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HYPERTENSION

Blood pressure. Arterial pressure.
10.12.2018

Blood pressure – pressure inside blood vessels (inside arteries – arterial pressure, inside capillaries – capillary pressure, and inside veins – venous pressure). Pressure provides for blood movement through the circulatory system, whereby metabolic processes occur in the body tissues.

Arterial pressure level is determined mainly by heart force, amount of blood pumped by the heart with each contraction, resistance provided against blood flow by blood vessel walls (especially peripheral vessels). Arterial pressure level is also influenced by the amount of circulating blood, its viscosity, pressure fluctuations in the abdominal and chest cavities, which are associated with respiratory movements, as well as with other factors.

Arterial pressure reaches its maximum level during contraction (systole) of the left ventricle of the heart. At that, 60-70 ml of blood is ejected out of the heart. This amount of blood can not pass directly through small blood vessels (especially capillaries), that is why elastic aorta is stretched, and pressure increases in it (systolic pressure). Normal blood pressure reading in large arteries is 100-140 mm Hg.

During a pause between contractions of the heart ventricles (diastole), blood vessel walls (aorta and large arteries), being stretched, begin to contract and push the blood into capillaries. Blood pressure gradually decreases and by the end of diastole reaches its minimum level (70-80 mm Hg in large arteries). The numeric difference between systolic and diastolic blood pressure, or rather fluctuations in their levels, is perceived as a pulse wave, which is called pulse.

Blood pressure in blood vessels decreases with the distance the blood travels from the heart. Thus, aortic pressure is 140/90 mm Hg (the first digit indicates systolic, or upper, pressure, and the second one – diastolic, or lower pressure). The blood pressure in large arteries is on average 120/75 mm Hg. In arterioles, there is almost no numeric difference between systolic and diastolic blood pressure, and the blood pressure is about 40 mm Hg. In capillaries, the blood pressure is reduced to 10-15 mm Hg. When blood passes into the venous channel, the blood pressure decreases even more, and in the largest veins (superior and inferior vena cavas), blood pressure can be negative.

Normally, blood pressure depends on individual characteristics, lifestyle and occupation. Its level changes with age, and increases due to physical exertion, emotional stress, etc. However, systolic and diastolic pressure in people who are regularly engaged in heavy physical labor, as well as in athletes may lower and make up 100-90 and 60 (even 50 mm Hg), correspondingly.

Approximate arterial pressure readings during different age periods are the following:

Normal arterial pressure of a healthy adult is 100-129 (upper) and 70-80 (lower). If the pressure is above the said readings, but below 140 (upper) and 90 (lower), it is called “normal increased”.
In children, systolic pressure can be estimated by the formula 80 + 2а, where “a” is number of life years of a child.

Despite significant fluctuations in blood pressure (for example, depending on tension, emotional state, etc.), there are complex mechanisms in the body of its level regulation, which tend to return blood pressure to its normal readings after termination of these factors. In some cases, these mechanisms are broken, which leads to a change in blood pressure. Persistent change in blood pressure in terms of raising is called arterial hypertension (hypertonia), and in terms of lowering – arterial hypotension. Although the change in blood pressure often serves a protective and adaptive purpose, it is better to consult your doctor if it deviates from the normal readings.

Essential hypertension

Hypertension makes up to 90% of all cases of chronic increase in arterial pressure. In economically developed countries, 18-20% of adults suffer from hypertension, that is, have repeated increase in arterial pressure up to 140/90 mm Hg and above. They are guided by the readings of a so-called “random” blood pressure measured after a five-minute rest, in a sitting position, three times in a row (the lowest readings are taken into account). During the first examination of a patient, the doctor measures blood pressure necessarily on both arms and, if necessary, on the legs.

Symptoms and course of hypertension

Hypertension usually occurs at the age of 30-60 years, proceeds chronically with periods of deterioration and improvement. 

Stage I hypertension (mild)

  • Characterized by increase in arterial pressure within 160-180/95-105 mm Hg. This level is unstable and gradually returns to normal during the rest. Pain and noise in the head, disturbed sleep, decrease in cognitive performance. Occasionally: dizziness, nosebleed. 

Stage II hypertension (moderate)

  • Higher and more stable arterial pressure (180-200/105-115 mm Hg at rest). Headaches and pain in the heart area are worsening, dizziness. Possible hypertensive crises (sudden and significant increases in arterial pressure). Signs of heart failure, central nervous system (transient disorders of cerebral circulation, strokes), changes in the fundus, decreased blood flow in the kidneys. 

