

For older people, the following pressure is considered normal: for 60-year-old men 142/85, for women of the same age 144/85.

For older people over 70 years old, normal blood pressure is 145/82 for men and 159/85 for women.

What is the normal blood pressure for an old or elderly person? For 80-year-old people, blood pressure of 147/82 and 157/83 for men and women, respectively, is considered normal.

For elderly ninety-year-old grandfathers, normal blood pressure is considered to be 145/78, and for grandmothers of the same age - 150/79 mm Hg.

With unusual physical activity or emotional stress, blood pressure increases. Sometimes this interferes with doctors when examining cardiac patients, who for the most part are impressionable people. American scientists even talk about the existence of the so-called “white coat effect”: when the results of measuring blood pressure in a doctor’s office are 30-40 mm Hg. Art. higher than when measuring his home independently. And this is due to the stress that the environment of the medical institution causes in the patient.

On the other hand, in people who are constantly exposed to heavy loads, such as athletes, a pressure of 100/60 or even 90/50 mmHg becomes normal. Art. But with all the variety of “normal” blood pressure indicators, each person usually knows the norm of his blood pressure, in any case, he clearly perceives any deviations from it in one direction or another.

There are also certain blood pressure guidelines that change with age (norms for 1981):

However modern ideas about normal blood pressure are somewhat different. It is now believed that even slight increases in blood pressure over time can increase the risk of developing coronary disease heart disease, cerebral stroke and other diseases of the cardiovascular system. Therefore, normal blood pressure levels in adults are currently considered to be up to 130-139/85-89 mmHg. Art. The norm for patients with diabetes is considered to be a blood pressure of 130/85 mmHg. Art. Arterial blood pressure at the level of 140/90 refers to the high norm. Blood pressure over 140/90 mm Hg. Art. is already a sign of arterial hypertension.

Normal human heart rate

Pulse (lat. pulsus blow, push) - periodic fluctuations in the volume of blood vessels associated with contractions of the heart, caused by the dynamics of their blood filling and pressure in them during one cardiac cycle. The average healthy person has normal resting heart rate is 60-80 beats per minute. So, the more economical metabolic processes, the fewer number of beats a person’s heart makes per unit of time, the longer the life expectancy. If your goal is to prolong life, then you need to monitor the effectiveness of the process, namely your heart rate.

Normal heart rate for different age categories:

• child after birth 140 beats/min
• from birth to 1 year 130 beats/min
• from 1 year to 2 years 100 beats/min
• from 3 to 7 years 95 beats/min
• from 8 to 14 years 80 beats/min
• average age 72 beats/min
• advanced age 65 beats/min
• for illness 120 beats/min
• shortly before death 160 beats/min

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Blood pressure and its deviations

Any person knows that the ideal values ​​of blood pressure on the walls of the arteries are 120/80 mm Hg. Art. But not everything is so simple. There are many factors that influence these parameters. In particular, blood pressure can vary depending on the weather, load, psychological state. But such changes are usually insignificant and are not dangerous to the body.

A much greater risk is borne by indicators that are consistently deviated from the norm, accompanied by changes in well-being. In the first case, when determining arterial values, the patient’s age is taken into account. In the second option, when the patient’s condition changes, the age factor is given a secondary role.

In any case, if a person is healthy, the blood pressure on the vessels changes throughout life.

So, at birth this indicator is within 66/55 mmHg. Art., after 50 years, the numbers on the tonometer can reach 140/90.

The differences are significant and the main role is played by physiological changes person throughout life.

Blood pressure in the arteries depends on the following factors:

1. Individual contractile abilities cardiac muscles and sufficient release of fluid into the vessels.
2. Density. The thicker it is, the worse it moves through small vessels.
3. Elasticity of arteries. This is entirely an age-related cause of changes in blood pressure. In infancy, the walls of the veins are more “extensible”, over the years they become dense, atherosclerotic deposits accumulate on them, which leads to an increase in blood pressure.
4. Frequent stress and hormonal disorders. These factors are more likely than others to cause increased blood pressure in women. Throughout the life of the fairer sex, hormonal levels change repeatedly (pregnancy, after 50 years, during menopause), which is a prerequisite for an increase in blood pressure.

