Asymmetry of blood pressure in the temporal arteries and internal pathology of humans.

Tyulin A. A., Lakinsk, Vladimir region.

annotation

In a study based on the results of measuring blood pressure (BP) in the temporal arteries in a group of randomly selected 1100 women, it was found that almost seven percent of patients (74 people) had asymmetry of blood pressure in the form of a stable sharply reduced blood pressure on the left (33 people) or on the right (41 people). ). Based on the criterion of statistical testing of hypotheses c 2 using the four-field method, a statistically significant relationship was established for this phenomenon, conventionally called left temporal atony syndrome (LTA) or right temporal atony syndrome (PTA), With various types morbidity.

Blood pressure asymmetry in the temporal arteries in relation to internal diseases.

Tioulin A. A., t. Lakinsk, Vladimir reg.

The article was published in mag.“Policlinica”, 2002

, N3, r. 49, Moscow.

Abstract. This randomized study of 1100 women analyzed the results of blood pressure in temporal arteries. It was found that approximately seven percent of patients (74 women) had blood pressure asymmetry indicated by a sharp persistent decrease in blood pressure in the left temporal artery (33 women) or in the written temporal artery (41 women). This phenomenon, arbitrarily called the left temporal atony syndrome (LTA syndrome) and the write temporal atony syndrome (WTA syndrome)

has been linked to morbidity and malignant diseases in women in particular, on the basis of statistical hypotheses testing (χ 2 criterion) by using the four fields’ method.

Introduction Features of vascular tone of the cerebral hemispheres and various applied aspects of functional diagnostics using indicators of intracerebral circulation were the subject of research large number
works, including the author of this article. However, many questions regarding the diagnostic value of blood pressure (BP) in the temporal arteries, associated, in particular, with hemispheric asymmetry of BP, remain open to this day. Our interest in this problem is associated with the concept of neuroglia formed together with the cerebral vessels that penetrate it. As is known, it is the slow potentials of neuroglia, which determine long-term human memory, in combination with neuronal impulses that form higher nervous activity in humans. Since the temporal arteries and neuroglia, through vascular anastomoses and general innervation, anatomically constitute one whole, we cannot exclude the relationship of pathological asymmetry of blood pressure in the temporal arteries with processes affecting functional hemispheric asymmetry and the morbidity of the body as a whole.
In this work, we will consider a particular, applied aspect of this problem, dedicated to establishing a statistically significant connection between internal pathology and hemispheric asymmetry of blood pressure in the temporal arteries.

Research methods

The studies were carried out as part of a planned annual preventive examination of female workers at a spinning mill in the city of Lakinsk (Vladimir region) in the functional diagnostics room of the Lakinsk city hospital. To study the diagnostic value of blood pressure asymmetry in the temporal arteries in randomly selected 1,100 female workers aged 16 to 55 years, maximum blood pressure (according to Markelov and Rovvinsky) was measured in the temporal arteries on the right and left, with mandatory measurement to control brachial blood pressure (BP) on the left. A head pressure cuff 5 cm wide was placed on the forehead and secured to the back of the head so that the temporal arteries above the cuff were palpable before air was inflated into the cuff. Next, the measurement of maximum pressure was carried out similarly to the measurement of brachial blood pressure. In contrast to the latter, the maximum pressure was taken to be the pressure gauge reading at the first appearance of a pulse in the temporal artery above the cuff, which was recorded by palpation as the pressure in the cuff decreased. To eliminate errors, each measurement of blood pressure in the temporal arteries was carried out four times and the average value was calculated. The accuracy of measurements using this method is similar to the accuracy of measurements using the traditional method of measuring brachial blood pressure.
It was found that out of the entire group of subjects, 74 women had limiting cases of relative asymmetry KD, that is, the absence of CD when measured by palpation either on the left (33 cases) or on the right (41 cases). In the future, the phenomenon of the absence of CD on the left or right will be called syndromes, respectively. left temporal atony(LVA), or right temporal atony(PVA), taking them further as criteria various types CD asymmetry.
In order to statistically assess the relationship between the obtained data on CD asymmetry and pathology, the method of statistical hypothesis testing c 2 was used . Legality practical use This criterion, implemented, in particular, using the four-field method, for the considered sample values ​​is justified in detail in and is not the subject of consideration of this work. Let us dwell on the technique of using the four-field method in relation to our problem.
Let it be necessary to confirm or refute the non-random nature of the relationship between the incidence and asymmetry of blood pressure in the temporal arteries. The four-field method involves dividing the entire sample of subjects into four groups, the number of patients in each of which (a, b, c, d) is written in special table(see table). These four groups are formed according to the presence of selected signs of morbidity and asymmetry, the non-random nature of the relationship of which needs to be confirmed or refuted, and the absence of these signs (alternative groups). For example, if the relationship between morbidity and LVA syndrome is being studied, then the table of four fields will look like this:

