Sad systolic blood pressure. Hypertension (increased blood pressure): causes, treatment with psychotherapy. Confirmation of stability and assessment of the degree of blood pressure increase

Institute of Clinical Cardiology named after. A.L. Myasnikova, RKNPK of the Ministry of Health of the Russian Federation, Moscow

URL

Introduction
Over the past two decades, Russia has seen an increase in mortality from coronary disease heart (CHD) and cerebral strokes, which are the main complications arterial hypertension(AG). According to the latest data from the WHO Working Group (1997), Russia ranks among the first in Europe in terms of mortality from coronary artery disease and strokes. In Russia, among men 45–74 years old, ischemic heart disease and stroke account for 87.5% of deaths from cardiovascular diseases, and the share of these diseases in the structure of overall mortality is 40.8%. In women of the same age, the share of ischemic heart disease and stroke in the structure of mortality from cardiovascular diseases is 85%, in the structure of general mortality - 45.4%.
In the US, older adults (over 65 years of age) make up only 12% of the population, but consume 1/3 of healthcare dollars. This requires special attention to the problem of hypertension in this population, since it leads to increased morbidity and mortality, decreased functional abilities and deterioration in quality of life. In older adults, hypertension is an important risk factor for cerebrovascular disease, coronary artery disease, and congestive heart failure, while heart disease and stroke remain the 1st and 3rd leading causes of death in the United States. Taking into account the fact that the share of older people in the population structure developed countries is steadily increasing, treatment of hypertension, including isolated systolic hypertension (ISAH) in this category of patients, reducing morbidity and mortality is an important social and economic task. Significant risk factors and its greatest determinants for ISAH were age, gender, all components of blood pressure (BP) and increased body mass index in women.

Definition and classification
ISAH is an increase in systolic blood pressure (SBP) > 140 mmHg. Art. with normal or slightly reduced diastolic blood pressure (DBP) Ј 90 mm Hg. Art. ISAH is accompanied by an increase in pulse blood pressure (PBP).
For almost a century, hypertension has been considered as a disease of small-caliber arterial vessels: an increase in muscle tone in the arterioles leads to an increase in vascular resistance, and as a result, to an increase in mean blood pressure (MAP). Considering that MAP is closer to DBP than to SBP, the only determining factor for diagnosis and treatment was the level of DBP.
Until the early 90s, the criterion for ISAH was often considered to be SBP > 160 mmHg. Art. at DBP< 90–95 мм рт. ст. В 1993 г. эксперты ВОЗ/МОГ и Объединенного национального комитета США по выявлению, оценке и лечению повышенного АД (ОНК) пересмотрели критерии диагностики АГ. Так, критерием ИСАГ стали считать уровень САД более 140 мм рт.ст. при ДАД ниже 90 мм рт. ст. В классификации ВОЗ/МОГ 1993 г. введено понятие "пограничной изолированной систолической гипертонии", под которой подразумевается повышение САД в пределах 140–160 мм рт.ст., а в классификации 1999 г. – в пределах 140–149 мм рт.ст.
The evolution of key concepts reflecting the general dynamics of ideas about hypertension is presented in two WHO-IOG classifications (Table 1) and the three latest classifications of the ONC (Table 2). Both classifications are based on large-scale epidemiological and controlled data. clinical trials. Fundamental difference latest version The difference from the previous ones is the disappearance of the concept of ISAH, which emphasizes the lack of age standards for blood pressure.

Table 1. Evolution of ideas about hypertension in the WHO-IOG classification

Table 2. Evolution of ideas about hypertension in the US classification of POC

Table 3. Characteristics of studies SHEP, SYST-EUR, SYST-CHINA

Epidemiology
In developed countries, both SBP and DBP levels increase with age. SBP continues to rise until age 70–80, while DBP only increases until age 50–60, and then may even decline. These trends in SBP and DBP have been observed in cross-sectional and prospective studies, suggesting explains the increase in PBP and the increase in the prevalence of ISAH with age. In the United States, SBP increases by 5–10 mm Hg in individuals aged 40 to 70 years. Art., while DBP is by 5–6 mm Hg. The peak increase in blood pressure is observed at a slightly younger age in men than in women. Individuals with high blood pressure in youth have a more pronounced increase in blood pressure with age. An increase in blood pressure is not, however, a natural consequence of aging. Many older people have normal or even low blood pressure, although the prevalence of hypertension and, in particular, ISAH is especially increasing among the elderly. ISAH is present in 64.8% of people over 60 years of age. Data from the SHEP study showed that at 60–69 years of age, ISAH is detected in 8%, from 70 to 79 in 11%, and over 80 years of age in 22%. There are differences in the prevalence of hypertension in different ethnic groups. It is possible that factors such as social status and cultural traditions play a role in the development of hypertension.
The assessment of the prevalence of ISAH is influenced by the methods used to establish the diagnosis of ISAH, in particular the frequency of blood pressure measurements and the selected cut-off point for DBP - 90 or 95 mmHg. Art. The prevalence of ISAH among 3245 individuals decreased from 13.9 to 2.7% when taking into account BP measurements obtained from three medical examinations. Similar dynamics have been identified by other authors..When the DBP threshold point changes from less than 95 mm Hg. Art. to less than 90 mm Hg. Art. the prevalence of ISAH decreased from 3.2 to 2.3% in studies conducted in Belgium, from 3.9 to 2.4% in the Hypertension Detection and Follow-up Program studies, and from 13.4 to 8.4% in Evans Country studies.
K. Ueda reviewed time trends in the prevalence of ISAH in Japan and three studies in the United States. Results suggested small and often transient declines in the prevalence of ISAH in specific age and racial groups, but no clear overall trend was found. Thus, the assumption of a decrease in the prevalence of ISAH remains unproven.
To describe the dependence of the prevalence of ISAH on age, a second-order regression model was created, the variations in which reflect not only biological variability, but also differences both in research methodology and between the studied populations. The prevalence of ISAH, predicted on the basis of this model, taking into account the sample size, is in a curvilinear relationship with the age of the patients and was 0.028% for 30 years of age, 0.1% for 40; 0.8% for 50; 5% for 60; 12.6% for 70 and 25.6% for 80 years. Similar values ​​were found in another study. On average, the prevalence of ISAH in women was 43% higher than in men (p< 0,01). Частота ИСАГ повышается при ожирении, особенно у женщин . Пограничная изолированная систолическая гипертония – самая распространенная форма АГ у нелеченых мужчин и женщин старше 60 лет .

Pathophysiology
Physiological and pathological changes during aging
In fact, hypertension is not a property of aging, but it is accompanied by age-related changes in the cardiovascular system. Many years ago, the results of the STARR study showed that there is a decrease in cardiac index (CI) of 8.4 ml/min/m2 for each year of life. Brandfonbrener et al. showed that there is a linear decrease in SI with increasing age by 1% per year. If blood pressure remains elevated, the decrease in cardiac output leads to an increase in total peripheral vascular resistance. This pattern is believed to exist in the normotensive elderly population. There is also a decrease in the sensitivity of the cardiovascular system to adrenergic stimulation (such as physical activity, administration of isoproterenol), which affects the acceleration of heart rate and an increase in volumetric blood flow to the brain. During the aging process, there is a decrease in the number of elastic fibers in the connective tissue in proportion to the increase in the deposition of collagen, elastin, glycosaminoglycans and calcium, which causes sclerosis and fibrosis of various tissues, including the media of blood vessels, heart valves and their chords, thereby reducing the elasticity of the aorta and other arteries. The increase in arterial stiffness is influenced by factors such as age, the presence of hypertension, atherosclerosis and diabetes mellitus. During ventricular systole, the distensibility of the aortic wall decreases and the pressure cannot be “extinguished” by the aortic wall. In the same way, the ability to reflect pressure in diastole decreases, all this leads to an increase in PAP. Also, with age, the speed of the pulse wave increases. Studies by Weisfeldt have shown that arterial vasodilators such as nitroprusside can reduce aortic pulse wave velocity, suggesting that aortic changes are a consequence of changes in smooth muscle compliance, neurohumoral status, arterial wall thickness, or a combination of these, and not a consequence of fibrosis or atherosclerosis .
Humoral influences
The activity of the renin-angiotensin-aldosterone system (RAAS) decreases with age, which is partly due to a decrease in the reactivity of the nervous system. Plasma renin activity and levels of angiotensin II and aldosterone decrease with age, but it is unknown how this affects the pathophysiology of hypertension in the elderly. Plasma renin secretion and activity, or both, in response to salt loss, diuretics, orthostasis, and catecholamine stimulation are suppressed in old age. There is also an age-dependent thinning of the renal cortex, a decrease in kidney mass, and a decrease in sensitivity to circulating catecholamines. Although the number or density, or both, b -adrenergic receptors do not change, their sensitivity decreases with age. The elderly are prone to developing dehydration and orthostatic hypotension partly due to slower activation of neurohumoral mechanisms in response to a decrease in effective blood volume. The sympathetic nervous system also changes with age: the level of catecholamines in the blood increases and by the age of 70 it becomes 2 times higher than at 20 years. This does not lead to a state of hyperadrenergy, since the sensitivity b -adrenergic receptors are reduced, as is reactivity a -adrenoreceptors. There is a decrease in the concentration of catecholamines in the myocardium, which, perhaps, in combination with age-related anatomical changes, may explain the decrease in contractility of the left ventricular myocardium. The mechanism for increasing norepinephrine levels in the elderly may be associated with a decrease in its hepatic clearance, as well as with a compensatory response to a decrease in the sensitivity of adrenergic receptors.
It is necessary to distinguish between primary and secondary ISAH. Secondary forms can be caused by an increase in cardiac output (for example, with thyrotoxicosis or anemia) or the superposition of direct and reflected pressure waves in systole (for example, with arteriosclerotic obliteration of the lower extremities). Many histological changes that occur with age in walls of blood vessels, similar to changes due to atherosclerosis. However, the role of atherosclerosis in the pathogenesis of ISAH in the elderly remains controversial. A study of autopsy specimens of the human aorta showed that the compliance of its walls decreases with age, but the extent to which aging and atherosclerosis contribute to this process is unknown. In addition, clinical practice shows that in many patients with severe forms of widespread atherosclerosis, SBP remains within normal limits. In contrast, in some populations with a low prevalence of atherosclerosis, SBP increases with age and ISAH is observed. The genetic aspects of hypertension have also been studied. A group of Belgian authors studied the hypothesis that haptoglobin polymorphism is a genetic factor associated with increased SBP in old age. The study found that in elderly patients with hypertension, the presence of the 1-1 haptoglobin phenotype is associated with an increase in SBP. D. Ciecwierz et al. (Poland)made an attempt to establish a possible connection between polymorphism of the angiotensin-converting enzyme (ACE) gene and the risk of developing hypertension and coronary artery disease in different age groups. Researchers have found that the DD genotype of the ACE gene is associated with the development of myocardial infarction (MI) in patients under 50 years of age and with the presence of ISAH in patients with coronary artery disease over 65 years of age.
Primary ISAH occurs when the SBP in individuals with normal blood pressure rises above 160 mmHg without any obvious reason. Art. However, it is likely that in some cases, ISAH may occur in those hypertensive patients who have previously experienced increases in both SBP and DBP, if SBP remains unchanged or even increases while DBP decreases.

