How to calculate mean arterial pressure. Hypertension (increased blood pressure): causes, treatment with psychotherapy

When it comes to blood pressure in relation 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. a device for non-invasive (bloodless) blood pressure measurement, this procedure, along with glucometry, 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 an 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

Age	Arterial pressure
(years)	Men		Women		Men	Women
	GARDEN	DBP	GARDEN	DBP	PAD	PAD
20	123	76	116	72	47	44
30	129	79	120	75	50	45
40	129	81	127	80	48	47
50	135	83	135	84	52	51
60-65	135	85	135	85	50	50
over 65 135	89	135	89	46	46

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 score and a low score 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. A low pulse pressure indicates that the heart is not functioning well, while an elevated pulse pressure may indicate that the heart valves are not closing enough and blood is backflowing 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, this applies to a greater extent to elderly and senile people. But in recent years, CVDs have become younger and are becoming relevant for both older and younger people.

Each age has its own blood pressure (BP) parameters. What is the normal blood pressure in children? The table below shows as fully as possible. At a young age, a person has quite low blood pressure compared to the later period. This is noted because in children the walls of blood vessels are much more elastic, their lumen is wide, and the capillary network is large.

Systolic pressure refers to the way blood pushes against the walls of the vessel when the heart muscle contracts. Diastolic shows how the blood presses on the vessels when the heart muscle relaxes. Indicators are distinguished by the tone, elasticity and peripheral resistance of blood vessels, and by the functioning of the kidneys, since they are responsible for the regulation of blood pressure. The indicators are influenced by weight, nutrition, genetic predisposition and height.

To determine what pressure a child should have, let's look at the table.

In this case, the numbers may differ from the normal blood pressure within a few mmHg. Art. This does not mean the presence of health problems. Blood pressure can change even within a few hours and several times a day, depending on the temperature and weather. After eating, it increases, when sleep ends, it decreases.

Normal blood pressure in a child should fit into the formula 76/0.5 from systolic D. By the end of the first month of life, systolic pressure approaches 70-90 mm Hg. Art., and diastolic - 45-60 mm Hg. Art.

A newborn is considered an infant in the first 28 days of life. Later, his blood pressure is calculated using the formula 76 + 2m / 0.5 from systolic. In this case, the systolic will be calculated as 76 + 2m, where m is the number of months, and DBP = 0.5 of SBP. On average it is 80-11/40-74 mm Hg. Art.

Blood pressure is measured in infants using a special children's cuff. Before reaching 1 month, the width of the inner chamber of the cuff does not exceed 3 cm, after 1 month - no more than 5 cm. Children's blood pressure is measured three times with an interval of several minutes. The most correct ones are taken to be the minimum indicators. Newborns and infants under 1 year of age are measured in a supine position. In the first days, only SBP is determined by palpation.

Upon reaching one year of age, the average blood pressure is: 80-100/50-60 mm Hg. Art.

Norms for children over 1 year of age

Using the formula, you can calculate child pressure in children over 1 year old: 90+21/60+1, given that 1 is age, and SBP = 90+21, DBP = 60+1. In children at this age, the increase in parameters occurs more slowly than before. Upon reaching 2 years of age, the normal blood pressure in children is as follows: SBP 90-105, DBP 60-65 mm Hg. Art.

You can determine the norms using centile tables by age. For indicators, weight and height standards are taken. From the 10th to the 90th centile, blood pressure levels are considered normal. A level of 90-95 centiles indicates borderline hypertension, and more than 95 indicates arterial hypertension.

Between the 5th and 10th centiles, borderline hypotension is established, below 5 - arterial hypotension.

Upon reaching 2-3 years of age, the average SBP is 100-112 mm Hg, DBP is 60-74 mm Hg. An increase is observed only when the digital indicator increases steadily for 3 weeks.

Indicators for school-age children

At this time, the lower parameters do not change, but the upper ones become higher. Normal blood pressure in children aged 6 to 9 years is 100-122/60-78 mmHg. Art. Since children at the beginning of school life may have heavy loads, physical activity becomes less, and the load on the nervous system increases, deviations from the norm are considered acceptable. But if they are observed in combination with fatigue and constant headaches, you should consult a doctor.

