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

When it comes to pressure in relation to the human body, there is an association with hypertension, severe complications and adverse outcomes of this disease. Moreover, with the invention of Korotkov N.S. device for non-invasive (bloodless) measurement of blood pressure, this procedure, along with glucometry, has become a routine not only for medical professionals, but also for patients themselves. And everyone understands why he measures his pressure. Everyone knows that there is systolic pressure, 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 pulse pressure?

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

The moment when the sounds (Korotkov sounds) disappear again with further slow deflation of the cuff and will be diastolic blood pressure (DBP), and the difference between them will be pulse. Thus, in order to know your pulse pressure, how to calculate its value, you just need to take a tonometer, measure your blood pressure, and subtract the bottom 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, then why do we need to know more about pulse pressure. Until recently, there was an opinion among the scientific medical elite that an increase in DBP has 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 values (both SBP and DBP) are integral, i.e. depending on many parameters:

stroke volume;
heart rate (HR);
total peripheral vascular resistance (OPSS);
volume of circulating blood (VCC);
blood viscosity, etc.,

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

What value of pulse pressure is considered normal

Normally, the indicator is considered 40 + 5 mm Hg. Art. It is possible to present the rate of pulse pressure by age in the table (Table 1), but we can say with confidence that in relation to PAP, as in everything related to the human body, it is necessary to adhere to the golden rule: the maximum is enough and the minimum is necessary. That is, the lower the PAD, but it provides 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 the fullness of its manifestation, without in any way belittling 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 due SBP and DBP, adjusted for weight for each age, can be calculated using the formulas:

GARDEN \u003d 109 + (0.5 * Age (in years)) + (0.1 * Weight (in kg))
DBP \u003d 63 + (0.1 * Age (in years) + (0.15 * Weight (in kg))
PAD = SAD - PAD

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

GARDEN \u003d 109 + (0.5 * 53) + (0.1 * 85) \u003d 144 mm Hg.
DBP \u003d 63 + (0.1 * 53) + (0.15 * 85) \u003d 81 mm Hg.
PAD \u003d 144 - 81 \u003d 63 mm Hg

What does pulse pressure represent?

When PAP is above 50 mm Hg. (high pulse pressure) or below 30 mm Hg (low pulse pressure) indicate a deviation from the norm. Both high and low values are indicative of cardiovascular risk. In healthy people, an increase can be with psycho-emotional or physical overstrain, a decrease can be observed in a dream. Those. almost always, when the work of the heart (stroke volume, heart rate) increases, the PBP increases, and vice versa.

High pulse pressure

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

Low pulse pressure

A decrease in PAP can occur with aortic diseases, myocardial infarction, kidney diseases, shock of various origins, etc. A low pulse pressure means that the heart is not functioning well, while an elevated 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, with discomfort in the heart area, general malaise and changes in PBP, 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, followed by elastic recoil at the end of each cycle. With aging, the vessels lose their elasticity, which leads to their rigidity, an increase in the speed of the pulse wave and, accordingly, an increase in PAD.

Of course, to a greater extent this applies to people of advanced and senile age. But in recent years, CVD has become younger and is becoming relevant for people of mature and younger ages.

Each age group has its own blood pressure (BP) parameters. What is the norm in children, the table below shows as fully as possible. At a young age, a person has a rather low blood pressure compared to a later period. This is noted due to the fact that 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 how blood presses against the walls of a vessel when the heart muscle contracts. Diastolic shows how blood presses on the vessels when the heart muscle relaxes. Indicators are distinguished by tone, elasticity and peripheral vascular resistance, and by the work 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, refer to the table.

In this case, the figures may differ from the norm of blood pressure within a few mm Hg. Art. This does not mean the presence of health deviations. Blood pressure can change even within a few hours and several times a day, it also depends on the temperature regime, on the weather. After eating, it rises, when sleep ends, it decreases.

Normal 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 approaches 70-90 mm Hg. Art., and diastolic - 45-60 mm Hg. Art.

A newborn is an infant in the first 28 days of life. Later, his blood pressure is calculated according to 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 the SBP. On average, this 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. Pressure measurement for children is carried out three times with an interval of several minutes. For the most correct, the minimum indicators are taken. 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 the age of 1 year

Using the formula, you can calculate the child's pressure in children older than 1 year: 90 + 21 / 60 + 1, while 1 is age, and SBP = 90 + 21, DBP = 60 + 1. In children at this age, the increase in parameters is slower than before. Upon reaching 2 years, the norm of blood pressure in children is as follows: GARDEN 90-105, DBP 60-65 mm Hg. Art.

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

In the range from the 5th to the 10th centile, borderline hypotension is established, below 5 - arterial.

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

Indicators for school-aged children

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

When determining what pressure is considered normal, you need to consider the stages of life. The next moment of growing up is puberty. At this time, there are drops in blood pressure. In girls, such phenomena are more common, as they experience maturation earlier than boys. The average parameters during this period are 110-70 and 126-82 mm Hg. Art. It is possible to increase the upper number to 120.