Diagnosis and clinical significance
Examination of elderly patients with hypertension is carried out in three areas: identification and determination of the severity of hypertension; assessment of target organ damage; identification of secondary conditions that may be a consequence of elevated blood pressure. It should be borne in mind that the frequent occurrence of the phenomenon of auscultation failure in the elderly can lead to an underestimation of SBP up to 50 mmHg. Art. , to avoid this, you should inflate the air into the cuff to at least 250 mmHg. Art. and release the air slowly. Blood pressure measurements should be taken not only while sitting and lying down, but also after 1 and 5 minutes of standing. The diagnosis of hypertension can only be made at an average blood pressure levelі 140/90 mm Hg. Art. when measuring blood pressure at three follow-up visits. Initially, blood pressure should be measured in both arms to reduce measurement error due to local vascular thrombotic pathology.
Pseudohypertension- this is a false increase in blood pressure when measured using a cuff, while blood pressure measured intra-arterially is normal. This phenomenon is believed to be a consequence of thickening and/or calcification of the arteries, which leads to worsening of arterial compression when measuring blood pressure with a cuff. The Osler maneuver, in which the cuff is inflated above the SBP and the brachial or radial artery is palpated, helps confirm the diagnosis of pseudohypertension if pulsation persists in at least one of these arteries. It is also important to control orthostatic hypotension in the elderly. This condition is common in the elderly, and many prescribed antihypertensive drugs (eg diuretics) and reducing salt intake may cause or worsen it. This may also be facilitated by taking medications such as tricyclic antidepressants, a - blockers, sedatives and levodopa. Orthostatic hypotension can have catastrophic consequences, such as a fall or head injury.
The examination of elderly patients with hypertension should include a number of laboratory tests, including general and biochemical blood tests (creatinine, potassium, uric acid, etc.), urine tests, ECG, identification of signs of parenchymal kidney disease and vascular damage associated with diabetes. These studies are necessary to stratify patients into risk groups and identify concomitant diseases. It is also necessary to exclude secondary forms of hypertension.

Clinical significance
In middle-aged and young people, systolic and diastolic pressure changes in the same direction. In this case, an increase in SBP is usually accompanied by an increase in DBP. Upon reaching the age of 50 (for most people), the DBP value “reaches” a plateau and even decreases, while the SBP value increases with age. This discordant change in SBP and DBP values, observed with age, significantly increases PBP and the incidence of ISAH. This concept has led to the prevailing view that an increase in SBP with age is inevitable and even desirable, as it serves to maintain blood flow to target organs. Unfortunately, this belief persisted until the EWPHE and SHEP studies showed it to be incorrect. Although the problem of “diastolic hypertension” has not disappeared at the present time, an increase in SBP is detected quite often, which largely determines cardiovascular morbidity and mortality. The risk of cerebrovascular complications, heart failure, coronary artery disease and end-stage chronic renal failure is independently associated with both SBP and DBP, but especially increases with age.
Patients with ISAH have a high risk of cardiovascular complications despite low DBP. The risk from elevated BP is best described by its relationship with SBP, since DBP may be falsely low due to arterial stiffness. Several recent studies have shown that PBP, especially when combined with elevated SBP, has the strongest association between BP and the risk of cardiovascular events.
Large epidemiological studies such as the MRFIT Multiple Risk Factor Adjustment Study and the Framingham Study n gham study), it is shown that SBP is an independent, constant and correctable risk factor for any cardiovascular complications. It has been proven that ISAH increases mortality from cardiovascular pathology by 2–5 times, overall mortality by 51%, frequency strokes by 2.5 times compared with persons with normal blood pressure and comparable by age and gender.
Data from the HDFP showed that for every 1 mmHg increase in SBP. Art., mortality increases by 1%. With each increase in SBP by 20 mm Hg. Art. the likelihood of developing a cerebral stroke doubles. The Chicago Stroke Study found that SBP is a more important risk factor for cerebrovascular events in the elderly than DBP. Patients with SBP > 179 mm Hg. Art. had 3 times more cases of brain strokes over 3 years than with SAD< 130 мм рт. ст.
The Framingham Study showed that SBP is a better predictor of cardiovascular mortality than DBP, and ISAH may be a risk factor for cardiovascular mortality. Over a 20-year period of observation of men 55–74 years old with ISAH, it was determined that the mortality rate among them was 2 times higher than among normotensive patients. The risk was 1.8 times higher in men and 4.7 times higher in women with ISAH. 80% of patients with borderline ISAH developed stable hypertension (> 160/90 mmHg) after 20 years of follow-up, compared with 45% of those with normal blood pressure.
The risk of heart failure is 6 times higher in hypertensives than in normotensives, and SBP is a more significant risk factor for heart failure than DBP in both men and women.
DBP is more closely associated with the development of CHD in people under 45 years of age, and after 45 years of age, DBP becomes less significant, and after 60 years of age, SBP is already a greater risk factor than DBP for CHD. The risk of developing coronary artery disease in patients 65–94 years old with SBP above 180 mmHg. Art. 3–4 times more than in patients with SBP below 120 mm Hg. Art. .