When determining what blood pressure is considered normal, life stages must be taken into account. The next moment of growing up is puberty. At this time, changes in blood pressure are observed. In girls, such phenomena occur more often, since they experience maturation earlier than boys. The average parameters during this period are considered to be 110-70 and 126-82 mm Hg. Art. It is possible to increase the top number to 120.

Hormonal changes during growing up bring their own adjustments. Study loads and other phenomena that cause juvenile hypertension or hypotension increase. The normal level is 110-70/136-86 mm Hg. Art. If there are changes, they are accompanied by loss of consciousness - fainting, pulse fluctuations, headaches. In case of these phenomena, it is better to consult a doctor.

If deviations from the norm are observed

Low blood pressure, especially if it drops rapidly, disrupts the metabolic process in the body, reduces renal activity, and creates a risk for liver function. Headaches may occur, fatigue increases, even to the point of fainting when rising from a lying position. If such phenomena occur, you should undergo examination or increase physical activity. You should not resort to medications or other means of increasing tonometer readings on your own; this can lead to a worsening of the condition.

In cases with high blood pressure, it is also worth monitoring the condition of the body, because high levels are even more dangerous. Such phenomena are observed due to a reaction to stress or excess load.

Hypertension can be primary or secondary. The following factors are characteristic of the primary one:

• changes in hormonal levels during puberty;
• moments of stressful situations;
• highly active sports activities;
• in case of conflicts and disputes at school or at home;
• diseases of the cardiac system, abnormalities of the kidneys, diseases of the endocrine system.

For secondary hypertension there are:

• pathologies of the cardiovascular and endocrine systems;
• diseases of the nervous system;
• entry of toxins into the body;
• brain diseases.

Low blood pressure and hypotension have several causes:

• ARVI with complications in the bronchi;
• trauma during childbirth;
• allergy;
• lack of vitamins;
• anemia;
• diabetes;
• defect in the development of the heart, myocarditis.

When it is necessary to reduce blood pressure in children, a cloth is soaked in apple cider vinegar and applied to the heels.

When you read the table, you can easily calculate the normal blood pressure in children. It is necessary to pay attention to measurement time, deviations due to weight and height. Changes accompanied by serious health problems should be checked by a specialist. In the case of age-related deviations from the norm, it is important to maintain a normal general condition, adhering to the general rules for organizing sleep, rest and exercise.

The electronic control unit has become an integral part of a modern engine, and without its help it is impossible to ensure the normal operation of all systems and monitor their serviceability. The absolute pressure sensor, also known as MAP, is just one of many control devices that affects the stability of the engine and transmits information to the ECU.

In many cars, it is located on the engine intake manifold and records fluctuations in the pressure level in the intake tract. Subsequently, based on the DBP data, the electronic unit optimizes the composition of the combustible mixture entering the combustion chamber.

Now let's take a closer look at what an absolute pressure sensor is, how it works and why you can't do without it?

What an absolute pressure sensor might look like.

This small device is responsible for measuring absolute pressure. The concept of “absolute pressure” is not used by chance, because the initial reference point for measurements is the state of vacuum, which is taken as an absolute.

After the data enters the ECU, the electronics, taking into account the pressure and temperature in the intake manifold, determines the most suitable air density and its expected flow rate, which is necessary to prepare a fuel-air mixture of the appropriate quality. The control unit, according to the calculated mass of consumed air, issues control commands of the required duration, due to which the injection nozzles are adjusted. Although a pressure sensor is a very worthy replacement for a flow meter, sometimes they are installed together on the unit.

How does an absolute pressure sensor work?

Thanks to DBP, it is possible to control how much air flows through the throttle valve. Based on this indicator, an impulse command is generated that determines the amount of fuel required to form a balanced fuel-air mixture. There is a vacuum chamber inside the sensor, from which the air is initially removed. It correlates the pressure in the inlet fitting with the pressure in the vacuum chamber and, according to the resulting difference, creates an outgoing signal. In order for the sensor to detect pressure, a whole chain of actions is necessary:

• The highly sensitive DBP diaphragm is deformed by pressure in the intake manifold.
• The stretching of the diaphragm causes a change in the resistance on the surface position strain gauges; in other words, the so-called piezoresistive effect occurs.
• Voltage fluctuations are observed in proportion to the dynamics of the resistance of strain gauges.
• The method of connecting strain gauges provides high sensitivity, which, thanks to the DBP chip, increases even more, resulting in the output voltage varying in the range of 1-5 V.
• According to the voltage received at the ECU input, a pulse is generated that goes to the injectors. It determines the pressure at the intake valve. In this case, voltage and pressure are directly proportional to each other.

