Measurement of blood pressure at an outpatient appointment, in a hospital and at home: rules, problems and ways to solve them. Measurement of blood pressure - algorithm of actions

One of the most important indicators of the functional state of the human body is the pressure in large arteries, that is, the force with which blood presses on their walls during the work of the heart. It is measured at almost any visit to the general practitioner, whether it is a program of preventive examinations or treatment of complaints of well-being.

A word about pressure

The blood pressure level is expressed as two numbers written as a fraction. The numbers mean the following: at the top - systolic pressure, which is popularly called the upper one, at the bottom - diastolic, or lower. Systolic is fixed when the heart contracts and pushes blood out, diastolic - when it is maximally relaxed. The unit of measurement is a millimeter of mercury. The optimal pressure level for adults is 120/80 mm Hg. pillar. Blood pressure is considered elevated if it is more than 139/89 mm Hg. pillar.

Why you need to know your blood pressure

Even a slight increase in blood pressure increases the risk of developing a heart attack, stroke, ischemia, heart and kidney failure. And the higher it is, the greater the risk. Very often, hypertension initial stage proceeds without symptoms, and the person does not even know about his condition.

Measurement of blood pressure is the first thing to do when complaining of frequent headaches, dizziness, weakness.

Hypertensive patients should measure blood pressure every day and monitor its level after taking the pills. People with high blood pressure should not be drastically reduced with medications.

Methods for measuring blood pressure

You can determine the level of blood pressure in a direct and indirect way.

Straight

This invasive method is highly accurate, but it is traumatic, since it consists in the direct insertion of a needle into a vessel or cavity of the heart. The needle is connected to the manometer by a tube containing an anticoagulant. The result is a blood pressure fluctuation curve recorded by a scribe. This method is most often used in cardiac surgery.

indirect methods

Usually pressure is measured on peripheral vessels upper limbs, namely on the elbow bend of the arm.

Nowadays, two non-invasive methods are widely used: auscultatory and oscillometric.

The first one (auscultatory), proposed by the Russian surgeon N. S. Korotkov at the beginning of the 20th century, is based on clamping the shoulder artery with a cuff and listening to the tones that appear when air is slowly released from the cuff. Upper and lower pressures are determined by the appearance and disappearance of sounds that are characteristic of turbulent blood flow. Measurement of blood pressure according to this technique is carried out using a very simple device, consisting of a pressure gauge, a phonendoscope and a cuff with a pear-shaped balloon.

When measuring blood pressure in this way, a cuff is placed on the shoulder area, into which air is pumped until the pressure in it exceeds systolic. The artery at this moment is completely clamped, the blood flow in it stops, the tones are not heard. When air is released from the cuff, the pressure decreases. When the external pressure is compared with the systolic pressure, blood begins to pass through the squeezed area, noises appear that accompany the turbulent flow of blood. They are called Korotkov's tones, and they can be heard with a phonendoscope. At the moment when they occur, the value on the pressure gauge is equal to the systolic blood pressure. When the external pressure is compared with the arterial pressure, the tones disappear, and at this moment the diastolic pressure is determined by the manometer.

The microphone of the measuring device picks up the Korotkov tones and converts them into electrical signals that are fed to the recording device, on the display of which the values ​​\u200b\u200bof the upper and lower blood pressure appear. There are other devices in which the emerging and disappearing characteristic noises are determined using ultrasound.

The method of measuring blood pressure according to Korotkov is officially considered the standard. It has both pros and cons. Among the advantages can be called high resistance to hand movement. There are a few more disadvantages:

• Sensitive to noise in the room where the measurement is taken.
• The accuracy of the result depends on whether the location of the phonendoscope head is correct and on the individual qualities of the person who measures blood pressure (hearing, vision, hands).
• Skin contact with the cuff and microphone head is required.
• It is technically complicated, which causes measurement errors.
• It requires special preparation.

Oscillometric
With this method, blood pressure is measured with an electronic tonometer. The principle of this method is that the device registers pulsations in the cuff that appear when blood passes through the squeezed portion of the vessel. The main disadvantage of this method is that the hand must be motionless during the measurement. There are quite a few advantages:

• For carrying out special training is not required.
• The individual qualities of the measurer (vision, hands, hearing) do not matter.
• Resistant to indoor noise.
• Determines blood pressure with weak Korotkoff tones.
• The cuff can be put on a thin jacket, while this does not affect the accuracy of the result.

Types of tonometers

Today, aneroid (or mechanical) and electronic devices are used to determine blood pressure.

The former are used to measure pressure using the Korotkoff method in a medical institution, since they are too complicated for home use, and untrained users receive measurement errors with errors.

The electronic device can be automatic and semi-automatic. These blood pressure monitors are designed for daily home use.

General rules for measuring blood pressure

Pressure is most often measured in a sitting position, but sometimes it is done in a standing and lying position.

Since the pressure depends on the condition of the person, it is important to provide the patient with a comfortable environment. The patient himself should not eat, do not engage in physical labor, do not smoke, do not drink alcoholic beverages, do not be exposed to cold for half an hour before the procedure.

During the procedure, you can not make sudden movements and talk.

It is recommended to take measurements more than once. If a series of measurements is taken, a break of about one minute (at least 15 seconds) and a change of position are needed between each approach. During the break, it is recommended to loosen the cuff.

The pressure on different hands can vary significantly, in connection with this, it is better to take measurements on the one where the level is usually higher.

There are patients whose pressure in the clinic is always higher than when measured at home. This is due to the excitement that many experience at the sight of medical workers in white coats. For some, this can happen at home, this is a reaction to the measurement. In such cases, it is recommended to take measurements three times and calculate the average value.

The procedure for determining blood pressure in different categories of patients

In the elderly

In this category of persons, unstable blood pressure is more often observed, which is associated with disturbances in the blood flow regulation system, a decrease in vascular elasticity, and atherosclerosis. Therefore, elderly patients need to take a series of measurements and calculate the average value.

In addition, they need to have their blood pressure measured while standing and sitting, as they often experience sudden drops in blood pressure when changing positions, such as getting out of bed and sitting up.

In children

Children are recommended to measure blood pressure with a mechanical sphygmomanometer or an electronic semi-automatic device, while using a children's cuff. Before you measure your child's blood pressure yourself, you need to consult a pediatrician about the amount of air injected into the cuff and the time of measurement.

In pregnant women

By blood pressure, you can judge how well the pregnancy is proceeding. For expectant mothers, it is very important to constantly monitor blood pressure in order to start treatment on time and avoid serious complications in the fetus.

Pregnant women need to measure the pressure in a semi-recumbent state. If its level exceeds the norm or, conversely, is much lower, you should immediately contact your doctor.

With cardioarrhythmia

People who have a broken sequence, rhythm and heart rate need to measure blood pressure several times in a row, discard obviously incorrect results and calculate the average value. In this case, the air from the cuff must be released at a lower speed. The fact is that with cardioarrhythmia, its level can vary significantly from stroke to stroke.

Algorithm for measuring blood pressure

Measurement of blood pressure should take place in the following order:

1. The patient is seated comfortably on a chair so that his back is adjacent to the back, that is, he has support.
2. The hand is freed from clothing and laid on the table with the palm up, placing a towel roller or the patient's fist under the elbow.
3. A tonometer cuff is applied to the bare shoulder (two or three centimeters above the elbow, approximately at the level of the heart). Two fingers should pass between the arm and the cuff, its tubes pointing down.
4. The tonometer is at eye level, its arrow is at zero.
5. Find the pulse in the cubital fossa and apply a phonendoscope to this place with a slight pressure.
6. A valve is screwed on the pear of the tonometer.
7. The pear-shaped balloon is compressed and air is pumped into the cuff until the pulsation in the artery ceases to be heard. This occurs when the pressure in the cuff exceeds 20-30 mm Hg. pillar.
8. The valve is opened and air is released from the cuff at a rate of about 3 mmHg. pillar, while listening to Korotkov's tones.
9. When the first constant tones appear, the pressure gauge readings are recorded - this is the upper pressure.
10. Continue to release air. As soon as the weakening Korotkoff tones disappear, the readings of the pressure gauge are recorded - this is the lower pressure.
11. Release air from the cuff, listening to tones, until the pressure in it becomes equal to 0.
12. The patient is allowed to rest for about two minutes and the blood pressure is measured again.
13. The cuff is then removed and the results recorded in a diary.

