The pulse pressure is exactly between the high pressure and the low pressure. Unknown to some patients, forgotten by others, but highly valued in medicine. Because when your heart pressure goes up, it’s a sign that your heart is in danger of having a heart attack.
The heart is the most “busy” organ of our body. He is not sleeping, not resting, he cannot go on vacation. It is thanks to him that our body still circulates blood supplying all organs with life-giving ingredients.
One heartbeat consists of two phases. When the heart is completely filled with blood, the first, or contraction, begins. The atria of the heart contract so that the blood fills the chambers as much as possible. Atrioventricular valves close to keep blood from withdrawing. At the same time, they produce an auscultation phenomenon called the first heart tone. After atrial contraction, the ventricles contract and blood is pushed to the aorta (large, left circulation) and to the pulmonary trunk (small, right circulation). At the same time, the valves of the aorta and the pulmonary trunk close, preventing the withdrawal of blood, and the auditory phenomenon that accompanies this process is called the second heartbeat. This is when diastole begins, i.e. the second phase of the heart’s cycle, during which blood flows from the veins (main, upper and lower) to both atria and ventricles. When the heart is fully filled with it again, another contraction will occur, and so on. Normally, a healthy heart works at a frequency of 60 to 80 cycles per minute.
Constant hesitation
In order for the blood to fill all the vessels well during contraction, and to return to the heart during diastole, it must be ejected from it with sufficient force. During each such cycle, the blood must therefore press against the delicate walls of the vessels under a certain pressure – simply called arterial pressure. Pressure increases during heart systole, and decreases during diastole.
This property of the cardiovascular system causes that we deal with two types of pressure: systolic, colloquially referred to as “upper”, and diastolic, or “lower”. The optimal arterial pressure in a healthy adult human is as follows: RR = 120/80 mmHg. In this entry, “RR” is an abbreviation of the surname: Scipio Riva-Rocci, an Italian scientist who in 1898 was the first to construct a pressure measuring device – manometer, “120” is the value of systolic pressure, “80” – the value of diastolic pressure, and “mmHg” is the unit of measurement for pressure, which is millimeters of mercury.
Blood pressure is constantly changing, be it natural or disease. In the long run, its value is closely related to our age. It increases with the maturation of the organism and the development of its functions. In adults, the normal blood pressure is 120-129 / 80-84 mmHg.
The pressure value also depends on the time of day, physical activity, consumed food and stimulants, and even our emotional state and biometeorological conditions. The blood pressure rises during the day, during exercise, after drinking coffee, when we feel stressed, and also during the sun boom. It lowers at night, when resting, when we are full and relaxed, and during rainy, lowland days.
The increase in blood pressure above the optimal norm is considered a disease – arterial hypertension. It is possible to diagnose it due to multiple measurements which show a value higher than 140/90 mmHg – this indication indicates the onset of hypertension. In people who are at risk of developing cardiovascular diseases, already suffer from them or have a heart attack, stroke or have diabetes, hypertension is diagnosed at repeated measurements of more than 130/80 mmHg. In 95% of all patients diagnosed with hypertension, it is of a primary (spontaneous) nature, and its causes are not fully explained. In the remaining 5%, we have secondary arterial hypertension, which is a symptom of a specific disease, such as the kidneys or endocrine glands. If properly treated, the blood pressure can be restored to normal. Treatment of primary hypertension is life-long.
New indicator
Everyone, regardless of gender, up to 50-60 years of age both the systolic (upper) and diastolic (lower) pressure increase in parallel, but in the following decades the former increases and the latter decreases. The difference between these values is called pulse pressure.
The optimal value of heart rate in a healthy adult is 40-60 mmHg – with systolic blood pressure in the range of 120-140 mmHg and diastolic pressure – 80-90 mmHg. A high pulse pressure is defined as when it reaches a value above 63 mmHg.
The main cause of the increase in heart rate is the stiffness and thickening of the arterial walls with age – mainly the aorta, which drains blood from the heart and carotid artery. This process is called arteriosclerosis (arteriosclerosis). Healthy arteries resemble flexible tubes. Thanks to this property, they can expand by about 10% under the pressure of blood rolled in the contraction of the heart and form the so-called Secondary arterial reservoir, which during diastole ensures the continuity of blood flow to the tissues. The causes of this flexibility are elastic elastin fibers, which are characterized by high strength, but after the age of 60. and they are starting to show signs of degeneration. Chronic hypertensive disease and atherosclerosis also contribute to stiffening of the arteries.
