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Korotkov method. Blood pressure measurement. Auscultatory method of measuring pressure Oscillometric method of measuring blood pressure: description and nuances

This method, developed by the Russian surgeon N.S. Korotkov in 1905, provides a very simple device for measuring blood pressure, consisting of a mechanical pressure gauge, a cuff with a bulb and a phonendoscope. The method is based on complete compression of the brachial artery with a cuff and listening to the sounds that occur when air is slowly released from the cuff.

Advantages:

recognized as the official standard for indirect blood pressure measurement for diagnostic purposes and when testing automatic blood pressure meters; high resistance to hand movements.

Flaws:

depends on the individual characteristics of the person making the measurement (good vision, hearing, coordination of the “hands-vision-hearing” system);

sensitive to noise in the room, the accuracy of the location of the phonendoscope head relative to the artery;

requires direct contact of the cuff and microphone head with the patient's skin;

technically complex (increases the likelihood of erroneous indicators during measurement) and requires special training.

II. Oscillometric method

This is a method that uses electronic devices. It is based on the device recording air pressure pulsations that occur in the cuff as blood passes through a compressed section of the artery.

Advantages:

does not depend on the individual characteristics of the person making the measurement (good vision, hearing, coordination of the “hands-vision-hearing” system); resistance to noise loads.

Korotkoff method

A cuff is placed on the arm between the shoulder and elbow, in which excess pressure is created above atmospheric pressure by pumping air. By pumping air, the pulse disappears from the wrist. In this case, we can assume that the artery is completely blocked due to compression. (Fig.2 a). If the muscles are relaxed, then the air pressure in the cuff is approximately equal to the pressure in the soft tissues in contact with the cuff. Subsequently, by releasing air from the cuff, the pressure in the surrounding tissues is reduced. When the pressure becomes equal to systolic, it becomes possible for the pulse wave to pass through the compression site. This moment is determined by the appearance of primary tones, listened to using a phonendoscope located distally (further from the heart) along the artery. The pressure that is recorded at this moment on the pressure gauge is taken as systolic. With a further decrease in pressure in the phonendoscope, in addition to tones, noises are heard, the cause of which is the turbulent flow that occurs in the artery due to its partial opening. (Fig. 2 b) Against the background of noise, secondary tones appear, often louder than the primary ones, which is explained by an increase in the elasticity of the arterial walls when the vascular muscles are weakened. Subsequently, as the pressure decreases, the sounds and noises subside and at the moment when they disappear, the systolic pressure is recorded.

Rice. 2 Radial artery at the moments of: a) complete compression,

b) partial opening

The value of blood pressure is not a constant value - it continuously fluctuates depending on the influence of various factors. One of the main factors influencing blood pressure levels is a person’s condition. Fluctuations in blood pressure in patients with arterial hypertension are significantly higher than in persons without this disease. Blood pressure measurement can be carried out both at rest and during physical or psycho-emotional stress, as well as at intervals between various types of activity. Measurements at rest allow you to estimate the approximate level of blood pressure at certain periods of time, associated, for example, with taking medications or with other aspects of life. Blood pressure is most often measured in a sitting position, but in some cases it becomes necessary to measure it in a lying or standing position.

To perform measurements at rest, it is necessary to ensure comfortable conditionsfor the subject and fulfill the following requirements:

30 minutes before measurement it is necessary to avoid eating, smoking, physical stress and exposure to cold;

before measuring pressure, you need to sit quietly or lie down (depending on the chosen body position in which the measurement will be taken) and relax;

measurement begins 5 minutes after resting in the above position: when measuring pressure in a sitting position, the back must be supported, since any form of isometric exercise causes an immediate increase in blood pressure. The midpoint of the shoulder should be at the level of the heart (4th intercostal space);

in a lying position, the arm should be located along the body and be slightly raised to a level corresponding to the middle of the chest;

During the measurement, you cannot talk or make sudden movements;

If a series of measurements is carried out, it is recommended to change the original position. The interval between measurements should be at least 15 seconds. (Recommended interval is 1 minute). During pauses between measurements, it is recommended to loosen the cuff.

The difference in pressure between different arms can be quite significant, so it is recommended to measure on the arm with higher blood pressure values.

Often, when a doctor measures blood pressure in patients, higher blood pressure values are recorded (30-40 mm Hg higher) than when measured independently at home, which is explained by the “white coat effect,” that is, a stressful situation associated with a medical examination. In some patients, this situation occurs even with self-measurement.

Errors in measuring blood pressure using the Korotkoff method.

Despite the simplicity and widespread use of measuring blood pressure using the Korotkoff method, it is not always easy for even qualified medical personnel to accurately measure it using this method.

Requirements for personnel measuring blood pressure using the Korotkoff method:

concentrate on the task;

have good vision, hearing, and coordination of the “hands-vision-hearing” system;

hear Korotkoff sounds, distinguishing them from extraneous noise;

take notes and remember the pressure level at the first appearance, attenuation and disappearance of Korotkoff sounds (initial and secondary), while continuing to reduce the pressure in the cuff;

remember and record systolic and diastolic pressure (with an accuracy of 2 mm Hg.

Principle of the Korotkoff method

Mechanical tonometer and stethoscope for measuring blood pressure using the Korotkoff method

Korotkoff method- sound (auscultatory) method of measuring blood pressure, proposed by Russian surgeon Nikolai Sergeevich Korotkov in 1905. Currently, the Korotkoff method is the only official method of non-invasive blood pressure measurement, approved by the World Health Organization in 1935.

Pressure is measured using a tonometer (sphygmomanometer), and Korotkoff sounds from a pulsating, pinched artery are heard using a stethoscope.

Story

Description

The sounds heard when measuring blood pressure are different from those of the heart, which are caused by vibrations inside the ventricles due to the closing of the valves. If a stethoscope is placed on the projection of the brachial artery in the cubital fossa of a healthy person (without vascular diseases), then no sound will be heard. During a heartbeat, these contractions are transmitted gently by the laminar (non-turbulent) flow of blood through the arteries, so there is no sound. Likewise, if the sphygmomanometer cuff is placed on the upper arm and inflated above the patient's systolic pressure level, there will be no sound. This is due to a fairly high pressure in the cuff of the device, which completely blocks the blood flow, which is similar to strong compression of a flexible pipe.

If the pressure drops to a level equal to the patient's systolic pressure, the first Korotkoff sound will be heard. As long as the pressure in the cuff of the device matches the pressure created by the heart, blood will be able to pass through the shoulder at the moment of systole, since at this moment the pressure in the artery increases. The blood flows in spurts at this point, as the pressure in the artery becomes even higher than in the cuff, and then drops, passing through the area surrounded by the cuff, causing a turbulent flow with an audible sound.

As long as the cuff pressure is between systolic and diastolic, muffled sounds will be heard as the blood pressure moves higher and lower than the cuff pressure at different points in the cardiac cycle.