Wrist Blood Pressure Technique

To measure blood pressure at the wrist with an electronic device with a cuff, you must follow the following instructions:

• Remove watches or bracelets from your arm, unbutton the sleeve and fold it back.
• Position the cuff of the tonometer above the hand by 1 centimeter with the display facing up.
• Place the arm with the cuff on the opposite shoulder, palm down.
• With the other hand, press the "Start" button and put it under the elbow of the arm with the cuff.
• Remain in this position until the air is automatically released from the cuff.

This method is not suitable for everyone. It is not recommended for people with diabetes, atherosclerosis and other circulatory disorders and changes in the vascular walls. Before using such a device, you need to measure the pressure with a tonometer with a cuff on the shoulder, then with a cuff on the wrist, compare the values ​​\u200b\u200band make sure that the difference is small.

Possible errors in measuring blood pressure

• Mismatch between cuff size and arm circumference.
• Wrong hand position.
• Inflating the cuff too fast.

What to consider when measuring pressure

• Stress can significantly change the readings, so you need to measure it in a calm state.
• Blood pressure rises with constipation, immediately after eating, after smoking and drinking alcohol, with excitement, in a sleepy state.
• It is best to carry out the procedure one to two hours after eating.
• It is necessary to measure blood pressure immediately after urination, since it is elevated before urination.
• The pressure changes after taking a shower or bath.
• A nearby mobile phone can change the readings of the tonometer.
• Tea and coffee can change blood pressure.
• To stabilize it, you need to take five deep breaths.
• It increases when you are in a cold room.

Conclusion

Determination of blood pressure at home follows the same principle as in a medical institution. The algorithm for measuring blood pressure remains approximately the same, but when using an electronic tonometer, the execution technique is noticeably simplified.

How to measure blood pressure

Causes and treatment of arterial hypertension

Normal - systolic 120-129, diastolic 80-84

High normal - systolic 130-139, diastolic 85-89

Arterial hypertension of the 1st degree - systolic 140-159, diastolic 90-99

Arterial hypertension of the 2nd degree - systolic 160-179, diastolic 100-109

Arterial hypertension of the 3rd degree - systolic above 180, diastolic above 110

Isolated systolic hypertension - systolic above 139, diastolic less than 90

Clinical picture

Symptoms of this disease are usually absent for a long time. Up to the development of complications, a person does not suspect about his disease if he does not use a tonometer. The main symptom is a persistent increase in blood pressure. The word "persistent" is paramount here, because. a person's blood pressure can also increase in stressful situations (for example, white coat hypertension), and after a while it normalizes. But, sometimes, the symptoms of arterial hypertension are headache, dizziness, tinnitus, flies before the eyes.

Other manifestations are associated with damage to target organs (heart, brain, kidneys, blood vessels, eyes). Subjectively, the patient may notice a deterioration in memory, loss of consciousness, which is associated with damage to the brain and blood vessels. With a long course of the disease, the kidneys are affected, which can be manifested by nocturia and polyuria. Diagnosis of arterial hypertension is based on the collection of anamnesis, measurement of blood pressure, detection of target organ damage.

One should not forget about the possibility of symptomatic arterial hypertension and exclude diseases that could cause it. Mandatory minimum examinations: general analysis blood with the determination of hematocrit, general urinalysis (determination of protein, glucose, urinary sediment), blood test for sugar, determination of cholesterol, HDL, LDL, triglycerides, uric acid and creatinine in blood serum, sodium and potassium of blood serum, ECG. There are additional examination methods that the doctor may prescribe if necessary.

Differential diagnosis of arterial hypertension

Differential diagnosis of arterial hypertension is between symptomatic and essential. This is necessary to determine the tactics of treatment. Suspect a secondary arterial hypertension can be based on certain features:

1. from the very beginning of the disease is established high pressure characteristic of malignant hypertension
2. high blood pressure is not amenable to medical treatment
3. hereditary history is not burdened by hypertension
4. acute onset of the disease

Arterial hypertension and pregnancy

Arterial hypertension in pregnant women can occur both during pregnancy (gestational) and before it. Gestational hypertension occurs after the 20th week of pregnancy and disappears after delivery. All pregnant women with hypertension are at risk for preeclampsia and placental abruption. In the presence of such conditions, the tactics of conducting childbirth change.

Treatment of the disease

Methods of treatment of arterial hypertension are divided into drug and non-drug. First of all, you need to change your lifestyle (do physical education, go on a diet, give up bad habits). What is the diet for hypertension?

It includes restriction of salt (2-4 g) and liquid, it is necessary to reduce the intake of easily digestible carbohydrates, fats. Food must be taken fractionally, in small portions, but 4-5 times a day. Drug therapy includes 5 groups of drugs for the correction of blood pressure:

• Diuretics
• Beta blockers
• ACE inhibitors
• calcium antagonists
• Angiotensin II receptor antagonists

All drugs have different mechanisms of action, as well as their contraindications. For example, thiazide diuretics should not be used during pregnancy, severe chronic renal failure, gout; beta-blockers are not used for bronchial asthma, COPD, severe bradycardia, atrioventricular block 2.3 degrees; angiotensin-2 receptor antagonists are not prescribed in cases of pregnancy, hyperkalemia, bilateral stenosis of the renal arteries).

Very often, drugs are produced in a combined state (the following combinations are considered the most rational: diuretic + ACE inhibitor, beta-blocker + diuretic, angiotensin-2 receptor antagonists + diuretic, ACE inhibitor + calcium antagonist, beta-blocker + calcium antagonist). There are new drugs for the treatment of hypertension: imidazoline receptor antagonists (they are not in the international recommendations for treatment).

Prevention

People who are predisposed to this disease are especially in need of prevention of arterial hypertension. As a primary prevention, it is necessary to lead an active lifestyle, go in for sports, as well as eat right, avoid overeating, excessive consumption of fats and carbohydrates, and give up bad habits.

All this is the most effective method prevention of hypertension.

Intraventricular hemorrhage (IVH) in newborns: causes, degrees, manifestations, prognosis

Neurological pathology in newborns and children of the first years of life is a very serious problem, and, unfortunately, brain damage in babies is by no means uncommon. IVH is intraventricular hemorrhage, which is very characteristic of the neonatal period and often accompanies the pathological course of childbirth.

Intraventricular hemorrhages are also found in adults, representing one of the forms of stroke with high mortality. As a rule, blood at the same time penetrates into the ventricular system from intracerebral hematomas when they break through into the brain cavity.

Hemorrhage into the ventricles of the brain in children is usually isolated, not associated with parenchymal hematomas, that is, it can be considered as an independent separate disease.

The significance of the problem of intraventricular hemorrhage in newborns is due not only to the difficulties of diagnosing and treating pathology, because many drugs are contraindicated for babies, and immature nervous tissue is extremely sensitive to any adverse circumstances, but also to a prognosis that can not always reassure young parents.

In addition to children born during the abnormal course of the birth period, IVH is diagnosed in preterm infants, and the shorter the gestation period at which the premature birth occurred, the greater the likelihood of IVH and the more severe the degree of ischemic-hypoxic brain damage.

In babies born prematurely, half of the hemorrhages in the ventricles occur already on the first day of life, up to 25% of IVH occurs on the second day after birth. How older child, the less the likelihood of circulatory disorders in the brain, even under the condition of an abnormal course of childbirth.

To date, the arsenal of neonatologists has highly informative research methods that allow timely diagnosis of intraventricular hemorrhage, but problems with classification, determining the stage of pathology have not yet been resolved. A unified classification of IVH has not been developed, and when formulating the stages, the features of the topography of the lesion are taken into account rather than the clinical severity and prognosis.

Causes of intraventricular hemorrhages in newborns

The causes of IVH in young children are fundamentally different from those that cause hemorrhages in adults. If in the latter vascular factors come to the fore - hypertension, atherosclerosis underlying strokes, and the very penetration of blood into the ventricles is secondary to intracerebral hematoma, then in newborn babies the situation is somewhat different: hemorrhage immediately occurs inside the ventricles or under their lining , and the reasons are somehow related to pregnancy and childbirth:

• state of prematurity;
• Long waterless period;
• Severe hypoxia in childbirth;
• Obstetric injuries (rare);
• Birth weight less than 1000 g;
• Congenital disorders of blood coagulation and vascular structure.

