Some car enthusiasts do not fully understand what an absolute pressure sensor is in the engine control system. Therefore, I decided to present this post in order to express my opinion on this topic and debunk some myths and misconceptions that we constantly encounter to one degree or another.

We know that atmospheric pressure is usually 101 kPa. And at idle speed of a warm engine, the values ​​in the intake manifold are 30-33 kPa or approximately 0.9 -1 V.

This is due to the fact that the internal combustion engine runs on air with a small addition of fuel mass. And he sucks this air into himself. Like a vacuum cleaner.

It has a great need for air, but since the throttle valve is practically closed and very little air is supplied, the engine sucks out everything it can from the intake manifold. Naturally, the pressure there drops due to a lack of air molecules.

And here many are convinced that if you open the throttle slightly, the pressure will rise.

But in reality everything will be completely different. Therefore, you have to constantly answer the same question - “Why did I open the damper, but the pressure did not rise, but fell even more? Should I change the absolute pressure sensor?

It was this constant question that prompted me to write this post and answer once and for all - The pressure in the intake manifold does not depend on the throttle valve, but on the load on the engine!

I'll try to explain.

The car is stationary and the engine is idling. If we open the throttle valve slightly, the pressure will actually jump to 50-100 kPa (depending on how it is opened).

But this jump will be short-lived. Since the engine itself is quite slow and it needs some time to start increasing speed, it simply does not have time to immediately suck in a sharp influx of air through the open remote control. But since nothing is holding it (the car is standing still in neutral), after a second it easily develops speed.

But since the passage of air through the slightly open remote control is still limited, the engine quickly sucks in everything it can. But since it has already raised the speed, its “suction” capacity has also increased. It has become more powerful and sucks air into itself with greater force. Naturally, the pressure in the intake manifold drops even below what it was at idle.

Here are examples of graphs. The revolutions are more than 2000, and the pressure in the manifold has dropped from 33 to 23 kPa!

That's how it should be! The absolute pressure sensor is working properly.

I repeat once again - opening the throttle valve does not necessarily lead to an increase in pressure in the manifold. Because it is not the damper that affects the increase in pressure, but the load on the engine!

This is what it looks like. Let's say we're driving down the road in 5th gear. Then we sharply open the throttle. Air rushes into the manifold without any obstacles, but the engine is no longer able to quickly develop speed and suck in all the air, since in addition to itself, it also needs to turn the wheels! Therefore, it’s hard for him and he develops speed very slowly (or maybe not at all if he’s driving uphill). Naturally, there is a lot of air in the manifold and the pressure rises almost to atmospheric

At this moment, the ECU sees, due to the high pressure in the manifold, that the engine is not able to “recycle” all the air that was given to it and understands this as heavy load to the engine.

I hope that it is now clear to those who did not understand this and were worried about the performance of their absolute pressure sensor.

If you don't understand, ask. If you want to add, add. Comments on the page below.

Peace and smooth roads to everyone

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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 exact value your blood pressure. To check this indicator, a tonometer is used. It can be freely purchased at any pharmacy or store medical equipment. 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 mm Hg. Art. If it is slightly higher, then this does not cause any concern among doctors. This phenomenon accepted as normal. Blood pressure is influenced by many external and internal factors. Among them are:

1. Human diet. Regularly eating meals that contain a large number of salt and spices have 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. Experience 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 use Alcoholic drinks 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 ordinary people who are 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 mmHg. Art.

Average blood pressure is calculated using special formulas

It wouldn'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 the correct calculation, it is necessary to subtract from systolic pressure diastolic. 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 receive 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. To calculate this equation, use the value cardiac output. 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 it becomes necessary to quickly estimate the average pressure of a person. 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 using special equipment.

Mean arterial pressure can be calculated according to 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 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 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., means a person no problems with functioning of cardio-vascular 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 advised 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 deplorable consequences for individual organs or the whole organism.