Hormonal shifts during adolescence bring their own adjustments. Increased study loads and other phenomena that cause juvenile hypertension or hypotension. The level of 110-70 / 136-86 mm Hg is considered the norm. Art. If there are differences, then they are accompanied by loss of consciousness - fainting, pulse fluctuations, headaches. With these phenomena, it is better to consult a doctor.

If deviations from the norm are observed

Low blood pressure, especially if it falls rapidly, disrupts the metabolic process in the body, reduces kidney activity, and creates a risk for liver function. Headaches may occur, fatigue increases up to fainting when getting up from a lying position. With such phenomena, you should undergo an examination or increase physical activity. It is not worth resorting to medications or other means of increasing the 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 state of the body, because high rates are even more dangerous. Such phenomena are observed due to a reaction to stress or excess load.

Hypertension is either primary or secondary. Primary factors are:

hormonal changes during puberty;
moments of stressful situations;
sports activities with great activity;
in conflicts and disputes at school or at home;
diseases of the heart system, abnormalities in the work of the kidneys, diseases of the endocrine system.

With secondary hypertension, there are:

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

Low pressure hypotension has several causes:

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

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

When reading the table, the normal blood pressure in children is easily calculated. It is necessary to pay attention to the time of measurement, 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 the general condition in the norm, 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 MBP, is just one of many control devices that affect the stability of the engine and transmit information to the computer.

In many vehicles, it is located on the engine intake manifold and registers fluctuations in the pressure level in the intake tract. In the future, 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 does an absolute pressure sensor 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 absolute.

After the data is received by the ECU, the electronics, taking into account the pressure and temperature in the intake manifold, determines the most suitable air density and its estimated flow rate, which is necessary to prepare the fuel-air mixture of the appropriate quality. The control unit, according to the calculated mass of air consumed, gives 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 an absolute pressure sensor works

Thanks to the DBP, it is possible to control how much air enters through the throttle. Based on this indicator, an impulse command is formed that determines the amount of fuel required to form a balanced fuel-air mixture. Inside the sensor there is a vacuum chamber, the air from which is removed initially. 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 determine the pressure, a whole chain of actions is necessary:

The highly sensitive DBP diaphragm deforms under the influence of pressure in the intake manifold.
The expansion of the diaphragm causes a change in resistance on the surface strain gauges, in other words, the so-called piezoresistor effect takes place.
Voltage fluctuations are observed in proportion to the resistance dynamics of strain gauges.
The method of connecting strain gauges provides high sensitivity, which, thanks to the DBP chip, increases even more, as a result of which the output voltage varies in the range of 1-5 V.
According to the input voltage of the computer, a pulse is formed that goes to the injectors. It determines the pressure at the inlet valve. In this case, the voltage and pressure are directly proportional to each other.

Where is DAD

DBP mount on the body.

It has already been mentioned that the sensor must be looked for on the collector. We only emphasize that it is used only on injection engines. This is especially true when the vehicle is equipped with a turbocharged powertrain and 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 by means of a flexible hose. It should be noted that DBP is also installed when there is no mass air flow sensor (MAF) on the car.

Symptoms of a Malfunctioning Absolute Air Pressure Sensor

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

There is a noticeable increase in fuel consumption, which occurs due to the 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 dynamics of the engine deteriorates, which does not return to normal even after warming up.
Even in the summer season, white-colored exhausts appear.
There may be a smell of gasoline coming from the exhaust.
Long time does not decrease idle speed.
Switching is accompanied by sharp jerks or dips.
An incomprehensible kind of noise, often developing into a hum.

How to check the absolute pressure sensor

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

A sensor adapter is attached 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 a few minutes. In the case of a vacuum in the manifold below 529 mm, it is worth looking to see if the hose itself is letting air through. It will not be superfluous to look at the sensor diaphragm and make sure that there are no flaws on it.
After taking the readings of the pressure gauge, it is necessary 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 transfer the tester to the 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. Its health is indicated by a voltage of 2.5 V or so. If the difference with the specified voltage upward or downward is significant, the device is out of order.
The tester switches to tachometer mode and the vacuum hose is disconnected.
The “+” probe must be connected to the signal output, and the “-” probe to ground. Normally, the device should show 4400-4900 rpm.
Now you need to connect the vacuum pump m to the absolute pressure sensor. According to the results of multiple changes in the rarefaction, there should be no jumps in the readings of the tachometer and pressure.
When the vacuum pump is turned off, the tachometer should show 4400-4900 rpm, which indicates that the DBP is working. Otherwise, the device is defective.

Modern classification

There are three options for normal 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 considered a condition in which the tonometer gives values \u200b\u200bless than 90/60. That is why, depending on individual characteristics, everything above this limit is acceptable.

On this online calculator you can see the norms of blood pressure by age.

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

30 minutes before the proposed procedure, you can not play sports or experience other physical activity.
To determine the true indicators, you should not conduct a study in a state of stress.
For 30 minutes, do not smoke, do not eat, drink alcohol, coffee.
Do not talk during the measurement.
The measurement results obtained on both hands should be evaluated. The highest value is taken as the basis. A difference of 10 mm Hg is allowed. Art.