Treatment
The need for antihypertensive therapy
The ultimate goal of treatment for elderly patients with ISAH is not to reduce blood pressure, but to prevent complications (often fatal) that occur with increased SBP and, therefore, prolong life, as well as improve its quality. The latter is achieved mainly by preventing cardiovascular complications of ISAH and maintaining a satisfactory physical, mental and psycho-emotional state of patients. Side effects of drug therapy should be minor.
The benefits of treating hypertension in the elderly clearly outweigh the potential risks or side effects. Many studies in recent years have shown a reduction in cardiovascular mortality, the incidence of coronary artery disease, heart failure, cerebrovascular complications and, in some of them, a reduction in overall mortality. Even before 1991, when the SHEP results were published, treatment of diastolic hypertension had been shown to have a beneficial effect on cardiovascular morbidity and mortality. Despite Although epidemiological studies have identified ISAH as an important risk factor for cardiovascular disease, none have examined the benefit of treating ISAH. The results of a meta-analysis of 3 large studies on the treatment of ISAH in the elderly (SHEP, SYST-EUR, SYST-CHINA; Table 3) indicate that active treatment of ISAH is certainly beneficial because it reduces:
– overall mortality by 17%;
– cardiovascular mortality by 25%;
– fatal and non-fatal cardiovascular complications by 32%;
– all strokes by 37%;
– MI and sudden death by 25%.
General treatment tactics
The benefits of treating hypertension are clear, but the choice of therapy should be based on stratification of the risk of cardiovascular diseases and target organ damage.
When prescribing drug therapy, it is recommended to reduce SBP to 140–160 mm Hg. Art. with maintaining DBP at 70 mm Hg. Art. and higher .
It is assumed that an excessive decrease in DBP is dangerous for coronary perfusion, especially in elderly patients in whom the coronary arteries are often narrowed due to obstructive atherosclerotic lesions, and the hypertrophied left ventricle requires increased oxygen supply. In an open randomized study conducted by J. Sorre and T..Warrender, 23% of included patients had ISAH with DBP below 90 mmHg. Art. Analysis conducted before completion of the study showed that in patients with DBP measured at least 90 mm Hg. Art., the number of deaths per 1000 patients tended to decrease in patients receiving active treatment compared with patients in the control group (16 and 24 deaths, respectively, per 1000 patients per year), while in patients with systolic hypertension (SBP< 90 мм рт. ст.) наблюдалась обратная тенденция (30 и 21 смерть соответственно на 1000 больных в год). Несмотря на незначительное различие в результатах лечения у больных с систолической и с комбинированной гипертонией, J.Сооре и Т.Warrender на основании своих данных предположили, что пожилым больным с ДАД < 90 мм рт. ст. не следует назначать лечение.
This assumption was not confirmed in two randomized, controlled trials in elderly patients with elevated both SBP and DBP, but the situation may differ in patients with ISAH who already had low DBP before treatment. The results of SHEP, SYST–EUR, SYST–CHINA showed that lowering BP generally prevented or reduced the incidence of cardiovascular events in older adults with ISAH, despite lowering DBP, which in these studies ranged from 75 to 85 mmHg. Art., which contradicts the J-curve hypothesis of Cruickshank et al. in DBP levels.
Combining controlled studies, taking into account the number of patients included, made it possible to determine the weighted average reduction in SBP in elderly patients with predominant ISAH; it was 12 mm Hg. Art. (95% confidence interval for mean reduction in SBP – 5 to 20 mmHg). In the same studies, the average reduction in DBP as a result of drug therapy was 3 mmHg. Art. (95%confidence interval 0–6 mm Hg. Art.) .
It must be remembered that with a high initial SBP, blood pressure must be reduced in 2 stages, as in severe and malignant hypertension. The need for a two-stage reduction in blood pressure is due to the fact that in most cases, elderly patients with initially high SBP suffer from atherosclerosis of the carotid and coronary arteries And a sharp decline Blood pressure can lead to impaired cerebral and coronary circulation. Drug therapy should be reduced or stopped if it causes harm to the patient, including a significant deterioration in quality of life.
Non-drug treatment
For the treatment of elderly patients with ISAH American working group on hypertension in the elderly recommends a salt-restricted diet and lifestyle optimization, since these measures can be quite effective in reducing blood pressure. Even if this method fails to adequately control blood pressure, its use in combination with pharmacological therapy makes it possible to reduce the amount and dose of drugs used. However, the effect of diet and lifestyle changes on blood pressure in elderly patients with hypertension has been described in single studies, which often did not include control groups. In addition, the relationship between the incidence of cardiovascular complications and risk factors such as body weight and total serum cholesterol levels changes with age.
Selection of therapy taking into account the pathophysiology of ISAH
From the point of view of the pathophysiology of ISAH, the ability of therapy to influence the stiffness of the aorta and large arteries is important. Theoretically, an increase in arterial distensibility, a decrease in the speed of propagation of the direct pulse wave in systole, and a change in the temporal characteristics of reflected pressure waves in systole can lead to a decrease in SBP in elderly patients with ISAH. Lifestyle changes (reducing salt intake, increasing physical activity) are associated with increased aortic compliance. Vasoactive drugs that reduce the smooth muscle tone of large arteries effectively increase their distensibility. This effect has been shown for calcium antagonists, ACE inhibitors, b -adrenergic blockers with sympathomimetic activity, such as pindolol, and low doses diuretics. On the contrary, others b -adrenergic blockers (propranolol, etc.) and direct vasodilators (hydralazine) do not increase the distensibility of the arteries. It has also been shown that calcium antagonists and ACE inhibitors reduce the speed of propagation of the pulse wave.
Diuretics
The greatest experience in the treatment of ISAH in old age has been accumulated through the use of diuretics. Diuretics, even when taken continuously, reduce both the volume of circulating plasma and the stroke volume of the heart, increase the distensibility of large arteries, and this may explain their effectiveness in reducing SBP in elderly patients with ISAH. In 1998, Messerla raised the issue of using b -adrenergic blockers as standard first-line therapy in the treatment of hypertension in the elderly. He reviewed a number of randomized trials of more than 1 year duration from 1966 to 1998 using diuretics and b -adrenergic blockers or both in the treatment of hypertension in the elderly. The results showed that diuretics were effective in preventing cerebrovascular events, coronary artery disease, cardiovascular mortality, and all-cause mortality. SHEP showed that diuretic-based treatment for ISAH reduces cardiovascular mortality. Several controlled studies have shown that diuretics are effective in 46–88% of cases in older men and women., whereas b -adrenergic blockers only in 22–48%.
b -Adrenergic blockers
Until recently, diuretics, especially thiazides, and b β-blockers have been the most studied drugs in trials to prevent cardiovascular mortality in the elderly. As a result of the analysis of research, Messerla found that b -blockers prevent cerebrovascular complications, but are not able to prevent ischemic heart disease, cardiovascular mortality and mortality from all causes. In contrast, diuretics were effective in preventing all of them. It must be taken into account that in old age, disturbances in the conduction system of the heart are often observed. For this reason, when used in elderly people b -adrenergic blockers should be monitored by ECG and heart rate.
Calcium antagonists
Calcium antagonists improve the elastic properties of the aorta and its large branches; therefore, in elderly individuals, calcium antagonists reduce SBP to a greater extent than DBP. The antihypertensive effectiveness of calcium antagonists does not change or increases slightly with age.
SYST-Eur and SYST-CHINA were especially important due to the existing controversy regarding the use of short-acting calcium antagonists for the treatment of hypertension. Until this point, diuretics, especially thiazides, and b -blockers, as already indicated, have been the most studied drugs in studies to prevent cardiovascular mortality in the elderly. The benefits of using these drugs are undeniable. However, SYST-Eur and SYST-CHINA have shown that other drugs, such as ACE inhibitors and calcium antagonists, can be used in the treatment of this group of patients. The presented data prove that treatment of ISAH in elderly patients using calcium antagonists prevents the development of a number of serious complications, improves the quality of life of patients and the prognosis of the disease.
However, there is an opinion that the use of calcium antagonists in patients over 65 years of age increases the incidence of oncological diseases. This issue was addressed in the large-scale STEPY II study conducted by R. Trenkvalder (Germany) among the elderly population of Europe. Based on the results of a 3-year follow-up, it was found that taking calcium channel blockers in patients over 60 years of age does not increase the risk of developing malignant neoplasms.
ACE inhibitors and angiotensin II receptor blockers
SYST-Eur and SYST-CHINA showed that ACE inhibitors can be used in the treatment of ISAH in elderly patients and their use in combination with long-acting calcium antagonists prevents the development of a number of serious complications, improves the quality of life of patients and the prognosis of the disease. Literature data on the antihypertensive effectiveness of ACE inhibitors depending on the age of patients are contradictory. While the effect of captopril and quinapril on DBP levels does not depend on the age of patients, the antihypertensive effectiveness of enalapril prescribed as monotherapy is slightly reduced in patients over 65 years of age. According to N. Schnapper , the effect of quinapril on the level of DBP does not depend on the age of the patient, while the effect on the level of SBP weakens somewhat with age. The addition of a diuretic enhances the effect of the ACE inhibitor on SBP levels to a greater extent than its effect on DBP levels.
Irbesartan and other AT1-angiotensin receptor blockers appear to be equally effective in older and younger patients, and they appear to be better tolerated than other antihypertensive drugs.
Metabolism of drugs
With age, a decrease in body weight occurs, mainly due to a decrease in muscle mass and fluid content in the body with an increase in the content of adipose tissue. By age 75, there is an 18% decrease in body fluid content compared to age 30 due to a 40% decrease in extracellular fluid and 8% decrease in plasma volume. There is a decrease in albumin synthesis by the liver and the configuration of the albumin molecule changes, which leads to a decrease in protein synthesis. These age-related changes are important for drug metabolism and lead to an increase in the content of active free drug at the tissue-cellular level and an increase in the pharmacodynamic activity of the drug. There is also a gradual decrease in blood flow in the liver and kidneys and a decrease in their clearance of drugs. All these factors can lead to increased concentrations of drugs in the blood and increased pharmacological activity of hydrophilic drugs. In contrast, lipophilic drugs will have longer lasting pharmacological activity because their volume of distribution is increased and their clearance is decreased. The decline in total body fluid volume with aging may increase the risk of dehydration when high doses of diuretics are used to treat hypertension. Patients constantly taking diuretics require special ECG monitoring. It is especially important to initiate therapy with low doses of drugs and increase them slowly, since drug metabolism and elimination may be reduced in the elderly and end-organ damage predisposes to the development of drug side effects in elderly patients.
Therapy for ISAH in patients over 80 years of age. The risk of hypertension and the effectiveness of antihypertensive therapy in elderly patients under 80 years of age have been studied quite well. At the same time, currently available data on patients aged 85 years and older are limited and contradictory. Several studies have established an association between blood pressure and survival. The reliability of this relationship after adjusting for many other factors influencing morbidity and mortality, according to the results of some studies, remains, but according to other studies, it is lost. Turning to randomized trials, it should be noted that the effectiveness of antihypertensive therapy was confirmed in the SHEP study; however, efficacy rates decreased with increasing patient age. According to the European Working Committee on High Blood Pressure in Old Age (EWPHE), patients over 80 years of age do not benefit from antihypertensive therapy.
In modern practice problems of choosing therapy can only be solved on the basis of generalizations dictated common sense. However, the data obtained effective reduction morbidity and mortality rates refute the possibility of the existence of a certain clinical boundary that separates cases of hypertension that do not require therapy.