Number of patients
	There is LVA	No LVA	Total
There is a morbidity	A		a+c
No morbidity			b+d
Total n	a+b	c + d	a+b+c+d

Four Field Table

The four field method is to calculate the value c 2 and definitions based on the found value c 2 probabilities ( p) that the so-called “null hypothesis”, which consists in the statement about the random nature of the relationship between the selected indicator of morbidity and the selected indicator of blood pressure asymmetry, is erroneous.
The value of the criterion c 2, calculated using the table above in accordance with the methodology, is found using the formula:

Results and discussion

As one of the morbidity criteria at the initial stage of the study, it was proposed to use the patient’s disability for more than 30 days in the current year before the start of the study. There were ten such patients out of 1,100 female subjects, and four of them had LVA syndrome. The remaining six women had no extreme asymmetry.
To establish the non-random nature of the connection between LVA syndrome and loss of ability to work for more than 30 days a year, let’s consider the null hypothesis in the following formulation: “the presence of LVA syndrome is not associated with loss of ability to work for more than 30 days per year.” Grouping the obtained blood pressure measurement results gives the following table values ​​of four fields: a = 4, b = 29, c = 6, d = 1061.
Calculating the value of c 2 using formula (1) gives a value of 47.5. It is obvious that the probability p of the null hypothesis corresponding to the calculated value c 2 is negligibly small. Thus, our assumption that the presence of LVA syndrome is not associated with morbidity turns out to be unreliable. In other words, the association of LVA syndrome with morbidity is not accidental.
Four women with disability for more than 30 days a year and with LVA syndrome (group a) had the following diseases (hereinafter, age and the value of blood pressure in the right temporal artery, as well as brachial blood pressure in mm Hg are given separated by commas): cancer stomach (age 43 years, 90 and 125/80);
hypertension of unknown etiology (52 years, 140 and 220/110) and two had pulmonary tuberculosis (19 years, 60 and 110/80; 21 years, 80 and 130/80).bThe remaining 29 people (group ) did not lose their ability to work for more than 30 days a year, although among them there were diseases: Chronical bronchitis (53 years, 65 and 140/80); psoriasis and polyarthritis (26 years, 75 and 130/80); varicose veins of the leg (50 years, 80 and 135/90); goiter of the second stage (19 years, 60 and 140/100); secondary radiculitis - (27 years, 65 and 105/60);
bronchial asthma (41 years, 75 and 90/65); cardiovascular neurosis (29 years, 40 and 100/60). In the group of examined women with PVA syndrome (41 people), no one lost working capacity for more than 30 days a year, however, in this group there was a significant number of patients (6 people) with increased brachial blood pressure (upper blood pressure 150 mm Hg or more) , accompanied in some cases by symptoms of pathological abnormalities in the endocrine system (hereinafter, age, blood pressure value in the left temporal artery, and brachial blood pressure in mm Hg are given separated by commas): thyrotoxic goiter, stage 3 (44 years, 90 and 180/100); condition after removal of the thyroid gland (50 years, 100 and 160/80); sudden violation water-salt metabolism(49 years old, 80 and 150/80); complaints of frequent numbness of the right hand (55 years, 80 and 150/80);
In addition, in this group of women (41 people) with PVA syndrome, two had obesity (42 years, 80 and 135/70; 58 years, 75 and 125/80) and one patient had nodular goiter, stage 3 (41 year, 40 and 105/60).
Note that in the remaining group of patients of 1026 people in whom there was no maximum asymmetry of blood pressure in the temporal arteries, the number of women with elevated brachial blood pressure (upper blood pressure 150 mm Hg or more) was 70 people, and the number of patients who had pathological abnormalities in functioning endocrine system, there were 18 people.
In order to statistically analyze the morbidity results in the group of patients with PVA syndrome, we first formulate the null hypothesis as follows: “increased upper blood pressure (150 mm Hg or more) is not associated with the presence of PVA syndrome.”
Forming a table of four fields and substituting the corresponding values ​​a = 6, b = 35, c = 71, d = 988 into formula (1) gives the value c 2 = 3.81, and the probability of the null hypothesis being false is p > 0.95. Thus, for this case, the null hypothesis about the independence of PVA syndrome and increased brachial blood pressure is refuted with a fairly high degree of probability.