Where is DBP located?

Mounting DBP on the body.

It has already been mentioned that the sensor must be looked for on the manifold. Let us only emphasize that it is used only on injection engines. This is especially true when the car is equipped with a turbocharged power unit and a compressor.

However, in many models its location is somewhat different - in the body part of the engine compartment and it is attached directly to the body. In this case, the inlet fitting and the inlet manifold are connected via a flexible hose. It should be noted that DBP is also installed when the car does not have a mass air flow sensor (MAF).

Symptoms of a malfunctioning absolute air pressure sensor

A whole group of “symptoms” can indicate a breakdown of DBP:

• Fuel consumption increases noticeably, which occurs due to the receipt of a signal from the sensor to the ECU about high pressure, the level of which is actually lower. In this case, the electronic unit gives a command to supply a mixture enriched more than necessary.
• The engine dynamics deteriorate, which does not return to normal even after warming up.
• Even in the summer season, white-colored exhausts appear.
• There may be a gasoline smell coming from the exhaust.
• The idle speed does not decrease for a long time.
• Switching is accompanied by sudden jerks or dips.
• An incomprehensible kind of noise, often developing into a hum.

How to check the absolute pressure sensor

The method for diagnosing DBP depends on the specification of the sensor device, which can be analog or digital. To confirm the functionality of the analog absolute pressure sensor, the following algorithm of actions is required:

• A sensor adapter is connected to the vacuum hose connecting the DBP and the inlet manifold, and a pressure gauge is connected to it.
• The engine starts and idles for several minutes. If the vacuum in the manifold is below 529 mm, it is worth checking whether the hose itself is leaking air. It would be a good idea to look at the sensor diaphragm and make sure there are no flaws in it.
• After taking the pressure gauge readings, you need to disconnect it and replace it with a vacuum pump. Next, you should create a vacuum of 55-56 mm Hg. and stop pumping. It can be considered that the DBP is not damaged when the vacuum remains unchanged for about 30 seconds, otherwise the device will need to be replaced.

When dealing with a digital sensor, you can do this:

• We switch the tester to voltmeter mode.
• We start the engine and determine the position of the power and ground contacts. We connect the wire connected to the output contact of the sensor to the tester. A voltage of 2.5 V or so indicates its serviceability. If the difference with the specified voltage up or down is significant, the device has failed.
• The tester switches to tachometer mode and the vacuum hose is disconnected.
• The “+” probe must be connected to the signal terminal, and the “-” probe to ground. Normally, the device should show 4400-4900 rpm.
• Now you need to connect the vacuum pump to the absolute pressure sensor. Based on the results of repeated changes in vacuum, there should be no jumps in the tachometer and pressure readings.
• When the vacuum pump is turned off, the tachometer should show 4400-4900 rpm, which indicates that the DBP is working properly. Otherwise, the device is faulty.

Video on the topic

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. Only the lower limit is not specified. 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.

On this online calculator you can see 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. Hereditary predisposition to hypertension or hypotension matters. 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 mmHg. 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. A sudden increase in pressure even to the “cosmic” 120/80 mm Hg. Art. may cause a deterioration in health, reminiscent of a hypertensive crisis.

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

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:

Age in years	SBP/DBP, mm Hg. Art.
20 – 30	117/74 – 121/76
30 – 40	121/76 – 125/79
40 – 50	125/79 – 129/82
50 – 60	129/82 – 133/85
60 – 70	133/85 – 137/88
70 – 80	137/88 – 141/91

Another reference table can be used to determine the norm:

Age in years	SBP/DBP in men, mm Hg. Art.	SBP/DBP in women, mm Hg. Art.
Up to 1 year	96/66	95/65
1 – 10	103/69	103/70
10 – 20	123/76	116/72
20 – 30	126/79	120/75
30 – 40	129/81	127/80
40 – 50	135/83	137/84
50 – 60	142/85	144/85
60 – 70	145/82	159/85
70 – 80	147/82	157/83
80 – 90	145/78	150/79

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 due to hormonal changes in the 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, vital organs do not suffer, and the risk of cardiovascular complications is reduced.

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 tonometer are associated with serious diseases, for example, the risk of cerebrovascular accident or 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 mm Hg. 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.