Measuring arterial parameters is mandatory when visiting a cardiologist. This is one of the main procedures to determine abnormalities in the functioning of the heart. Thus, the systolic indicator (upper blood pressure) reflects the force of blood pressure during ejection; The diastolic number (lower blood pressure) indicates the condition of the arteries during the period between heart contractions.

An adult's blood pressure is measured using a special tonometer. The procedure is carried out in a sitting position, in a warm room and in complete calm.

The cuff is placed on the forearm in such a way that the lower edge is slightly above the elbow. The material is not tightened too much, nothing should put pressure on the limb, the hand is completely relaxed.

The sound-conducting membrane of the stethoscope is applied in the area of ​​the ulnar fossa. After this, the air outlet in the cylinder is blocked and by repeatedly pressing this element, the flow is pumped into the cuff.

This is done until the sound manifestations disappear, after which it is necessary to increase the pressure in the cuff by a few more millimeters. Then the tap on the “pear” is slowly opened and the first and last sounds are recorded.

1. If the numerical values ​​are significantly higher than 140/90 mmHg. Art. – this may indicate a dysfunction of the cardiovascular system (in particular, the development of hypertension).
2. The readings are much lower than 120/80 mmHg. Art. may indicate the appearance of hypotension. But when analyzing the significance of deviations from such indicators, the doctor must take into account age criteria.

Normal blood pressure depending on age

But today the situation has changed a little. And it is becoming more and more difficult to meet people under 50 with such indicators. When measuring blood pressure, doctors are increasingly focusing on the maximum permissible norms.

Today, in a middle-aged adult, it is considered correct when systolic numbers do not exceed 130 mmHg. Art., and diastolic - 85. In this case, the pulse should be within 60 -80 beats per minute. But these are not considered uniformly correct indicators. In addition to a person’s personality traits, these numbers are significantly influenced by gender. So, if we compare the obtained tonometer values ​​in men and women of the same age, then in the fairer sex they will be several millimeters less.

Also, blood pressure norms depend on age. If for healthy twenty-year-old boys the optimal blood pressure is considered to be within 125/75 mm Hg. Art., then at 50 years old the ideal is 135/85.

But, in practice, at an advanced age, such indicators are rare. Most often, numbers within the range of 140/90 mm Hg are stated. Art.

The main reasons for this are:

• excess weight,
• smoking,
• alcohol abuse,
• sedentary lifestyle,
• nervous tension,
• genetic inheritance.

That is why at this age people are most often susceptible to diseases of the heart and blood vessels, especially ischemic pathologies.

As for children and adolescents, from birth to adulthood there is a continuous process of formation of personal blood pressure standards. In small children vascular system more elastic than in adults. And, therefore, blood pressure levels are lower.

For children there is no uniformly established norm of arterial parameters. This is explained by physiological age-related fluctuations. So, for one-year-old babies, the optimal numbers should be within 95/65 mmHg. Art. During the school period, these values ​​depend on the phase of puberty and range from 100/70 to 120/75 mm Hg. Art.

In the age range from 12 to 14 years, girls have higher blood pressure than boys. This is due to hormonal changes occurring in the fairer sex at this time. At the age of 16 the situation changes dramatically. At this age, boys have slightly higher blood pressure compared to girls.

Blood pressure, its norm and its extremes, are especially important for pregnant women. The good course of pregnancy and the life of the unborn baby directly depend on this. Over the course of two trimesters, blood pressure values ​​do not change and correspond to those that the woman had before pregnancy. In the third trimester, under the influence of hormones, the tonometer values ​​may increase slightly. A deviation from the norm of no more than 10 mmHg is allowed. Art.

In the case of a pathological course of pregnancy, gestosis with significant changes in arterial parameters, kidney damage, preeclampsia and eclampsia may be observed. If pregnancy occurs against the background of hypertension, the woman’s condition may worsen in the form of hypertensive crises or a persistent increase in blood pressure.