With an even higher degree of probability, another null hypothesis is refuted - the hypothesis about the independence of the presence of PVA syndrome with diseases of the endocrine system.
The values ​​of the table of four fields in this case are equal: a = 5, b = 36, c = 19, d = 1040. The value of c 2, calculated by formula (1), gives a value of 20.01, which corresponds to the negligible probability of the formulated null hypothesis.
Thus, our assumption about the connection between atony of the temporal artery in the left (LVA syndrome) or in the right (PVA syndrome) hemisphere with pathology is statistically confirmed with a fairly high degree of probability.
The patients were classified into clinical groups, described, in particular, in: group I a - patients with suspected malignancy, group Ib - patients with precancerous diseases, group II - patients subject to special treatment; This group includes subgroup IIa - patients subject to radical treatment (both surgical, radiation and chemotherapy), group III - patients who have undergone radical treatment, but need preventive treatment to protect against relapses and metastases, group IV - patients in an advanced stage of the disease, for whom radical treatment is not feasible.
As already mentioned, LVA syndrome was detected in five women with diagnoses (hereinafter, age and blood pressure values ​​in the right temporal artery, as well as brachial blood pressure in mmHg are given in parentheses): cervical disease (38 years, 40 and 110/ 80); left ovarian cancer (59 years, 30 and 145/80); breast cancer (61 years, 120 and 140/80); cancer of the uterine cavity (65 years, 60 and 165/100) cancer of the uterine body (77 years, 50 and 160/80). Corresponding clinical groups: III, III, III, I b, III. The duration of the disease in all women with cancer did not exceed 5 years.
The remaining 10 women were diagnosed without LVA syndrome: colon and stomach cancer, uterine cavity cancer, antral cancer, thyroid cancer, right kidney cancer, colon cancer, transverse colon cancer, colon cancer, lower lobe cancer right lung, ovarian cancer. Relevant clinical groups: III, IV, IV, III, Ia, III, III, III, II, Ia. Age: 35, 45, 49, 50, 57, 70, 72, 77, 78, 80 years old.
It should be noted that in all the cancer patients studied, no signs of circulatory failure above stage I were found. In 14 of the women, depending on age, blood pressure in the brachial artery ranged from 110/80 to 160/80. Only one woman aged 80 years diagnosed with ovarian cancer (group Ia, without LVA syndrome) had a brachial pressure of 190/100.
To statistically process the results obtained, we, as before, used the four-field method. For this purpose, in addition to the group of women with cancer (15 people), a group of women also over 35 years old was formed, obtained from a previously studied group of 1100 women by simply excluding patients aged 16 to 34 years. The number of women in the resulting group was 375 people. Of these, 15 people were diagnosed with LVA syndrome.
The data obtained using the four-field method were summarized in the appropriate table. The null hypothesis, subject to statistical testing, was formulated as follows: “the presence of LVA syndrome is not associated with cancer in women.” Grouping the obtained data into a table of four fields gives the following values: a = 6 (there is LVA, there is cancer, b = 14 (there is LVA, no cancer), c = 10 (oncology, there is no LVA), d = 360 (no LVA, no oncological diseases). Note that in this table
In order to maintain a uniform approach, only those morbidity cases that were actually detected at the time of the survey were included. = 35,94. The value of c 2, calculated in accordance with formula (1), gives the value of c 2 This value
c 2 corresponds to an almost negligible probability of the null hypothesis, that is, the connection between LVA syndrome and cancer in the studied group of women is statistically significant.
We cannot yet accurately explain the nature of the relationships found and cannot immediately apply the obtained data in diagnostic practice, since this requires systematic additional research. In particular, cases of blood pressure asymmetry in men have not been studied, the cause-and-effect relationship of blood pressure asymmetry with various types of pathology remains unclear, and research methods using modern and objective electronic-computer means of blood pressure registration have not been developed.