In premature babies, the presence of the so-called germinal (embryonic matrix) is considered as the main cause of intraventricular hemorrhages, which should gradually disappear as the fetal brain and vascular system mature. If the birth occurred prematurely, then the presence of this structure creates the prerequisites for IVH.

The germinal matrix is ​​a region of nervous tissue around the lateral ventricles containing immature cells that migrate to the brain and become neurons or neuroglia when they mature. In addition to cells, this matrix carries immature capillary-type vessels, the walls of which are single-layered, therefore they are very fragile and can break.

Hemorrhage into the germinal matrix is ​​not yet IVH, but it most often leads to the penetration of blood into the ventricles of the brain. A hematoma in the nervous tissue adjacent to the wall of the ventricle breaks through its lining, and blood rushes into the lumen. From the moment of the appearance of even a minimal volume of blood in the ventricle of the brain, one can speak of the onset of an independent disease - intraventricular hemorrhage.

Determining the stages of IVH is necessary to assess the severity of the disease in a particular patient, as well as to determine the prognosis in the future, which depend on the amount of blood that has entered the ventricles and the direction of its spread towards the nervous tissue.

Radiologists base IVH staging on results computed tomography. They highlight:

• IVH of the 1st degree - subependymal - blood accumulates under the lining of the ventricles of the brain, without destroying it and without entering the ventricle. In fact, this phenomenon cannot be considered a typical IVH, but at any time a breakthrough of blood into the ventricles can occur.
• IVH of the 2nd degree is a typical intraventricular hemorrhage without expansion of its cavity, when blood exits from the subependymal space. On ultrasound, this stage is characterized as IVH with less than half of the volume of the ventricle filled with blood.
• IVH grade 3 - blood continues to flow into the ventricle, filling more than half of its volume and expanding the lumen, which can be seen on CT and ultrasound.
• IVH of the 4th degree is the most severe, accompanied not only by the filling of the ventricles of the brain with blood, but also by its spread further into the nervous tissue. CT shows signs of IVH of one of the first three degrees along with the formation of foci of parenchymal intracerebral hemorrhage.

Based on structural changes in the brain and its cavities, three stages of IVH are distinguished:

1. At the first stage, the ventricles are not completely filled with blood contents, they are not dilated, spontaneous cessation of bleeding and the preservation of normal liquorodynamics are possible.
2. Continued filling of the lateral ventricles with possible expansion when at least one of the ventricles is filled with blood by more than 50%, and the blood spreads to the 3rd and 4th ventricles of the brain occurs in the second stage.
3. The third stage is accompanied by the progression of the disease, the ingress of blood under the choroid of the cerebellum, medulla oblongata and spinal cord. High risk of fatal complications.

The severity of IVH and its manifestations will depend on how quickly the blood penetrated into the brain tissue and its cavity, as well as on its volume. Hemorrhage always spreads along the course of the flow of cerebrospinal fluid. In severely premature babies, as well as those who have undergone deep hypoxia, disturbances in the blood coagulation system occur, so clots in the brain cavities do not appear for a long time, and liquid blood “spreads” freely through the brain regions.

At the heart of the CSF circulation disorder and the subsequent increase in hydrocephalus is the penetration of blood into the ventricle, where it mixes with the cerebrospinal fluid, but does not immediately clot. Part of the liquid blood penetrates into other cavities of the brain, but as it coagulates, its clots begin to block the narrow zones through which the CSF circulates. The blockage of any of the openings of the brain entails a blockade of the CSF pathway, expansion of the ventricles and hydrocephalus with characteristic symptoms.

IVH manifestations in young children

Up to 90% of all hemorrhages in the ventricular system occur in the first three days of a baby's life, and the lower its weight, the higher the likelihood of pathology. After the first week of a child's life, the risk of hemorrhage is significantly reduced, which is associated with the adaptation of the vascular system to new conditions and the maturation of the structures of the germ cell matrix. If the child was born prematurely, then for the first days he should be under the close supervision of neonatologists - for 2-3 days the condition may deteriorate sharply due to the onset of IVH.

Small subependymal hemorrhages and grade 1 IVH may be asymptomatic. If the disease does not progress, then the condition of the newborn will remain stable, and neurological symptoms will not even occur. With multiple hemorrhages under the ependyma, signs of brain damage will appear closer to the year with leukomalacia.

A typical intracerebral hemorrhage is manifested by symptoms such as:

• Decreased muscle tone;
• Flaccid tendon reflexes;
• Respiratory disorders up to a stop (apnea);
• convulsions;
• Focal neurological symptoms;
• Coma.

The severity of the course of the pathology and the features of the symptoms are associated with the volume of blood that has entered the ventricular system and the rate of pressure increase in the cranial cavity. Minimal IVH, which does not cause obstruction of the CSF tract and changes in ventricular volume, will be accompanied by an asymptomatic course, and it can be suspected by a decrease in the hematocrit number in the baby's blood.

A spasmodic flow is observed with moderate and submassive IVH, which are characterized by:

1. Oppression of consciousness;
2. Paresis or muscle weakness;
3. Oculomotor disorders (histagmus, strabismus);
4. Respiratory disorders.

Symptoms with an intermittent course are expressed for several days, after which they gradually decrease. Both a complete recovery of brain activity and minor deviations are possible, but the prognosis is generally favorable.

The catastrophic course of IVH is associated with severe disorders of the brain and vital organs. Characterized by coma, respiratory arrest, generalized convulsions, cyanosis of the skin, bradycardia, lowering blood pressure, violations of thermoregulation. Intracranial hypertension is evidenced by the bulging of the large fontanel, which is clearly visible in newborns.

Apart from clinical signs disorders of nervous activity, there will be changes in laboratory parameters. The occurrence of IVH in newborns may be indicated by a drop in hematocrit, a decrease in calcium, fluctuations in blood sugar, blood gas disorders (hypoxemia), and electrolyte disturbances (acidosis) are not uncommon.

The complications of IVH include blockade of the CSF pathways by blood clots with the development of acute occlusive hydrocephalus, atrophy of the cerebral cortex, and impaired psychomotor development. Violation of the circulation of cerebrospinal fluid leads to an increase in the size of the ventricles, an increase in intracranial pressure and compression of the cerebral cortex, which already suffers from hypoxia. The result is a convulsive syndrome, depression of consciousness and coma, cardiac and respiratory arrest.

The progression of bleeding leads to the spread of blood from the ventricles into the cisterns of the brain and nervous tissue. Parenchymal intracerebral hematomas are accompanied by gross focal symptoms in the form of paresis and paralysis, sensory disturbances, generalized convulsive seizures. When IVH is combined with intracerebral hemorrhage, the risk of an unfavorable outcome is extremely high.

Among the long-term consequences of IVH, ischemic-hypoxic damage and residual changes in the brain in the form of cysts, periventricular leukomalacia, white matter gliosis, and cortical atrophy are noted. By about a year, a developmental lag becomes noticeable, motor skills suffer, the child cannot walk and perform the correct movements of the limbs in due time, does not speak, and lags behind in mental development.

Diagnosis of IVH in infants is based on an assessment of symptoms and examination data. The most informative is CT, neurosonography and ultrasound. CT is accompanied by radiation, so it is preferable for premature babies and newborns of the first days of life to conduct an ultrasound examination.

Treatment and prognosis

Children with IVH are treated by neurosurgeons and neonatologists. Conservative therapy It is aimed at restoring the work of vital organs and blood counts. If the child did not receive vitamin K at birth, then it must be introduced. Deficiency of coagulation factors and platelets is replenished by transfusion of plasma components. When breathing stops, artificial ventilation of the lungs is performed, but it is better to establish it as planned if there is a risk of respiratory disorders.

Medical therapy includes:

• Normalization of blood pressure to prevent a sharp decrease or jumps that aggravate hypoxia and damage to the nervous tissue;
• oxygen therapy;
• anticonvulsants;
• Blood clotting control.

To reduce intracranial pressure, the introduction of magnesium sulfate intravenously or intramuscularly is indicated, diacarb, furosemide, veroshpiron are used for full-term children. Anticonvulsant therapy consists in the appointment of diazepam, valproic acid preparations. To relieve symptoms of intoxication, infusion therapy is carried out, acidosis (acidification of the blood) is eliminated by using a solution of sodium bicarbonate intravenously.