Eventually, the pressure in the cuff drops even more, the sound changes, becomes muffled and disappears completely. This occurs because the cuff pressure has dropped below diastolic pressure, so the cuff does not create any restrictions on the blood flow, which again becomes smooth, loses turbulence and does not produce an audible sound.

Five phases of Korotkoff sounds

Korotkov describes five phases of tones:

Notes

additional literature

It is possible to control blood pressure at home. Usually the Korotkoff method is used for this.

The advantage of the technique is the fact that it is very accurate. Measuring blood pressure using the Korotkoff method allows you to obtain an accurate clinical picture, with which you can judge the condition of a particular patient.

Pressure measurement using the Korotkov method: essence and algorithm

If you have hypertension, you should definitely monitor your blood pressure and regularly undergo comprehensive diagnostics in order to timely identify concomitant pathologies. Observation will allow timely adjustment of the existing treatment regimen.

The Korotkoff method for measuring blood pressure has been used for more than 100 years. The technique is widely used for screening studies. Moreover, the algorithm is even used to test blood pressure meters. The predecessor was the Riva-Rocci method, which has a very similar principle, which is also based on the use of a cuff.

To accurately determine the indicators, it is necessary to refrain from eating food, intense physical activity, smoking and drinking caffeinated drinks for 15-20 minutes before measurements. The procedure must be carried out in a quiet room.

The algorithm is as follows:

Sit on a chair, straighten your back. You can't cross your legs.
Place the cuff on the shoulder. Place the middle of the cuff in line with the heart. It is worth noting that the camera must cover at least 80% of the shoulder circumference. The lower edge of the cuff should be fixed at a level of 1-2 centimeters above the elbow. There should be a small gap between the camera and the limb.
Palpate to find the pulsating artery and apply an endoscope to it.
Pump air into the cuff until the pressure in it reaches maximum and blood flow stops.
Turn the screw valve.
Listen to the vascular tone. The sound that appears is called the first tone. It corresponds to systolic pressure.
Continue to reduce the pressure in the cuff. The tone should increase. The moment the sounds disappear corresponds to diastolic pressure.

It is advisable to take measurements at least 2 times in a row. Moreover, before each measurement, the air from the compression cuff must be completely released.

Advantages and disadvantages

Determining blood pressure using the Korotkoff method has a number of advantages and disadvantages. The most significant advantage is the fact that the measurement allows you to obtain the most reliable values.

Another advantage is that measuring blood pressure using the Korotkoff method does not require precise fixation of the hand. Even if a person has tremors of the limbs, the results of determining pressure will be very accurate.

The disadvantages of the technique include:

The need for special skills. You need to properly palpate and find the pulsating artery.
If the cuff is not secured tightly, it may move, resulting in inaccurate measurements.
The Korotkov technique is not suitable for elderly patients who have problems with vision and hearing.
The pressure gauge needs to be calibrated every six months.

Important! Doctors say that daily fluctuations of 10-15 mmHg are normal. This applies to both diastolic and systolic indicators.

Oscillometric method of measuring blood pressure: description and nuances

Due to physiological characteristics, weak Korotkoff sounds may be observed. That is why other, more sensitive methods are sometimes used to measure blood pressure.

Nowadays, the oscillometric method has become widespread. It involves the use of specialized electronic devices that independently read the vibrations of the cuff.

When using electronic blood pressure monitors, the cuff should also be secured to the upper arm. The advantages of oscillometric measurements include:

The possibility of using the technique by people who have hearing or vision problems.
There is no need to pump air into the cuff. The instructions for electronic tonometers indicate that you just need to press the “start” button, and air will automatically flow into the chamber.
Ability to take measurements in noisy rooms.
It is permissible to place a cuff over clothing.
Electric tonometers are perfect for people who have weak Korotkoff sounds.

Disadvantages include the fact that with oscillometric measurements, the results will be inaccurate if the person moved the limb during the measurement process. That is why this technique is completely unsuitable for elderly patients whose hypertension is accompanied by severe hand tremors.

With technology gradually improving, people can now measure their blood pressure at their wrist. To do this, you need to purchase a specialized electronic tonometer.

The manual for such products says that the cuff should be secured 1-2 centimeters above the hand. Next, the hand with the cuff must be placed palm down on the shoulder of the opposite hand. Then the start button is pressed and air begins to be pumped. When the air completely leaves the chamber, the person will receive the measurement result.

Arterial pressure.

Blood pressure (BP) is the most important parameter of human health. There are systolic (maximum) pressure, diastolic (minimum) pressure, mean pressure and pulse pressure.

Blood pressure is directly proportional to the magnitude of cardiac output, circulating blood volume and vascular resistance, and the relationship between cardiac output and resistance in large arteries determines mainly systolic pressure, and the relationship between cardiac output and peripheral resistance in arterioles determines diastolic pressure. Pulse pressure is the difference between systolic and diastolic pressure.

Since blood pressure is variable and depends on many factors, basic (basal) and random blood pressure are distinguished. The main pressure is measured in a person under basal metabolic conditions, almost in the morning in bed immediately after waking up from sleep. Pressure measured under all other conditions is random. The pressure measured 2 hours after eating and 5 minutes of rest is called random standardized pressure. This pressure is recommended to be determined by WHO experts.

Mass determination of blood pressure and its study became possible after the development of a method for bloodless determination of blood pressure. Modern methods for determining blood pressure are associated with the work of mainly two scientists: the Brazilian doctor Riva-Rocci and the Russian doctor N.S. Korotkova.

Riva-Rocci in 1896 invented a device for bloodless determination of blood pressure, which consisted of a mercury manometer, a rubber cuff and a balloon for inflating air into the cuff.

The cuff was placed on the lower third of the shoulder, air was pumped into it until the pulse disappeared, and then the air was slowly released from the cuff. The Riva-Rocha technique made it possible to accurately determine systolic pressure, but did not reveal diastolic pressure. More precisely, the author’s proposal to determine diastolic pressure by a special vibration of the brachial artery at the cuff was not feasible in practice.

On November 8, 1905, an adjunct of the St. Petersburg Military Academy, Nikolai Sergeevich Korotkov, presented, developed by him, a new method of bloodless determination of blood pressure in humans, which has since been known throughout the world as the auscultatory method of measuring blood pressure according to Korotkov.

At the scientific seminar S.N. Korotkov reported that, while studying the possibilities of restoring blood flow in case of injuries to the great vessels, he noticed that when they are compressed, sounds appear, by which the nature of the blood flow in the vessels can be determined. This made it possible, using the Riva-Rocci apparatus, to clearly determine both systolic and diastolic pressure. The following year S.N. Korotkov together with Professor M.V. Yanovsky published the first results of using the auscultatory technique for measuring pressure.

Korotkov identified the following 5 phases of sounds with a gradual decrease in pressure in the cuff compressing the shoulder:

1st phase. As the cuff pressure approaches systolic, sounds appear that gradually increase in volume.