At the same time, the observed and statistically confirmed relationship between signs of asymmetry of arterial pressure in the temporal arteries (left temporal and right temporal atony) with some diseases is, in our opinion, of significant interest for the purpose of its further study and research into the possibility of using this relationship in functional diagnostics and the development of scientific research. prognostic techniques.

It was found that in a group of randomly selected 1100 women aged 16 to 55 years, more than 6% of women have a pronounced stable asymmetry of blood pressure (BP) in the temporal arteries, characterized by left temporal atony (LTA) or right temporal atony (RTA).

Using the method of statistical hypothesis testing c 2 a statistically significant relationship was found between the presence of LVA (sustained sharply reduced blood pressure in the left temporal artery) and the presence of PVA (sustained sharply reduced blood pressure in the right temporal artery) with various types of internal pathology.

The obtained data, after establishing the nature of the cause-and-effect relationship between blood pressure asymmetry in the temporal arteries and pathology, can be used in diagnostic practice in the development of diagnostic and scientific prognostic methods.

LITERATURE

Tyulin A. A., Ermolaev Yu. N., Mkheidze G. A., Nikolskaya V. D. Some features of cerebral circulation during sudden cessation of high-intensity running in young people (according to REG data) // Theory and Practice physical culture.

1978. T. 10. No. 9. P. 40-42.

Tyulin A. A. Dynamics of rheographic indicators in athletes during high-intensity discrete running // Theory and practice of physical culture. 1995. No. 10. P. 56-57. c.

Pribram K. Languages ​​of the brain. M.: Progress, 1975. 463 c.

Bragina N. N., Dobrokhotova T. A. Functional asymmetries of man. M.: Medicine, 1981. 269 Bessmertny B.S. Mathematical statistics in clinical, preventive and experimental medicine. M.: Medicine, 1967.. 103.

C

BME.

2nd ed., vol. 27. M.: Soviet Encyclopedia, 1962. P. 1224.

Hawthorn infusion gently reduces blood pressure Hawthorn is considered a good remedy in the treatment of cardiovascular disorders. Thanks to the unique composition, the fruits of this plant eliminate arterial spasm, reduce blood pressure, and restore heart rhythm.

One tablespoon of hawthorn berries is poured into a glass of boiling water and left for a couple of hours. . Then filter and take two tablespoons several times a day before meals. Sometimes you can eliminate the difference in blood pressure in both arms by revising your diet and regimen. It is important to use only

healthy foods

. There is no special diet that reduces the difference between the tonometer numbers on the right and left hands. It is selected based on the disease that caused such a defect.

Thus, most people do not have the same blood pressure in both arms. The reason for this may be physiological and anatomical features, serious pathologies. If the difference is no more than 5 units, this is considered normal. Otherwise, the person needs to make an appointment and undergo a full examination.