Conclusion
Because hypertension in the elderly leads to multiple target organ damage and is not part of the normal aging process, antihypertensive therapy is necessary to reduce target organ damage. Drug therapy may cause more harm than good if the physician does not take into account the relationship between age, hypertensive cardiovascular disease, and antihypertensive therapy.
The latest JNC VI report recommends diuretics, especially thiazide ones, and b -adrenergic blockers for initial treatment of hypertension in elderly patients without concomitant diseases. Patients with concomitant diseases should receive individual therapy, for example, in patients with hypertension and diabetic nephropathy, first-line drugs are ACE inhibitors. Older men with hypertension and prostatitis may benefit from long-acting a -adrenergic blockers (doxazosin), patients with recent acute myocardial infarction should receive b - adrenergic blockers for secondary prevention cardiovascular death. Postmenopausal women with hypertension and osteoporosis may benefit from diuretics that lower blood pressure and reduce urinary calcium excretion. Each class of antihypertensive drugs has its own side effects, which can be so severe that the doctor is forced to stop treatment and turn to a different class of drugs. b -Adrenergic blockers can cause sleep disturbances, depression, and nightmares. Drugs central action ( a -agonists) can cause bradycardia, dry mouth, and drowsiness. Short-acting calcium antagonists (sublingual nifedipine) can be dangerous in the elderly because they cause an uncontrolled decrease in blood pressure. In patients with coronary artery disease and cerebrovascular disease, this decrease in SBP can reduce perfusion pressure to a critical level and cause the development of myocardial infarction and cerebrovascular complications. If ACE inhibitors or angiotensin II receptor blockers are used to treat hypertension, it is necessary to monitor renal function, since patients with stenosis renal arteries have a high risk of developing acute renal failure when using these drugs. IN last years All new classes of drugs are being studied to determine their effectiveness and tolerability in the elderly.

Literature
1. Prevention, diagnosis and treatment of primary arterial hypertension in the Russian Federation. The first report of experts from the Scientific Society for the Study of Arterial Hypertension, the All-Russian Scientific Society of Cardiologists and the Interdepartmental Council on cardiovascular diseases(DAG 1).
2. Byyny R.L. Hypertension in the elderly. In Laragh JH, Brenner BM (eds). Hypertension: Pathophysiology, Diagnosis and Management. New York, Raven. 1990; 1869–1887.
3. Hypertension: a comparison to Brenner and Rector’ s the kidney leading by B.M. Brenneri 5th ed. c. 1996. 2000 by W.B. Sounders Company. P 551–58.
4. Arabidze G.G., Fagard R., Petrov V.V., Stassen Y. Isolated systolic hypertension in the elderly. Ter. arch. 1996; 11: 77-82.
5. Systolic Hypertension n in the Elderly Program Cooperative Research Group. Implications of the Systolic Hypertension in the Elderly Program. Hypertension 1993; 21: 335–43.
6. Borhani N.O. Isolated systolic hypertension in the elderly. J Hypertens 1988; Vol 6 (Suppl 1): 15–1 9 .
7. Kannel W.V., Wolf P.A., McGee D.L., et al. Systolic blood pressure arterial rigidity and risk of stroke The Framingham study JAMA 1981; 245:1225–9.
8. Rutan G.H., Kuller L.H., Neaton J.D., et al. Mortality associated with diastolic hypertensi on and isolated systolic hypertension among men screened for the Multiple Risk Factor Intervention Trial. Circulation 1988; 77:504–14.
9. Staessen J., Amery A., Fagard R. Isolated systolic hypertension in the elderly. J Hypertension 1990; 8:393–405.
10. Sleight P. Isolated systolic hypertension: the WISHE study. Eur Heart J 1991; Suppl. P: 17–P20.
11. Frishman W.H. Epidemiology, pathophysiology, and management of isolated systolic hypertension in the elderly. Am J Med 1991; 90(Suppl 4B): 14–20.
12. Brandfonbrener M., Landowne M., Shock NW. Changes in cardiac output with age. Circulation 1955; 12:557.
13. Weisfeldt M. Aging changes in the cardiovascular system and responses to sties. Am J Hypertens 1998; 11:41S–45S.
14. Simon A.S., Levenson J.A., Safar M.E. Hemodynamic mechanisms of and therapeutic approach to systolic hypertension. J Cardiovasc Pharmacol 1985; 7:S22–S27.
15. Delanghe J., Duprez D., De Buyzere M., et al. Haptoglobin polymorphism and hypertension in the elderly. E ur Heart J 1998;19(Abstr Suppl):72.
16. Niarchos A.P., Laragh J.H. Hypertension in the elderly. Mod Concepts Cardiovasc Dis 1980; 49:49.
17. Messerli F. Isolated systolic hypertension. International directions in the study of arterial hypertension. Issue 2000; 11:4–6.
18. Staessen J., Bulpitt S., Clement D., et al. Relation between mortality and treated blood pressure in elderly patients with hypertension report of the European Working Party on High Blood Pressure in the Elderly . Br Med J 1989; 298:1552–6.
19. SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. JAMA 1991; 265:3255–3264.
20. Dustan H.P. Isolated systolic hypertension a long neglected cause of cardiovascular complications. Am J Med 1989; 86:368–9.
21. Benetos A., Rudnichi Am., Safar M., Guize L. Pulse pressure and cardiovascular mortality in normotensive and hypertensive subjects Hypertension; 1998; 32:560–4.
22 . Franklin S.S., Khan S.A., Wong N.D., Larson M.G., Levy D. Is pulse pressure useful in predicting risk for coronary heart disease? The Framingham Heart Study Circulation 1999; 100:354–60.
23. Alii S., Avanzmi F., Bettelh G., Colombo F., Torn V., Togn o ni G. The long-term prognostic significance of repeated blood pressure measurements in the elderly: SPAA (Studio sulla Pressione Artenosa nellўAnziano) 10 year follow up. Arch Intern Med 1999; 159:1205–12.
24. Martynov A.I., Ostroumova O.D., Rolik I. L. Arterial hypertension in elderly and senile patients: etiology, clinical picture, diagnosis, treatment. Wedge. honey. 1997; 12:8-14.
25. Chalmers J, MacMahon S, Anderson S, et al. Blood pressure and stroke prevention. London: Science Press 1 996; 56.
26. Kannel W.B., Dawber T. Perspectives on systolic hypertension: The Frammingham Study. Circulation 1980; 61:1179–82.
27. Sagie A., Larson M.G., Levy D. The natural history of border line isolated systolic hypertension. New Engl J Med 1993; 329:1912–17.
28. Weber M.A., Neutel J.M., Cheung D.G. Hypertension in the aged: A pathophysiological basis for treatment. Am J Cardiol 1989; 63: 25H–32H.
29. Freis E.D. for the Veterans Affairs Cooperative Study Group on Antihypertensive Agents. V eterans Affairs Cooperative Study Group on Antihypertensive Agents: Effects of age on treatment results. Am J Med 1991; 90 (Suppl 3A): 20S–23S.
30. Medical Research Council Working Party. MRC Trial of Hypertension in Older Adults: Principal results. B.M. J 1992; 304:405–12.
31. MacMahon S., Rodgers A. The effects of blood pressure reduction in older patients: An overview of five randomized controlled trials in elderly hypertensives. Clin Exp Hypertens 1993; I5: 967–78.
32. The Working Group on Hypertension in the Elderly: Statement on hypertension in the elderly. JAMA 1986; 256:70–4.
33. Neaton J.D., Grimm R.H. Jr. Prineas R.J. et al., for the Treatment of Mild Hypertension Study Research Group. Treatment of Mild Hypertension Study: Final results. JAMA 1993; 270:713–24.
34. Niarchos A.P., Wemstem D.L., Laragh J.H. Comparison of the effects of diuretic therapy and low sodium intake in isolated systolic hypertension. Amer J Med 1984; 77:1061–8.
35. Safar M., Van Bortel L., Struijker-Boudier H. Resistance and conduit arteries following converting enzyme inhibition in hypertension. J Mat Res 1997; 34:67–81.
36. Girerd X., Giannattasio C., Moulin C., Safar M., Mancia G., Laurent S. Regression of radial arterial wall hypertrophy and improvement of carotid artery compliance after long-term antihypertensive treatment in elderly patients. J Am Coll Cardiol 1998; 31:1064–73.
37. Ekbom T., Dahlof B., Hansson L., Lindholm L., Schersten B., Webster P. Antihypertensive efficacy and side effects of three beta-blockers and a diuretic in elderly hypertensives a report from the STOP-Hypertension study. J Hypertens 1992; 10: 1525–30.
38. Heesen W., Beltman F., Smit A., et al. Effect of quinapril an triamterene/hydrochlorothiazide on cardiac and vascular and-organ damage in isolated systolic hypertension. J Cardiovasc Pharmacol 1998; 31: 187–94.
39. Ting C., Chen C., Chang M., Yin F. Short- and long-term effects of antihypertensive drugs on arterial reflections, compliance and impedance. Hypertension 1995; 26: 524–30.
40. De Cesans R., Ranien G., Filitti V., Andriani A. Large artery compliance in essential hypertension effects of calcium antagonism and beta blocking. Am J Hypertens 1992; 5:624–8.
41. O "Malley K., McCormack P., O" Brien E.T. Isol ated systolic hypertension: data from the European Working Party on High Blood Pressure in the Elderly. J Hypertens; 1988; 6(Suppl 1):S105–S108.
42. Messerli F.H., Grossman E, Goldhourt U. Are β-blockers effective as first line therapy for hypertensi on in the elderly? JAMA 1998; 279:1903–7.
43. Materson V.J., Reda D.J., Cushman W.S., et al. Department of Veterans Affairs single-drug therapy of hypertension study. Am J Hypertension 1995; 8: 189–92.
44. Ben-Ishay D, Leibel B, Stessman J. Calcium channel blockers in the management of hypertension in the elderly. Am J Med 1986; 81(Suppl 6A): 30–4.
45. Hansson L. Treatment of elderly hypertensive patients with calcium antagonists. Research and clinical forums 1994; 16:61–6.
46. ​​Trenkwalder P. Treatment with calcium channel blocker does not increase the risk of fatal and non-fatal cancer in an elderly European population: results from STEPY II. Eur Heart J 1997;18 (Abstr. Suppl): 363.
47. Canter D., Frack G. ACE inhibitors in the treatment o f hypertension in the older patient. Eur Heart J 1990; 11(Suppl D): 33–43.
48. Schnaper H.W. The management of hypertension in older patients. J Cardiovasc Pharmacol 1990; IS Suppl 2: S56–S61.
49. Gillis J.S., Markham A. Irbesartan A review of phar m acodynamic and pharmacokinetic properties and therapeutic use in the management of hypertension. Drugs 1997; 54:85–92.
50. Forett F. How beneficial is antihypertensive therapy in patients old age outweighs the risk? 18th Congress of the International Society of Arterial Hypertension. Chicago, USA 08/20/2000