Individual norm

The ideal pressure is that at which a person feels great, but at the same time it corresponds to the norm. Hereditary predisposition to hypertension or hypotension matters. The numbers may change during the day. They are lower at night than during the day. During wakefulness, pressure can increase with physical exertion, stress. Trained people and professional athletes often have indicators below the age norm. Medications and the use of stimulants like coffee, strong tea affect the measurement results. Fluctuations within 15–25 mm Hg are permissible. Art.

With age, the 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 stiffness of the vascular wall due to age-related features. So, people who have lived all their lives with the numbers 90/60 may find that the tonometer began to show 120/80. And that's okay. A person feels good, because the process of pressure increase goes 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 at the same time a person feels better than with the one that is considered optimal for him. This is true for older people suffering from arterial hypertension. The diagnosis of hypertension is established if the blood pressure is 140/90 mm Hg. Art. and higher. Many older patients feel better at 150/80 than at lower values.

In such a situation, you should not seek the recommended rate. With age, atherosclerosis of the cerebral vessels develops. Higher systemic pressure is required to ensure satisfactory blood flow. Otherwise, there are signs of ischemia: headaches, dizziness, nausea, etc.

Another situation is a young hypotonic patient who has been living with the numbers 95/60 all his life. A sudden increase in pressure, even to the "cosmic" 120/80 mm Hg. Art. can cause a deterioration in well-being, reminiscent of a hypertensive crisis.

Possible white coat hypertension. At the same time, the doctor cannot determine the correct pressure, since at the reception it will be higher. And at home, normal indicators are fixed. Only regular monitoring at home will help determine the individual norm.

Ways to determine the norm

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

For this, the Volynsky formula is suitable. 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 × life years) + (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 do not 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 can see that with age they become higher. In people under 40, there are higher rates in men. After this milestone, the picture changes, and the pressure in women becomes higher. This is due to hormonal changes in the female body. Attention is drawn to the numbers in people after 50 years. They are higher than what is today defined as normal.

Conclusion

Evaluating the indicators of the tonometer, the doctor always focuses on the accepted classification, regardless of how old the person is. The same rate of blood pressure should be taken into account in home control. Only at such values the body functions fully, vital organs do not suffer, the risk of cardiovascular complications decreases.

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

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Arterial pressure 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 time of maximum heart contraction.
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 as mmHg. Art. A blood pressure value of 120/80 means that the systolic (upper) pressure is 120 mm Hg. Art., and the value of diastolic (lower) blood pressure is 80 mm Hg. Art.

Increased numbers on the tonometer are associated with serious diseases, for example, the risk of cerebrovascular accident, heart attack. In the case of a chronic increase in 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 pressure? What are its indicators at rest and during motor 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., 85-89 mm Hg. Art. A pressure of 140 over 90 mm Hg is considered high. Art. and more. With motor activity, blood pressure rises 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 with age, blood pressure changes: diastolic increases up to 60 years, and systolic increases throughout life.

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

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
1 degree (soft)	140—159	90-99
Grade 2 (moderate)	160-179	100-109
3 degree (severe)	Over 180	Over 110
border	140-149	Less than 90
Isolated systolic hypertension	Over 140	Less than 90

* If systolic and diastolic blood pressure are 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 classification of arterial hypertension by the World Health Organization is adopted, based on the defeat of the so-called target organs.

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

Normal pressure in newborns is 70 mm Hg.

Normal 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 is 103/69 for boys and 103/70 for girls.

And what is the normal pressure for a person who has already matured?
Normal pressure in young people 20 years old: in boys - 123/76, in girls - 116/72.

Normal 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 129/81, in 40-year-old women 127/80.

For fifty-year-old men and women, pressures of 135/83 and 137/84, respectively, are considered normal.

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

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

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

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

With unusual physical exertion or emotional stress, the value of blood pressure increases. Sometimes this prevents doctors from examining cardiac patients, who are mostly impressionable people. American scientists even talk about the existence of the so-called "white coat effect": when the results of measuring blood pressure in the doctor's office are 30-40 mm Hg. Art. higher than when self-measuring it at home. 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, the pressure becomes normal 100/60 or even 90/50 mm Hg. Art. But with all the variety of "normal" blood pressure indicators, each person usually knows the norm of his pressure, in any case, he clearly captures any deviations from it in one direction or another.

There are certain guidelines for blood pressure that change with age (standards 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 coronary heart disease, stroke and other diseases of the cardiovascular system. Therefore, indicators up to 130-139 / 85-89 mm Hg are now considered normal indicators of blood pressure in adults. Art. The norm for patients with diabetes is considered to be a pressure of 130/85 mm Hg. Art. An arterial blood pressure of 140/90 is considered high. Blood pressure over 140/90 mm Hg. Art. is already a sign of hypertension.