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 the mean arterial pressure, you must first measure the upper and lower blood pressure. This data will need to be substituted into the formula. It must be remembered that the 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 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. Based on materials from a survey conducted as part of the target federal program"Prevention and treatment of hypertension in Russian Federation", the frequency of hypertension among the population of the Russian Federation is 39.5%. Early diagnosis initial stages Hypertension allows you to promptly change your lifestyle, give up bad habits and, if necessary, prescribe medications antihypertensive therapy, which leads to a fatal decrease dangerous complications, prolongs working age and increases life expectancy.

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

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

Table 1.

Indications for ABPM

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

Contraindications to ABPM are complications during previous blood pressure monitoring, skin diseases on the shoulder, thrombocytopenia, thrombocytopathy and other blood diseases during exacerbation, trauma upper limbs, 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 average daily blood pressure and pulse values, average blood pressure values ​​during the day and night, determine the degree of nocturnal decrease and morning increase in blood pressure, blood pressure response to physical activity and psycho-emotional stress, the degree and duration of hypertensive load on target organs, blood pressure variability and pulse during the day, detect episodes of hypotension.

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

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

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

Table 2.

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

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

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

Table 3.

Normal values ​​of pressure load indicators (%)

To quantify the amount of “pressure load” exerted on target organs high blood pressure, use the terms time index (TI) and area index (AI). 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.

The AI ​​in most healthy individuals ranges from 10 to 20% and does not exceed 25%. An IV for SBP greater than 25% is considered unambiguously pathological, which warrants a diagnosis of hypertension or symptomatic hypertension. Stable hypertension is diagnosed when the AI ​​is at least 50% during the day and night. The presence of 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 blood pressure 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 average blood pressure values ​​during the day and at night. To determine SNABP in %, use the formula:

(SADd - SADn)x100% / SADd,

where SADd is the average 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 have 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”. 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 daily blood pressure profiles depending on SBP

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

Table 5.

Critical values ​​of standard deviation (variability)

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

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

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

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

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

where ADmax is the maximum value of morning blood pressure,

ADmin - the minimum value of morning blood pressure,

tmax - time of maximum morning blood pressure,

tmin - time of minimum night blood pressure.

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

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

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

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

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

Table 6.

Correlation between the results of clinical and ambulatory blood pressure measurements

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

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

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

Diagnosis of ICAH based on ABPM and ABPM data may not coincide; this is especially often observed in working patients. In this case, it is necessary to focus on the results of ABPM. In case of diagnosing ICAG, it is necessary to carry out additional research to clarify the presence of risk factors and target organ damage. Patients with ICAH should be advised non-drug methods treatment of hypertension, and in the presence of a 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” hypertension, when when measuring blood pressure in medical institution Normal blood pressure values ​​are determined, but the results of ABPM and/or ABPM indicate the presence of hypertension. It is estimated that IAAH occurs in 12-15% of individuals in the general population. The frequency of identification of risk factors and target organ damage in such patients compared to normotensive patients is significantly higher, and the risk of cardiovascular complications is almost the same as in patients with hypertension.

Assume IAAG in individuals with normal pressure possible if the following factors are present:

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

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

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

Kazan State Medical Academy

Interregional Clinical Diagnostic Center, Kazan

Akhunova Svetlana Yurievna - candidate medical sciences, Associate Professor, Department of Functional Diagnostics

Literature:

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

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

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

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

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

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

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

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

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

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

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

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

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

(Fig. 2.9 b):

Рср = (Pi + Р2 + ... + Pn)/n,

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

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

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

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

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

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

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

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

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

Methods for determining blood pressure

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

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

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

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

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

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

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

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

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

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

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

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

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

Of the other indirect methods for determining blood pressure, the most commonly used are oscillography, tachooscillography and ultrasonic methods vascular studies, which are not only more accurate when measuring SBP and DBP, but also allow you to determine mean and lateral blood pressure.