Recent years have been marked by increasingly widespread large-scale population studies to develop ABPM standards (Ohasama (Japan), HARVEST and PAMELA, Italy).

The study under the latter program was carried out from the beginning of the 90s (duration about 5 years) on the basis of 5 research medical centers. The number of normotensive patients examined was 2400, age range 25-64 years. The formation of representative subgroups was carried out according to strict criteria for population studies. In addition to the monitoring results, the data bank included clinical characteristics volunteers, data on the presence of bad habits, social status, psychological picture on the day of the study, etc.

Here are some preliminary results of the project (G. Sega et al. 1994).

Blood pressure according to the Korotkoff method was measured in medical institution on average 127/82 mm Hg, at home - 119/75 mm Hg, based on monitoring SBP (24) = 118, DBP (24) = 74. The difference between clinical and monitor, as well as clinical and “home” blood pressure progressively increases with age, reaching 16 and 8 mm Hg for systolic blood pressure. in men and 19 and 14 mm Hg. in women in the older age group (from 55 to 63 years). Blood pressure is higher in men than in women. The main body of data is in statistical processing.

The development of SPAD standards is currently intensively continuing in a number of countries around the world and according to E. O’Brien and J. Staessen (1995):

a) three areas of work are promising - 1) studying the relationship between morbidity and mortality and SPBP indicators, 2) establishing the relationship between SPBP indicators and traditionally measured blood pressure values ​​with extrapolation to SPBP of prognostic data obtained in traditional population studies, 3) assessing the limits of variations in SPBP indicators in populations of practically healthy people.

b) until the final SPAD standards are formed, a temporary classification can be used

AVERAGE DECLINE VALUES (GARDEN/DBP) (E.O'Brien and J.Staessen,1995)

Day = wakefulness, Night = sleep.

Experts from the USA (T. Pickering, 1996) and Canada (M. Myers, 1996) suggest focusing on slightly different limit values.

AVERAGE DECLINE VALUES (GARDEN/DBP)

Day = wakefulness, Night = sleep.

Later, E. O’Brien and J. Staessen summarized data from studies conducted in a number of countries in Europe and North America and proposed the following proper values.

AVERAGE DECLINE VALUES (GARDEN/DBP) (E.O'Brien and J.Staessen,1998)

Day = wakefulness, Night = sleep.

At the same time, we present estimates by O’Brien (1991) for the upper limit of the norm of averages for daytime SPBP values ​​(obtained in a sample of 815 people): 17-19 years old - men 144/88 mm Hg, women 131/83 mm Hg, 30-39 years old - men 143/91 mm Hg. , women 132/85 mm Hg, 40-49 years old men 150/98 mm Hg, women 150/94 mm Hg, 50-79 years old - men 155/103 mm Hg, women 177/97 mm Hg.

According to a cumulative analysis of the results of 24 groups of researchers (4577 normotonics and 1773 patients with mild-moderate forms of AD) L Thijs et al. (1995) estimated the 95th percentile for 24-hour BP values ​​to be 133/82 mmHg.

However, 24% of patients with isolated systolic hypertension had a SBP(24) below 133 mmHg. and in 30% of patients with diastolic hypertension, DBP(24) did not exceed 82 mmHg. The reported percentages were significantly higher in studies focusing on single rather than triple Korotkoff blood pressure measurements.

When assessing SPAD standards in groups, almost healthy children and adolescents in Spain (E. Lurbe, 1997) the upper estimates (95th percentile, P95) and median (P50) were obtained for the daily blood pressure profile in three age groups: 6-9, 10-12 and 13-16 years

At night, SBP decreased by an average of 12%, and DBP by 22%. The upper limit of the time index (TI) was 39% for SBP and 26% for DBP.

PRESSURE LOAD INDICATORS.

Experts from the USA (T. Pickering, 1996) and Canada (M. Myers, 1996) suggest focusing on following values time index "IV":

Generally accepted standards for time indices (TI) and area indices (IA) have not currently been developed. Let us present an estimate of the upper limit of normal (M+2σ) for systolic IV - IVSAD(D) - and diastolic - IVDBP(D) pressure in the daytime based on data from Zachariah et al. (1989).

circadian rhythm of blood pressure

The optimal degree of nocturnal blood pressure reduction (NBP) is from 10 to 20-22%.

At the same time, decreased SNS, manifestations of persistent nighttime increases in blood pressure, as well as increased SNS, are potentially dangerous as factors of damage to target organs, myocardial and cerebral “catastrophes”.

Almost all researchers agree with the lower limit (10%) (about 30 papers at the 16th Congress of the International Society of Hypertension Research in Glasgow, 1996). The upper limit of optimal SNA has been estimated relatively recently at 20-22% based on frequency analysis ECG signs ischemia at night in patients with a combination of hypertension and ischemic heart disease (S. Pierdomenico et al., 1995), as well as when analyzing signs of disorders cerebral circulation(K.Kario et al., 1996).

Based on data on the SNS, a classification scheme for patients is used (separately according to the criteria of systolic and diastolic pressure):

1. Normal (optimal) degree of nocturnal reduction in blood pressure (in the English literature “dippers”) - 10%<СНСАД<20 %

2. Insufficient degree of nocturnal reduction in blood pressure (in the English literature “nondippers”) - 0<СНСАД<10 %

3. Increased degree of nocturnal reduction in blood pressure (in the English literature “overdippers”) - 20%<СНСАД

4. Sustained increase in night blood pressure (in the English literature “nightpickers”) - NBP<0

A decrease in the SNS below the optimal range is observed in a number of patients with primary hypertension (including with atherosclerotic lesions of the carotid arteries), it is also characteristic of the syndrome of malignant hypertension, chronic renal failure, vasorenal hypertension, Cushing's syndrome, and is observed after heart and kidney transplantation, with congestive heart failure, eclampsia, diabetic and uremic neuropathy, with widespread atherosclerosis in the elderly. Reduced SNS is typical for the black population of the United States.

Note that the degree of nocturnal decrease in blood pressure is extremely sensitive to the quality of sleep, daily routine and type of daytime activity, and is relatively poorly reproduced with repeated monitoring. Taking these circumstances into account, most researchers are inclined to carry out control repeated monitoring to confirm deviations in SPBP for this sign, detected during one-time monitoring.