Placenta – vascular organ, and when blood pressure drops, this affects the condition of both mother and baby. The flow of blood to the fetus slows down, the embryo feels a lack of oxygen, which negatively affects its development and can cause miscarriage. This affects a pregnant woman with dizziness and severe weakness.

An increase in blood levels for a pregnant woman is also unacceptable.

This may result in:

• placental abruption,
• premature birth,
• In some cases, the baby may be lost.

Therefore, pregnant women should especially monitor their blood pressure and immediately consult a doctor if there are any deviations from the norm.

If these numbers are significantly exceeded, there is a risk of stroke or heart attack. In such cases, immediate treatment is carried out.

Table normal indicators Blood pressure depending on age

The figures in the table above are statistical averages. These figures do not take into account the personal characteristics of the human body and external influencing factors.

serdce1.ru

Where is the norm?

The normal blood pressure in adults is considered to be120/80 mm Hg. st. But how can this indicator be fixed if a living organism, which is a person, must constantly adapt to different conditions existence? And people are all different, so blood pressure still deviates within reasonable limits.

Let modern medicine and abandoned the previous complex formulas for calculating blood pressure, which took into account parameters such as gender, age, weight, but there are still discounts on something. For example, for an asthenic “lightweight” woman, the pressure is 110/70 mm Hg. Art. is considered quite normal, and if blood pressure increases by 20 mm Hg. Art., then she will certainly feel it. In the same way, the normal pressure will be 130/80 mmHg. Art. for a trained young man. After all, athletes usually have it this way.

Variations in blood pressure will still be affected by factors such as age, exercise stress, psycho-emotional situation, climatic and weather. Arterial hypertension (AH), perhaps, would not have befallen a hypertensive patient if he lived in another country. Otherwise, how can we understand the fact that on the black African continent, hypertension can be found only occasionally among the indigenous population, while blacks in the USA suffer from it en masse? It turns out that only BP does not depend on race.

However, if the pressure rises slightly (10 mm Hg) and only to give a person the opportunity to adapt to the environment, that is, occasionally, all this is considered normal and does not give reason to think about the disease.

With age, blood pressure also rises slightly. This is due to changes in the blood vessels, which deposit something on their walls. In practically healthy people, the deposits are very small, so the pressure will increase by 10-15 mm Hg. pillar

If blood pressure values ​​exceed 140/90 mm Hg. st., will steadfastly stay at this figure, and sometimes even move upward, such a person will be diagnosed with arterial hypertension of the appropriate degree, depending on the pressure values. Consequently, for adults there is no norm for blood pressure by age; there is only a small discount for age. But for children everything is a little different.

Video: how to keep blood pressure normal?

What about the children?

Blood pressure in children has different values ​​than in adults. And it grows, starting from birth, at first quite quickly, then growth slows down, with some upward leaps in adolescence, and reaches the level of blood pressure of an adult. Of course, it would be surprising if such pressure small newborn a child with everything “new” was 120/80 mmHg. Art.

The structure of all organs of a newly born baby is not yet complete, this also applies to the cardiovascular system. The blood vessels of a newborn are elastic, their lumen is wider, the network of capillaries is larger, so the pressure is 60/40 mm Hg. Art. for him it will be the absolute norm. Although, maybe someone will be surprised by the fact that lipid stains can be found in the aorta of newborns yellow color, which, however, do not affect health and go away over time. But this is so, a retreat.

As the baby develops and further formation of his body, blood pressure rises and by the year of life the normal figures will be 90-100/40-60 mmHg. Art., and the child will reach the values ​​of an adult only by the age of 9-10. However, at this age the pressure is 100/60 mmHg. Art. will be considered normal and will not surprise anyone. But in adolescents, a blood pressure value that is considered normal is slightly higher than that established for adults, 120/80. This is probably due to the hormonal surge characteristic of adolescence. For calculation normal values Pediatricians use blood pressure in children special table, which we bring to the attention of readers.