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

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

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

In order to clarify the etiology and pathogenesis of hypertension;

At emergency conditions to assess basic hemodynamic parameters;

With individual selection medicines in patients with hypertension.

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

Interpretation of blood pressure measurement results

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

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

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

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

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

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

	Criteria
	SBP, mmHg	DBP, mm Hg.
Optimal blood pressure
Normal blood pressure
High normal blood pressure
Systolo-diastolic arterial hypertension*
I degree (soft)
Subgroup: “borderline” hypertension
II degree (moderate)
III degree (severe)
Isolated systolic arterial hypertension
I degree
Subgroup: “borderline” hypertension
II degree
III degree

Note:* if SBP and DBP fall into different categories, the higher category is assigned

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

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

it, which largely determines the prognosis of the disease. Despite the fact that more high level Blood pressure is associated with a high risk of target organ damage; a direct correlation between blood pressure levels and structural and functional changes in these organs is not always found. Moreover, in recent years great attention It is the soft AG that attracts.

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

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

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

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

Acute and chronic adrenal insufficiency and other diseases.

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

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

Average daily systolic blood pressure (SADav);

Average daily diastolic blood pressure (DABP;

Daily maximum SBP (SADmax);

Daily maximum DBP (DBPmax);

Average SBP and DBP during the day and night hours;

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

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

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

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

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

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

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

Atherosclerosis or aortoarteritis subclavian artery, or brachiocephalic trunk;

Embolism or acute thrombosis subclavian or brachial artery;

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

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

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

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

Obliterating atherosclerosis; aortoarteritis;

Embolism and thrombosis;

coarctation of the aorta

Traumatic occlusions, etc.

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

Catad_tema Arterial hypertension - articles

Results of assessing blood pressure variability and the degree of its decrease at night in the ORIGINAL program

O.A.Kislyak, S.L.Postnikova, A.A.Kopelev
Russian state medical University, Moscow

Daily monitoring of blood pressure (ABPM) during normal human activities opens up additional diagnostic opportunities, allowing more accurate verification of initial deviations in the circadian rhythm and blood pressure (BP), and more accurately reflect the severity of hypertension and its prognosis.

As noted in the recommendations of the All-Russian Scientific Society of Cardiologists and the All-Russian Medical Society for Arterial Hypertension, for the diagnosis and treatment of arterial hypertension, clinical blood pressure is the main method for determining blood pressure and risk stratification, but ABPM has a number of certain advantages, since it provides information about blood pressure during “everyday” daytime activity and at night and allows you to clarify the prognosis of cardiovascular complications (CVC). It is equally important that ABPM indicators are more closely related to changes in target organs initially and to their observed dynamics during treatment, which makes it possible to more accurately assess the antihypertensive effect of therapy. ABPM provides important information about the state of the mechanisms of cardiovascular regulation, in particular, it 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.

When analyzing data obtained from ABPM, the most informative are the average blood pressure values ​​per day, day and night, the maximum and minimum blood pressure values ​​in different periods days, indicators of “pressure load”, blood pressure variability, diurnal index (degree of nocturnal decrease in blood pressure), morning rise in blood pressure (magnitude and speed of the morning rise in blood pressure). It is believed that the average values ​​of systolic (SBP) and diastolic (DBP) blood pressure give an idea of ​​the patient’s blood pressure level, most accurately reflect the true level of hypertension and are more correlated with the degree of target organ damage (TOD) in arterial hypertension (AH), than the results of blood pressure assessment in the clinic.

In addition to average blood pressure values, important indicators that influence the prognosis are the variability of systolic (VSBP) and diastolic (VDBP) blood pressure and the daily index of SBP and DBP and the characteristics of the morning rise in pressure. A series of studies have shown that increased BP variability is an important and independent factor in POM and high risk of cardiovascular events. It is known that blood pressure variability largely depends on the degree of decrease in blood pressure at night and the magnitude and speed of the morning rise in blood pressure, which, in turn, are associated with POM and the risk of cardiovascular events.