Normal human heart rate

Pulse (lat. pulsus blow, push) - periodic fluctuations in the volume of blood vessels associated with contractions of the heart, due to the dynamics of their blood supply and pressure in them during one cardiac cycle. The average healthy person has a normal resting heart rate is 60-80 beats per minute. So, the more economical the metabolic processes, the fewer beats the human 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 the pulse rate.

Normal heart rate for different age categories:

child after birth 140 bpm
from birth to 1 year 130 bpm
from 1 year to 2 years 100 bpm
from 3 to 7 years 95 bpm
from 8 to 14 years 80 bpm
mean age 72 bpm
old age 65 bpm
with illness 120 beats / min
shortly before death 160 bpm

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BP and its deviations

Anyone knows that the ideal values for blood pressure on the walls of the arteries are 120/80 mm Hg. Art. But not everything is so clear. There are many factors that affect these parameters. In particular, blood pressure may vary depending on the weather, load, psychological state. But such differences, as a rule, are insignificant and are not dangerous for the body.

A much greater risk is stably deviated from the norm, accompanied by changes in well-being. In the first case, when determining arterial values, the age of the patient is taken into account. In the second variant, when the patient's condition changes, the age factor plays a secondary role.

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

So, at birth, this indicator is noted within 66/55 mm Hg. 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 such factors:

Individual contractility of the heart muscles and a sufficient release of fluid into the vessels.
density. The thicker it is, the worse it moves through small vessels.
elasticity of the arteries. This is a completely age-related cause of pressure changes. 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.
Frequent stress and hormonal disorders. These factors, more than others, are the causes of increased pressure in women. Throughout the life of the representatives of the weaker sex, the hormonal background changes repeatedly (pregnancy, after 50 years, during menopause), which is a prerequisite for an increase in blood pressure.

Measurement of arterial parameters is mandatory when contacting a cardiologist. This is one of the main procedures to determine abnormalities in the work of the heart. So, the systolic indicator (upper blood pressure) reflects the strength of the onslaught of blood during the release; diastolic number (lower blood pressure) indicates the state of the arteries in the period between heart contractions.

Measurement of pressure in an adult is done by a special apparatus with a tonometer. The procedure is carried out in a sitting position, in a warm room and in complete tranquility.

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

In the region of the cubital fossa, a sound-conducting membrane of the stethoscope is applied. After that, the air outlet is blocked in the balloon and by repeatedly pressing this element, the flow is forced 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 crane on the “pear” is slowly opened and the first and last sounds are recorded.

If the numerical values are significantly higher than 140/90 mm Hg. Art. - this may indicate a violation of the functioning of the cardiovascular system (in particular, the development of hypertension).
Indicators are much lower than 120/80 mm Hg. Art. may indicate hypotension. But when analyzing the significance of deviations from such indicators, the doctor must take into account age criteria.

Normal blood pressure according to age

But today the situation has changed a little. And meeting people under 50 with such indicators is becoming increasingly difficult. Measuring blood pressure, doctors are increasingly guided by the marginally acceptable norms.

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

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

But, in practice, at a respectable age, such indicators are rare. Most often, numbers are stated within 140/90 mm Hg. 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 prone 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 norms. In young children, the vascular system is more elastic than in adults. And, therefore, blood pressure indicators are lower.

For children, there is no single established norm for arterial indicators. This is due to physiological age fluctuations. So, in one-year-old babies, numbers within 95/65 mm Hg should be optimal. 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, the blood pressure in young men is slightly higher than in girls.

Especially important is blood pressure, its norm and its extremes for women in position. The good course of pregnancy and the life of the unborn baby directly depend on this. For two trimesters, blood pressure indicators do not change and correspond to those that a woman had before pregnancy. In the third trimester, under the influence of hormones, the values \u200b\u200bof the tonometer may increase slightly. A deviation from the norm is allowed no more than 10 mm Hg. Art.

In the case of a pathological course of pregnancy, preeclampsia with significant changes in arterial parameters, kidney damage, preeclampsia and eclampsia can be observed. If pregnancy takes place 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 with a decrease in blood pressure, this affects the condition of both the mother and the 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 a miscarriage. In a pregnant woman, this is reflected in dizziness and severe weakness.

An increase in arterial parameters for a woman in position is also unacceptable.

This may threaten:

detachment of the placenta,
premature birth,
in some cases, the loss of the baby is possible.

Therefore, pregnant women should especially monitor their pressure and, in case of any deviations from the norm, immediately consult a doctor.

In the case of a significant excess of these numbers, there is a risk of stroke, heart attack. In such cases, immediate therapy is carried out.

Table of normal blood pressure indicators depending on age

The figures in the table above are 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 norm of blood pressure in adults is considered to be the value120/80 mmHg st. But how can this indicator be fixed if a living organism, which is a person, must constantly adapt to various conditions of existence? And people are all different, so within reasonable limits, blood pressure still deviates.