UDC 612.1464-612.18

N. V. Pleshkova, A. A. Koidyyuev> V. D. Kiselev

THE PROBLEM OF ASYMMETRY IN INDIRECT MEASUREMENT OF BLOOD PRESSURE

has been linked to morbidity and malignant diseases in women in particular, on the basis of statistical hypotheses testing (χ 2 criterion) by using the four fields’ method.

Currently, a lot of data has been accumulated on blood pressure (BP) asymmetry, but they are considered alternative, fragmentary and contradictory. Some authors have found that in most healthy people, blood pressure in the vessels of the right arm and systolic blood pressure in the right carotid artery are higher than in the left. S.K. Divakova believes that the reason for the asymmetry is anatomical features vessels. the right vascular trunk departs earlier from the aortic arch and is 27 mm shorter than the left one. In this regard, the blood entering the vessels of the right upper limb has greater potential energy, and therefore the blood pressure on this limb is higher in the majority of subjects. The author associates higher blood pressure values ​​on the right arm with another morphological feature - asymmetry in the distribution of afferent fibers in the composition depressor first, since the number of afferent fibers on the right and left sides is characterized by a ratio of 4:1.

However, our data, obtained on a similar group of subjects, reveal a change in the sign of blood pressure asymmetry in the upper extremities, which occurs during measurements taken during the day. Such a change in the sign of asymmetry does not fit into the framework of the anatomical hypothesis of asymmetry.

Some researchers see the reasons for blood pressure asymmetry in the methodological aspects of measuring this indicator. In particular, A.B. Nazarchuk and V.V. Orlov believe that blood pressure asymmetry is caused by the degree of pressure of the cuff to the shoulder. However, our data obtained by synchronous oscillovasometry showed that varying the tightness of the cuff did not significantly change the results obtained. Using the same method, B.I. Mazhbich studied blood pressure in the vessels of the upper and lower extremities in healthy people and in patients with neurocirculatory dystonia. The author reports that there are no significant differences in any of the types of pressure between the right and left of the same name.

no significant limbs were detected in either healthy or sick people.

Thus, both the fact of blood pressure asymmetry and the mechanisms of asymmetry (if any) remain controversial and require further research.

Research methodology

Blood pressure was recorded using the oscillovasometric method in the supine position. Two cuffs, fixed on the shoulders or hips, were connected to one Riva-Rocci apparatus, which made it possible to perform compression and decompression simultaneously in both cuffs. Determination of pressure in the same subject both on the arms and legs was carried out 3 times, sequentially with a break 5 min between compressions. For each of the 37 male and female subjects from 20 to 23 years old, oscillograms of the forearms and shins were recorded using the rheographic method (rheographic blocks of the Polygraph-6 device) with electrical differentiation of the rheosignal (differentiation block of the same device) and synchronous recording of the pressure oscillogram ( electromanometer of the Salyut polygraph).

Daily measurements of 17 people aged 20 to 23 years of both sexes were taken every 4 hours: at 24, 4, 8, 12, 16, 20 hours. In each measurement during the day, the level and sign of blood pressure asymmetry were assessed.

In addition, during the study, blood pressure measurements were taken in 15 male and female people aged 19-22 years before and after intensive muscle work one of the hands until fatigue. The level of blood pressure asymmetry and its values ​​after work were assessed every two minutes

In some observations, blood pressure was determined during the compression and decompression phases on one arm. Computer registration of pressure in the cuff was carried out (using the electromanometer of the Salyut polygraph), sphygmograms from two photo-optical sensors (FPG-2 device) located under the cuff, using a multi-channel 10-bit analog-to-digital converter. The signal was differentiated using software. The tone of the vascular wall was assessed using the lo-

cal speed of propagation of the Pulse Wave (PWV) (distance between sphygmogram sensors 4-5 cm). 15 people aged 18 to 22 years were examined.