Blood pressure problems in children and adolescents

Unfortunately, such a pathology as arterial hypertension is no exception for the child’s body. Blood pressure lability most often manifests itself in adolescence, when the body undergoes restructuring, but puberty This is why it is dangerous because a person at this time is not yet an adult, but no longer a child. This age is difficult for the person himself, because it often leads to pressure surges. instability of the nervous system teenager, and for his parents, and for the attending physician. However, pathological deviations must be noticed and leveled out in time. This is the task of adults.

The causes of increased blood pressure in children and adolescents may be:

As a result of the influence of these factors, vascular tone increases, the heart begins to work harder, especially its left side. If not taken urgent measures, a young man can meet his coming of age with a ready-made diagnosis: arterial hypertension or, at best, cardiopsychoneurosis of one type or another.

Measuring blood pressure at home

We talk about blood pressure for quite a long time, implying that all people know how to measure it. It seems that there is nothing complicated, we put a cuff above the elbow, pump air into it, slowly release it and listen.

Everything is correct, but before moving on to blood pressure in adults, I would like to dwell on the algorithm for measuring blood pressure, since patients often do this on their own and not always according to the method. As a result, inadequate results are obtained, and, accordingly, unreasonable use of antihypertensive drugs. In addition, when people talk about upper and lower blood pressure, they do not always understand what it all means.

To correctly measure blood pressure, it is very important what conditions a person is in. To avoid getting “random numbers”, in America they measure blood pressure following the following rules:

1. A comfortable environment for a person whose blood pressure is of interest should be at least 5 minutes;
2. Half an hour before the procedure, do not smoke or eat;
3. Visit the toilet to bladder was not filled;
4. Take into account the voltage painful sensations, bad feeling, taking medications;
5. Measure blood pressure twice on both arms in a lying, sitting, standing position.

Probably, each of us will not agree with this, except for the military registration and enlistment office or in strict inpatient conditions This measurement is appropriate. Nevertheless, you should strive to fulfill at least some points. For example, It would still be good to measure the pressure in calm atmosphere , having comfortably laid or seated a person, take into account the influence of a “good” smoke break or just eaten a hearty lunch. It should be remembered that the accepted antihypertensive may not yet have had its effect (not much time has passed) and not grab onto next pill, seeing a disappointing result.

A person, especially if he is not completely healthy, usually does a poor job of measuring his own blood pressure (it costs a lot to put a cuff on!). It is better if one of the relatives or neighbors does this. Very seriously need to treat And to the method of measuring blood pressure.

Video: measuring pressure with an electronic tonometer

Cuff, tonometer, phonendoscope... systole and diastole

The algorithm for determining blood pressure (auscultatory method by N.S. Korotkov, 1905) is very simple if everything is done correctly. The patient is seated comfortably (can be lying down) and measurement begins:

• Air is released from the cuff connected to the tonometer and the bulb by squeezing it with the palms;
• Wrap the cuff around the patient’s arm above the elbow (tightly and evenly), trying to ensure that the rubber connecting tube is on the side of the artery, otherwise you may get an incorrect result;
• Select a listening location and install a phonendoscope;
• Inflate air into the cuff;
• When inflating air, the cuff compresses the arteries due to its own pressure, which is 20-30 mm Hg. Art. above the pressure at which the sounds heard on the brachial artery with each pulse wave completely disappear;
• Slowly releasing air from the cuff, listen to the sounds of the artery on the elbow;
• The first sound heard by the phonendoscope is recorded with a glance on the tonometer scale. It will mean the breakthrough of a portion of blood through the compressed area, since the pressure in the artery has slightly exceeded the pressure in the cuff. The impact of escaping blood against the artery wall is called in Korotkov's tone, top or systolic pressure;
• The series of sounds, noises, tones following systole is understandable to cardiologists, but ordinary people must catch the last sound, which is called diastolic or lower, it is also marked visually.

Thus, contracting, the heart pushes blood into the arteries (systole), creating pressure on them equal to the upper or systolic. Blood begins to distribute through the vessels, which leads to a decrease in pressure and relaxation of the heart (diastole). This is the last, lower, diastolic beat.