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

Fluctuations in blood pressure will still be influenced by factors such as age, physical activity, psycho-emotional environment, climatic and weather conditions. Arterial hypertension (AH), perhaps, would not have suffered hypertension if he lived in another country. How else to understand the fact that on the black African continent among the indigenous population of the AG can be found only occasionally, and blacks in the United States suffer from it indiscriminately? 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 the norm and does not give reason to think about the disease.

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

If the blood pressure values cross the line of 140/90 mm Hg. st., will steadfastly hold on to this figure, and sometimes also move upwards, such a person will be diagnosed with arterial hypertension of the appropriate degree, depending on the pressure values. Therefore, for adults there is no norm for blood pressure by age, there is only a small discount for age. But with children, things are a little different.

Video: how to keep blood pressure normal?

And what about children?

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

The structure of all organs of a newly born baby has not yet been completed, this also applies to the cardiovascular system. The vessels of the newborn are elastic, their lumen is wider, the network of capillaries is larger, so the pressure is 60/40 mm Hg. Art. it will be the norm for him. Although, perhaps, someone will be surprised by the fact that yellow lipid spots can be found in newborns in the aorta, which, however, do not affect health and disappear with time. But it is, digression.

As the baby develops and the further formation of his body, blood pressure rises and by the year of life the numbers 90-100 / 40-60 mm Hg will be normal. 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 mm Hg. Art. will be considered normal and will not surprise anyone. But in adolescents, the normal value of blood pressure 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 present to our readers.

Age	Normal minimum systolic pressure	Normal maximum systolic pressure	Normal low 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 old	100	122	60	78
10-12 years old	110	126	70	82
13-15 years old	110	136	70	86

BP problems in children and adolescents

Unfortunately, such a pathology as arterial hypertension is no exception for the child's body. The lability of blood pressure is most often manifested in adolescence, when the body is being restructured, but the puberty period is dangerous because a person at this time is not yet an adult, but not a child either. This age is also difficult for the person himself, because often it leads to pressure surges. instability of the nervous system teenager, and for his parents, and for the attending physician. However, pathological deviations should be noticed and leveled in time. This is the task of adults.

The causes of high blood pressure in children and adolescents can be:

As a result of these factors, vascular tone increases, the heart begins to work with a load, especially its left section. If urgent measures are not taken, a young person can meet his majority with a ready-made diagnosis: arterial hypertension or, at best, cardiopsychoneurosis one type or another.

Measurement of pressure at home

We have been talking about blood pressure for quite some time, implying that all people know how to measure it. It seems 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 the blood pressure of adults, I would like to dwell on the algorithm for measuring blood pressure, since patients often do it on their own and not always according to the method. As a result, inadequate results are obtained, and, accordingly, the unreasonable use of antihypertensive drugs. In addition, people, talking about upper and lower blood pressure, do not always understand what it all means.

For the correct measurement of blood pressure, it is very important in what conditions a person is. In order not to get "random numbers", pressure is measured in America, observing the following rules:

A comfortable environment for a person whose pressure is of interest should be at least 5 minutes;
Do not smoke or eat for half an hour before the manipulation;
Visit the toilet so that the bladder is not full;
Take into account tension, pain, feeling unwell, taking medication;
Measure pressure twice on both hands in the prone position, sitting, standing.

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

A person, especially if he is not completely healthy, usually does not cope well with measuring pressure on himself (it costs a lot to put on a cuff!). It is better if one of the relatives or neighbors does it. Highly Seriously need treat and to the method of measuring blood pressure.

Video: measuring pressure with an electronic tonometer

Cuff, blood pressure monitor, phonendoscope… systole and diastole

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

Air is released from the cuff connected to the tonometer and the pear, squeezing it with the palms of your hands;
Wrap the cuff around the patient's arm above the elbow (tightly and evenly), trying to keep the rubber connecting tube on the side of the artery, otherwise you can get an incorrect result;
Choose a place to listen and install a phonendoscope;
Inflate the cuff;
The cuff, when air is injected, 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 bend;
The first sound heard by the phonendoscope is fixed with a glance on the scale of the tonometer. It will mean a breakthrough of a portion of blood through the clamped area, since the pressure in the artery slightly exceeded the pressure in the cuff. The impact of escaping blood against the wall of an artery is called in Korotkov's tone, top or systolic pressure;
The series of sounds, noises, tones following the systole is understandable to cardiologists, and ordinary people should catch the last sound, which is called diastolic or lower, it is also noted visually.

Thus, contracting, the heart pushes blood into the arteries (systole), creates pressure on them equal to the upper or systolic pressure. Blood begins to be distributed 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 by 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 redeemed 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, patients do not differ in the same complexion. For example, in thin people, the determined values are lower. And for full ones, on the contrary, it is higher than in reality. This difference can be leveled 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 for this.

There are cases when, with the auscultatory method of measuring blood pressure, in the interval between the upper and lower blood pressure in the sound wave, there is a break (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 value of blood pressure (the lower limit of the auscultatory "failure") will be mistakenly taken as the value of systolic pressure. Sometimes this difference can even be 50 mm Hg. Art., which, of course, will greatly affect the interpretation of the result and, accordingly, the treatment, if any.

