Big difference between upper and lower blood pressure
The content of the article:
- Upper and lower pressure and the normal difference between them
- Reasons for the big difference between upper and lower pressure
- Why is high pulse pressure dangerous?
- What to do if there is a big difference between the upper and lower pressure?
- Video
A large difference between the upper and lower pressure, exceeding a certain indicator, is a sign of pathology, it is necessary to find out its cause and eliminate it.
The blood pressure (BP) indicator consists of two numbers - the upper (systolic) and lower (diastolic) pressure, which, under normal conditions, increase and decrease synchronously. Such changes in this may indicate a disease, but most often appear spontaneously in the context of primary hypertension. At the same time, the interval between the upper and lower pressure remains stable. In some cases, it increases. What can such a state speak about and what to do if it appears? Let's talk about it.
Pulse pressure is increased when the difference between upper and lower exceeds 50 units
Upper and lower pressure and the normal difference between them
Maintaining normal blood pressure depends on many systems in the body, but the main ones are cardiovascular, endocrine, and urinary. Systolic pressure depends on the state of the heart muscle (myocardium) - it reflects the strength of heart contractions and cardiac output that occurs after the contraction. Also, the elastic wall of the vessels closest to the heart plays an important role - they compensate for cardiac output, amortize it, preventing the pressure indicator from reaching pathological values. Normally, systolic blood pressure is in the range of 100–129 mm Hg. Art. If the upper pressure changes to dangerous levels, the problem is usually in the heart.
Diastolic pressure reflects the peripheral vascular tone. For the constant movement of blood through the bloodstream, it is necessary for the vessels to contract, exchange in the capillary bed takes place, and osmotic pressure is maintained. These functions are performed by the kidneys and endocrine glands, which secrete hormones (aldosterone, vasopressin, and others). This pressure is usually 70–90 mm Hg. Art., and if it is violated, this may indicate kidney disease or secondary hypertension.
The difference between the high and low reading is called pulse pressure. Normally, it is 40 mm Hg. Art., an excess of 10 units up or down is permissible. With such indicators, the work of the heart is adequately correlated with the peripheral vascular resistance. Too large a difference between the upper and lower blood pressure (60 units or more) appears in a pathology called isolated systolic hypertension.
Reasons for the big difference between upper and lower pressure
The most common causes of isolated hypertension are the pathology of the heart and blood vessels of large caliber, while the upper blood pressure rises, and the lower remains normal or increases insignificantly. Less often, the systolic remains within the normal range, and the diastolic decreases. The main reasons for these changes:
- A decrease in the content of elastic elements in the vessel wall, in particular the aorta, is a characteristic condition for older people. High systolic pressure occurs because the fragile aorta no longer compensates for cardiac output.
- Atherosclerosis is the accumulation of fat-protein detritus in the vascular wall, which leads to the formation of plaque and its overgrowth with fibrin, due to which the elasticity of the wall decreases, and the fragility and risk of rupture increases.
- Increased cardiac output - can be triggered by an increase in the amount of stress hormones in the blood. Due to the constant psycho-emotional stress, the strength of the heart contractions increases along with the pressure.
- Violation of filtration in the kidneys - if the filtration barrier in the nephrons of the kidneys poorly passes blood plasma, oliguria (insufficient urine output) develops, the volume of circulating blood increases with pressure.
- Renal failure - This leads to low diastolic blood pressure, leading to an increase in the difference between upper and lower pressure. In this case, loss of vascular tone plays an important role.
Why is high pulse pressure dangerous?
For adequate blood supply to the target organs, coordinated work of all systems is necessary. A frequently occurring or long-lasting difference between the upper and lower blood pressure is fraught with complications: the likelihood of a transient ischemic attack is significantly increased, and then hemorrhage in the brain tissue, i.e., stroke. This is due to constant decompensated pressure surges.
The same applies to the heart - if the strength of the contractions of the heart muscle increases, its need for oxygen and nutrients increases. Lack of adequate trophism is a risk factor for myocardial infarction.
With prolonged isolated systolic hypertension, an aortic aneurysm may develop, and subsequently - its rupture. This is a terminal condition that is highly lethal.
If the pathology exists for a long time and is not treated, hypertensive crises may appear against the background of isolated hypertension, while maintaining the lower blood pressure within the normal range. The resulting severe hypertension can increase the interval between pressures to 70, 80, even 100 mm Hg. Art. It is dangerous for target organs - kidneys, heart, brain, lungs, retina.
The disease progresses rapidly, as evidenced by the appearance of symptoms associated with functional failure of some systems: dizziness, flies before the eyes, blurred vision, forgetfulness, shortness of breath, arrhythmia, tachycardia, chest pain, renal failure.
Isolated systolic hypertension - an increase in pulse pressure due to an increase in systolic
What to do if there is a big difference between the upper and lower pressure?
Regardless of whether, due to an increase in the upper or lowering of the lower pressure, the interval increases, it is necessary to undergo a comprehensive examination and immediately begin treatment.
The diagnostics include:
- ECG (electrocardiogram);
- ultrasound examination of the kidneys;
- contrast examination of the renal arteries (if necessary);
- ultrasound examination of the heart (echocardiography);
- electrovasography of limb vessels;
- general analysis of urine and blood;
- biochemical blood test (in particular, for the content of free cholesterol and glucose);
- coagulogram (coagulation rate test).
Blood pressure is also necessarily measured throughout the day. Why is it needed? Sometimes the pressure rises only at night, and in the daytime does not provide a basis for a diagnosis.
Once the diagnosis is established, treatment begins. All medications should only be taken for medical reasons. The following groups of pharmacological agents are used:
- Beta-blockers - affect to a greater extent the heart, reducing the frequency and strength of contractions, lowering the upper pressure, but also dilate blood vessels, renew blood flow in ischemic areas, normalize lower pressure.
- ACE inhibitors - prevent the synthesis of angiotensin II, preventing systemic vasospasm. They act more on systolic pressure.
- Angiotensin receptor blockers - break the pathogenesis at the angiotensin stage, like the previous group, but lower the pressure more smoothly (which is necessary in conditions of increased fragility of the vessel wall).
- Diuretics - contraindicated in renal failure, but in its absence are quite effective. Reduce the volume of circulating blood, thereby reflexively reducing cardiac output, reducing the difference between upper and lower pressure.
- Medicines that improve cerebral blood flow - help to avoid the negative effects of prolonged increases in systolic pressure. Resumes microcirculation in the brain tissues, thereby returning cognitive functions to normal.
- Drugs that enhance coronary circulation - spasm of the coronary vessels is fraught with heart attack, therefore, it is necessary to ensure good blood circulation in the heart muscle during the period of increased stress, and in parallel to lower these loads.
It is not possible to cure isolated hypertension - the elasticity of the wall cannot be restored. But you can minimize its manifestations and avoid complications.
Video
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Nikita Gaidukov About the author
Education: 4th year student of the Faculty of Medicine No. 1, specializing in General Medicine, Vinnitsa National Medical University. N. I. Pirogov.
Work experience: Nurse of the cardiology department of the Tyachiv Regional Hospital No. 1, geneticist / molecular biologist in the Polymerase Chain Reaction Laboratory at VNMU named after N. I. Pirogov.
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