Research results

and their discussion

Precision oscillovasometry, performed under conditions of maximum symmetry of cuff application and pressure in them with simultaneous compression and decompression, gave results indicating the existence of differences in the level of blood pressure in the upper and lower extremities of a person on the left and right. On the upper extremities, the maximum range of asymmetry of systolic blood pressure (SBP) was 20 mmHg Art., diastolic blood pressure (DBP) - 14 mm Hg. Art., which is 16.7 and 17.5% of the initial blood pressure level, respectively. On lower limbs the maximum range of SBP asymmetry was 16 mmHg. Art., DBP - 19 mm Hg. Art., this amounted to 13.4 and 23.8%, respectively. Asymmetry of SBP and DBP in the upper extremities occurred in 57% of subjects, in the majority of whom (76%) SBP and DBP were higher on the right. In the upper extremities, asymmetry of SBP and DBP was present in 81% of subjects, among whom in 80% of cases blood pressure was higher on the left lower extremities. There was a slight asymmetry of pulse arterial pressure (PAP) (p>0.05). Taking into account the level and sign of blood pressure asymmetry in the upper and lower extremities of a person, 5 main groups were identified.

1. Group including subjects with symmetry of SBP and DBP in both arms and legs. No blood pressure asymmetry was detected in 16% of people

2. A group characterized by symmetry of SBP and DBP in the arms and the presence of higher SBP and DBP on the left in the legs. This group includes 24% of subjects

3. A group that unites individuals with higher values ​​of SBP and DBP on the left upper and lower extremities compared to the right. Includes 13.5% of those studied.

4. Group including subjects with higher values ​​of SBP and DBP on the right upper and lower extremities compared to the left. This group comprises 13.5% of those studied.

5. Group, which included subjects with higher SBP and DBP on the right in the arms and higher SBP and DBP on the left in the legs. This group included 27% of the subjects.

In one subject, blood pressure was higher on the right arm, but blood pressure values ​​did not differ on the legs. Another subject had no BP asymmetry in the upper extremities, but in the lower extremities BP was higher on the right

The values ​​of the levels of asymmetry of SBP and DBP in the lower and upper extremities (modulo) are shown in Figure 1.

Level of asymmetry: groups of subjects

□ GARDEN on the hands (SH DBP on the hand*.

d] GARDEN on. yogah LAD on your feet

Rice. 1. Levels of asymmetries of systolic and diastolic blood pressure (modulo)

As can be seen from Figure 1, in groups 3, 4, 5, asymmetries of SBP in the arms were identified, the levels of which were respectively 9.4 ± 1.3, 8.2 + 1.3, 8.0 ± 1.3 mm Hg. Art. (p>0.05).

In both groups 1 and 2, the level of SBP asymmetry in the arms was 0.0±±0.0 mmHg. Art. and was significantly lower than that in groups 3, 4, 5 (p<0,05). Наибольшие значения уровня асимметрии ДАД на руках были характерны для 4-й (9,0±2,1 мм рт. ст.) и 5-й (6,7±1,5 мм рт. ст.) групп (р>0.05); Compared to the above groups, this indicator was significantly lower in group 3 (4.8±0.8 mmHg) (p<0,05). Как в 1-й, так и во

In groups 2, the level of DBP asymmetry in the arms was 0.0±0?0 mm Hg. Art. and was significantly lower than that in groups 3, 4 and 5 (p<0,05).

In the lower extremities, there were different values ​​of the levels of asymmetry of SBP and DBP. The levels of SBP and DBP asymmetry in group 1 were 0.0±0.0 mmHg. Art. and were significantly lower than the values ​​of group 2 - 13.5±2.0 mmHg. Art. for SBP and 13.5+2.9 mm Hg. Art. for DBP (p<0,05); отличались от значений

3rd group - 12.8±1.8 mmHg. Art. for SBP, 9.8±2.9 mmHg. Art. for DBP (p<0,05); и 4-й группы - 9,4±2,5 мм рт. ст. для САД и 7,0+ ± 2,9 мм рт. ст. для ДАД (р<0,05); 5-й группы - 16,1±4,1 мм рт. ст. для САД и

groups of subjects

Ш systolic pressure

Sh dmastolicog diilsiye

Rice. 2. Level of blood pressure asymmetry (X±5x; p<0,05)

mmHg Art. for DBP. The maximum levels of SBP and DBP asymmetry in the lower extremities are characteristic of group 5 and were significantly different from the values ​​of groups 1 and 4 (p<005). Других существенных различий по сравниваемым показателям выявлено не было (р>0,05).

