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

Volumetric sphygmography - multifactorial screening for cardiovascular risks and diseases

- Why is it important to simultaneously measure and evaluate BP balance and systolic blood pressure asymmetry in the upper extremities?

- In normal medical practice, the process of estimating the magnitude blood pressure most often comes down to its measurement on one of the upper limbs. This does not take into account the probability of determining a significant (more than 10 mmHg) SBP asymmetry, the presence of which indicates an obstructive lesion of the subclavian-vertebral segment on the side of the SBP decrease. Simultaneous and bilateral examination of blood pressure is especially important because an isolated lesion of the subclavian-vertebral segment is quite rare. More often, such a pathology is combined with damage to other arteries (internal carotid arteries) that feed the brain. Therefore, the revealed 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 basin.

CONCLUSIONS:

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

SBP balance should be assessed by the position "lying", capable of rest And simultaneously on both upper limbs.

In the “lying” position, in a state of rest, and with a simultaneous study of blood pressure, normal indicators of asymmetry of SBP between the limbs cannot exceed 10 mm Hg.

Asymmetry of SBP on the upper limbs by more than 10 mm Hg. indicates hemodynamically significant obstruction of the subclavian artery on the side of the decrease in systolic blood pressure.

With asymmetry of SBP on the upper limbs by more than 10 mm Hg. there is a high probability of a combined lesion of other arteries of the brachiocephalic basin.

Patients with an asymmetry in upper limb systolic blood pressure greater than 10 mm Hg should be categorized as very high risk for cardiovascular disease and referred for additional (ultrasound imaging) examinations of the brachiocephalic arteries.

Asymmetry of SBP on the lower extremities by more than 10 mm Hg. indicates a hemodynamically significant obstruction of the peripheral bloodstream on the side of the decrease in systolic blood pressure.

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

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IN Lately doctors recommend measuring blood pressure on both arms. As a rule, when measuring, there is a different pressure on the right and left hand. This is a fairly common phenomenon, although sometimes the difference in indicators serves as a warning of health problems. Therefore, timely detection of pathology will help to take the necessary measures to stabilize health in time.

How to measure blood pressure correctly?

To properly control blood pressure, you need to accurately know the indicators of "working" pressure. To do this, it is enough to take measurements for several days in the morning and in the evening. The average indicator will be the "working" pressure. In the future, it is enough for healthy people to carry out control measurements every 2-3 months. Hypertensive patients should monitor indicators at least 2 times a day. People with physiologically low blood pressure (hypotension) should be monitored as symptoms of hypotension occur.

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It is recommended to measure blood pressure twice a day: in the morning (an hour after waking up) and in the evening. Before measurement, you should not drink coffee or tea, eat, exercise, smoke, or drink alcohol. Before starting the measurement, you need to sit in a calm state for 5-10 minutes. The best position is sitting (in a chair with your back slightly leaning back). When measuring pressure, the arm should be relaxed. The correct position is when the worn cuff is in line with the heart. For more accurate measurements, the cuff should not be worn over clothing. It is better to measure pressure with the help of another person. This allows the patient to maintain the recommended comfortable body position.

To check the conductivity of the vessels in the lower extremities, pressure is measured in the arms and legs. With normal patency, the indicators differ slightly. If the pressure on the legs is very different (by 30-50%), this is a symptom of a significant narrowing of the arteries of the lower extremities.

Blood pressure measurements with an automatic blood pressure monitor

At home, it is easier to measure blood pressure using electronic blood pressure monitors - automatic or semi-automatic. It is important that a cuff is attached to the tonometer, the size of which corresponds to the diameter of the forearm. If the cuff is small or large, then the measurement results will not be reliable. Experts recommend choosing a cuff for the forearm. The cuff worn on the wrist is suitable for people with a very large volume.

When measuring pressure on two hands, it will be different, depending on a left-handed or right-handed person.

The forearm cuff is worn 2-3 cm above the elbow bend, the carpal cuff - 2-3 cm above the wrist. When measuring pressure with a semi-automatic tonometer, the air is manually pumped with a rubber bulb to the level of 200-220 mm. In the automatic air injection into the cuff is performed programmatically. Bleeding of air in both devices occurs automatically, after which the readings are displayed on the display. In addition to reading blood pressure, the pulse is shown. The following pressure is considered normal: lower - 80-90 mm Hg. Art., upper - 120-130 mm Hg. Art. In a healthy person, the pulse should be in the range of 60-90 beats per minute.

On which hand is it better to measure?

It is believed that the choice of limb for measuring blood pressure is not significant. Especially if the measurement is carried out by another person. With self-measurement, the cuff, as a rule, is put on the “non-working” arm for ease of manipulation. Blood pressure is measured to detect vascular pathologies. different hands. If you have an electronic tonometer at home, this procedure will not be difficult even with self-measurement.