Phase 2. As the cuff deflates further, “rusting” sounds appear.

Phase 3. Tones appear again and increase in intensity.

Phase 4. Loud tones suddenly change to quiet tones.

Phase 5. Quiet tones disappear completely.

N.S. Korotkov and M.V. Yanovsky proposed recording systolic pressure with gradual release of pressure in the cuff at the moment the first tone appears (phase 1), and diastolic pressure at the moment of transition of loud tones to quiet ones (phase 4) or at the moment of disappearance of quiet tones (phase 5). Moreover, with the first option for determining diastolic pressure, it is 5 mm Hg. higher than the pressure determined directly in the artery, and in the second option - by 5 mm Hg. lower than true.

The Korotkov method, despite the fact that other methods of bloodless blood pressure measurement were subsequently developed, for example, electronic processor tonometers based on the analysis of oscillatory oscillations of the arteries, is the only method of measuring blood pressure that is approved by the World Health Organization (WHO) and recommended for use doctors all over the world.

Considering the importance of a qualified determination of blood pressure in humans, we present method for measuring blood pressure approved by WHO (1999).

Technique for measuring blood pressure using the auscultatory Korotkov method
(WHO expert recommendations)

1. Blood pressure measurement.
1. Setting. Blood pressure measurements should be carried out in a quiet, calm and comfortable environment at a comfortable temperature. External influences that may increase blood pressure variability or interfere with auscultation should be avoided. When using a mercury sphygmomanometer, the meniscus of the mercury column should be at eye level of the person taking the measurement. The patient should sit in a straight-backed chair next to the table. To measure blood pressure in a standing position, a stand with adjustable height and a supporting surface for the arm and tonometer is used. The height of the table and stand should be such that when measuring blood pressure, the middle of the cuff placed on the patient’s shoulder is at the level of the patient’s heart, i.e. approximately at the level of the fourth intercostal space in a sitting position or at the level of the midaxillary line in a lying position. Deviation of the position of the middle of the cuff placed on the patient's shoulder or thigh from the level of the heart can lead to a false change in blood pressure of 0.8 mmHg. for every 1 cm: overestimation of blood pressure when the cuff is positioned below the heart level and underestimation of blood pressure when the cuff is positioned above the heart level. Supporting your back on the back of the chair and your arms on a supporting surface prevents an increase in blood pressure due to isometric muscle contraction.
Blood pressure measurements should be taken in a quiet, calm and comfortable environment.

2. Preparation for blood pressure measurement and duration of rest. Blood pressure should be measured 1-2 hours after eating. The patient should not smoke or drink coffee for 1 hour before measurement. The patient should not wear tight, constricting clothing. The arm on which blood pressure will be measured must be bare. The patient should sit supported by the back of a chair with relaxed, uncrossed legs. Explain the measurement procedure to the patient and warn that you will answer all questions after the measurement. It is not recommended to talk during measurements, as this may affect blood pressure levels. Blood pressure measurements should be taken after at least 5 minutes of rest.

The patient should not smoke or drink coffee for an hour before measuring blood pressure. The hand on which the pressure will be measured must be bare. The patient should sit supported by the back of a chair with relaxed, uncrossed legs. Blood pressure measurements should be taken after at least 5 minutes of rest.

3. Cuff size. The width of the cuff should cover at least 40% of the shoulder circumference and at least 80% of its length. Blood pressure is measured on the left arm or on the arm with a higher blood pressure level (in diseases in which there is a significant difference between the patient’s right and left arms, as a rule, lower blood pressure is recorded on the left arm). The use of a narrow or short cuff leads to a significant false increase in blood pressure.

The width of the cuff should cover at least 40% of the shoulder circumference and at least 80% of its length. Blood pressure is usually measured on the left arm, and with unequal filling and pulse tension (pulsus differens) on both arms.

4. Cuff position. Determine by palpation the pulsation of the brachial artery at the level of the middle of the shoulder. The center of the cuff balloon should be located exactly above the palpable artery. The lower edge of the cuff should be 2.5 cm above the cubital fossa. The tightness of the cuff: a finger should fit between the cuff and the surface of the patient's shoulder.
The lower edge of the cuff should be 2.5 cm above the cubital fossa. The tightness of the cuff: the index finger should fit between the cuff and the surface of the patient's shoulder.

5. Determining the maximum level of air injection into the cuff is necessary to accurately determine systolic blood pressure with minimal discomfort for the patient and avoid “auscultatory failure.”

1) Determine the pulsation of the radial artery, the nature and rhythm of the pulse. In case of severe rhythm disturbances (atrial fibrillation), the value of systolic blood pressure may vary from contraction to contraction, therefore, to more accurately determine its level, an additional measurement should be made.
2) Continuing to palpate the radial artery, quickly inflate air into the cuff to 60 mm Hg, then inflate 10 mm Hg at a time. until the pulsation disappears.
3) The air from the cuff should be deflated at a speed of 2 mmHg. per second. The blood pressure level at which the pulse appears again is recorded.
4) Completely deflate the cuff.
To determine the level of maximum air injection into the cuff, the value of systolic blood pressure determined by palpation is increased by 30 mm Hg.

6. Position of the stethoscope. The point of maximum pulsation of the brachial artery is determined by palpation, which is usually located immediately above the cubital fossa on the inner surface of the shoulder. The membrane of the stethoscope should be in full contact with the surface of the shoulder. Excessive pressure with the stethoscope should be avoided as it may cause additional compression of the brachial artery. It is recommended to use a low frequency membrane. The head of the stethoscope should not touch the cuff or tubes, since the sound from contact with them may interfere with the perception of Korotkoff sounds.

7. Inflating and deflating the cuff. Air is pumped into the cuff to the maximum level (see point 5) quickly. Slow injection of air into the cuff leads to disruption of the venous outflow of blood, increased pain and blurred sound. Air is released from the cuff at a rate of 2 mm Hg. per second until Korotkoff sounds appear, then at a speed of 2 mm Hg. from blow to blow. If hearing is poor, you should quickly release the air from the cuff, check the position of the stethoscope and repeat the procedure. Slow release of air allows you to determine systolic and diastolic blood pressure at the beginning of the phases of Korotkoff sounds. The accuracy of blood pressure determination depends on the decompression rate: the higher the decompression rate, the lower the measurement accuracy.

8. Systolic blood pressure. The value of systolic blood pressure is determined when phase I of Korotkoff sounds appears using the nearest scale division (2 mm Hg). When phase I appears between two minimum divisions, the blood pressure corresponding to the higher level is considered systolic. In case of severe rhythm disturbances, additional blood pressure measurement is necessary.