Studies have revealed the existence of differences in blood pressure levels in the upper extremities of a person during the day. The oscilloscope-ometric method revealed asymmetry of both SBP and DBP during the day. The maximum range of SBP asymmetry was 10 mm Hg. Art., DBP - 8 mm Hg. art., PAP - 4 mm Hg. It was found that in 88% of cases there was symmetry of blood pressure during the day. Depending on the level and sign of blood pressure asymmetry during the day, 4 groups of subjects were divided.

1. Symmetry of SBP and DBP occurred in all six measurements (angiostable group). In 12% of subjects, asymmetry of various types of blood pressure during the day was not detected.

2. Asymmetry of blood pressure was detected in only one of six measurements; in the remaining five measurements, symmetry of SBP and DBP was observed in all subjects - the so-called monophasic group, uniting 35% of all subjects.

3. Asymmetry of blood pressure was noted in two or more measurements, but the sign did not change. Taking into account the dynamics of blood pressure asymmetry during the day, this group was called polyphasic. The group included 24% of subjects

4. During the day, individuals in this group experienced repeated changes in the level and sign of blood pressure asymmetry (sign-asymmetric group, including 29% of subjects).

The average daily values ​​of the level of blood pressure asymmetry in different groups were calculated.

groin. In order of increasing average daily values ​​of SBP asymmetry, the compared groups were distributed in the following sequence. in group 1, the studied indicator is zero and significantly lower than in groups 2, 3, 4 (p<0,05); во 2-й группе этот показатель составил 0,9±0,2 мм рт. ст. и был существенно ниже, чем в 3-й и 4-й группах (р<0,05): в 4-й группе - 2,5±0,4 мм рт. ст. и был существенно выше, чем в 1-й и во 2-Й группах (р<0,05); наибольшие значения среднесуточного уровня асимметрии САД наблюдались в 3-й группе - 3,8±0,2 мм рт ст. и существенно отличались от значений этого показателя в 1-й, 2-Й и 4-й группах (р<0,05) (рис 2).

In order of increasing average daily values ​​of DBP asymmetry, the study groups were distributed as follows: in group 1, the indicator in question was equal to zero and showed the same significant differences as the SBP indicator; in group 2, the indicator we were interested in was 0.8±0.2 mm Hg. Art. and differed significantly from the values ​​of the 3rd (3.6±0.9 mm Hg; p<0,05) и 4-й групп (3,5±0,8 мм рт. ст.; р<0,05). Существенных различий по изучаемому показателю между 3-й и 4-й группами не выявлено (р>0,05).

The next part of the work is devoted to clarifying the question of whether the indicators of the indirect (oscillovasographic) method of measuring blood pressure are a reflection of vascular tone. In connection with the above, blood pressure was measured using the oscillovasographic method on both limbs before and after physical work with the right limb. Analysis of the data obtained revealed that in subjects with BP symmetry, physical work with the right hand until fatigue caused an increase in SBP of the contralateral limb by 10.1 ± 2.2 mmHg. Art. (R<0,05), ДАД - на 9,2±2,8 мм рт. ст. (р<0,05). Обращает на себя внимание тот факт, что у испытуемых с правосторонней асимметрией АД физическая нагрузка правой конечности приводила к смене знака асимметрии. САД достоверно повышалось на левой конечности на 9,3±1,9 мм рт. ст. (р<0,05), ДАД - соответственно на 8,9±2,5 мм рт. ст. (р<0,05), на работающей конечности существенных сдвигов АД не выявлено (р>0.05). It is obvious that the unchanged blood pressure in the right arm before and after physical work with this limb is due to endothelium-dependent, flow-sensitive regulation.