However, there are nuances...

Scientists have found that when measuring blood pressure traditional method its values ​​are 10% different from the true ones (direct measurement in the artery during its puncture). Such an error is more than compensated for by the accessibility and simplicity of the procedure; moreover, as a rule, one measurement of blood pressure in the same patient is not enough, and this makes it possible to reduce the magnitude of the error.

In addition, the patients do not differ in the same build. For example, thin people have lower detectable values. But for overweight people, on the contrary, it is higher than in reality. This difference can be leveled out by a cuff with a width of more than 130 mm. However, there are not just fat people. Obesity of 3-4 degrees often makes it difficult to measure blood pressure on the arm. In such cases, the measurement is carried out on the leg using a special cuff.

There are cases when, with the auscultatory method of measuring blood pressure in the interval between the upper and lower arterial pressure, a break is observed in the sound wave (10-20 mm Hg or more), when there are no sounds above the artery (complete silence), but on the vessel itself there is a pulse. This phenomenon is called auscultatory “failure”, which can occur in the upper or middle third of the pressure amplitude. Such a “failure” should not go unnoticed, because then a lower blood pressure value (the lower limit of the auscultatory “failure”) will be mistakenly taken for the value of systolic pressure. Sometimes this difference can be even 50 mm Hg. Art., which, naturally, will greatly affect the interpretation of the result and, accordingly, treatment, if necessary.

An error like this is highly undesirable and can be avoided. To do this, simultaneously with pumping air into the cuff, the pulse in the radial artery should be monitored. The pressure in the cuff must be increased to values ​​sufficiently above the level at which the pulse disappears.

The phenomenon of "infinite tone" well known to adolescents, sports doctors and in military registration and enlistment offices when examining conscripts. The nature of this phenomenon is considered to be a hyperkinetic type of blood circulation and low vascular tone, the cause of which is emotional or physical stress. IN in this case it is not possible to determine the diastolic pressure, it seems that it is simply equal to zero. However, after a few days, in a relaxed state of the young man, measuring the lower pressure does not present any difficulties.

Video: measuring pressure using the traditional method

Blood pressure increases... (hypertension)

The causes of high blood pressure in adults are not much different from those in children, but those who are... undoubtedly have more risk factors:

1. Of course, atherosclerosis, leading to vasoconstriction and increased blood pressure;
2. BP clearly correlates with excess weight;
3. Glucose level ( diabetes) greatly influences the formation of arterial hypertension;
4. Excessive consumption of table salt;
5. Life in the city, because it is known that an increase in blood pressure parallels the acceleration of the pace of life;
6. Alcohol. Strong tea and coffee become a cause only when they are consumed in excessive quantities;
7. Oral contraceptives, which many women use to avoid unwanted pregnancy;
8. Smoking itself, perhaps, would not be among the causes of high blood pressure, but this bad habit has too bad an effect on the blood vessels, especially peripheral ones;
9. Low physical activity;
10. Professional activities associated with high psycho-emotional stress;
11. Changes in atmospheric pressure, changes in weather conditions;
12. Many other diseases, including surgical ones.

People suffering from arterial hypertension, as a rule, control their condition themselves by constantly taking medications to lower blood pressure, prescribed by a doctor in individually selected dosages. These may be beta blockers, calcium antagonists or ACE inhibitors. Considering the good awareness of patients about their illness, there is no point in dwelling too much on arterial hypertension, its manifestations and treatment.

However, everything begins somewhere, and so it is with hypertension. It is necessary to determine: this is a one-time increase in blood pressure caused by objective reasons (stress, drinking alcohol in inadequate doses, some medicines), or there is a tendency for it to increase on an ongoing basis, for example, blood pressure rises in the evening, after a working day.

It is clear that an evening rise in blood pressure indicates that during the day a person bears an excessive load on himself, so he must analyze the day, find the cause and begin treatment (or prevention). In such cases, the presence of hypertension in the family should be even more alarming, since it is known that this disease has a hereditary predisposition.