9. Diastolic blood pressure. The level at which the last distinct tone is heard corresponds to diastolic blood pressure. When Korotkoff sounds continue to very low values or to 0, the blood pressure level corresponding to the beginning of phase IV is recorded. The absence of phase V Korotkoff sounds can be observed in children, during pregnancy, in conditions accompanied by high cardiac output. In these cases, the beginning of phase IV of Korotkoff sounds is taken as diastolic blood pressure.
If diastolic blood pressure is above 90 mm Hg, auscultation should be continued for 40 mm Hg, in other cases - for 10-20 mm Hg. after the last tone disappears. Compliance with this rule will allow you to avoid determining a falsely elevated diastolic blood pressure when sounds resume after auscultatory failure.

10. Recording blood pressure measurement results. It is recommended to record which arm the measurement was taken on, the cuff size and the patient's position. The measurement results are recorded in the form KI/KV. If the IV phase of Korotkoff sounds is determined - in the form of KI/KIV/KV. If complete disappearance of tones is not observed, the V phase of tones is considered equal to 0.

11. Repeated blood pressure measurements. Repeated blood pressure measurements are taken 1-2 minutes after the air is completely released from the cuff.
Blood pressure levels may fluctuate from minute to minute. The average of two or more measurements taken on the same arm more accurately reflects blood pressure levels than a single measurement.

12. Measuring blood pressure in other positions. During the first visit, it is recommended to measure blood pressure in both arms, in a lying and standing position. Postural changes in blood pressure are recorded after 1-3 minutes of the patient being in a standing position. It should be noted on which arm the blood pressure level is higher.
The difference in blood pressure between arms can be more than 10 mm Hg. A higher value more accurately corresponds to intra-arterial blood pressure.
Special situations when measuring blood pressure
Auscultatory failure. The period of temporary absence of sound between phases I and II of Korotkoff sounds. May last up to 40 mm Hg. It is observed with high systolic blood pressure.
Absence of phase V of Korotkoff sounds (the “infinite tone” phenomenon). It is observed with high cardiac output: in children, with thyrotoxicosis, fever, aortic insufficiency, in pregnant women. Korotkoff sounds are heard until the zero division of the sphygmomanometer scale. In these cases, the beginning of phase IV of Korotkoff sounds is taken as diastolic blood pressure and blood pressure is recorded as KI/KIV/K0.
Blood pressure measurement in the elderly. With age, thickening and compaction of the wall of the brachial artery are observed, and it becomes rigid. A higher (above intra-arterial) pressure level in the cuff is required to achieve compression of the stiff artery, resulting in a false increase in blood pressure (the phenomenon of “pseudohypertension”). Palpation of the radial pulse when the cuff pressure level exceeds systolic blood pressure helps to recognize this error. Blood pressure in the forearm should be determined by palpation. If the difference between systolic blood pressure determined by palpation and auscultation is more than 15 mm Hg. Only direct invasive measurement allows one to determine the patient's true blood pressure level. The patient should be informed about the problem and an appropriate entry should be made in the medical history to avoid measurement errors in the future.
Very large shoulder circumference (obese, very well developed muscles), conical arm. In patients with an upper arm circumference greater than 41 cm or with a tapered upper arm where normal cuff position cannot be achieved, accurate blood pressure measurement may not be possible. In such cases, using a cuff of the appropriate size, you should try to measure blood pressure by palpation and auscultation on the shoulder and forearm. If the difference is more than 15 mm Hg. Blood pressure determined by palpation on the forearm more accurately reflects true blood pressure.
Blood pressure standards.
In general, normal blood pressure is considered to be between 100/60 and 140/90. Blood pressure 140/90 and above is arterial hypertension, below 100/60 is arterial hypotension.
Since arterial hypertension develops in a population of people with normal blood pressure, in recent years several variants of normal blood pressure have been differentiated, which makes it easier to identify risk groups.

Arterial hypertension.
Arterial hypertension is an increase in blood pressure to 140/90 and higher with repeated (at least 2 times) measurements under different conditions according to the WHO method.
Arterial hypertension can be primary (essential) and secondary (symptomatic). Primary hypertension is observed in 95-97% of cases, secondary - in 3-5% of cases.
In Russia, primary arterial hypertension is usually called hypertension.
Primary arterial hypertension is one of the most common non-infectious human diseases, occurring in 15-40% of the adult population. Under the age of 40, hypertension is more often observed in men, after 50 years – in women.
In difficult cases, especially in people with labile blood pressure, it is recommended to measure blood pressure at home and use 24-hour blood pressure monitoring.
Blood pressure at home in people with labile blood pressure is usually lower than in a clinic, since the “white coat effect” is eliminated.
For 24-hour blood pressure monitoring, special equipment is used, which allows, under normal living conditions, to measure blood pressure every 15 minutes during the day and every 30 minutes during sleep.
The normal average blood pressure value during wakefulness is 135/85, and during sleep – 120/70.
When monitoring is used, arterial hypertension is diagnosed when the average daily pressure is 135/85 or higher, the pressure during wakefulness is 140/90 or more, and during sleep – 125/75 or higher.
All patients with newly diagnosed arterial hypertension are examined.
The objectives of the initial survey are the following:

confirm the stability of the blood pressure increase;
Exclude the secondary nature of hypertension;
Establish avoidable and irreducible risk factors for cardiovascular diseases;
Assess for the presence of target organ damage, cardiovascular and other associated diseases.
Assess the individual risk level of coronary artery disease and cardiovascular complications.

Features of physical examination of patients with newly diagnosed arterial hypertension:

2-3 times blood pressure measurement according to WHO standard;
measuring height, weight, waist and hip circumference, calculating body mass index and waist/hip ratio;
examination of the cardiovascular system: determination of heart size, heart sounds and murmurs, pulse in the temporal, carotid, brachial, femoral arteries, arteries of the foot. If there is a change in the pulsation of the aorta or femoral arteries, measure blood pressure in the legs to exclude coarctation of the aorta. Looking for signs of heart failure;
examination of the lungs: searching for signs of congestion, bronchospasm;
examination of the abdominal cavity: search for vascular murmurs, pathological pulsation of the aorta, enlarged kidneys;
study of the nervous system to clarify the presence of cerebrovascular pathology;
fundus examination to determine the degree of hypertensive retinopathy.

Mandatory studies conducted before treatment to identify target organ damage and risk factors:

Analysis of urine;
general blood analysis;
biochemical blood test: determination of potassium, sodium, creatinine, glucose, total cholesterol and high-density lipoproteins;
ECG in 12 leads.

If signs of secondary arterial hypertension, signs of damage to other organs, complications are detected, then an appropriate special examination is carried out.