The flexibility of the arteries and their ability to “bulge” when the heart contracts, reduces the pressure of blood flowing into the tissues. Thus, the stiff and narrow arteries force the heart to work harder to move the same amount of blood at the same time when the arteries were more flexible. To meet this requirement, the heart must “release” blood under greater pressure. The stiffer large arterial vessels are, the greater the increase in systolic pressure and, consequently, in pulse pressure. Pulse pressure may also increase with severe anemia (anemia), an overactive thyroid gland or with aortic valve disease.
Reliable measurement
The diagnosis of hypertensive disease enables the measurement of blood pressure. Various types of devices – spring or electronic – are used for this purpose. They consist of a cuff filled with a rubber cushion and connected by a rubber tube to a pear-shaped rubber pump as well. This system is connected with a spring pressure gauge showing the pressure on the clock or with an electronic reader. After the cuff is inflated on the patient’s arm, the doctor or nurse places the stethoscope just above the elbow artery. Then, air is slowly deflated from the cuff and the tester listens to the tones of the pulse wave. The first audible tones correspond to the systolic value of the pressure, and the diastolic value is determined at the moment of their complete extinction.
There are a few rules to follow when taking a pressure measurement. Before we measure the pressure, let’s rest for a few minutes and calm down the body. It is also worth refraining from drinking coffee and smoking. We take the measurement while sitting or lying down. The cuff of the apparatus must be adapted to the size of our arm. Too thick will lower the pressure value, and too small – will increase it. The cuff is put on the naked body, 2-3 cm from the elbow joint – usually on the left hand. The arm should be positioned so that the cuff is at the same level as your heart. If we measure the pressure with the wrist apparatus – the hand with the applied device is placed over the heart.
In the diagnosis of hypertensive disease, specialized manometers are also used, which enable measurement and monitoring of pressure around the clock. Their software allows for the recording of blood pressure values in short time intervals, and the small size makes it possible to carry out the examination during the normal, everyday activity of the patient.
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Exercise the arteries
High heart pressure leads to myocardial hypertrophy and contributes to high mortality – especially in women over 55 years of age. – precisely because of the bad work of this organ. Therefore, high pulse pressure is treated as a harbinger of numerous cardiovascular complications, especially strokes and heart attacks. And this regardless of whether the patient has already been diagnosed with hypertension or not. Elevated pulse pressure is also an important indicator of the risk of developing a hypertensive disease.
To lower your pulse pressure, you need to reduce the stiffness of the arteries. Unfortunately, so far no one universal drug has been invented that would improve the elasticity of the arteries in all patients. These types of therapies are used individually. Previous studies show that the best effects are achieved by long-term antihypertensive drugs that lower blood pressure, as well as beta-blockers that slow down the heart rate.
Physical activity is of great importance for the condition of blood vessels. Aerobics, cycling and swimming have a great influence on reducing the stiffness of the vessels and strengthening the strength of their walls.
Blood pressure classification according to the Polish Society of Hypertension *
Optimal blood pressure: systolic <120 (mmHg); diastolic <80 (mmHg)
Normal blood pressure: systolic 120-129 (mmHg); diastolic 80-84 (mmHg)
High normal blood pressure: systolic 130-139 (mmHg); diastolic 85-89 (mmHg)
Grade 1 hypertension – mild: systolic 140-159; diastolic 90-99 (mmHg)
Grade 2 hypertension – moderate: systolic 160-179 (mmHg); diastolic 100-109 (mmHg)
Grade 3 hypertension – severe: systolic ≥180 (mmHg); diastolic ≥110 (mmHg)
Isolated systolic hypertension: systolic ≥140 (mmHg); diastolic <90 (mmHg)
Isolated diastolic hypertension: systolic <140 (mmHg); diastolic ≥90 (mmHg)
* applies to people who do not take medications for hypertension
Text: Magdalena Gajda
Consultation: lek. med. Robert Drozdowski, internist at the Department of Internal Diseases of the Military Institute of Aviation Medicine in Warsaw
Source: Let’s live longer