In addition to medication, surgical treatment of IVH is carried out: evacuation of blood from the ventricles of the brain by means of their puncture under ultrasound control, the introduction of fibrinolytic agents (actelyse) into the lumen of the ventricles to prevent thrombosis and occlusive hydrocephalus. Perhaps a combination of puncture with the introduction of fibrinolytic drugs.

In order to remove tissue decay products and eliminate the symptoms of intoxication, liquor filtration, liquor sorption and intraventricular lavage with artificial cerebrospinal fluid preparations are indicated.

With blockage of the cerebrospinal fluid and hydrocephalic syndrome, temporary drainage of the ventricles is established with the evacuation of blood and clots until the cerebrospinal fluid is cleared and the obstruction of its outflow pathways is eliminated. In some cases, repeated lumbar and ventricular punctures, external ventricular drainage, or temporary internal drainage with implantation of artificial drainage under the skin are used.

If hydrocephalus has acquired a persistent and irreversible character, and there is no effect from fibrinolytic therapy, then neurosurgeons provide permanent drainage by surgery:

1. Installation of permanent shunts with CSF outflow into the abdominal cavity (a silicone tube passes under the skin from the head to the abdominal cavity, the shunt can be removed only if the child's condition stabilizes and there is no progression of hydrocephalus);
2. Endoscopic imposition of anastomoses between the ventricles of the brain and the basal cisterna.

The most common method of surgical treatment of occlusive hydrocephalus associated with IVH is ventriculoperitoneal drainage. It is affordable, allows you to enter into the ventricles medicines, has a low probability of infection, can be carried out for a long time, while caring for a child is not accompanied by difficulties. The use of alteplase, which accelerates the dissolution of blood clots in the ventricles, can reduce mortality and maximize brain function.

The prognosis for IVH is determined by the stage of the disease, the amount of hemorrhage, and the location of brain tissue damage. In the first two degrees of IVH, blood clots resolve themselves or under the influence of treatment, without causing significant neurological disorders, therefore, with small hemorrhages, the child can develop normally.

Massive intraventricular hemorrhages, especially if they are accompanied by damage to the brain tissue, can lead to the death of an infant in a short time, and if the patient survives, then it is problematic to avoid neurological deficit and gross violations of psychomotor development.

All children with intracranial hemorrhages are subject to careful observation in intensive care and timely surgical treatment. After installing a permanent shunt, the disability group is determined, and the baby should be regularly shown to a neurologist.

To avoid the severe changes described, it is important to observe measures to prevent brain damage in newborns and very preterm infants. Expectant mothers need to undergo the necessary preventive examinations and examinations in a timely manner, and with the threat of premature birth, the task of obstetrician-gynecologists is to prolong the pregnancy as much as possible with medications until such a time when the risk of hemorrhages becomes minimal.

If the child is still born prematurely, then he is placed in the intensive care unit for observation and treatment. Modern methods diagnostics and therapy of IVH can not only save the lives of babies, but also significantly improve their quality, even if this requires a surgical operation.

Blood pressure is measured by a doctor or nurse on an outpatient basis or in a hospital (clinical blood pressure). Measurements are carried out by the auscultatory method (according to N.S. Korotkov). It is allowed to use automatic (auscultatory or oscillometric) devices, but only in cases where their accuracy in clinical practice is confirmed in special studies conducted in accordance with international and domestic standards. The patient or his relatives can measure blood pressure independently using automatic or semi-automatic "household" blood pressure meters at home. This method, which has become widespread in recent years, is referred to as the BP self-monitoring method (SCAD). Ambulatory blood pressure monitoring (ABPM) is carried out by medical workers on an outpatient basis or in a hospital setting.

Clinical measurement of blood pressure has the greatest evidence base for diagnosing hypertension and evaluating the effectiveness of antihypertensive therapy (AHT). The accuracy of blood pressure measurement and, accordingly, the diagnosis of hypertension, the determination of its severity, depend on compliance with the rules for measuring blood pressure.

The position of the patient

Sitting in a comfortable position; the hand is placed on the table at the level of the heart; the cuff is superimposed on the shoulder, its lower edge is 2 cm above the elbow.

Conditions for measuring blood pressure

The use of coffee and strong tea is excluded for 1 hour before the study; it is not recommended to smoke for 30 minutes before measuring blood pressure; sympathomimetics are canceled, including nasal and eye drops; BP is measured at rest after a 5-minute rest; if the procedure for measuring blood pressure was preceded by significant physical or emotional stress, the rest period should be extended to 15-30 minutes.

Equipment

The size of the cuff should correspond to the size of the arm: the rubber inflated part of the cuff should cover at least 80% of the circumference of the upper arm; Measurements of the arm circumference at the upper third of the upper arm can be helpful in selecting the appropriate cuff size. The following cuff sizes are recommended: for a shoulder with a circumference of 27-34 cm - a cuff of 13 × 30 cm; for a shoulder with a circumference of 35-44 cm - cuff 16 × 38 cm; for an arm with a circumference of 45-52 cm, a cuff of 20 × 42 cm. Thus, for many obese patients, standard-sized cuffs may not be sufficient to obtain reliable blood pressure measurements. The mercury column or the arrow of the tonometer must be at zero before starting the measurement.

Multiplicity of measurement

To determine the level of blood pressure, at least two measurements should be performed with an interval of at least 1 minute on each arm; with a difference in blood pressure> 5 mm Hg. Art. make an additional measurement; for the final value of blood pressure is taken the average of 2-3 measurements. In the elderly, patients with diabetes and patients with other conditions that may be accompanied by orthostatic hypotension, it is advisable to measure blood pressure 1 and 3 minutes after standing (orthostasis). To more accurately determine the level of blood pressure in patients with cardiac arrhythmias (in particular, atrial fibrillation), it is advisable to measure blood pressure several times.

To confirm hypertension when detecting blood pressure in the range of 135-139 / 85-89 mm Hg. repeated measurement (2-3 times) is carried out after a certain period of time, determined by the doctor in each case. In these individuals, it is useful to recommend home BP measurement and/or ABPM. When diagnosing hypertension in a patient, along with conducting studies to identify signs of POM and prescribing treatment (non-drug and drug if indicated), repeated measurements of blood pressure are carried out depending on the clinical situation.

Measurement technique

Inflate the cuff to a pressure level that is 20 mmHg above the systolic blood pressure. Art. (assessed by the disappearance of the pulse). Decrease cuff pressure slowly at a rate of 2 mm Hg. Art. in 1 second. The level of blood pressure at which the 1st tone appears corresponds to SBP (phase 1 of Korotkoff's tones), the pressure level at which the tones disappear (phase 5 of Korotkoff's tones) corresponds to DBP. In children, adolescents and young people immediately after exercise, in pregnant women and in some pathological conditions in adults, it is sometimes impossible to determine the 5th phase, in such cases one should try to determine the 4th phase of the Korotkoff sounds, which is characterized by a significant weakening of the tones. If the tones are very weak, then you should raise your hand and perform several squeezing movements with the brush, then repeat the measurement, while not strongly squeezing the artery with the membrane of the phonendoscope.

At the initial examination of the patient, the pressure on both hands should be measured; in the future, measurements are carried out on the arm on which blood pressure is higher. The heart rate is calculated from the pulse per radial artery(at least 30 seconds) after the second BP measurement in the sitting position.

In patients over 65 years of age, in the presence of diabetes and in persons receiving antihypertensive therapy (AHT), blood pressure should be measured not only in the sitting position, but also in orthostasis after 3 minutes of standing.

BP self-monitoring method

Blood pressure indicators obtained during self-monitoring of blood pressure (SBP) can be a valuable addition to clinical blood pressure in the diagnosis of hypertension and monitoring the effectiveness of treatment, but suggest the use of other standards (Table 2). The value of BP obtained by the SCAD method correlates more closely with POM and disease prognosis than clinical BP and its predictive value is comparable to the 24-hour BP monitoring method (ABPM) after adjusting for sex and age. It has been proven that the SCAD method increases the adherence of patients to treatment. The limitations of using the SCAD method are those cases when the patient is inclined to use the obtained results for self-correction of therapy.