Blood pressure category*	Systolic (upper) blood pressure mm Hg. Art.	Diastolic (lower) blood pressure mm Hg. Art.
Norm
Optimal**	Less than 120	Less than 80
Normal	Less than 130	Less than 85
Increased normal	130-139	85-89
Hypertension
1st degree (soft)	140—159	90-99
2nd degree (moderate)	160-179	100-109
3rd degree (severe)	More than 180	More than 110
border	140-149	Less than 90
Isolated systolic hypertension	More than 140	Less than 90

* If systolic and diastolic blood pressure are found in different categories, the highest category is selected.
** 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 clinical practice, the World Health Organization classification of arterial hypertension is adopted, based on damage to the so-called target organs.

o the most common complications occurring in the brain, eyes, heart, kidneys and blood vessels.
What should a person's normal blood pressure be?What is a person's blood pressure that can be considered normal? The correct answer is: each person has their own norm . Indeed, the value of normal blood pressure depends on a person’s age, his individual characteristics, lifestyle, and occupation.

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 mm Hg 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 a slight increase in blood pressure over time can increase the risk of developing coronary heart disease, 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. Blood pressure of 140/90 is considered high. 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 are, the fewer number of beats a person’s heart makes per unit of time, the longer 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 change depending on the weather, load, and 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 in this is played by physiological changes in a person throughout life.

Blood pressure in the arteries depends on the following factors:

1. Individual contractility of the heart 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 young children, the vascular system is 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.

The placenta is a 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 of normal blood pressure indicators 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.

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Where is the norm?

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

Even though modern medicine has abandoned the previous complex formulas for calculating blood pressure, which took into account such parameters as gender, age, weight, 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.

Fluctuations in blood pressure will still be influenced by factors such as age, physical activity, psycho-emotional situation, climatic and weather conditions. 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 the pressure of such a small newborn baby, with everything so “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, perhaps, someone will be surprised by the fact that yellow lipid stains can be found in the aorta of newborns, which, however, do not affect health and go away over time. But this is so, a retreat.

As the baby develops and his body further develops, blood pressure rises and by the age of one year 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. To calculate normal blood pressure values ​​in children, pediatricians use special table, which we bring to the attention of readers.

Age	Normal minimum systolic pressure	Normal maximum systolic pressure	Normal minimum diastolic pressure	Normal maximum diastolic pressure
Up to 2 weeks	60	96	40	50
2-4 weeks	80	112	40	74
2-12 months	90	112	50	74
2-3 years	100	112	60	74
3-5 years	100	116	60	76
6-9 years	100	122	60	78
10-12 years	110	126	70	82
13-15 years old	110	136	70	86

Blood pressure problems in children and adolescents

Unfortunately, such a pathology as arterial hypertension is no exception for the child’s body. Lability of blood pressure most often manifests itself in adolescence, when the body is undergoing restructuring, but the puberty period 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 urgent measures are not taken, a young man may reach adulthood 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 so that your bladder is not full;
4. Take into account tension, pain, feeling unwell, 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, unless such a measurement is suitable for a military registration and enlistment office or in strict stationary conditions. 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 It might not have had its effect yet (not much time has passed) and you might not grab the next pill after 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 using the 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 this case, it is not possible to determine the diastolic pressure; it seems that it is simply 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 levels (diabetes mellitus) greatly influence 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 whether this is a one-time increase in blood pressure caused by objective reasons (stress, drinking alcohol in inadequate doses, certain medications), or whether there is a tendency to increase it 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.

By creating a menu of such affordable foods as garlic, cabbage 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 high blood pressure, is still uncomfortable for a person to live with. Typically, such patients have a diagnosis of vegetative-vascular (neurocirculatory) dystonia of the hypotonic type, which is quite common these days, when at the slightest sign of 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 you suddenly end up in a hospital with a hypertensive crisis, then 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 and coffee, do not think about alcoholic beverages, do not 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

Be sure to read other articles:

Lowest blood pressure in a person Human blood pressure normal table for adults

The article presents the most important practical aspects of the use of 24-hour blood pressure monitoring, assessment and interpretation of the method data, its clinical and prognostic significance. Indications for 24-hour BP monitoring are systematized, and the relationship between the results of clinical BP measurements and 24-hour BP monitoring is shown.