An increase in the lumen of blood vessels in our studies causes a decrease in vascular tone in the working arm. Obviously, the tone of the artery in the non-working arm will be higher. Probably, the intravascular pressure of the main arteries of the upper extremities before and after work on the right and left is the same. To cover the more toned arteries on the non-working limb, greater pressure in the cuff is required than for the less toned arteries of the working limb. Six minutes after work, the sign and magnitude of blood pressure were restored.

Thus, the differences in blood pressure of the great vessels on the right and left, measured by the oscillovasometric method, are obviously due to the difference in the tone of these vessels.

When analyzing measurements of SBP and DBP during the compression and decompression phases, no significant differences were revealed (p>0.05), although in individual cases these values ​​are

whether variations. Also, no significant relationships were found between PWV and blood pressure levels (p>0.05), which, apparently, is due to modification of the compliance of the vascular wall not so much by intravascular pressure, but by changes in transmural pressure. Therefore, taking into account the presence of differences in blood pressure in individual cases and the same change in transmural pressure, it can be assumed that the result of measuring blood pressure also depends on the initial state of the active element of the vascular wall.

It is known that blood pressure asymmetry in healthy people, reflecting the heterogeneity and mosaic nature of autonomic regulation, may be a certain criterion for the state of autonomic regulation. The indirect method of measuring blood pressure can produce distortions of up to 15-20%. Further research is required on the issue of blood pressure measurement.

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Tell your loved ones over 45 about why it is important to measure blood pressure in both arms at the same time

Volumetric sphygmography - multifactorial screening of cardiovascular risks and diseases

- Why is it important to simultaneously measure and assess blood pressure balance and SBP asymmetry in the upper extremities?

- In ordinary medical practice, the process of assessing blood pressure most often comes down to measuring it on one of the upper limbs. This does not take into account the probability of determining a significant (more than 10 mmHg) asymmetry of sBP, the presence of which indicates an obstructive lesion of the subclavian-vertebral segment on the side of the decrease in sBP. Simultaneous and bilateral study of blood pressure is especially important because isolated damage to the subclavian-vertebral segment is a rather rare phenomenon. More often, this pathology is combined with damage to other arteries (internal carotid arteries) supplying the brain. Consequently, the detected asymmetry of sBP during the routine procedure of simultaneous measurement of blood pressure in the arms is a valuable diagnostic marker of obstructive atherosclerosis of the brachiocephalic arterial system.

CONCLUSIONS:

Simultaneous measurement of blood pressure and assessment of SBP asymmetry in the arms is an inexpensive and highly informative procedure for angiological screening during medical examinations, medical examinations and outpatient visits.

SBP balance should be assessed in position "lying down", able peace And simultaneously on both upper limbs.

In the supine position, at rest, and with simultaneous blood pressure testing, normal indicators of SBP asymmetry between the extremities cannot exceed 10 mmHg.

Asymmetry of SBP in the upper extremities by more than 10 mmHg. indicates hemodynamically significant obstruction of the subclavian artery on the side of the decrease in SBP.

If SBP asymmetry in the upper extremities is more than 10 mmHg. there is a high probability of combined damage to other arteries of the brachiocephalic system.

Patients with SBP asymmetry in the upper extremities of more than 10 mmHg should be considered at very high risk for developing cardiovascular disease and referred for additional (ultrasound imaging) examinations of the brachiocephalic arteries.

Asymmetry of SBP in the lower extremities by more than 10 mmHg. indicates hemodynamically significant obstruction of the peripheral bloodstream on the side of the decrease in SBP.

Obstructive atherosclerosis is a systemic disease of the arteries, so you should always keep in mind the high probability of combined damage to the peripheral bloodstream and coronary arteries.

Blood pressure balance and its asymmetry in the lower extremities: http://abi-system.ru/ABI-foot.htm

Tags: #Simultaneous #ABI #system #measurement #assessment #balance #asymmetry #Angiological #screening #ankle-brachial #index #arterial #pressure #total #relative #risk #cardio #vascular #device #volume #sphygmography #anklebrachialindex #volume sphygmography apparatus

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