It should be taken into account that the SCAD cannot provide information about the levels of blood pressure during the "everyday" (real) daytime activity, especially among the working part of the population, and at night.

For ACS, traditional tonometers with dial gauges, as well as automatic and semi-automatic devices for home use that have passed certification, can be used. To assess the level of blood pressure in situations of a sudden deterioration in the patient's well-being outside the hospital (when traveling, at work, etc.), it is possible to recommend the use of automatic carpal blood pressure meters, but with the same rules for measuring blood pressure (2-3 times measurement, the location of the hand at the level of the heart etc.). It should be remembered that blood pressure measured at the wrist may be slightly lower than the blood pressure at the upper arm.

Method of daily monitoring of blood pressure

Clinical BP is the primary method of BP measurement and risk stratification, but ABPM has a number of distinct advantages:

provides information about the level of blood pressure during "everyday" activity (in the real life of the patient)

provides information about the level of blood pressure during the night

allows you to refine the forecast of CCO

more closely associated with target organ damage than clinical BP

more accurately evaluates the antihypertensive effect of therapy.

Only the ABPM method allows you to determine the circadian rhythm of blood pressure, nocturnal hypotension or hypertension, blood pressure dynamics in the early morning hours, the uniformity and sufficiency of the antihypertensive effect of drugs.

Indications for ABPM are given below in conjunction with CAD.

For ABPM, only devices that have successfully passed clinical trials according to international protocols, confirming the accuracy of measurements, can be recommended. When interpreting ABPM data, the focus should be on the average values ​​of blood pressure for the day, night and day; daily index (difference between blood pressure during the daytime and at night); the value of blood pressure in the morning; BP variability, daytime and nighttime (std) and pressure load indicator (percentage of elevated BP values ​​during daytime and nighttime hours).

Clinical indications for the use of ABPM and SCAD for diagnostic purposes

Central blood pressure

Complex hemodynamic phenomena are observed in the arterial bed, leading to the appearance of "reflected" pulse waves mainly from resistive vessels, and their summation with the main (direct) pulse wave that occurs when blood is ejected from the heart. The summation of direct and reflected waves in the systole phase leads to the formation of the phenomenon of "augmentation" (amplification) of the SBP. The sum of direct and reflected waves differs in different parts of the main vessels. Normal SBP for lower limbs, higher than the SBP measured at the shoulder, by 5-20%.

The greatest prognostic value has blood pressure in the ascending or central part of the aorta or "central" blood pressure (CAP). There are special techniques (applanation tonometry of radiation or carotid artery), which allow, based on the quantitative sphygmogram and blood pressure measured on the shoulder, to calculate the CAP. The first studies have shown that the estimated CAP may be more valuable in assessing the effectiveness of the therapy. CAP allows to identify additional groups of patients with "pseudohypertension", for example, isolated systolic hypertension in young people who have normal CAP, with elevated blood pressure on the shoulder (high summation of direct and abnormally high reflected pressure waves in the upper extremities).

Examination methods:

collection of anamnesis, includes data collection about the presence of RF, subclinical symptoms of POM, the presence of a history of CVD, CVD, CKD and secondary forms of hypertension, as well as previous experience in the treatment of hypertension.

Physical examination in a patient with hypertension is aimed at identifying risk factors, signs of secondary forms of hypertension and organ damage. Height, body weight are measured with the calculation of body mass index (BMI) in kg / m 2 (determined by dividing body weight in kilograms by the height in meters squared) and waist circumference, which is measured in a standing position (the patient should be undergarments only, the measurement point is the middle of the distance between the apex of the iliac crest and the lower lateral edge of the ribs), the measuring tape should be held horizontally. Auscultation of the heart, carotid, renal and femoral arteries is performed (the presence of noise suggests an ECHOCG, duplex scanning of the brachiocephalic / renal / iliac-femoral arteries).

Laboratory and instrumental research methods (Table 5). At the first stage, routine studies are performed, which are mandatory for each patient with hypertension. At the second stage, additional studies are recommended to clarify the genesis of AH, to assess the presence and severity of POM, CVD, CVD and CKD. According to indications, a more in-depth examination of the patient is carried out to verify secondary forms of hypertension in specialized hospitals.

Examination to assess the state of POM extremely important, as it allows you to determine the degree of risk of developing CVS and, accordingly, the tactics of treatment. To detect POM, it is advisable to use additional methods for examining the heart (ECHOCG with the determination of LVMI), kidneys (determination of microalbuminuria and proteinuria), blood vessels (determination of IMT of the common carotid arteries, the presence of atherosclerotic plaques in the brachiocephalic, renal and iliac-femoral vessels, determination of pulse wave velocity) .

Table 5. Laboratory and instrumental research methods

* In patients with nephropathy, hyperaldosteronism, CKD, CHF, on long-term diuretic therapy, potassium determination is mandatory.

A heart

1. An ECG is recommended for all patients with hypertension to detect LVH (Sokolov-Lyon index SV 1 + RV 5-6 > 35 mm; Cornell index (R AVL + SV 3) ≥ 20 mm for women, (R AVL + SV 3) ≥ 28 mm for men; Cornell product (R AVL + SV 5) mm x QRS ms > 2440 mm x ms), arrhythmias and conduction of the heart and other heart lesions.

   An exercise ECG test (physical, pharmacological, transesophageal electrical stimulation) should be performed in patients with arrhythmia and cardiac conduction disorders (history, according to physical examination, Holter ECG monitoring, or in case of suspicion of exercise-induced arrhythmias).

   Echocardiography is performed to clarify the presence and severity of LVH (distinguish between concentric and eccentric LVH, prognostically more unfavorable is concentric LVH), LA dilatation and other heart lesions. If myocardial ischemia is suspected, an ECG test with exercise (physical, pharmacological, transesophageal electrical stimulation) is recommended. If positive or questionable results are obtained, stress echocardiography, MRI, or stress myocardial scintigraphy is recommended.

Vessels

1. Duplex scanning of the brachiocephalic arteries is done to detect vessel wall thickening (IMT ≥ 0.9 mm) or the presence of atherosclerotic plaque, especially in men over 40 years of age, women over 50 years of age, and in patients with a high overall CV risk.

   Determination of the speed of the pulse wave is carried out to determine the stiffness of the arterial wall. The risk of developing CVS increases with a pulse wave speed of more than 10 m/s.

   Ankle-brachial index (ABI) should be determined if peripheral atherosclerosis is suspected. A decrease in its value less than 0.9 indicates an obliterating lesion of the arteries of the lower extremities and can be regarded as an indirect sign of severe atherosclerosis.

kidneys

1. All patients with hypertension should determine the blood creatinine clearance (ml / min), GFR (ml / min / 1.73 m 2). Decreased creatinine clearance< 60 мл/мин или СКФ < 60 мл/мин/1,73м 2 свидетельствует о нарушении функции почек.

   It is necessary to determine the concentration of uric acid in the blood, since hyperuricemia is often observed in hypertension, including in patients with MS, DM, and is an independent risk factor for kidney damage.

   All patients with hypertension should determine the presence of protein in the urine in the morning or daily portion.

   With a negative test result for proteinuria and a high risk of kidney damage, especially in patients with MS, DM, it is recommended to use special quantitative methods to detect MAU.

   Microscopy of the urinary sediment is necessary to detect erythrocytes, leukocytes, epithelial cells, cylinders, crystalline and amorphous salts.

   Ultrasound of the kidneys is performed to assess their size, structure and congenital anomalies.

Vessels of the eye

1. The study of the fundus (hemorrhages, exudates, edema of the optic nerve papilla) should be performed in patients with refractory hypertension, as well as in patients with severe hypertension and a high total CV risk.

Brain

1. The study of the brain using CT or MRI in patients with hypertension is carried out in order to detect asymptomatic cerebral infarctions, lacunar infarctions, microhemorrhages and white matter lesions in dyscirculatory encephalopathy, and transient ischemic attacks/strokes.

Ways to measure blood pressure: Blood pressure is measured by a doctor or nurse on an outpatient basis or in a hospital (clinical blood pressure). In addition, blood pressure can also be recorded by the patient himself or by relatives at home - self-monitoring of blood pressure (SCAD). Daily monitoring of blood pressure is carried out by health workers on an outpatient basis or in a hospital. Clinical measurement of blood pressure has the largest evidence base for substantiating the classification of blood pressure levels, predicting risks, and evaluating the effectiveness of therapy.