Practical aspects of the method of daily monitoring of blood pressure

The article presents the most important practical aspects of daily blood pressure monitoring, evaluation and interpretation of the method, its clinical and prognostic significance. Systematized statements to daily monitoring of blood pressure, shows the relationship between the clinical measurement of blood pressure and daily blood pressure monitoring.

Arterial hypertension (AH) is the most important risk factor for the development of cardiovascular complications and mortality. According to a survey conducted within the framework of the targeted federal program “Prevention and Treatment of Hypertension in the Russian Federation,” the frequency of hypertension among the population of the Russian Federation is 39.5%. Early diagnosis of the initial stages of hypertension allows timely lifestyle changes, giving up bad habits and, if necessary, prescribing drug antihypertensive therapy, which leads to a reduction in deadly complications, extends working age and increases life expectancy.

Today, the main method for diagnosing high blood pressure and assessing the effectiveness of treatment remains one or more measurements of blood pressure (BP) during the day. However, such measurements do not provide complete information about the 24-hour blood pressure profile. Not only traditional one-time blood pressure measurements are of diagnostic value, but also blood pressure values ​​during sleep, physical and mental stress, at different times after taking medications, etc. . This information is provided by the method of 24-hour blood pressure monitoring (ABPM). Daily blood pressure monitoring is used to diagnose hypertension or hypotension, select drug therapy, and assess the effectiveness and safety of treatment. ABPM allows you to exclude isolated clinical hypertension and isolated ambulatory hypertension. In addition, ABPM provides important information about the state of the mechanisms of cardiovascular regulation, allows you to determine the daily rhythm of blood pressure, nocturnal hypotension and hypertension, the dynamics of blood pressure over time and the uniformity of the antihypertensive effect of drugs.

Indications for ABPM can be divided into three groups (Table 1).

Table 1.

Indications for ABPM

Diagnostic	1. Diagnosis of isolated clinical hypertension (“white coat hypertension”).2. Diagnosis of isolated outpatient hypertension, identification of “workday hypertension” in patients with high levels of stress in the workplace. 3. Diagnosis of borderline hypertension. 4. Detection of nocturnal hypertension. 5. Diagnosis of symptomatic arterial hypotension caused by the use of antihypertensive drugs, autonomic disorders, myocardial infarction, heart failure, adrenal insufficiency, poor tolerance of constant cardiac pacing. 6. Increased lability of blood pressure during repeated measurements, visits, or according to self-monitoring of blood pressure (SBP). 7. To assess changes in blood pressure during nocturnal angina and respiratory failure in patients with sleep apnea syndrome. 8. High values ​​of clinical blood pressure in patients with a small number of risk factors and the absence of changes in target organs characteristic of hypertension. 9. Normal values ​​of clinical blood pressure in patients with a large number of risk factors and/or the presence of changes in target organs characteristic of hypertension. 10. Hypertension in pregnant women and suspected preeclampsia.
Therapy control	1. Selection of patients for drug treatment.2. Assessing the effectiveness and safety of therapy. 3. Assessment of resistance to drug treatment and selection of the optimal treatment regimen in such patients. 4. Study of the individual daily rhythm of blood pressure during treatment. 5. Assessing the effectiveness of correction of hypertension during pregnancy.
Prognostic	1. Before surgical treatment.2. Before childbirth. 3. To assess the risk of developing cardiovascular complications.

Contraindications to ABPM are complications during previous blood pressure monitoring, skin diseases on the shoulder, thrombocytopenia, thrombocytopathy and other blood diseases during an exacerbation, trauma to the upper extremities, diseases with damage to the vessels of the upper extremities, and patient refusal. Relative contraindications include poor tolerability of the study, severe rhythm and conduction disturbances, systolic blood pressure over 200 mm Hg. Art.

The ABPM method allows you to calculate average daily blood pressure and pulse values, average blood pressure values ​​during the day and night, determine the degree of nocturnal decrease and morning increase in blood pressure, blood pressure response to physical activity and psycho-emotional stress, the degree and duration of hypertensive load on target organs, blood pressure variability and pulse during the day, detect episodes of hypotension.

The main indicators for assessing the results of ABPM include average values, pressure load indices, indicators of the circadian rhythm of blood pressure, blood pressure variability, and indices for assessing the morning rise in blood pressure.