This error is highly undesirable and can be avoided. To do this, simultaneously with the injection of air into the cuff, the pulse on the radial artery should be monitored. It is necessary to increase the pressure in the cuff to values \u200b\u200bthat sufficiently exceed the level of disappearance of the pulse.

The phenomenon of "infinite tone" well known to teenage, sports doctors and in military enlistment offices when examining recruits. 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 equal to zero. However, after a few days, in a relaxed state of a young man, the measurement of the lower pressure presents no difficulty.

Video: traditional pressure measurement

Blood pressure rises ... (hypertension)

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

Of course, atherosclerosis, leading to vasoconstriction and increased blood pressure;
BP clearly correlates with being overweight;
The level of glucose (diabetes mellitus) greatly affects the formation of arterial hypertension;
Excess consumption of table salt;
Life in the city, because it is known that the increase in pressure goes hand in hand with the acceleration of the pace of life;
Alcohol. Strong tea and coffee become the cause only when they are consumed in excessive quantities;
Oral contraceptives, which many women use to avoid unwanted pregnancies;
By itself, smoking, perhaps, would not be among the causes of high blood pressure, but this bad habit affects the vessels too badly, especially peripheral ones;
low physical activity;
Professional activity associated with high psycho-emotional stress;
Changes in atmospheric pressure, changes in weather conditions;
Many other diseases, including surgical ones.

People suffering from arterial hypertension, as a rule, control their condition themselves, taking constantly drugs to lower blood pressure, prescribed by a doctor in individually selected dosages. These may be beta-blockers, calcium antagonists, or ACE inhibitors.. Given the good awareness of patients about their illness, it makes no sense to dwell on arterial hypertension, its manifestations and treatment.

However, everything once begins, and 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 drugs), or there has been a tendency to increase it on an ongoing basis, for example, blood pressure rises in the evening, after a hard day.

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

If high blood pressure is detected repeatedly, even if in numbers 135/90 mm Hg. Art., it is advisable to start taking measures so that it does not become high. It is not necessary to immediately resort to medications, you can first try to regulate blood pressure by observing the regime of work, rest and nutrition.

A special role in this regard belongs, of course, to diet. 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 compiling a menu of such affordable products as 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)

Although low blood pressure is not fraught with such formidable complications as high blood pressure, it is uncomfortable for a person to live with him. Usually, such patients have a diagnosis, quite common today, of vegetative-vascular (neurocirculatory) dystonia of the hypotonic type, 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 are thrown into a cold sweat, fainting may occur.

There are a great many reasons for this, the treatment of such people is very difficult and lengthy, besides, there are no drugs for permanent use, except that patients often drink freshly brewed green tea, coffee and occasionally take Eleutherococcus tincture, ginseng and pantocrine tablets. Again, the regimen helps to normalize blood pressure in such patients, and especially sleep, which requires at least 10 hours. Nutrition for hypotension should be high enough in calories, because low blood pressure requires glucose. Green tea has a beneficial effect on blood vessels in case of hypotension, increasing pressure somewhat and thereby bringing a person to life, which is especially noticeable in the morning. A cup of coffee also helps, but be aware of the addictive property of the drink., that is, imperceptibly you can "get hooked" on it.

The complex of recreational activities for low blood pressure includes:

Healthy lifestyle (active rest, sufficient exposure to fresh air);
High physical activity, sports;
Water procedures (aroma baths, hydromassage, swimming pool);
Spa treatment;
Diet;
Elimination of provoking factors.

Help yourself!

If problems with blood pressure have begun, then 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 happen to be in a hospital with a hypertensive crisis, then there they will prescribe a blood pressure profile and pick up pills. But, when a patient comes to an outpatient appointment with complaints of an increased increase in pressure, then a lot will have to be taken on. For example, it is difficult to trace the dynamics of blood pressure from the words, therefore The patient is asked to keep a diary(at the stage of observation for the selection of antihypertensive drugs - a week, during a 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 graphs for convenience. It should be remembered that the measurement of the first day, although performed, is not taken into account. In the morning (6-8 hours, but always before taking medication) and in the evening (18-21 hours), 2 measurements should be taken. 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 (endure!);
Do not comment on the actions of the measurer, do not discuss the news, remember that there should be silence when measuring blood pressure;
Sit comfortably with your hand on a hard surface.
Carefully enter the values of blood pressure in a notebook, so that later you can show your notes to the attending physician.

You can talk about blood pressure for a long time and a lot, patients are very fond of doing this, sitting under the doctor's office, but you can argue, but you should not take advice and recommendations, because everyone has their own cause of arterial hypertension, their concomitant diseases and their medicine. For some patients, blood pressure lowering drugs are taken for more than one day, so it is better to trust one person - a doctor.

sosudinfo.ru

Be sure to read other articles:

The lowest pressure in a person Human pressure norm table in adults

The article presents the most important practical aspects of the use of 24-hour BP monitoring, evaluation and interpretation of the method data, its clinical and prognostic significance. Systematized indications for daily monitoring of blood pressure, shows the ratio of the results of clinical measurement of blood pressure and daily monitoring of blood pressure.