Stage III hypertension (severe)

  • Blood pressure reaches 200-230/115-130 mm Hg, blood pressure does not get normalized by itself. Such tension in blood vessels causes irreversible changes in the activity of the heart (angina, myocardial infarction, heart failure, arrhythmia), brain (strokes, encephalopathy), fundus (retinal vessel damage – retinopathy), kidneys (reduced blood flow, reduced glomerular filtration, chronic renal failure).


This stage of hypertension is determined based on the data of systematic measurement of arterial pressure, detection of specific fundus changes, and specific changes displayed in electrocardiogram.

Hypertension shall be distinguished from (symptomatic) secondary arterial hypertension arising from kidney diseases, renal vessels, endocrine organs (Cushing syndrome, acromegaly, primary aldosteronism, thyrotoxicosis), and circulatory disorders (aortic atherosclerosis, aortic valve insufficiency, complete atrioventricular block, coarctation of aorta).

Treatment.

Non-medicinal treatment: weight loss, table salt restriction, health resort treatment, physiotherapy.

The doctor prescribes medicinal treatment, which may include different kind of medicines that lower arterial pressure (Enalapril, Metoprolol, etc.), diuretics (Hydrochlorothiazide, Brinaldix, Triampur), etc. At that, therapy shall be determined strictly individually.

Thus, the patient with hypertension is not allowed to do the following: 

  • smoke;
  • eat salty, spicy, fatty foods;
  • gain extra weight;
  • drink too much alcohol, especially to combine alcohol with medication intake;
  • work nights, sleep less than 7 hours;
  • be nervous for nothing;
  • live a sedentary lifestyle;
  • skip or stop taking medications prescribed by your doctor;
  • take medications that “have helped” your neighbor (brother, friend, etc.).


It is necessary to do the following:

  • quit smoking;
  • reduce salt intake; herbal seasonings will make food more tasty;
  • eat more greens, fruits, foods rich in potassium, and do not be addicted to protein foods;
  • eat regularly, especially if food is occasioned with medication intake;
  • try to work off excess weight;
  • be able “to relax”, not to be hung up on misfortunes;
  • move more: walking, swimming, therapeutic exercises are especially useful;
  • use a blood pressure monitor and measure arterial pressure on a regular basis;
  • follow all doctor’s recommendations; and it is necessary to pay special attention to the administration of medicines.


Hypotension

Hypotension
(primary chronic hypotension, essential hypotension) is a disease associated with an impairment of the nervous system function and neurohormonal regulation of vascular tone, which is accompanied by a decrease in arterial pressure. The original background of such a condition is fatigue associated with psychotraumatic situations, chronic infections, intoxication (occupational hazards, alcohol abuse), and neuroses.

Symptoms and course.

Patients are sluggish, apathetic, they feel weak and exhausted in the morning, do not feel vivacity even after a long sleep; memory deteriorates, scattered brain, volatile attention, reduced working capacity, the patient constantly worries about the feeling short of breath, violation of potency and sexual attraction in men and menstruation in women.

Emotional instability, irritability, light and sound sensitivity are predominant. Usual headache is often associated with fluctuations in atmospheric pressure, abundant food intake, prolonged stay in an upright position. Headache occurs as a migraine with nausea and vomiting, and decreases after a walk in the fresh air or physical exercise, rubbing of temporal areas with vinegar, applying of ice or a cold towel onto the head. Dizziness, swaying when walking and fainting also occur. Arterial pressure is usually slightly or moderately decreased to 90/60-50 mm Hg.

This stage of hypotension is determined based on clinical signs and after exclusion of diseases accompanied by secondary arterial hypotension (Addison’s disease, pituitary failure, Simmonds’ disease, acute and chronic infections, tuberculosis, peptic ulcer, etc.).

Treatment.

The correct mode of work and rest. The attending physician may prescribe sedatives and tranquilizers (Mesaton, Ephedrine), as well as medicines that stimulate the central nervous system (ginseng tincture, Chinese lemongrass, devil’s-club, pantocrine, etc.). In addition, physiotherapy (baths, massage), health resort treatment, physical therapy are also possible.

Interesting thing

Does a person’s character have any impact on the development of arterial hypertension? Not directly, only indirectly. If a person is nervous and quick-tempered, this does not mean that he will necessarily suffer hypertension. However, if there is genetic predisposition, the occurrence of hypertension is quite possible. It is important to cultivate the correct psychological attitudes and not to worry constantly for no obvious reason.

One who knows how to rejoice, find a source of positive emotions, whether it is a hobby, communication with a pleasant conversational partner or pets will be obviously less prone to stress, hence, to drops in arterial pressure.

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