If high blood pressure is detected repeatedly, even if in numbers 135/90 mmHg. Art., then it is advisable to start taking measures to prevent it from becoming high. It is not necessary to immediately resort to medications; you can first try to regulate your blood pressure by following a regimen of work, rest and nutrition.

Of course, diet plays a special role in this regard. By giving preference to products that lower blood pressure, you can do without pharmaceuticals for a long time, or even avoid taking them altogether, if you do not forget about folk recipes containing medicinal herbs.

Having compiled a menu of these available products, like garlic, white and Brussels sprouts, beans and peas, milk, baked potatoes, salmon fish, spinach, you can eat well and not feel hungry. And bananas, kiwi, orange, pomegranate can perfectly replace any dessert and at the same time normalize blood pressure.

Video: hypertension in the program “Live Healthy!”

Blood pressure is low... (hypotension)

Low blood pressure, although not fraught with such dangerous complications, as tall, but a person is uncomfortable living with it. Typically, such patients have a diagnosis of vegetative-vascular (neurocirculatory) dystonia of the hypotonic type, which is quite common these days, when the slightest sign Under unfavorable conditions, blood pressure decreases, which is accompanied by pallor of the skin, dizziness, nausea, general weakness and malaise. Patients break into a cold sweat and may faint.

There are many reasons for this, the treatment of such people is very difficult and lengthy, moreover, there are no medications for constant use, except that patients often drink freshly brewed green tea, coffee and occasionally take tincture of Eleutherococcus, ginseng and pantocrine tablets. Regime, especially sleep, which requires at least 10 hours, helps normalize blood pressure in such patients. Nutrition for hypotension should be sufficiently high in calories, because low blood pressure requires glucose. Green tea has a beneficial effect on blood vessels during hypotension, increasing blood pressure somewhat and thereby bringing a person to his senses, which is especially noticeable in the morning. A cup of coffee also helps, but you should remember that the drink is addictive, that is, you can get hooked on it unnoticed.

The range of health measures for low blood pressure includes:

1. Healthy lifestyle (active recreation, sufficient time in the fresh air);
2. High physical activity, sports;
3. Water treatments (aroma baths, hydromassage, swimming pool);
4. Spa treatment;
5. Diet;
6. Elimination of provoking factors.

Help yourself!

If you have problems with blood pressure, you should not passively wait for the doctor to come and cure everything. The success of prevention and treatment largely depends on the patient himself. Of course, if suddenly hypertensive crisis If you happen to end up in a hospital, they will prescribe a blood pressure profile and select pills. But when a patient comes to an outpatient appointment with complaints of increased blood pressure, he will have to take on a lot. For example, it is difficult to trace the dynamics of blood pressure from words, therefore the patient is asked to keep a diary(at the observation stage for the selection of antihypertensive drugs - a week, during the period of long-term use of drugs - 2 weeks 4 times a year, that is, every 3 months).

The diary can be an ordinary school notebook, divided into columns for convenience. It should be remembered that the measurement of the first day, although carried out, is not taken into account. In the morning (6-8 hours, but always before taking medications) and in the evening (18-21 hours) you need to take 2 measurements. Of course, it will be better if the patient is so careful that he measures the pressure every 12 hours at the same time.

• Rest for 5 minutes, and if there was emotional or physical stress, then 15-20 minutes;
• An hour before the procedure, do not drink strong tea or coffee. alcoholic drinks and don’t think, don’t smoke for half an hour (tolerate it!);
• Do not comment on the actions of the person measuring, do not discuss the news, remember that there should be silence when measuring blood pressure;
• Sit comfortably, keeping your hand on a hard surface.
• Carefully record your blood pressure values ​​in a notebook so that you can later show your notes to your doctor.

You can talk about blood pressure for a long time and a lot, patients love to do this, sitting under the doctor’s office, but you can talk, but you should not take advice and recommendations into account, because everyone has their own cause of arterial hypertension, their own concomitant diseases and their own medicine. For some patients, blood pressure-lowering medications take more than one day to select, so it is better to trust one person - the doctor.

sosudinfo.ru

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