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 target 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 you to change your lifestyle in a timely manner, give up bad habits and, if necessary, prescribe antihypertensive drug therapy, which leads to a decrease in deadly complications, prolongs working age and increases life expectancy.

To date, the main method for diagnosing high blood pressure and evaluating the effectiveness of treatment is one or more measurements of blood pressure (BP) during the day. However, such measurements do not provide complete information about the 24-hour BP profile. Not only traditional one-time measurements of blood pressure are of diagnostic value, but also blood pressure values during sleep, physical, mental stress, at different times after taking drugs, etc. . This information is provided by the 24-hour blood pressure monitoring (ABPM) method. 24-hour blood pressure monitoring is used to diagnose hypertension or hypotension, select drug therapy, and evaluate the effectiveness and safety of treatment. ABPM excludes 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 ambulatory hypertension, detection of “workday hypertension” in patients with high levels of stress at the workplace.

3. Diagnosis of borderline hypertension.

4. Detection of nocturnal hypertension.

5. Diagnosis of symptomatic arterial hypotension caused by taking antihypertensive drugs, vegetative disorders, myocardial infarction, heart failure, adrenal insufficiency, poor tolerance of permanent pacing.

6. Increased lability of blood pressure during repeated measurements, visits, or according to self-monitoring of blood pressure (SCAD).

7. To assess changes in blood pressure in 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 BP 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 suspicion of preeclampsia.

Therapy control

1. Selection of patients for medical treatment.2. Evaluation of the effectiveness and safety of therapy.

3. Evaluation of resistance to drug treatment and selection of the optimal treatment regimen for such patients.

4. The study of the individual daily rhythm of blood pressure during treatment.

5. Evaluation of the effectiveness of hypertension correction 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 of the upper extremities, diseases with damage to the vessels of the upper extremities, 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 the average daily values of blood pressure and pulse, the average values of blood pressure in the daytime and at night, determine the degree of nighttime decrease and morning increase in blood pressure, the response of blood pressure to physical exertion and psycho-emotional stress, the degree and duration of hypertensive load on target organs, variability of blood pressure and pulse during the day, to detect episodes of hypotension.

The main indicators for evaluating the results of ABPM include average values, pressure load indices, indicators of the circadian rhythm of blood pressure, blood pressure variability, 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. The periods of day and night are set according to the information obtained from the patient's diary. The average values obtained 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 evaluating mean values obtained from monitoring blood pressure, different criteria are used than when evaluating traditional measurements of blood pressure. In table. 2 shows the standards for average values recommended by the Russian Medical Society for Arterial Hypertension and the All-Russian Scientific Society of Cardiology.

Table 2.

Norms of average values of blood pressure according to ABPM data (mm Hg. Art.)

These standards can also serve as target values in assessing the effectiveness of antihypertensive therapy. In order to assess the effect of therapy, you can also use the criteria developed by the specialists of the RKNPK them. 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. Of great importance is the duration of the increase in blood pressure during the day. To quantify its value, pressure load indices are used. This indicator has several names (frequency of increase in blood pressure, pressure load, hypertensive load, time index) and represents the percentage of blood pressure measurements that exceed 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 load pressure indicators (%)

To quantify the magnitude of the “pressure load” exerted on target organs by increased pressure, the terms time index (TI) and area index (AI) are used. The VI 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 monitoring duration (or in what percentage of measurements) the blood pressure was above (below) normal, and the conditional limit of the norm for the daytime is 140/90, and for the night - 125-130/80 mm Hg. Art.

IV in most healthy individuals ranges from 10 to 20% and does not exceed 25%. An IV for SBP greater than 25% is considered unambiguously pathological, which warrants a diagnosis of hypertension or symptomatic hypertension. Stable hypertension is diagnosed when IV is at least 50% during the day and at night. The presence of a patient receiving antihypertensive therapy, IV above 25% indicates the lack of effectiveness of the treatment. In severe arterial hypertension, when during all measurements the BP figures exceed the established limits of the norm, the IV 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 acts on the body, i.e. how long in a 24-hour period the patient has elevated blood pressure and how much, on average, it exceeds the upper limit of the normal range (in the 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 at night experience a decrease in blood pressure by 10-20% compared to daytime levels. To assess the circadian rhythm of blood pressure, an indicator of the degree of nighttime decrease in blood pressure (SNBP) is used. It reflects the difference between the average values of blood pressure during the day and at night. To determine SBP in%, use the formula:

(SADd - SADn)x100% / SADd,

where SADd is the average blood pressure during the day,

SADN - average blood pressure at night.