Estimation of average values. The analysis program calculates mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP), mean blood pressure and pulse rate. Day and night periods are set according to information obtained from the patient's diary. The obtained average values ​​give the main idea of ​​the level of blood pressure in a particular patient, are the most reliable and reproducible, and have high prognostic significance, which has been proven by numerous studies.

When assessing average values ​​obtained from blood pressure monitoring, different criteria are used than when assessing traditional blood pressure measurements. In table Table 2 shows the standards for average values ​​recommended by the Russian Medical Society for Arterial Hypertension and the All-Russian Scientific Society of Cardiologists.

Table 2.

Standards for average blood pressure values ​​according to ABPM data (mm Hg)

These standards can also serve as target values ​​when assessing the effectiveness of antihypertensive therapy. In order to evaluate the effect of therapy, you can also use the criteria developed by specialists from the RKNPK named after. Myasnikov: changes less than 5 mm Hg. Art. - slight dynamics, 5-10 mm Hg. - significant dynamics, more than 10 mm Hg. Art. - pronounced dynamics.

Pressure load assessment. The duration of the increase in blood pressure during the day is of great importance. To quantify its value, pressure load indices are used. This indicator has several names (frequency of increased blood pressure, pressure load, hypertensive load, time index) and represents the percentage of blood pressure measurements exceeding the upper limit of normal in the total number of registrations. Table 3 shows the normal values ​​of pressure load indicators in %.

Table 3.

Normal values ​​of pressure load indicators (%)

To quantify the amount of “pressure load” exerted on target organs by increased pressure, the terms time index (TI) and area index (AI) are used. The AI ​​indicator determines the percentage of time during which blood pressure values ​​exceed the critical (“safe”) level, i.e. shows in what percentage of the time of the total duration of monitoring (or in what percentage of measurements) blood pressure was above (below) normal, and the conventional limit of normal for daytime is considered to be 140/90, and for nighttime - 125-130/80 mm Hg. Art.

The AI ​​in most healthy individuals ranges from 10 to 20% and does not exceed 25%. An IV for SBP greater than 25% is considered clearly pathological, which gives rise to a diagnosis of hypertension or symptomatic hypertension. Stable hypertension is diagnosed when the AI ​​is at least 50% during the day and night. The presence of an AI above 25% in a patient receiving antihypertensive therapy indicates insufficient effectiveness of the treatment. In severe arterial hypertension, when during all measurements the blood pressure figures exceed the established normal limits, the AI ​​becomes equal to 100% and ceases to objectively reflect the increase in pressure overload of the target organs.

The area index shows what kind of hypertonic load affects the body, i.e. How long in a 24-hour period does the patient have elevated blood pressure and by how much on average is it above the upper limit of the normal range (in graphs, this is the area under the curve above the normal level).

Assessment of the circadian rhythm of blood pressure. Under physiological conditions, most healthy people experience a decrease in blood pressure by 10-20% at night compared to daytime levels. To assess the circadian rhythm of blood pressure, the nocturnal blood pressure reduction rate (NBP) index is used. It reflects the difference between average blood pressure values ​​during the day and at night. To determine SNABP in %, use the formula:

(SADd - SADn)x100% / SADd,

where SADD is the average daytime blood pressure,

SBP - average blood pressure at night.

Depending on the degree of nocturnal reduction in blood pressure, several types of daily blood pressure profiles are distinguished (Table 4).

Patients with a daily index of 10-20% are called dippers. Their blood pressure profile is recorded with a dip at night, shaped like a bucket. Less common are patients whose blood pressure decreases less at night or does not decrease at all. They belong to the category of “non-dippers”. The daily index is less than 10% and the external shape of the profile is without a night deepening. There is also a group of patients with an excessive drop in blood pressure at night, or “over-dippers.” Their daily index is above 20%. In this case, hypoperfusion of the brain and myocardium occurs, especially in patients with reduced coronary reserve due to left ventricular hypertrophy. There is also a group with a stable increase in night-time blood pressure (“night-peakers”), where a nocturnal rise in blood pressure is recorded and the daily index has a negative value.

Table 4.

Types of daily blood pressure profiles depending on SBP

Assessment of blood pressure variability. Blood pressure variability during ABPM is calculated as the standard deviation from the average value for the day and night periods. Standard deviation is expressed in millimeters of mercury. The critical values ​​of this indicator, according to A.N. Rogoza. et al. , are given in table. 5.

Table 5.