The standards for cosinor analysis indicators are at the stage of formation. The assessment of these values ​​for “normotonics”, as well as patients with mild and moderate forms of headache, is given in Table 1 of the APPENDIX.

VARIABILITY OF BP.

Limits for conclusions of increased variability are under development. Most researchers form them on the basis of average values ​​characteristic of various observation groups. According to P. Verdecchia (1996), these values ​​are for VAP1 (or STD) SBP 11.9 / 9.5 mm Hg. (day Night). Moreover, in the group of hypertensive patients with increased SBP variability, the incidence of cardiovascular complications is 60-70% higher (1372 patients, follow-up time up to 8.5 years).

As temporary variability standards (VAR1 or STD) for patients with mild and moderate forms of hypertension, the RKNPK has formed (based on an assessment of the upper limits for normotensive patients) the following critical values:

for SBP - 15/15 mm Hg. (day Night),

for DBP - 14/12 mm Hg. (day Night).

Patients belong to the group of increased variability when at least one of the four critical values ​​is exceeded.

According to data obtained in the arterial hypertension department of the Research Institute of Cardiology of the Russian Scientific Research Pedagogical University, in the group of patients with a mild form of hypertension and increased variability in comparison with patients with normal blood pressure variability (with the same level of blood pressure according to the Korotkov method and average blood pressure values ​​​​according to ABPM data), there is a significant increase in the frequency atherosclerotic changes in the carotid arteries, changes in microvascular fundus, echocardiographic signs of left ventricular hypertrophy (Fig. 7).

Target organs with increased blood pressure variability VAR1

NOTES.

A) When focusing on standard values, it is necessary to pay special attention to the daily routine and conditions for ABPM. The vast majority of studies are focused on monitoring during a “typical working day”. Meanwhile, a comparative study of SBP (N=12, men, 43+2 years old, mild and moderate hypertension, no therapy at the time of the study) during the working day and a week later in the RKNPK hospital showed that the average daily value of SBP decreases in in hospital conditions by an average of 9%, and DBP by 8%. This circumstance must be taken into account not only when trying to transfer standards obtained in an outpatient setting to a clinical hospital setting, but also when assessing the dynamics of SPBP during treatment.

Blood pressure problems can occur in absolutely anyone. In order to notice deviations in the functioning of blood vessels and the heart in time, you need to know the exact value of your blood pressure. To check this indicator, a tonometer is used. It can be freely purchased at any pharmacy or medical equipment store. The tonometer makes it possible to find out the current systolic and diastolic pressure. If the data obtained differs from normal, the doctor may suspect the patient has developed vascular or heart disease. To obtain a complete assessment of the condition of individual organs and systems, it is necessary to additionally calculate the mean arterial pressure. It will help the specialist make the correct diagnosis.

Not only diastolic and systolic, but also pulse and average pressure are considered. Particular attention should be paid to the latter type of blood pressure.

The average blood pressure of the entire cardiac cycle is called average. To calculate it, doctors use a special formula. If a person has no health problems, then his SBP should be in the range of 80-95 mmHg. Art.

Pulse pressure is also not difficult to calculate. To do this, it is enough to subtract the diastolic from the systolic indicator. Normally, the resulting number should not exceed 45 units.

Mean pressure is not used to study cardiac function. If a specialist wants to know exactly what condition his patient’s body is in, he must take into account the following values:

• Stroke volume. Lets you know exactly how much blood was ejected during a single contraction of the organ;
• Cardiac index. Describes the work of the heart in the most accurate way;
• Cardiac output. Shows how much blood is ejected from the heart in 1 minute.

Determination of mean arterial pressure

Calculation of average blood pressure cannot be done by finding the average value between the lower and upper BP. This is because during the cardiac cycle the pressure is not systolic, but diastolic. Therefore, we can say that it is 40% correlated with the upper indicator and 60% with the lower one.

What affects the pressure indicator

For an adult who has no health problems, blood pressure should be 120/80 mmHg. Art. If it is slightly higher, then this does not cause any concern among doctors. This phenomenon is accepted as normal. Blood pressure is influenced by many external and internal factors. Among them are:

1. Human diet. Regular consumption of dishes that contain large amounts of salt and spices has a detrimental effect on health. This explains why hypertensive patients are advised to adhere to a gentle diet and give up coffee and other similar drinks that negatively affect blood pressure;
2. Experiencing stressful situations. Any experience causes an increase in blood pressure. Especially if they last for a long time;
3. Physical activity. After performing exercises, a person's blood pressure increases for a short period of time. This is why you should not take blood pressure measurements after training, as they will turn out to be incorrect;
4. Bad habits. Smoking and frequent drinking harm the entire body. Tobacco and alcohol have a bad effect on the condition of blood vessels.

Any of these factors may affect pressure measurements. To get more accurate data, a person should temporarily exclude them from his life.

Formulas for calculating average pressure

There are several simple formulas that help calculate CPAD. They are used not only by doctors, but also by ordinary people interested in their own health.

The first step is to measure your current blood pressure. To calculate the average, you need to know your diastolic and systolic blood pressure. To obtain more accurate results, you should use a working tonometer and phonendoscope. If a person is unable to take measurements on his own, he can make this request to any clinic. This procedure is also carried out in many pharmacies.

Formula No. 1: (2(DBP)+SBP)/3

To find out how to calculate the average pressure value, you must use this formula. It will require systolic and diastolic blood pressure. These measurements should be multiplied and then added. The final result must be divided by 3. The final value is measured in mm Hg. Art.

Average blood pressure is calculated using special formulas

It doesn't hurt to pay attention to one important point. Diastolic blood pressure must be multiplied by 2. This is because the heart spends 2/3 of its time in a state of relaxation.

Formula No. 2: 1/3(SBP - DBP) + DBP

Mean arterial pressure can also be calculated using this alternative formula. This equation is quite simple and understandable. In order to carry out a correct calculation, it is necessary to subtract diastolic pressure from systolic pressure. The result obtained must be divided by 3. Then the lower blood pressure indicator is added to it. If all numerical manipulations were carried out correctly, then the person will get the same result as when using the first formula.

Formula No. 3: SV × OPSS

Not the most popular determining formula, but it also helps to find out the approximate value of ADSR. Cardiac output should be used to calculate this equation. It is measured in l/min. Peripheral vascular resistance is also taken into account. This indicator is measured in mmHg. Art. The calculation formula is used in certain situations when there is a need to quickly estimate a person’s average pressure. But you need to understand that the obtained value is approximate. It is impossible to obtain a 100% correct result using such a calculation.

It is recommended to measure cardiac output and total peripheral vascular resistance in a hospital setting using special equipment.

Average arterial pressure can be calculated using one of the developed formulas without the participation of auxiliary equipment. However, to obtain a more accurate result, it is recommended to use a calculator during the calculation.

If a person does not have time to manually insert the obtained values ​​of blood pressure and other indicators into the formula, then he can use a modern online calculator for this purpose. To see the correct result, you just need to enter the required numbers in the cells provided for them. The system itself will carry out the calculation and show the correct answer.

What does average blood pressure mean?

Interpretation of average pressure indicators

For blood pressure, a normal value is indicated. This means that there are certain boundaries within which blood pressure should be in a completely healthy person. This principle is used to determine the average pressure.

Each specialist is familiar with the generally known values, which help to understand that the blood pressure measured in a person is normal. Small deviations from it are usually not taken into account. You should especially not take them into account if, before measuring blood pressure, the body was influenced by factors that contributed to its increase.

After the average pressure is calculated using one of the special formulas, the resulting value should be compared with the normal one. According to doctors, if it is in the range of 70-110 mm Hg. Art., which means that a person has no problems with the functioning of the cardiovascular system. If the indicator is lower or higher, then we can safely say that there is a pathology that should be studied and eliminated.

You should not be negligent about the average pressure value if it does not fit within the normal range. A person is recommended to make an appointment with a specialist in order to identify the cause of such a deviation. It is possible that there is no cause for concern, and such pressure is quite natural. However, there is a possibility of developing heart or vascular disease, which can have very disastrous consequences for individual organs or the entire body.

Completion

If a person knows exactly what his average pressure is, then he can easily notice even minor deviations from the norm, which are a good reason to visit a doctor. Many people find this indicator at home. To do this, you just need to choose the appropriate formula and carry out simple calculations.

Before you start calculating mean arterial pressure, you must first measure your upper and lower blood pressure. This data will need to be substituted into the formula. It must be remembered that average pressure, unlike diastolic and systolic, does not change over time. It is not affected by a person's age. So this indicator should always remain constant.

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

Hypertension (HTN) is one of the most common diseases of the cardiovascular system, which only according to approximate data affects a third of the world's inhabitants. By the age of 60-65 years, more than half of the population has been diagnosed with hypertension. The disease is called a “silent killer”, because its signs may be absent for a long time, while changes in the walls of blood vessels begin already in the asymptomatic stage, greatly increasing the risk of vascular accidents.