Arterial hypertension syndrome
1. Blood pressure is 140/90 or higher with repeated (at least 2) measurements under different conditions. This is a pathognomonic sign of the disease.
2. An increase in pulse tension in the radial arteries (tense, hard pulse: pulsus durus), associated with an increase in blood pressure. A major symptom of hypertension syndrome.
3. 3. Strengthened, usually unspread and shifted to the left apical impulse. Such changes are associated with prolonged hypertension and left ventricular hypertrophy. This is a big but late sign.
4. An increase in the left border of the heart, the length and left part of the diameter of the heart due to arterial hypertension, an increase in vascular resistance at the outlet and hypertrophy of the left ventricle. This is a major but late symptom of hypertension syndrome.
5. Emphasis of the 2nd tone on the aorta due to an increase in pressure in the aorta and an increase in the force of slamming of the cusps of the aortic semilunar valve. A major and relatively early sign of hypertension.
6. Headaches are often constant in the occipital region, as well as paroxysmal, sometimes accompanied by nausea and vomiting. This is a large, but optional sign of arterial hypertension, since headaches are observed in only 60% of patients.
7. Electrocardiographic signs of left ventricular hypertrophy, the main of which are the following:
- Sokolov-Lyon index (SV1 +RV5 or RV6 > 35 mm).
- Cornell voltage index (RaVL + SV3 > 28 mm in men and > 20 mm in women).
- RaVL > 11 mm.
8. Echocardiographic signs of increased left ventricular mass.
9. Signs of hypertensive retinopathy.

Primary arterial hypertension (hypertension).

Primary arterial hypertension (PAH) accounts for 95-97% of all arterial hypertension. The etiology of PAH is unknown. Social factors play a major role in its development. To some extent, the definition of PAG formulated by G.F. is preserved. Lang back in the forties of the last century: hypertension is a neurosis of the higher vasomotor centers.

The clinical picture of PAG is largely determined by damage to target organs, which include the brain, heart, kidneys, and retina.

In more than half of the cases, patients may not feel symptoms of the disease and consider themselves healthy. Sometimes the first manifestations of the disease can be such serious complications as stroke or myocardial infarction.

This is why the key to timely diagnosis of PAH is regular blood pressure measurement in the entire population.
In others, PAG manifests itself as headaches, dizziness, visual disturbances (“flickering spots before the eyes”), pain in the heart area, and palpitations.

Headaches are often localized in the occipital region, less often in the parietal and frontal parts of the head, and worsen in the morning, after physical and mental stress. Very severe paroxysmal headaches with nausea and vomiting can occur during a hypertensive crisis.

Pain in the heart area can be of 3 types. The first type is anginal pain (paroxysmal, retrosternal, squeezing or pressing, lasting less than 10 minutes and quickly passing after taking nitroglycerin) associated with damage to the coronary arteries of the heart. The second type is mild stabbing or pressing pain in the apex of the heart, associated with increased pressure and overload of the left ventricle. Such pain usually goes away after blood pressure normalizes. The third type is emotionally brightly colored short-term or long-term, often stabbing, less often aching pain in the heart area, “lumbago.” This type of pain is associated with neurotic disorders.

Palpitations, a feeling of heart failure, are often caused by rhythm disturbances - extrasystole, atrial fibrillation, but sometimes neurotic disorders.

An objective examination reveals partial or complete arterial hypertension syndrome.

Some variants of arterial hypertension are characterized by hypertensive crises - paroxysmal, severe increases in blood pressure, fraught with life-threatening complications: acute cerebrovascular accident (stroke), myocardial infarction, acute left ventricular heart failure (cardiac asthma, pulmonary edema). This condition requires emergency treatment.

According to the WHO classification (1999), the degrees of arterial hypertension are distinguished (first, second, third), predominant damage to target organs and the degree of risk of complications.

The degree of arterial hypertension can be reliably determined only in persons with newly diagnosed hypertension and in the absence of use of antihypertensive drugs.

Note. If SBP and DBP are in different categories, the higher category is assigned.

Classification according to predominant target organ damage:

PAH with predominant brain damage;

PAH with predominant damage to the heart;

PAH with predominant kidney damage.

Classification according to the degree of risk of developing circulatory diseases:

First degree: low risk group
This group includes men and women under 55 years of age with stage I hypertension in the absence of risk factors, target organ damage and concomitant cardiovascular diseases. In such people, the risk of developing cardiovascular complications in the next 10 years is less than 15%.

Second degree: medium risk group
This group includes patients with a wide range of blood pressure fluctuations. The main sign of belonging to this group is the presence of risk factors in the absence of target organ damage and concomitant diseases. The risk of developing cardiovascular complications in the next 10 years in this group will be 15-20%.

Third degree: high risk group
This category includes patients with target organ damage, regardless of the degree of hypertension and associated risk factors. The risk of developing cardiovascular complications in the next 10 years in these patients is more than 20%.

Stage 4: very high risk group
This group includes patients with associated diseases (angina pectoris and/or previous myocardial infarction, revascularization surgery, heart failure, previous cerebral stroke or transient ischemic attack, nephropathy, chronic renal failure, peripheral vascular disease, stage III–IV retinopathy) regardless of the degree AG. This group also includes patients with high normal blood pressure in the presence of diabetes mellitus. The risk of developing cardiovascular complications in the next 10 years in this group exceeds 30%.

Basic principles of treatment of primary arterial hypertension.

The goal of treatment for patients with PAH is to reduce the risk of cardiovascular morbidity and mortality as much as possible. This goal should be achieved primarily through a targeted reduction in blood pressure. The target pressure for young and middle-aged people is 130/85 mm Hg. Art., for older people – 140/90 mmHg.
Both non-medicinal (smoking cessation, weight loss in people with excess nutrition, reducing salt consumption, increasing physical activity in people with physical inactivity) and drug therapy are used. The use of drug therapy requires special knowledge and skills.

Secondary (symptomatic) arterial hypertension.

Despite the fact that secondary arterial hypertension makes up only 3-5% of the total structure of arterial hypertension, their diagnosis is extremely important, since most of them require special, sometimes surgical, treatment.
There are 3 groups of secondary hypertension:

First group. Renal hypertension, which accounts for 70% of all secondary hypertension. These include renovascular hypertension (atherosclerosis of the renal arteries, fibromuscular dysplasia, arteritis of the renal arteries, etc.) and nephritis.

Second group. Endocrine hypertension (Conn syndrome, pheochromocytoma, Itsenko-Cushing's disease, thyrotoxicosis).

Third group. Hemodynamic hypertension (coarctation of the aortic arch, aortic atherosclerosis, aortic insufficiency).

According to the article: prof. V.A. Good, Prof. FROM. Batkin "Arterial hypertension: semiotics and diagnostics."
Main literature.
1. Prevention, diagnosis and treatment of primary arterial hypertension.
RMJ, 2000, 8:3-19.
2. 1999 World Health Organization-International Society of Hypertension, Guidelines for the Management of Hypertension. J. Hypertens, 1999,17,151-183.

Pressure measuring instruments:

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There are people who in their lives made only one discovery, invention, wrote one book, but as a result they forever entered the history of civilization. Each of us at least occasionally measured our blood pressure using a tonometer. This method is used all over the world, because it is the simplest, most accessible and reliable. But only specialists remember the name of the creator of this method.