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

Patients with a daily index of 10-20% are called dippers. They record a blood pressure profile with a deepening at night, looking 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" (non-dippers). In this case, 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 with left ventricular hypertrophy. There is also a group with a steady increase in nocturnal 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 diurnal BP profiles depending on SNBP

Assessment of BP variability. BP variability in ABPM is calculated as the standard deviation from the average value for the daytime and nighttime periods. The standard deviation is expressed in millimeters of mercury. The critical values of this indicator, according to Rogoza A.N. et al. , are given in table. 5.

Table 5

Critical values of standard deviation (variability)

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

When assessing the variability of blood pressure, it is necessary, in accordance with the diary, to take into account the patient's activity, his daily routine and other factors. When evaluating nighttime variability values, it is imperative to pay attention to episodes without sleep, getting up, restless sleep. Turning from one side to the other leads to an increase in pressure by 20 mm Hg. Art. Significantly changes the indicators of variability, mean values and the degree of nighttime decrease in blood pressure sleep apnea syndrome.

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 (myocardial infarctions, episodes of painless myocardial ischemia, strokes, malignant arrhythmias) occur. 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 night hours, the presence of a "peak", i.e. BP values exceeding subsequent "daily" values.

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

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

where ADmax - 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 nighttime blood pressure.

Normally, the rate of morning rise in systolic blood pressure is less than 10 mm Hg. Art. in hour. The critical speed that provokes the occurrence of most episodes of "silent" myocardial ischemia in patients with IHD in combination with A is 15 mm Hg. Art. in hour.

Prognostic value of ABPM. Based on the results of ABPM, more accurately than clinically determined blood pressure, it is possible to predict the course of hypertension. 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;
decrease in the daily index in the absence of a decrease in blood pressure at night;
an increase in the daily index in case of an excessive decrease in blood pressure at night in patients with severe atherosclerosis;
high numbers of mean blood pressure;
high BP variability index.

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

The ratio of the results of clinical measurement of blood pressure and ABPM. According to the 2008 European Society of Hypertension Guidelines for SCAD, there are four options for the correlation of the results of clinical and ambulatory measurements of blood pressure (Table 6). In cases 2 and 3, when the results of clinical and ambulatory BP measurements are the same, the evaluation of the data is simple. In cases 1 and 4, when there are different results of clinical and ambulatory measurements of blood pressure, one speaks of isolated clinical hypertension and isolated ambulatory hypertension.

Table 6

Correlation between clinical and ambulatory BP measurements

Isolated clinical hypertension. In some individuals, when blood pressure is measured by medical personnel, the recorded values of blood pressure correspond to hypertension, while the values of ABPM or blood pressure measured at home remain within normal values, i.e. there is white-coat hypertension, or (more preferably called) isolated clinical hypertension (ICAH). ICAG 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 normotonics, this category is more likely to have target organ damage and metabolic changes. Quite often, ICAG eventually transforms into ordinary AH. It is difficult to foresee the possibility of detecting hypertension in each specific case, however, ICAH is more often observed in AH of the 1st degree in women, in the elderly, in non-smokers, with a recent detection of AH and with a small number of blood pressure measurements in outpatient and clinical settings.

Diagnosis of ICAG is carried out on the basis of SCAD and ABPM data. At the same time, there is an increased clinical BP on repeated measurements (at least three times), while the systolic blood pressure (mean blood pressure over 7 days of measurement) and ABPM are within the normal range (table 6).

If ICAG is suspected, SCAD should be performed. In the case of normal blood pressure, according to the SCAD, it can be concluded that the risk of hypertension is low and observation is recommended. If elevated blood pressure is detected, according to the SCAD, antihypertensive therapy is recommended. In the case of doubtful or borderline results of SCAD, the patient is indicated for ABPM.

Diagnosis of ICAH according to SCAD and ABPM may not coincide, especially often this is observed in working patients. In this case, it is necessary to focus on the results of SMAD. If ICAH is diagnosed, additional studies are required to clarify the presence of risk factors and damage to target organs. Patients with ICAH should be advised non-pharmacological treatment of hypertension, and in the presence of high and very high risk of cardiovascular complications, it is recommended to start antihypertensive therapy.

Isolated ambulatory hypertension (IAAH). The opposite phenomenon for ICAG is IAAG, or “hidden” AH, when normal BP values are determined when measuring blood pressure in a medical institution, but the results of SCAD 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 detection of risk factors and target organ damage in such patients compared with normotonic patients is much higher, and the risk of cardiovascular complications is almost the same as in patients with hypertension.

Assume IAAG in individuals with normal pressure can be in the presence of the following factors:

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

Thus, the results obtained with 24-hour blood pressure monitoring provide important diagnostic and prognostic information. The method allows you to individually select the dose and time of taking medications; to identify patients with symptomatic hypertension, in which it is possible to increase blood pressure at night with normal values of blood pressure during the day, to determine a significant effect and duration of the drug, to reduce the cost of antihypertensive therapy, to reduce the incidence of cardiovascular complications in arterial hypertension. Correct methodological approaches to daily monitoring of blood pressure increase the accuracy and information content of the study.

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

Kazan State Medical Academy

Interregional Clinical and Diagnostic Center, Kazan

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

Literature:

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