Critical values ​​of standard deviation (variability)

Most patients with arterial hypertension are characterized by high blood pressure variability. Increased blood pressure variability is associated with damage to target organs (left ventricular myocardial hypertrophy, atherosclerosis of the carotid arteries, changes in the fundus vessels, etc.). High blood pressure variability can also be observed with autonomic dysfunction and other pathologies leading to disruption of blood pressure regulation mechanisms. When carrying out antihypertensive therapy, an increase in variability is considered as an unsatisfactory treatment result.

When assessing blood pressure variability, it is necessary to take into account the patient’s activity, his daily routine and other factors in accordance with the diary. When assessing nighttime variability values, it is necessary to pay attention to episodes of sleeplessness, getting up, and restless sleep. Turning from one side to the other leads to an increase in pressure by 20 mmHg. Art. Sleep apnea syndrome significantly changes the variability, average values ​​and degree of nocturnal decrease in blood pressure.

Assessment of the morning rise in blood pressure. When analyzing blood pressure monitoring data, an important task to clarify the degree of risk of complications in the morning is to assess the dynamics of blood pressure in the morning. During this period, the greatest number of cardiovascular events occurs (myocardial infarction, episodes of silent myocardial ischemia, strokes, malignant arrhythmias). They evaluate such indicators as the rate of increase in SBP and DBP in the first 2-4 hours after waking up (the rate of morning rise in blood pressure), the maximum values ​​of blood pressure in the morning, the increase in blood pressure compared to the night hours, the presence of a “peak”, i.e. blood pressure values ​​exceeding subsequent “daytime” values.

The rate of morning rise in blood pressure is most often calculated. It is calculated separately for SBP and DBP using the formula:

(ADmax - ADmin) / (tmax - tmin),

where ADmax is the maximum value of morning blood pressure,

ADmin - the minimum value of morning blood pressure,

tmax - time of maximum morning blood pressure,

tmin - time of minimum night blood pressure.

Normally, the rate of morning rise in systolic blood pressure is less than 10 mmHg. Art. at one o'clock. The critical speed that provokes the occurrence of most episodes of “silent” myocardial ischemia in patients with coronary artery disease in combination with A is 15 mm Hg. Art. at one o'clock.

Prognostic value of ABPM. Based on ABPM results, the course of hypertension can be predicted more accurately than clinically determined BP. A high risk of developing cardiovascular complications of hypertension, such as acute cerebrovascular accident and myocardial infarction, will be observed in the following cases:

• pronounced morning rise in blood pressure;
• a decrease in the daily index in the absence of a decrease in blood pressure at night;
• an increase in the daily index in the case of an excessive decrease in blood pressure at night in patients with severe atherosclerosis;
• high average blood pressure numbers;
• high blood pressure variability index.

It is believed that the most significant indicators in the prognosis of target organ damage are indicators of blood pressure variability, the degree of nocturnal decrease in blood pressure, and pressure load, which differ significantly in individuals with normal blood pressure and patients with hypertension. In elderly patients, an important risk factor is a pulse pressure (the difference between systolic and diastolic blood pressure) of more than 53 mm. rt. Art.

Correlation between the results of clinical measurements of blood pressure and ABPM. According to the 2008 European Society of Hypertension Guidelines for AMS, there are four options for the relationship between the results of clinical and ambulatory blood pressure measurements (Table 6). In cases 2 and 3, when the results of clinical and ambulatory BP measurements are the same, evaluation of the data is simple. In cases 1 and 4, when different results of clinical and ambulatory blood pressure measurements are noted, they speak of isolated clinical hypertension and isolated ambulatory hypertension.

Table 6.

Correlation between the results of clinical and ambulatory blood pressure measurements

Isolated clinical hypertension. In some individuals, when measuring blood pressure by medical personnel, the recorded blood pressure values ​​​​correspond to hypertension, while ABPM or blood pressure measured at home remain within normal values, i.e. there is “white coat” hypertension, or (more preferably) “isolated clinical hypertension” (ICAH). ICAH is detected in 15% of individuals in the general population. These individuals have a lower risk of cardiovascular complications than patients with hypertension. However, compared with normotensives, this category more often experiences target organ damage and metabolic changes. Quite often, ICAH transforms over time into conventional hypertension. It is difficult to predict the possibility of detecting hypertension in each specific case, but more often ICAH is observed in grade 1 hypertension in women, in the elderly, in non-smokers, with recent detection of hypertension and with a small number of blood pressure measurements in outpatient and clinical settings.