The accuracy of blood pressure measurement and, accordingly, the guarantee of the correct diagnosis of hypertension,

Definitions of its severity depend on compliance with the rules for its measurement.

To measure blood pressure, the following conditions are important:

Position of the patient: sitting in a comfortable position; the hand is on the table and is at the level of the heart; the cuff is superimposed on the shoulder, its lower edge is 2 cm above the elbow.

Conditions for measuring blood pressure

The use of coffee and strong tea is excluded for 1 hour before the study;

Reception of sympathomimetics is canceled, including nasal and eye drops;

BP is measured at rest after a 5-minute rest; if the procedure for measuring blood pressure was preceded by significant physical or emotional stress, the rest period should be extended to 15-30 minutes.

Equipment:

The size of the cuff should correspond to the size of the arm: the rubber inflated part of the cuff should cover at least 80% of the circumference of the upper arm; for adults, a cuff 12-13 cm wide and 30-35 cm long (medium size) is used; but it is necessary to have a large and small cuff for full and thin arms, respectively;

The mercury column or the arrow of the tonometer must be at zero before starting the measurement.

Multiplicity of measurement:

To assess the level of blood pressure on each arm, at least two measurements should be performed with an interval of at least a minute; at the difference? 5 mmHg make one additional measurement; the final (recorded) value is the average of the last two measurements;

For the diagnosis of hypertension with a slight increase in blood pressure, a second measurement (2-3 times) is carried out after a few months;

With a pronounced increase in blood pressure and the presence of POM, high and very high risk of CVE, repeated blood pressure measurements are carried out after a few days.

Measurement technique

Quickly inflate the cuff to a pressure of 20 mmHg.

Exceeding SBP (by the disappearance of the pulse);

Blood pressure is measured with an accuracy of 2 mm Hg;

Decrease cuff pressure at a rate of approximately 2 mmHg. per second;

The level of pressure at which 1 tone appears corresponds to SBP (1 phase of Korotkoff tones);

The level of pressure at which the tones disappear (phase 5 of Korotkoff's tones) corresponds to DBP; in children, adolescents and young people immediately after exercise, in pregnant women and in some pathological conditions in adults, when it is impossible to determine the 5th phase, one should try to determine the 4th phase of the Korotkoff sounds, which is characterized by a significant weakening of the tones;

If the tones are very weak, then you should raise your hand and perform several squeezing movements with the brush, then repeat the measurement, while not strongly squeezing the artery with the membrane of the phonedoscope;

At the initial examination of the patient, the pressure on both hands should be measured; in the future, measurements are carried out on the arm where blood pressure is higher;

In patients over 65 years of age, in the presence of diabetes and in those receiving antihypertensive therapy, blood pressure should also be measured after 2 minutes of standing;

It is also advisable to measure blood pressure in the legs, especially in patients under 30 years of age; the measurement is carried out using a wide cuff (the same as in obese persons); the phonendoscope is located in the popliteal fossa; to detect occlusive lesions of the arteries and assess the ankle-brachial index, systolic blood pressure is measured using a cuff located on the ankle and / or by ultrasound;

Heart rate is calculated from the radial artery pulse (at least 30 seconds) after the second BP measurement in the sitting position.

Measurement of blood pressure at home. Home-based BP measurements can be a valuable adjunct to clinical BP in diagnosing hypertension and monitoring treatment efficacy, but suggest other guidelines. It is generally accepted that a blood pressure value of 140/90 mmHg measured at a doctor's appointment corresponds to a blood pressure of approximately 130-135/85 mmHg. when measuring at home. The optimal value of blood pressure during self-control is 130/80 mm Hg. For self-monitoring of blood pressure, traditional tonometers with dial gauges can be used, but in recent years, preference has been given to automatic and semi-automatic devices for home use, passed rigorous clinical tests to confirm measurement accuracy.

Caution should be exercised in interpreting the results obtained with most currently available devices that measure blood pressure at the wrist; it must also be borne in mind that devices that measure blood pressure in the arteries of the fingers are distinguished by the low accuracy of the blood pressure obtained.

BP values ​​obtained with SCAD allow obtaining additional information about the prognosis of CVC. It is indicated for suspected isolated clinical arterial hypertension (ICAH) and isolated ambulatory arterial hypertension (IAAH), if long-term control of blood pressure is necessary against the background of drug treatment, in treatment-resistant hypertension. SCAD can be used in the diagnosis and treatment of hypertension in pregnant women, in patients with diabetes mellitus, and in the elderly.

SCAD has the following advantages:

Provides additional information about the effectiveness of antihypertensive therapy;

Improves patient adherence to treatment;

The measurement is carried out under the control of the patient, therefore, unlike ABPM, in relation to the obtained data on the level of blood pressure, there are less doubts about the reliability of the device and the conditions for measuring blood pressure;

The measurement causes concern to the patient;

The patient is inclined to use the obtained results for self-correction of therapy.

At the same time, it should be taken into account that the SCAD cannot provide information about BP levels during "everyday" daytime activity, especially among the working part of the population and about BP at night.

24 hour blood pressure monitoring

Clinical BP is the main method for determining the magnitude of BP and risk stratification, but ambulatory BP monitoring has a number of specific advantages:

Gives information about blood pressure during "everyday" daytime activities and at night;

Allows you to clarify the prognosis of cardiovascular complications;

It is more closely related to changes in target organs at baseline and to their observed dynamics during treatment;

More accurately evaluates the antihypertensive effect of therapy, as it allows to reduce the effect of the "white coat" and placebo.

SMAD provides important information about the state of mechanisms cardiovascular regulation, in particular, 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.

Situations in which the implementation of ABPM is most appropriate:

Increased lability of blood pressure during repeated measurements, visits or according to self-monitoring data;

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;

Normal values ​​of clinical blood pressure in patients with a large number of risk factors and / or the presence of changes in target organs characteristic of hypertension;

Large differences in the value of blood pressure at the reception and according to self-control;

Resistance to antihypertensive therapy;

Episodes of hypotension, especially in elderly and diabetic patients;

Hypertension in pregnant women and suspicion of preeclampsia.

For ABPM, only devices that have successfully passed rigorous clinical trials according to international protocols to confirm the accuracy of measurements can be recommended. When interpreting ABPM data, the main attention should be paid to the average values ​​of blood pressure for the day, night and day (and their ratios). The remaining indicators are of undoubted interest, but require further accumulation of the evidence base.

Isolated clinical hypertension

In some individuals, when measuring blood pressure by medical personnel, the recorded values ​​of blood pressure correspond to hypertension, while the values ​​of ABPM or blood pressure measured at home remain within normal values, i.e. there is "white-coat" hypertension, or more preferably "isolated clinical hypertension". ICAH is detected in approximately 15% of individuals in the general population. These individuals have a lower risk of CVD than patients with hypertension. However, compared with normotonics, organ and metabolic changes are more often observed in this category of persons. Often enough

ICAG eventually transforms into normal AH. It is difficult to foresee the possibility of detecting hypertension in each specific case, however, ICAH is more often observed in women with grade 1 hypertension, in the elderly, in non-smokers, with a recent detection of hypertension, and with a small number of blood pressure measurements in outpatient and clinical settings.

Diagnosis of ICAG is carried out on the basis of SCAD and ABPM data. Wherein

Elevated clinical BP is observed on repeated measurements (at least three times), while BP (mean BP over 7 days of measurement) and ABPM are within normal limits (Table 1). Diagnosis of ICAH according to the data of SBP and ABPM may not coincide, and this is especially often observed in working patients. In these cases, it is necessary to focus on the ABPM data. The establishment of this diagnosis requires a study to clarify the presence of risk factors and damage to target organs. In all patients with ICAH, non-pharmacological methods of treatment of hypertension should be used. In the presence of high and very high risk of CVD, it is recommended to start antihypertensive therapy.

Isolated ambulatory hypertension

The reverse phenomenon for ICAH is "isolated ambulatory hypertension" or "masked" hypertension, when blood pressure measurements in a medical facility reveal normal blood pressure values, but BPMS and/or ABPM results indicate the presence of hypertension. Information about AIAH is still very limited, but it is known that it is detected in approximately 12-15% of individuals in the general population. In these patients, compared with normotonic patients, RF, POM are more often detected, and the risk of CVE is almost the same as in patients with AH.