The relationship between blood pressure variability and CVS is due to for various reasons. In particular, it has been shown that high blood pressure variability contributes to the development of endothelial dysfunction, since with ABPM such patients have more severe endothelial dysfunction compared to patients with normal blood pressure variability. It has been suggested that increased BP variability causes endothelial dysfunction due to suppression of nitric oxide production and effects on the vascular intima, which in turn may lead to atherogenesis. Another explanation is that patients with high BP variability tend to be those with abnormal neurohumoral activity, primarily increased activity sympathetic nervous system, as it increases vascular tone, especially in the morning, which leads to an increased risk of cardiovascular events. It is also assumed that high blood pressure variability and a significant morning rise in blood pressure may contribute to increased platelet aggregation, which certainly affects the risk of thrombotic complications.

In international and Russian recommendations for the diagnosis and treatment of hypertension, risk stratification is currently based on blood pressure levels, the presence of risk factors, POM and associated clinical conditions. At the same time, increasing evidence suggests that not only cardiovascular risk, but also the effectiveness of antihypertensive therapy should be assessed by determining blood pressure variability and circadian index. IN clinical practice the use of antihypertensive drugs with a clear positive effect on blood pressure variability may be most useful from the standpoint of organ protection and prevention of cardiovascular events.

In 2010, a Russian study was completed under the ORIGINAL program - Assessing the effectiveness of transferring from indapamide generics to Arifon retard in patients with arterial hypertension, during which it was planned to evaluate the blood pressure-lowering effect after transferring to Arifon retard in patients with varying degrees severity of hypertension treated with generic indapamide in mono- or combination therapy, but without necessary control for blood pressure The study involved 309 doctors who included from 1 to 10 patients. A total of 1319 patients were included in 73 localities of the Russian Federation. The program involved patients over the age of 18 years, with essential hypertension, stable flow hypertension in the last 3 months before inclusion in the program, who did not achieve target blood pressure values ​​(SBP 140-180 mm Hg, DBP<110 мм рт. ст.), несмотря на прием антигипертензивных препаратов, а именно прием генерического индапамида в монотерапии или в комбинации с другими антигипертензивными препаратами.

During the implementation of the ORIGINAL program, it was shown that replacing generic indapamide with the original drug Arifon retard in patients with uncontrolled blood pressure led to a significant decrease in clinical blood pressure and made it possible to achieve the target blood pressure level in 80% of patients. These results were confirmed by ABPM data, which was carried out in two clinical centers (Volgograd State Medical University and Russian State Medical University). It was shown that at the 4th (final) visit (after 3 months of treatment) after transferring patients to the original indapamide retard, the average values ​​of SBP and DBP in all periods of the day were below threshold levels, which indicated effective blood pressure control (Fig. 1) .

Rice. 1. Dynamics of SBP and DBP indicators according to ABPM data (in mmHg).

Analysis of ABPM results taking into account BP variability and 24-hour BP index in 30 patients in our clinical center provided additional data to assess the effectiveness of replacing generic indapamide with Arifon retard.

Daily blood pressure index
At baseline (1st visit), in the group of patients with hypertension, patients with varying degrees of decrease in SBP and DBP at night were identified (Fig. 2).

Rice. 2. Daily index of SBP and DBP initially.

It turned out that the majority of patients in the study group not only did not have clinical BP under control, but they also had an unfavorable 24-hour BP index. The most serious violations were noted in relation to the decrease in SBP at night. Only 27% of patients had a normal (optimal) degree of nocturnal decrease in SBP (dipper), while 53% of patients had a normal 24-hour DBP index. There were 43% of patients with an insufficient degree of nocturnal reduction in SBP (non dipper), and 30% in DBP. A sustained increase in night SBP (night peaker) was observed in 10% of patients, but was not detected in DBP. There were approximately equal numbers of patients with an increased degree of nocturnal decrease in SBP and DBP (over dipper).