Nikolai Sergeevich Korotkov was born on February 25, 1874 in Kursk.The family was a merchant, but trade did not attract the young man at all. In 1893 he graduated from the Kursk gymnasium, and in 1898 from the medical faculty of Moscow University. The abilities and diligence of the aspiring doctor were noticed: upon graduation, he was left to work as a surgeon at a Moscow surgical clinic, and then invited to the Military Medical Academy.

The Russo-Japanese War began, and the young surgeon went to the combat area. The greatest mortality rate at the front was due to injury to large vessels and, as a consequence, blood loss. Doctor Korotkov noted this for himself. Returning to the Military Medical Academy, he took up the issues of diagnosis, clinical presentation and treatment of traumatic injuries of arterial and venous vessels. Based on the experience already accumulated, he establishes signs for diagnosing traumatic vascular aneurysms and describes their most important symptoms.

When examining patients with vascular injuries, N.S. Korotkov gradually compressed the arteries until the pulse in the periphery completely disappeared, and at the same time listened to sounds in the segment of the vessel located below the place of compression. He wrote about this: “... while doing research on sounds when squeezing blood vessels, I had to find out what phenomena are accompanied by the transformation of one type of energy into another in the arteries.” And I found out that a completely compressed artery does not produce any sounds. With the gradual decompression of the artery, sound phenomena occur, which can be used to judge the level of blood pressure. To measure pressure, Korotkov proposed an elastic rubber sleeve-cuff, which we still use today.

It all seems so simple! After all, existing methods of measuring blood pressure required artery puncture, connecting blood vessels to a pressure gauge, and other inconveniences. But the simplicity of any discovery is always deceptive. So Korotkov, before announcing his method, tested it many times on animals and people.

Having summarized his observations, at the end of 1905 he reported on them at a scientific meeting in St. Petersburg. The message immediately aroused interest. It didn't take long for this method of measuring blood pressure to be accepted throughout the world.

It remains a mystery why such a gifted researcher ended up in Siberia as a simple mine doctor in 1908-1909. But he does not stop scientific work. In 1910, Korotkov came to the Military Medical Academy and defended his doctoral dissertation. However, he immediately returns to the Lena mines as a simple surgeon. What kind of person was this? An incorrigible romantic, an inquisitive researcher or a democrat who has gone “to the people”? He witnessed the execution of miners who demanded economic reforms at the Lena mines, which shocked the whole of Russia. Apparently, this was the reason for his return to St. Petersburg. During the First World War, Korotkov worked as a surgeon at the Invalides' Home, and after the revolution, as a senior doctor at the Mechnikov Hospital in Leningrad. He died in 1920.

In 2005, the discovery of N.S. Korotkov will turn 100 years old. Scientific thought and medical technology have made great strides forward. However, the method of auscultatory measurement of blood pressure, due to its simplicity and sufficient accuracy of the data obtained, undoubtedly remains the most convenient in everyday medical work.

Mikhail Lagutich, doctor, local historian.

Kursk.

KOROTKOV METHOD

Arterial pressure.

Blood pressure (BP) is the most important parameter of human health. There are systolic (maximum) pressure, diastolic (minimum) pressure, mean pressure and pulse pressure.

Riva-Rocci in 1896 invented a device for bloodless determination of blood pressure, which consisted of a mercury manometer, a rubber cuff and a balloon for inflating air into the cuff.

Korotkov identified the following 5 phases of sounds with a gradual decrease in pressure in the cuff compressing the shoulder:

1st phase. As the cuff pressure approaches systolic, sounds appear that gradually increase in volume.

Phase 2. As the cuff deflates further, “rusting” sounds appear.

Phase 3. Tones appear again and increase in intensity.

Phase 4. Loud tones suddenly change to quiet tones.

Phase 5. Quiet tones disappear completely.

Considering the importance of a qualified determination of blood pressure in humans, we present a method for measuring blood pressure approved by WHO (1999).

Methodology for measuring blood pressure using the Korotkov auscultation method (WHO expert recommendations)

1. Blood pressure measurement.

1. Setting. Blood pressure measurements should be carried out in a quiet, calm and comfortable environment at a comfortable temperature. External influences that may increase blood pressure variability or interfere with auscultation should be avoided. When using a mercury sphygmomanometer, the meniscus of the mercury column should be at eye level of the person taking the measurement. The patient should sit in a straight-backed chair next to the table. To measure blood pressure in a standing position, a stand with adjustable height and a supporting surface for the arm and tonometer is used. The height of the table and stand should be such that when measuring blood pressure, the middle of the cuff placed on the patient’s shoulder is at the level of the patient’s heart, i.e. approximately at the level of the fourth intercostal space in a sitting position or at the level of the midaxillary line in a lying position. Deviation of the position of the middle of the cuff placed on the patient's shoulder or thigh from the level of the heart can lead to a false change in blood pressure of 0.8 mmHg. for every 1 cm: overestimation of blood pressure when the cuff is positioned below the heart level and underestimation of blood pressure when the cuff is positioned above the heart level. Supporting your back on the back of the chair and your arms on a supporting surface prevents an increase in blood pressure due to isometric muscle contraction.

Blood pressure measurements should be taken in a quiet, calm and comfortable environment.

2. Preparation for blood pressure measurement and duration of rest. Blood pressure should be measured 1-2 hours after eating. The patient should not smoke or drink coffee for 1 hour before measurement. The patient should not wear tight, constricting clothing. The arm on which blood pressure will be measured must be bare. The patient should sit supported by the back of a chair with relaxed, uncrossed legs. Explain the measurement procedure to the patient and warn that you will answer all questions after the measurement. It is not recommended to talk during measurements, as this may affect blood pressure levels. Blood pressure measurements should be taken after at least 5 minutes of rest.

3. Cuff size. The width of the cuff should cover at least 40% of the shoulder circumference and at least 80% of its length. Blood pressure is measured on the left arm or on the arm with a higher blood pressure level (in diseases in which there is a significant difference between the patient’s right and left arms, as a rule, lower blood pressure is recorded on the left arm). The use of a narrow or short cuff leads to a significant false increase in blood pressure.

4. Cuff position. Determine by palpation the pulsation of the brachial artery at the level of the middle of the shoulder. The center of the cuff balloon should be located exactly above the palpable artery. The lower edge of the cuff should be 2.5 cm above the cubital fossa. The tightness of the cuff: a finger should fit between the cuff and the surface of the patient's shoulder.

The lower edge of the cuff should be 2.5 cm above the cubital fossa. The tightness of the cuff: the index finger should fit between the cuff and the surface of the patient's shoulder.

5. Definition the maximum level of air injection into the cuff is necessary to accurately determine systolic blood pressure with minimal discomfort for the patient and avoid “auscultatory failure.”

2) Continuing to palpate the radial artery, quickly inflate air into the cuff to 60 mm Hg, then inflate 10 mm Hg at a time. until the pulsation disappears.