Central blood pressure

Complex hemodynamic phenomena are observed in the arterial bed, leading to the appearance of so-called "reflected" pulse waves mainly from resistive vessels, and their summation with the main (direct) pulse wave that occurs when blood is ejected from the heart. The summation of direct and reflected waves in the systole phase leads to the formation of the phenomenon of "augmentation" (amplification) of the SBP. The sum of direct and reflected waves differs in different vessels, as a result of which blood pressure (primarily SBP) differs in different main vessels, and does not coincide with that measured on the shoulder. Thus, it is a well-known fact that normal SBP on the lower extremities exceeds SBP measured on the shoulder by 5-20%. The greatest prognostic value has blood pressure in the ascending or central part of the aorta or "central" blood pressure. In recent years, special techniques have appeared (for example, aplanation tonometry of the radial or carotid artery), which allow, based on the quantitative sphygmogram and blood pressure measured on the shoulder, to calculate the central blood pressure. Early studies have shown that this estimated central aortic pressure may be more valuable in evaluating the effectiveness of ongoing therapy and, apparently, will allow to identify an additional group of patients with "pseudohypertension", who have normal central pressure, but increased blood pressure on the shoulder from - due to an abnormally high sum of direct and reflected pressure waves in the upper limbs.

A certain contribution to the increase in blood pressure in the brachial artery relative to blood pressure in the aorta is made by an increase in the rigidity of its wall, which means the need to create greater compression in the cuff. These facts certainly need to be taken into account, but the evidence base regarding the advantages of calculated central pressure over conventional BP measured at the upper arm requires further full-scale studies.

Measurement of pressure is the first thing to do when you feel unwell. The evaluation of the tonometer indicators can be carried out only if all the rules for this manipulation are observed. Timely detection of problems associated with blood pressure is the goal of all physicians. At this initial stage, the disease can be controlled, preventing it from developing to a serious stage.

The force with which blood flow presses on the walls of blood vessels and arteries is called. There are two types of pressure, these are upper (systolic) and lower (diastolic). The normal blood pressure is 120/80 mm Hg. Art. What does ideal blood pressure mean? Often, the individual characteristics of the body affect, that is, from birth, a person may have blood pressure above or below normal, and at the same time he feels good.

Many factors can affect the level of blood pressure, but more often, a regular increase in blood pressure signals that diseases have appeared in the body.

Diseases affecting the increase in blood pressure:

1. Diseases of the cardiovascular system.
2. Kidney disorders.
3. Diseases of the endocrine system.
4. Neurological problems, etc.

Certain ailments can also lower blood pressure, along with individual predisposition and stress.

Diseases affecting the lowering of blood pressure:

1. Heart failure.
2. Vegetovascular dystonia of hypotonic type.
3. Peptic ulcer of the duodenum and stomach in the acute stage.
4. Internal bleeding.
5. depressive states.

However, it is often not possible to determine the cause of a constant decrease or increase in blood pressure. The goal of doctors is to understand this situation and improve the patient's well-being. Hypertension is much more common than hypotension and is a serious condition. To find out if this disease really exists, you need to carefully monitor your blood pressure, measure your blood pressure regularly.

In the case of a constant increase in blood pressure, the question of the development of hypertension is raised. The more frequent and higher the increase in blood pressure, the more advanced the stage of the disease. Hypertension is classified into 4 degrees, each of which requires a different treatment approach.

BP measurement

Determining the level of blood pressure in a person is quite simple. There is a large selection of blood pressure monitors, the purpose of which is absolutely accurate readings of blood pressure. The first thing to do for a person who constantly suffers from an increase or decrease in pressure is to purchase a good device for such a purpose in order to conveniently and as often as possible measure blood pressure.

Hypertension can be difficult for a person and cause great harm to the body, so hypertensive patients must have a good and convenient tonometer so that measuring blood pressure does not cause inconvenience. Sometimes a person may feel unwell, and the first thing that comes to mind is an increase or decrease in blood pressure, in order to exclude such factors, it is necessary to determine the level of blood pressure.

Rules for measuring blood pressure:

• 50-60 minutes before measuring pressure, you can not smoke and lift weights;
• coffee and caffeinated drinks should be excluded 1-2 hours before the measurement;
• you can not measure blood pressure immediately after a bath or a hot bath, you need at least an hour to pass;
• tonometer readings may be incorrect if on a full stomach;
• a person, before measuring blood pressure, should be at rest for 15-20 minutes;

More often . The indicators of such a device are more accurate than those of its electronic counterpart.

How to measure pressure with a tonometer?

Before proceeding, everyone needs to familiarize themselves with the rules for measuring pressure.

1. The patient must definitely sit down at the table, all manipulations are performed only while sitting, in no case lying down. The arm to which the blood pressure cuff is attached should be at the level of the heart.
2. Take the device out of the box and arrange all the equipment without confusing the tubes.
3. Wrap the cuff around your forearm and secure with Velcro, not too tight, but not too loose. The assessment of the tonometer indicators cannot be adequate if the cuff was attached to clothing. The measurement must be taken on a bare arm or very thin sleeve fabric is acceptable. It is considered correct to fasten the cuff 2-3 cm above the elbow.
4. Position the membrane of the stethoscope at the level of the forearm so that it fits snugly against the skin. It is in this zone that brachial artery. Insert the earpieces of the stethoscope into your ears.
5. The monometer must be positioned stably, you can fix it on the book so that it is good review dial.
6. Take a pear in your hand and twist its valve all the way clockwise.
7. With quick movements of the brush, you need to pump up the pear so that the cuff inflates. You need to pump until the arrow of the monometer shows 180 mm Hg. Art. An inflated cuff blocks a large artery, and blood will temporarily not flow into it.
8. Upon reaching the indicator - 180, it is necessary to slowly open the pear valve and bleed the air. At this time, you need to carefully monitor the numbers of the monometer.
9. When air is released, it is necessary to listen to beats with a stethoscope, the first beat means an indicator of systolic pressure. On which figure the first blow is recorded, that one means the upper blood pressure.
10. After finding out the first digit of blood pressure, you need to continue to monitor the monometer. As soon as complete silence and the absence of shocks and noises are recorded in the stethoscope headphones, it is necessary to remember the number of the monometer. This will be the low pressure.

If for some reason one of the indicators is omitted, you can inflate the cuff 1 time, you can’t pump more than 1 time, otherwise the tonometer readings will be incorrect.

The purpose of measuring blood pressure is to determine the level of blood pressure, therefore, for the accuracy of the readings, the measuring manipulations must be repeated 10-15 minutes after the first procedure.

What does high BP mean?

Regular measurements of blood pressure will allow you to identify the disease at the very beginning of its development. Sometimes elevated blood pressure is recorded for the first time, and the person is confused and does not know what to do. A single increase in blood pressure does not mean that hypertension has occurred, the pressure can suddenly rise for several reasons.

1. Emotional overload the day before.
2. Excessive physical activity.
3. Eating large amounts of salt and fatty foods.
4. Large body weight.
5. Alcohol consumption.
6. Frequent smoking.
7. hereditary factor.
8. Elderly age.
9. Diabetes and other diseases.

Only a doctor can find out the exact cause of an increase in blood pressure, therefore, with repeated increases in blood pressure, you should consult a doctor. Hypertension manifests itself in this way, so this symptom cannot be ignored.

Signs of high blood pressure:

• headache, often pulsating in the neck;
• nausea, vomiting;
• pain in the region of the heart;
• lack of air;
• insomnia;
• feeling of anxiety;
• impaired speech and coordination;
• convulsions;
• fainting.

High blood pressure readings over 180/110 are very dangerous. With this condition, serious complications can develop, leading to a stroke, heart attack, and even death. When taking antihypertensive drugs, one goal is pursued - lowering blood pressure. But they don't always help. medications, chosen independently, you need to take the drugs prescribed by the doctor, this will reduce the risk of complications and safely bring down the pressure. Hypertension requires special attention and control of blood pressure, as well as regular medication.