Diagnosis of ICAH is carried out on the basis of data from SCAD and ABPM. In this case, increased clinical blood pressure is observed with repeated measurements (at least three times), while the ABPM (average blood pressure value for 7 days of measurement) and ABPM are within normal limits (Table 6).

If ICAH is suspected, SCAD should be performed. In the case of normal blood pressure, according to the SCAD, we can conclude that the risk of hypertension is low and recommend observation. If elevated blood pressure is detected, according to the SCAD, antihypertensive therapy is recommended. In case of questionable or borderline ABMS results, the patient is advised to undergo ABPM.

Diagnosis of ICAH based on ABPM and ABPM data may not coincide; this is especially often observed in working patients. In this case, it is necessary to focus on the results of ABPM. In the case of diagnosing ICAG, additional studies are necessary to clarify the presence of risk factors and target organ damage. Patients with ICAH should be recommended non-drug treatments for hypertension, and in the presence of a high and very high risk of cardiovascular complications, it is recommended to begin antihypertensive therapy.

Isolated ambulatory hypertension (IAAH). The opposite phenomenon for ICAH is IAAH, or “hidden” hypertension, when when measuring blood pressure in a medical institution, normal blood pressure values ​​​​are determined, but the results of ABPM and/or ABPM indicate the presence of hypertension. It is estimated that IAAH occurs in 12-15% of individuals in the general population. The frequency of identification of risk factors and target organ damage in such patients compared to normotensive patients is significantly higher, and the risk of cardiovascular complications is almost the same as in patients with hypertension.

IAAH can be assumed in persons with normal blood pressure if the following factors are present:

• smoking,
• male gender,
• pronounced orthostatic blood pressure reactions, “high normal” clinical blood pressure (130-139–85-89 mm Hg),
• development of left ventricular hypertrophy,
• high overall cardiovascular risk,
• diabetes,
• kidney diseases,
• registration of elevated blood pressure values ​​in the anamnesis,
• heredity for hypertension.

Thus, the results obtained from 24-hour blood pressure monitoring provide important diagnostic and prognostic information. The method allows you to individually select the dose and timing of medication; identify patients with symptomatic hypertension, in which blood pressure may increase at night with normal blood pressure values ​​during the day, determine the reliable effect and duration of action of the drug, reduce the cost of antihypertensive therapy, and reduce the incidence of cardiovascular complications in arterial hypertension. Correct methodological approaches to conducting 24-hour blood pressure monitoring increase the accuracy and information content of the study.

S.Yu. Akhunova, I.P. Kirilyuk, S.N. Prokopieva

Kazan State Medical Academy

Interregional Clinical Diagnostic Center, Kazan

Akhunova Svetlana Yurievna - Candidate of Medical Sciences, Associate Professor of the Department of Functional Diagnostics

Literature:

1. Diagnosis and treatment of arterial hypertension. Recommendations of the Russian Medical Society on arterial hypertension and the All-Russian Scientific Society of Cardiologists. - Appendix 2 to the journal “Cardiovascular Therapy and Prevention”, 2008. - 7 (6).

2. Rogoza A.N., Nikolsky V.P., Oshchepkova E.V. etc. - Daily monitoring of blood pressure for hypertension. - M., 1999. - 45 p.

3. Rogoza A.N., Oshchepkova E.V., Tsagareishvili E.V., Gorieva Sh.B. Modern non-invasive methods of measuring blood pressure for diagnosing arterial hypertension and assessing the effectiveness of antihypertensive therapy. A manual for doctors. - M.: MEDICA. - 2007.

4. Makolkin V.I., Podzolkov V.I., Gilyarov M.Yu. Possibilities of daily blood pressure monitoring in the differential diagnosis of neurocirculatory dystonia and hypertension // Cardiology. - 1997. - No. 6. - P. 96-104.

5. ESH guidelines for blood pressure monitoring at home: a summary report of the Second International Consensus Conference on Home Blood Pressure // Monitoring J Hypertens. - 2008. - No. 26. - R. 505-1530.

6. European Society of Hypertension Recommendations for conventional, ambulatory and home blood pressure measurement // Journal of Hypertension. - 2003. - No. 21. - R. 821-846.