3) The air from the cuff should be deflated at a speed of 2 mmHg. per second. The blood pressure level at which the pulse appears again is recorded.

4) Completely deflate the cuff.

To determine the level of maximum air injection into the cuff, the value of systolic blood pressure determined by palpation is increased by 30 mm Hg.

6. Position of the stethoscope. The point of maximum pulsation of the brachial artery is determined by palpation, which is usually located immediately above the cubital fossa on the inner surface of the shoulder. The membrane of the stethoscope should be in full contact with the surface of the shoulder. Excessive pressure with the stethoscope should be avoided as it may cause additional compression of the brachial artery. It is recommended to use a low frequency membrane. The head of the stethoscope should not touch the cuff or tubes, since the sound from contact with them may interfere with the perception of Korotkoff sounds.

7. Inflating and deflating the cuff. Air is pumped into the cuff to the maximum level (see point 5) quickly. Slow injection of air into the cuff leads to disruption of the venous outflow of blood, increased pain and blurred sound. Air is released from the cuff at a rate of 2 mm Hg. per second until Korotkoff sounds appear, then at a speed of 2 mm Hg. from blow to blow. If hearing is poor, you should quickly release the air from the cuff, check the position of the stethoscope and repeat the procedure. Slow release of air allows you to determine systolic and diastolic blood pressure at the beginning of the phases of Korotkoff sounds. The accuracy of blood pressure determination depends on the decompression rate: the higher the decompression rate, the lower the measurement accuracy.

8. Systolic blood pressure. The value of systolic blood pressure is determined when phase I of Korotkoff sounds appears using the nearest scale division (2 mm Hg). When phase I appears between two minimum divisions, the blood pressure corresponding to the higher level is considered systolic. In case of severe rhythm disturbances, additional blood pressure measurement is necessary.

9. Diastolic blood pressure . The level at which the last distinct tone is heard corresponds to diastolic blood pressure. When Korotkoff sounds continue to very low values or to 0, the blood pressure level corresponding to the beginning of phase IV is recorded. The absence of phase V Korotkoff sounds can be observed in children, during pregnancy, in conditions accompanied by high cardiac output. In these cases, the beginning of phase IV of Korotkoff sounds is taken as diastolic blood pressure.

If diastolic blood pressure is above 90 mm Hg, auscultation should be continued for 40 mm Hg, in other cases - for 10-20 mm Hg. after the last tone disappears. Compliance with this rule will allow you to avoid determining a falsely elevated diastolic blood pressure when sounds resume after auscultatory failure.

10. Recording blood pressure measurement results. It is recommended to record which arm the measurement was taken on, the cuff size and the patient's position. The measurement results are recorded in the form KI/KV. If the IV phase of Korotkoff sounds is determined - in the form of KI/KIV/KV. If complete disappearance of tones is not observed, the V phase of tones is considered equal to 0.

11. Repeated blood pressure measurements. Repeated blood pressure measurements are taken 1-2 minutes after the air is completely released from the cuff.

Blood pressure levels may fluctuate from minute to minute. The average of two or more measurements taken on the same arm more accurately reflects blood pressure levels than a single measurement.

12. Measuring blood pressure in other positions. During the first visit, it is recommended to measure blood pressure in both arms, in a lying and standing position. Postural changes in blood pressure are recorded after 1-3 minutes of the patient being in a standing position. It should be noted on which arm the blood pressure level is higher.

The difference in blood pressure between arms can be more than 10 mm Hg. A higher value more accurately corresponds to intra-arterial blood pressure.

Special situations when measuring blood pressure

Auscultatory failure. The period of temporary absence of sound between phases I and II of Korotkoff sounds. May last up to 40 mm Hg. It is observed with high systolic blood pressure.

Absence of phase V of Korotkoff sounds (the “infinite tone” phenomenon). It is observed with high cardiac output: in children, with thyrotoxicosis, fever, aortic insufficiency, in pregnant women. Korotkoff sounds are heard until the zero division of the sphygmomanometer scale. In these cases, the beginning of phase IV of Korotkoff sounds is taken as diastolic blood pressure and blood pressure is recorded as KI/KIV/K0.

Blood pressure measurement in the elderly. With age, thickening and compaction of the wall of the brachial artery are observed, and it becomes rigid. A higher (above intra-arterial) pressure level in the cuff is required to achieve compression of the stiff artery, resulting in a false increase in blood pressure (the phenomenon of “pseudohypertension”). Palpation of the radial pulse when the cuff pressure level exceeds systolic blood pressure helps to recognize this error. Blood pressure in the forearm should be determined by palpation. If the difference between systolic blood pressure determined by palpation and auscultation is more than 15 mm Hg. Only direct invasive measurement allows one to determine the patient's true blood pressure level. The patient should be informed about the problem and an appropriate entry should be made in the medical history to avoid measurement errors in the future.

Very large shoulder circumference (obese, very well developed muscles), conical arm. In patients with an upper arm circumference greater than 41 cm or with a tapered upper arm where normal cuff position cannot be achieved, accurate blood pressure measurement may not be possible. In such cases, using a cuff of the appropriate size, you should try to measure blood pressure by palpation and auscultation on the shoulder and forearm. If the difference is more than 15 mm Hg. Blood pressure determined by palpation on the forearm more accurately reflects true blood pressure.

Blood pressure standards.

In general, normal blood pressure is considered to be between 100/60 and 140/90. Blood pressure 140/90 and above is arterial hypertension, below 100/60 is arterial hypotension.

Since arterial hypertension develops in a population of people with normal blood pressure, in recent years several variants of normal blood pressure have been differentiated, which makes it easier to identify risk groups.

Arterial hypertension.

Arterial hypertension – an increase in blood pressure to 140/90 and higher with repeated (at least 2 times) measurements under different conditions according to the WHO method.

Arterial hypertension can be primary (essential) and secondary (symptomatic). Primary hypertension is observed in 95-97% of cases, secondary - in 3-5% of cases.

In Russia, primary arterial hypertension is usually called hypertension.

Primary arterial hypertension – one of the most common non-infectious human diseases, occurring in 15-40% of the adult population. Under the age of 40, hypertension is more often observed in men, after 50 years – in women.

In difficult cases, especially in people with labile blood pressure, it is recommended to measure blood pressure at home and use 24-hour blood pressure monitoring.

Blood pressure at home in people with labile blood pressure is usually lower than in a clinic, since the “white coat effect” is eliminated.

For 24-hour blood pressure monitoring, special equipment is used, which allows, under normal living conditions, to measure blood pressure every 15 minutes during the day and every 30 minutes during sleep.

The normal average blood pressure value during wakefulness is 135/85, and during sleep – 120/70.

When monitoring is used, arterial hypertension is diagnosed when the average daily pressure is 135/85 or higher, the pressure during wakefulness is 140/90 or more, and during sleep – 125/75 or higher.

All patients with newly diagnosed arterial hypertension are examined.