In Western literature, the disease is called arterial hypertension (AH). Domestic specialists have adopted this formulation, although both “hypertension” and “hypertension” are still in common use.

Close attention to the problem of arterial hypertension is caused not so much by its clinical manifestations as by complications in the form of acute vascular disorders in the brain, heart, and kidneys. Their prevention is the main goal of treatment aimed at maintaining normal blood pressure (BP).

An important point is to identify all possible risk factors, as well as clarify their role in the progression of the disease. The relationship between the degree of hypertension and existing risk factors is displayed in the diagnosis, which simplifies the assessment of the patient’s condition and prognosis.

For most patients, the numbers in the diagnosis after “AH” do not mean anything, although it is clear that the higher the degree and risk indicator, the worse the prognosis and the more serious the pathology. In this article we will try to understand how and why one or another degree of hypertension is diagnosed and what underlies the determination of the risk of complications.

Causes and risk factors of hypertension

The causes of arterial hypertension are numerous. When we talk about primary, or essential, hypertension, we mean the case when there is no specific previous disease or pathology of the internal organs. In other words, such hypertension occurs on its own, involving other organs in the pathological process. Primary hypertension accounts for more than 90% of cases of chronic high blood pressure.

The main cause of primary hypertension is considered to be stress and psycho-emotional overload, which contribute to disruption of the central mechanisms of pressure regulation in the brain, then humoral mechanisms suffer, and target organs are involved (kidneys, heart, retina).

Secondary hypertension is a manifestation of another pathology, so its cause is always known. It accompanies diseases of the kidneys, heart, brain, endocrine disorders and is secondary to them. After the underlying disease is cured, hypertension also goes away, so it makes no sense to determine the risk and degree in this case. Symptomatic hypertension accounts for no more than 10% of cases.

Risk factors for hypertension are also known to everyone. Hypertension schools are being created in clinics, whose specialists convey information to the population about unfavorable conditions leading to hypertension. Any therapist or cardiologist will tell the patient about the risks already at the first case of recorded high blood pressure.

Among the conditions predisposing to hypertension, the most important are:

1. Smoking;
2. Excess salt in food, excessive fluid intake;
3. Insufficient physical activity;
4. Alcohol abuse;
5. Excess weight and fat metabolism disorders;
6. Chronic psycho-emotional and physical overload.

If we can exclude the listed factors or at least try to reduce their impact on health, then such characteristics as gender, age, heredity cannot be changed, and therefore we will have to put up with them, but not forgetting the increasing risk.

Classification of arterial hypertension and determination of risk level

Classification of hypertension involves identifying the stage, degree of the disease and the level of risk of vascular accidents.

The stage of the disease depends on the clinical manifestations. Highlight:

• Preclinical stage, when there are no signs of hypertension and the patient is unaware of the increase in blood pressure;
• Stage 1 of hypertension, when the pressure is elevated, crises are possible, but there are no signs of target organ damage;
• Stage 2 is accompanied by damage to target organs - the myocardium hypertrophies, changes in the retina of the eyes are noticeable, and the kidneys suffer;
• At stage 3, strokes, myocardial ischemia, vision pathology, changes in large vessels (aortic aneurysm, atherosclerosis) are possible.

Degree of hypertension

Determining the degree of hypertension is important in assessing risk and prognosis and is based on pressure figures. It must be said that normal blood pressure values ​​also have different clinical significance. So, the indicator is up to 120/80 mm Hg. Art. considered optimal, normal pressure will be in the range of 120-129 mmHg. Art. systolic and 80-84 mm Hg. Art. diastolic. Pressure numbers 130-139/85-89 mmHg. Art. are still within normal limits, but are approaching the borderline of pathology, so they are called “highly normal”, and the patient may be told that he has elevated normal blood pressure. These indicators can be regarded as pre-pathology, because the pressure is only “a few millimeters” from being elevated.

From the moment the blood pressure reached 140/90 mm Hg. Art. we can already talk about the presence of the disease. This indicator is used to determine the degree of hypertension itself:

• 1st degree of hypertension (HTN or AH 1st stage in the diagnosis) means an increase in pressure in the range of 140-159/90-99 mm Hg. Art.
• Stage 2 headache is accompanied by numbers 160-179/100-109 mm Hg. Art.
• With stage 3 hypertension, the pressure is 180/100 mmHg. Art. and higher.

It happens that the systolic pressure figures increase, amounting to 140 mm Hg. Art. and higher, while the diastolic value is within normal values. In this case, they speak of an isolated systolic form of hypertension. In other cases, the indicators of systolic and diastolic pressure correspond to different degrees of the disease, then the doctor makes a diagnosis in favor of a greater degree, and it does not matter whether conclusions are drawn based on systolic or diastolic pressure.

The most accurate diagnosis of the degree of hypertension is possible when the disease is first diagnosed, when treatment has not yet been carried out and the patient has not taken any antihypertensive drugs. During therapy, the numbers fall, and when it is discontinued, on the contrary, they can increase sharply, so it is no longer possible to adequately assess the degree.

The concept of risk in diagnosis

Hypertension is dangerous due to its complications. It is no secret that the vast majority of patients die or become disabled not from the fact of high blood pressure itself, but from the acute disorders to which it leads.

Cerebral hemorrhages or ischemic necrosis, myocardial infarction, renal failure are the most dangerous conditions provoked by high blood pressure. In this regard, for each patient, after a thorough examination, the risk is determined, indicated in the diagnosis by the numbers 1, 2, 3, 4. Thus, the diagnosis is based on the degree of hypertension and the risk of vascular complications (for example, hypertension/hypertension of the 2nd degree, risk 4).

Risk stratification criteria for patients with hypertension include external conditions, the presence of other diseases and metabolic disorders, involvement of target organs, and concomitant changes in organs and systems.

The main risk factors affecting the prognosis include:

1. The patient’s age is after 55 years for men and 65 for women;
2. Smoking;
3. Lipid metabolism disorders (exceeding the norm of cholesterol, low-density lipoproteins, decreased high-density lipid fractions);
4. Presence of cardiovascular pathology in the family among blood relatives under 65 and 55 years of age for females and males, respectively;
5. Excess body weight, when the abdominal circumference exceeds 102 cm in men and 88 cm in women.

The listed factors are considered the main ones, but many patients with hypertension suffer from diabetes, impaired glucose tolerance, lead a sedentary life, and have abnormalities in the blood coagulation system in the form of an increase in fibrinogen concentration. These factors are considered additional, also increasing the likelihood of complications.

Damage to target organs characterizes hypertension starting from stage 2 and serves as an important criterion by which risk is determined, therefore, examination of the patient includes an ECG, ultrasound of the heart to determine the degree of hypertrophy of his muscles, blood and urine tests for indicators of kidney function (creatinine, protein).

First of all, the heart suffers from high blood pressure, which pushes blood into the vessels with increased force. As the arteries and arterioles change, when their walls lose elasticity and the lumens become spasmodic, the load on the heart progressively increases. A characteristic feature taken into account during risk stratification is myocardial hypertrophy, which can be suspected by ECG and detected by ultrasound.

The involvement of the kidneys as a target organ is indicated by an increase in creatinine in the blood and urine and the appearance of albumin protein in the urine. Against the background of hypertension, the walls of large arteries thicken, atherosclerotic plaques appear, which can be detected by ultrasound (carotid, brachiocephalic arteries).

The third stage of hypertension occurs with associated pathology, that is, associated with hypertension. Among the associated diseases, the most important for prognosis are strokes, transient ischemic attacks, cardiac infarction and angina, nephropathy due to diabetes, kidney failure, retinopathy (retinal damage) due to hypertension.

So, the reader probably understands how you can even independently determine the degree of headache. This is not difficult, you just need to measure the pressure. Next, you can think about the presence of certain risk factors, take into account age, gender, laboratory parameters, ECG data, ultrasound, etc. In general, everything listed above.

For example, a patient’s blood pressure corresponds to stage 1 hypertension, but at the same time he suffered a stroke, which means that the risk will be maximum – 4, even if stroke is the only problem besides hypertension. If the pressure corresponds to the first or second degree, and the only risk factors that can be noted are smoking and age against the background of quite good health, then the risk will be moderate - 1 tbsp. (2 tbsp.), risk 2.

To make it clearer what the risk indicator in a diagnosis means, you can summarize everything in a small table. By determining your degree and “counting” the factors listed above, you can determine the risk of vascular accidents and complications of hypertension for a particular patient. The number 1 means low risk, 2 means moderate, 3 means high, 4 means very high risk of complications.

Low risk means the probability of vascular accidents is no more than 15%, moderate - up to 20%, high risk indicates the development of complications in a third of patients from this group, with a very high risk more than 30% of patients are susceptible to complications.

Manifestations and complications of headache

Manifestations of hypertension are determined by the stage of the disease. In the preclinical period, the patient feels well, and only the tonometer readings indicate a developing disease.