Low blood pressure

Hypotension is much less common than hypertension, but can be just as dangerous. With low blood pressure, the body lacks the necessary substances delivered by the blood to all organs and systems, and this leads to various diseases. Hypotension is a condition in which blood pressure is 100/60 mm Hg. Art. and below. There are cases when physiological hypotension is observed, then we are not talking about a health hazard, but if low pressure indicators are not typical for a particular person, then you should figure out what the cause is and treat this ailment. In addition to the main causes of hypotension, there are a number of factors that lead to a decrease in pressure.

1. Physical exhaustion.
2. Lack of vitamins.
3. Poisoning.
4. Depressive state.

Both hypertension and hypotension can occur when taking inappropriate medicines, in which case the doctor's goal is to recognize this cause and stop the drug.

Signs of low blood pressure:

• weakness and lethargy;
• frequent yawning (a sign of lack of oxygen);
• dizziness;
• pain in the head, mainly in the temples;
• dyspnea;
• poor memory and concentration;
• nausea.

Often, a decrease in blood pressure occurs asymptomatically, which does not mean that there are no health problems. Hypotension can significantly harm the body, so for any ailments, it is necessary to measure blood pressure.

The life of hypotensive patients passes in a constant state of fatigue, the goal of the doctor is to improve the well-being of his patient by increasing his pressure with the help of special drugs. The assessment of a person's condition is carried out only by a specialist, it is impossible to independently decide which medicines to take.

What do tonometer readings mean?

In some cases, even small deviations from the norm of blood pressure significantly worsen the condition of a person, the manifestation of symptoms can be very strong. The purpose of measuring blood pressure is to accurately measure the force with which blood presses against the walls of blood vessels. Only knowing how much blood pressure does not correspond to the norm, you can take action.

As you know, a normal level of blood pressure is the most important indicator of physical health. If it is normal, it can be concluded that the person is experiencing serious health problems. However, the slightest deviation up or down leads to severe symptoms. During the treatment of any cardiovascular diseases, a tonometer should be used regularly. Thanks to the use of this device, you can regularly obtain information about systolic and diastolic indicators, making a conclusion about the degree and stage of the disease, the rate of its progression.

Cardiovascular disorders

There is a special algorithm for measuring blood pressure. This figure can vary significantly depending on age. In the absence of any pathologies in a person, blood pressure is approximately at the same level, however, various factors can provoke an excess of the norm: unbalanced nutrition, stress, obesity, fatigue. During the day, slight drops in blood pressure are possible. If the jumps do not exceed 10 mm Hg. Art. for the bottom scores and 20 for the top scores, such changes should not be cause for concern.

People suffering from disorders of the cardiovascular system need to constantly monitor the slightest changes in their well-being. It is extremely important and also convenient to take measurements yourself at home. If you know the algorithm for measuring blood pressure, there should be no difficulties.

Types of instruments for measuring pressure

The first point that you should pay attention to is the choice of a tonometer. As you know, these devices are of two types:

• electronic;
• manual.

Relatively simple and easy to use is an automatic device. Even a child can cope with the instruction manual here. Before starting measurements, it is necessary to correctly position the cuff on the arm. In order for the device to show reliable results, it is important to place it above the elbow, leaving it at the same level as the heart. The remaining steps will be performed automatically by the electronic tonometer. As soon as the measurements are received, the device will transfer them to the screen.

How to use a mechanical device?

In comparison with an electronic device, a mechanical one requires additional effort from the application. However, this does not mean at all that not everyone can cope with a hand-held device at home. After the cuff is put on, it is necessary to pump air into it using a special pump attached to it. The rubber pear-shaped device is squeezed and unclenched in the hand until the device exceeds the expected results by several divisions (40-50 mm Hg). The algorithm of actions for measuring blood pressure in children and adults is practically the same. After the systolic and diastolic readings are obtained, the air from the cuff should be gradually released, which will restore blood circulation.

Algorithm of actions for measuring pressure

It is possible that the result will be above the norm or the expected level. You should not panic, since you can get optimal information only after the procedure has been carried out three times.

Adhering to the correct technique, the algorithm for measuring blood pressure in children and adults, it is advisable to repeat the process after 20 minutes, and after three hours - one more time:

• Blood pressure measurements should only be taken in a comfortable and comfortable position. Sitting is considered ideal, in which the hand is placed on the table with the palm up. It is necessary to measure the pressure alternately on both hands.
• The elbow is placed in such a way that it ends up at the same level as the heart.
• The cuff is wrapped around the arm three centimeters above the elbow joint. A stethoscope is applied under the cuff.
• During the procedure, you can not talk and move.
• After 5 minutes, it is advisable to re-measure.

What else needs to be taken into account?

Considering the above algorithm of actions for measuring blood pressure, it is necessary to remember the rules for preparing for the procedure. Reliable results can only be obtained if all the rules below are followed:

• Measure pressure on an empty stomach or a couple of hours after eating - this minimizes the likelihood of measurement errors.
• Do not drink drinks that increase blood pressure (coffee, alcohol) and smoke immediately before the procedure.
• The use of nasal or ocular vasoconstrictor drugs can distort the measurement data.
• The condition of the subject is also of great importance: before the procedure, it is important not to perform physical activity, do sport.

Norm of blood pressure in children: calculation formulas

As already mentioned, there are no fundamental differences in the procedure and algorithm for measuring blood pressure in children and adults. However, it should be borne in mind that for an early age, the indicators of 120/80 can remain stable only in isolated cases. In order to understand whether the results obtained are the norm, you must use the following formula for measuring blood pressure in children:

• In newborn babies, systolic pressure should be in the range of 74-76 mm Hg. Art. Based on this, diastolic can also be calculated, which, with a healthy cardiovascular system in babies, is 50-66% of the upper indicator.
• For children of 1 year of age, the optimal criterion for systolic pressure is an indicator equal to 76 + 2x, where x is the number of months from birth. Lower pressure (diastolic) is calculated according to the same principle (from half to two thirds of the upper value).
• According to the method of measuring blood pressure in children who have reached the age of one, the final indicators should average 90/60 mm Hg. Art.
• In the future, individual blood pressure indicators are determined by the formula 90 + 2x, where x is the number of full years. So the norm is calculated for the upper indicator, and for the lower one the calculation is somewhat different - 60 + x, where x is also the child's age.

These formulas are used to measure blood pressure in childhood all domestic pediatricians.

Choosing a cuff for a child

The technique of measuring blood pressure in children requires additional training. It is especially important to pay attention to the condition of the child: the baby should be extremely calm. After playing and running, it is necessary to wait about 20 minutes for the child's blood pressure to return to normal. In addition, it is desirable to make sure that the size of the cuff used is suitable for the volume of the child's arm. So, for kids of different ages, products with different diameters are produced:

• From birth to reaching the first year of life, babies wear a product that does not exceed 7 centimeters in volume;
• For children under two years old, cuffs are suitable, the diameter of which is from 4.5 to 9 cm.
• After two years - 5.5 - 11 centimeters.
• From four to seven years, the cuff is selected according to a diameter not exceeding 13 cm.
• After the age of seven - up to 15 cm.

Cuff standard sizes used for children over 10 years of age.

How to measure blood pressure in babies?

The algorithm for measuring blood pressure is simple:

1. In a sitting position (for babies - lying down) put left hand on the table, turning its inner surface up.
2. The cuff is superimposed on a couple of centimeters of the higher elbow joint. It is not necessary to pull it strongly on the child’s arm, therefore, free space should be left between the skin and the cuff, about one and a half centimeters.
3. The person performing the measurements needs to feel the place of the pulsation of the artery on the arm with his fingers and attach a stethoscope to it.

Technique for measuring blood pressure for children and adults

If the procedure is carried out using an electronic tonometer, then there is nothing left but to wait for the results on the screen. If the device is mechanical, then first you have to inflate the cuff with air to a value of 150-160 mm Hg. Art. After that, carefully turn the valve in the opposite direction and release the air, watching the rate of pressure decrease - it should not be higher than 3-4 mm Hg. Art. in one second.

Systolic and diastolic indicators are determined in the same way in children and adults: when air is released from the cuff, it is important to listen and expect the appearance of a characteristic tapping pulsation. The numbers currently indicated by the needle of the sphygmomanometer are the upper indicator of blood pressure. By fixing the moment when the pulsation ends, you can determine the lower value - diastolic.

Measurement of blood pressure is an additional diagnostic method that helps to make an accurate diagnosis and choose the best treatment tactics. To obtain reliable results, you must follow the rules and sequence of actions.