These data indicate that the therapy available to patients at the time of inclusion in the study not only did not control clinical BP, but also BP at night, especially SBP. As is known, persistent high SBP at night is a risk factor for POM, especially left ventricular hypertrophy, and the development of CVD. On the other hand, patients with an increased degree of nocturnal decrease in blood pressure, as a rule, have an excessively high morning rise in blood pressure, which is also associated with an increased risk of cardiovascular events. In this regard, the question of the need for antihypertensive therapy in patients with hypertension, taking into account these characteristics of ABPM, is seriously raised.

At the final visit, we assessed the effect of replacing generic indapamide with Arifon retard on the degree of blood pressure reduction at night. Convincing results were obtained regarding the positive effect of Arifon retard on these ABPM parameters (Fig. 3). Thus, at the end of the study, the number of patients who had a normal (optimal) degree of night-time reduction in SBP more than doubled due to a significant decrease in the number of patients with unfavorable characteristics of blood pressure reduction at night. I would especially like to note the fact that as a result of the drug’s administration, there was no increase in the number of patients with an increased degree of decrease in SBP and DBP; moreover, the number of such patients decreased.

Rice. 3. Daily SBP and DBP index at the final visit.

Blood pressure variability
BP variability is calculated using the standard deviation of the mean BP value. It is known that blood pressure variability usually ranges from 10 to 20% of the mean blood pressure according to ABPM data, with significant individual deviations. Currently, there are no absolute criteria for increased blood pressure variability. Some authors consider the level of 15 mm Hg to be increased variability in SBP. Art., others consider 20 mm Hg to be the upper limit. Art., for DBP, the figure of 14 mm Hg is most often called increased variability. Art. .

Analysis of ABPM data at the 1st visit revealed a wide range of characteristics of SBP and DBP variability in the examined patients. Thus, 21 (70%) patients had increased SBP variability; in the group as a whole, VSBP was 19.6 ± 6.1 mm Hg. Art. Increased variability of DBP was observed less frequently - in 8 (26%) patients and amounted to 14.3 ± 4.5 mm Hg in the group as a whole. Art. Of interest is the fact that all these patients also had a high IRR. When creating groups with high and normal variability of SBP and DBP, we conditionally set threshold levels of VSBP - 17 mm Hg. art., HPBP - 14 mm Hg. Art.

When assessing the variability indicators for the group as a whole at the final visit, we did not receive a significant decrease in the variability indicators of SBP and DBP (18.7±4.7 and 13.5±4.8 mm Hg. Art., respectively), which is due to our view, with a small sample and a significant deviation of these indicators. However, in groups of patients with increased BP variability, a clear positive effect of Arifon retard on VSBP and IPBP parameters was found (Fig. 4). At the end of the study, elevated IBP remained in only 10 patients (all with initially high IBP), and increased variability in IBP remained in only 2 patients (all with initially high IBP).

Rice. 4. Dynamics of IBP and IBP (mm Hg).

Thus, within the framework of the ORIGINAL program, it was not only shown that replacing generic indapamide with Arifon retard allows for adequate control of blood pressure according to office measurements of blood pressure and ABPM, as well as achieving the target blood pressure level in the majority of patients, but also has a positive effect on the daily index and blood pressure variability. The data obtained suggest that ABPM during treatment with antihypertensive drugs should be assessed not only from the standpoint of reducing average blood pressure levels, but also from the standpoint of the effect of antihypertensive therapy on blood pressure variability, which should become another goal in the treatment of patients with hypertension. Despite the difficulties in carrying out this task, it is necessary to evaluate the effect of the drug on the daily blood pressure index and blood pressure variability, since if a positive effect is identified, we can obtain an additional organoprotective effect and reduce cardiovascular risk.

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