As changes in blood vessels and the heart progress, symptoms appear in the form of headache, weakness, decreased performance, periodic dizziness, visual symptoms in the form of weakened visual acuity, flashing “spots” before the eyes. All these signs are not expressed during a stable course of the pathology, but at the time of development of a hypertensive crisis, the clinic becomes brighter:

• Strong headache;
• Noise, ringing in the head or ears;
• Darkening in the eyes;
• Pain in the heart area;
• Dyspnea;
• Facial hyperemia;
• Excitement and feeling of fear.

Hypertensive crises are provoked by traumatic situations, overwork, stress, consumption of coffee and alcoholic beverages, so patients with an already established diagnosis should avoid such influences. Against the background of a hypertensive crisis, the likelihood of complications increases sharply, including life-threatening ones:

1. Hemorrhage or cerebral infarction;
2. Acute hypertensive encephalopathy, possibly with cerebral edema;
3. Pulmonary edema;
4. Acute renal failure;
5. Heart attack.

How to measure blood pressure correctly?

If there is reason to suspect high blood pressure, the first thing a specialist will do is measure it. Until recently, it was believed that blood pressure numbers could normally differ in different hands, but, as practice has shown, even a difference of 10 mm Hg. Art. may occur due to pathology of peripheral vessels, so different pressures on the right and left hands should be treated with caution.

To obtain the most reliable figures, it is recommended to measure the pressure three times on each arm at short time intervals, recording each result obtained. In most patients, the smallest values ​​obtained are the most correct, but in some cases the pressure increases from measurement to measurement, which does not always speak in favor of hypertension.

A large selection and availability of devices for measuring blood pressure make it possible to monitor it in a wide range of people at home. Typically, hypertensive patients have a tonometer at home, on hand, so that if their health worsens, they can immediately measure blood pressure. It is worth noting, however, that fluctuations are also possible in absolutely healthy individuals without hypertension, so a single excess of the norm should not be regarded as a disease, and to make a diagnosis of hypertension, the pressure must be measured at different times, under different conditions and repeatedly.

When diagnosing hypertension, blood pressure figures, electrocardiography data and cardiac auscultation results are considered fundamental. When listening, it is possible to detect noise, increased tones, and arrhythmias. The ECG, starting from the second stage, will show signs of stress on the left side of the heart.

Treatment of hypertension

To correct high blood pressure, treatment regimens have been developed that include drugs of different groups and different mechanisms of action. Their combination and dosage is chosen by the doctor individually, taking into account the stage, concomitant pathology, and the response of hypertension to a specific drug. After the diagnosis of hypertension is established and before starting drug treatment, the doctor will suggest non-drug measures that significantly increase the effectiveness of pharmacological drugs, and sometimes allow you to reduce the dose of drugs or abandon at least some of them.

First of all, it is recommended to normalize the regime, eliminate stress, and ensure physical activity. The diet is aimed at reducing salt and fluid intake, eliminating alcohol, coffee and drinks and substances that stimulate the nervous system. If you are overweight, you should limit calories and avoid fatty, floury, fried and spicy foods.

Non-drug measures in the initial stage of hypertension can have such a good effect that the need to prescribe medications will no longer be necessary. If these measures do not work, the doctor prescribes appropriate medications.

The goal of treating hypertension is not only to reduce blood pressure, but also to eliminate, if possible, its cause.

Antihypertensive drugs from the following groups are traditionally used to treat hypertension:

• Diuretics;
• Angiotensin II receptor antagonists;
• ACE inhibitors;
• Adrenergic blockers;
• Calcium channel blockers.

Every year the list of drugs that reduce blood pressure grows and at the same time becomes more effective and safe, with fewer adverse reactions. When starting therapy, one medicine is prescribed in a minimum dose; if it is ineffective, it can be increased. If the disease progresses and the pressure does not remain at acceptable values, then another drug from a different group is added to the first drug. Clinical observations show that the effect is better with combination therapy than with prescribing one drug in the maximum amount.

Reducing the risk of vascular complications is important in choosing a treatment regimen. Thus, it has been noted that some combinations have a more pronounced “protective” effect on organs, while others allow better control of pressure. In such cases, experts prefer a combination of drugs that reduces the likelihood of complications, even if there are some daily fluctuations in blood pressure.

In some cases, it is necessary to take into account concomitant pathology, which makes adjustments to headache treatment regimens. For example, men with prostate adenoma are prescribed alpha-blockers, which are not recommended for constant use to reduce blood pressure in other patients.

The most widely used are ACE inhibitors, calcium channel blockers, which are prescribed to both young and elderly patients, with or without concomitant diseases, diuretics, and sartans. Drugs in these groups are suitable for initial treatment, which can then be supplemented with a third drug of a different composition.

ACE inhibitors (captopril, lisinopril) reduce blood pressure and at the same time have a protective effect on the kidneys and myocardium. They are preferable in young patients, women taking hormonal contraceptives, indicated for diabetes, and for older patients.

Diuretics are no less popular. Hydrochlorothiazide, chlorthalidone, torasemide, and amiloride effectively reduce blood pressure. To reduce adverse reactions, they are combined with ACE inhibitors, sometimes “in one tablet” (Enap, berlipril).

Beta-blockers (sotalol, propranolol, anaprilin) ​​are not the first-line group for hypertension, but are effective for concomitant cardiac pathology - heart failure, tachycardia, coronary disease.

Calcium channel blockers are often prescribed in combination with ACE inhibitors; they are especially good for bronchial asthma in combination with hypertension, since they do not cause bronchospasm (riodipine, nifedipine, amlodipine).

Angiotensin receptor antagonists (losartan, irbesartan) are the most prescribed group of drugs for hypertension. They effectively reduce blood pressure and do not cause coughing like many ACE inhibitors. But in America they are especially common due to a 40% reduction in the risk of Alzheimer's disease.

When treating hypertension, it is important not only to choose an effective regimen, but also to take the drugs for a long time, even for life. Many patients believe that when the pressure reaches normal levels, treatment can be stopped, but they grab the pills by the time of the crisis. It is known that the unsystematic use of antihypertensive drugs is even more harmful to health than the complete absence of treatment, therefore, informing the patient about the duration of treatment is one of the important tasks of the doctor.

Video: lecture on hypertension

Human blood pressure 110 over 80

• 1 What is normal blood pressure?
• 2 What does pressure 100 over 80 mean?
• 3 Reasons for blood pressure readings 110/80
• 4 Symptoms
• 5 Is it dangerous?
• 6 How are measurements taken?
• 7 What to do if the upper data is lowered?

There are generally accepted norms for blood pressure. Indicators of 110 to 80 for some people are a variant of the norm. Sometimes they are temporary and do not pose a serious threat to health. And sometimes they can indicate the onset of a pathological process in the body. To avoid troubles, you need to consult a doctor and periodically monitor them yourself.

What is normal blood pressure?

It is generally accepted that normal blood pressure in humans is 120/80 mmHg. Art. with minor deviations. The difference between the maximum and minimum parameters (pulse pressure) should be 30−40 mmHg. Art. These indicators are relative because they vary depending on subjective and objective factors. They depend:

• from age;
• growth;
• physique;
• gender;
• weight;
• time of day;
• climate;
• physiological state;
• presence of chronic or acute diseases;
• physical activity;
• hormonal balance;
• taking medications;
• emotional state;
• weather;
• individual characteristics of the body.

Pressure surges indicate the development of a pathology that provokes an increase in pressure.

When the readings are consistently elevated from 140 to 100 and above, hypertension is diagnosed; when the readings are consistently low from 100 to 65 (or 60) and below, hypotension is diagnosed. If the indicators increase or decrease periodically, and quickly return to normal, this indicates arterial hypertension or hypotension. Pressure consists of 2 key indicators - the upper (systolic, maximum) parameter and the lower (diastolic, minimum). They take into account the ejection of blood from the artery into the blood vessels during systole and diastole.

The value of blood pressure depends on the following factors:

• strength of heart contraction;
• blood clotting;
• elasticity of vascular walls;
• blood thickness;
• dilatation or constriction of blood vessels.

Return to contents

What does pressure 100 over 80 mean?

Indicators 110 to 80 mm Hg. sometimes they are a variant of the norm, the same as 120 over 70, and sometimes they indicate hypotension or hypotension, depending on the accompanying symptoms and the duration of this condition. They indicate that the systolic pressure is slightly low, and the diastolic pressure is normal.

A blood pressure of 110 over 80 is sometimes the norm for the following categories of people:

• pregnant women (III trimester);
• teenagers (up to 15 years old);
• thin women;
• athletes.

Such indicators sometimes indicate pathology:

• in young children;
• pregnant women (I-II trimesters);
• old people.

Return to contents

Reasons for blood pressure readings 110/80

A decrease in heart pressure can be caused by external factors.

A decrease in systolic pressure can be due to various reasons. If it is permanent and accompanied by pathological symptoms, you should not hesitate to go to the doctor. Because this may indicate serious health problems. If the maximum values ​​decrease occasionally, slightly, and do not cause concern, they are provoked by external factors and should soon stabilize. The cause of the decline in indicators is presented in the table.