The objectives of the initial survey are the following:

Confirm the stability of the blood pressure increase;

Exclude the secondary nature of hypertension;

Establish avoidable and irreducible risk factors for cardiovascular diseases;

Assess for the presence of target organ damage, cardiovascular and other associated diseases.

Assess the individual risk level of coronary artery disease and cardiovascular complications.

Features of physical examination of patients with newly diagnosed arterial hypertension:

2-3 times blood pressure measurement according to WHO standard;

measuring height, weight, waist and hip circumference, calculating body mass index and waist/hip ratio;

examination of the cardiovascular system: determination of heart size, heart sounds and murmurs, pulse in the temporal, carotid, brachial, femoral arteries, arteries of the foot. If there is a change in the pulsation of the aorta or femoral arteries, measure blood pressure in the legs to exclude coarctation of the aorta. Looking for signs of heart failure;

examination of the lungs: searching for signs of congestion, bronchospasm;

examination of the abdominal cavity: search for vascular murmurs, pathological pulsation of the aorta, enlarged kidneys;

study of the nervous system to clarify the presence of cerebrovascular pathology;
fundus examination to determine the degree of hypertensive retinopathy.

Mandatory studies conducted before treatment to identify target organ damage and risk factors:

Analysis of urine;

general blood analysis;

biochemical blood test: determination of potassium, sodium, creatinine, glucose, total cholesterol and high-density lipoproteins;

ECG in 12 leads.

If signs of secondary arterial hypertension, signs of damage to other organs, complications are detected, then an appropriate special examination is carried out.

Arterial hypertension syndrome

1. Blood pressure is 140/90 or higher with repeated (at least 2) measurements under different conditions. This is a pathognomonic sign of the disease.

2. An increase in pulse tension in the radial arteries (tense, hard pulse: pulsus durus), associated with an increase in blood pressure. A major symptom of hypertension syndrome.

3. Strengthened, usually unspread and shifted to the left apical impulse. Such changes are associated with prolonged hypertension and left ventricular hypertrophy. This is a big but late sign.

4. An increase in the left border of the heart, the length and left part of the diameter of the heart due to arterial hypertension, an increase in vascular resistance at the outlet and hypertrophy of the left ventricle. This is a major but late symptom of hypertension syndrome.

5. Emphasis of the 2nd tone on the aorta due to an increase in pressure in the aorta and an increase in the force of slamming of the cusps of the aortic semilunar valve. A major and relatively early sign of hypertension.

6. Headaches are often constant in the occipital region, as well as paroxysmal, sometimes accompanied by nausea and vomiting. This is a large, but optional sign of arterial hypertension, since headaches are observed in only 60% of patients.

7. Electrocardiographic signs of left ventricular hypertrophy, the main of which are the following:

Sokolov-Lyon index (SV1 +RV5 or RV6 > 35 mm).

Cornell voltage index (RaVL + SV3 > 28 mm in men and > 20 mm in women).

RaVL > 11 mm.

8. Echocardiographic signs of increased left ventricular mass.

9. Signs of hypertensive retinopathy.

Primary arterial hypertension (hypertension).

The clinical picture of PAG is largely determined by damage to target organs, which include the brain, heart, kidneys, and retina.

This is why the key to timely diagnosis of PAH is regular blood pressure measurement in the entire population.

In others, PAG manifests itself as headaches, dizziness, visual disturbances (“flickering spots before the eyes”), pain in the heart area, and palpitations.

Palpitations, a feeling of heart failure, are often caused by rhythm disturbances - extrasystole, atrial fibrillation, but sometimes neurotic disorders.

An objective examination reveals partial or complete arterial hypertension syndrome.

According to the WHO classification (1999), the degrees of arterial hypertension are distinguished (first, second, third), predominant damage to target organs and the degree of risk of complications.

The degree of arterial hypertension can be reliably determined only in persons with newly diagnosed hypertension and in the absence of use of antihypertensive drugs.

Note. If SBP and DBP are in different categories, the higher category is assigned.

Classification according to predominant target organ damage:

PAH with predominant brain damage;

PAH with predominant damage to the heart;

PAH with predominant kidney damage.

Classification according to the degree of risk of developing circulatory diseases:

First degree: low risk group

This group includes men and women under 55 years of age with stage I hypertension in the absence of risk factors, target organ damage and concomitant cardiovascular diseases. In such people, the risk of developing cardiovascular complications in the next 10 years is less than 15%.

Second degree: medium risk group

This group includes patients with a wide range of blood pressure fluctuations. The main sign of belonging to this group is the presence of risk factors in the absence of target organ damage and concomitant diseases. The risk of developing cardiovascular complications in the next 10 years in this group will be 15-20%.

Third degree: high risk group

This category includes patients with target organ damage, regardless of the degree of hypertension and associated risk factors. The risk of developing cardiovascular complications in the next 10 years in these patients is more than 20%.

Stage 4: very high risk group

This group includes patients with associated diseases (angina pectoris and/or previous myocardial infarction, revascularization surgery, heart failure, previous cerebral stroke or transient ischemic attack, nephropathy, chronic renal failure, peripheral vascular disease, stage III–IV retinopathy) regardless of the degree AG. This group also includes patients with high normal blood pressure in the presence of diabetes mellitus. The risk of developing cardiovascular complications in the next 10 years in this group exceeds 30%.

Basic principles of treatment of primary arterial hypertension.

Both non-medicinal (smoking cessation, weight loss in people with excess nutrition, reducing salt consumption, increasing physical activity in people with physical inactivity) and drug therapy are used. The use of drug therapy requires special knowledge and skills.

Secondary (symptomatic) arterial hypertension.

There are 3 groups of secondary hypertension:

First group. Renal hypertension, which accounts for 70% of all secondary hypertension. These include renovascular hypertension (atherosclerosis of the renal arteries, fibromuscular dysplasia, arteritis of the renal arteries, etc.) and nephritis.

Second group. Endocrine hypertension (Conn syndrome, pheochromocytoma, Itsenko-Cushing's disease, thyrotoxicosis).

Third group. Hemodynamic hypertension (coarctation of the aortic arch, aortic atherosclerosis, aortic insufficiency).

Traditional spiritual healer VICTORIA.

Welcome to my site.celitel.kiev.ua

For 25 years people have been coming to me, each with their own problems. After the sessions they receive: healing of the most complex diseases, meet their other half, get married, husband, wife returns to the family, find a job, business gets better, childless people have children, fear and fear, especially in children, goes away, they stop drinking, smoking is removed from the negative energy (evil eye damage), housing, offices, cars are cleansed.

.My method is a sincere prayer to God, the Most Holy Theotokos, and to all the saints, for those who turn to me for help.I don’t tell fortunes.

Call, write, I will do everything possible to be useful for you. I accept you personally and helpfor those wishing to do so remotely With other cities, countries from abroad.This e-mail address is being protected from spambots. You need JavaScript enabled to view it.