Measuring blood pressure on two arms

Reasons for the difference in performance

The difference in pressure can be caused by physiological or pathological changes. Also, the difference between the indicators can be caused by non-compliance with the recommended rules - for example, drinking caffeinated drinks or alcohol before measuring. It should be noted that the asymmetry of blood pressure is observed even in absolutely healthy people. It is important to understand what difference to pay attention to. For example, for a right-hander, it is normal when the indicators on the left hand are normal, and on right hand they are a little higher. But a decrease in indicators on one of the limbs below the norm against the background of normal ones on the other may indicate vascular disorders.

Nonspecific aortoarteritis (NAA)- chronic inflammatory lesions of large arteries, mainly the aorta and its branches (much less often - the branches of the pulmonary artery).

NAA is a rare disease (2.6 cases per 1 million population per year), as is periarteritis nodosa. Mostly young women and girls are ill with NAA (the ratio of sick women and men is 8.5-3:1).

Etiology and pathogenesis. The reasons for the development of NAA are currently unclear. Vascular damage has an immunocomplex character, which is confirmed by the detection of circulating immune complexes and anti-aortic antibodies in the blood serum and in the aortic wall during the period of exacerbation. It was noted that in sick individuals more often than in the population, there are histocompatibility antigens HLA-B5, HLA-A10, which indicates a genetic predisposition.

Morphologically, there are two types of lesions - granulomatous (characteristic of the active phase of the disease) and sclerotic. The vascular lesion is segmental in nature, while the intraorgan arteries are usually not affected.

clinical picture. Due to the multiplicity of lesions of various vascular areas, the clinical picture of NAA is characterized by pronounced polymorphism. Based on the predominant involvement of blood vessels in the pathological process, it is customary to distinguish four types of lesions:

Type I - the lesion is limited to the aortic arch and its branches; Type II - the thoracic and abdominal parts of the aorta are affected;

Type III - damage to the aortic arch and its descending part (the so-called
my mixed type, the most common - in 65% of cases);

Type IV - the above lesions are combined with veterinary
vei of the pulmonary artery.

Naturally, depending on the type of lesion, the clinical picture of the disease will vary significantly. Schematically, the clinical manifestations of NAA can be represented as the so-called ischemic syndromes.

Cerebral disorders in combination with asymmetry of the pulse and blood pressure in the upper limbs (lesion of the brachiocephalic vessels).

Arterial hypertension (due to damage to the abdominal part
aorta and renal vessels).

Coronaritis (damage to the aorta and its branches, in particular coronary).

Aortic valve insufficiency (combined with ascending
descending part of the aortic arch).

Damage to the vessels of the abdominal cavity (sometimes in combination with renova-
scular hypertension).

Arteritis of the pulmonary vessels (development of pulmonary hypertension).

In addition to the main syndromes, there are signs of immune, as well as nonspecific inflammation, damage to the kidneys, joints, skin, and general signs in the form of weight loss and fever. All of the above points to the extreme polymorphism of the clinical picture of NAA, which differs significantly in patients.

At the first stage of the diagnostic search, it is possible to obtain information indicating the defeat of one or another vascular pool, as well as the severity of the course of the disease.

In young people (up to 20 years old), the disease usually begins acutely and is characterized by fever, asthenia, arthralgia, myalgia. At an older age, complaints are dominated by symptoms caused by ischemia of various organs and systems. So, patients may complain of headaches, dizziness, fainting, which is due to damage to the vessels of the brain. If the vessels of the abdominal cavity are affected, there may be complaints of abdominal pain, impaired stool, and bloating. With damage to the cerebral vessels, symptoms associated with visual impairment (transient blindness, decreased visual acuity) appear. Damage to the pulmonary artery can cause chest pain, shortness of breath, and sometimes hemoptysis. With the defeat of the coronary arteries, patients may complain of attacks of compressive (anginous) pain behind the sternum. Finally, some patients have progressive weight loss, most often in combination with an increase in body temperature, usually reduced by taking non-steroidal anti-inflammatory drugs. Some patients may report changes in their blood counts (increased ESR)*. However, these symptoms can be observed at very in large numbers diseases, therefore, after stage I of the diagnostic search, it is impossible to conclude that there is NAA. It would be more correct to include NAA in the circle of diagnostic search along with other diseases. Such non-specificity of complaints, of course, complicates the diagnostic search, and therefore the collection of information at subsequent stages is of great importance.

At stage II of the diagnostic search, all attention should be directed to the search for signs indicating damage to the arterial vessels of various vascular regions. First of all, you should carefully examine the radial arteries: a characteristic sign of NAA is the absence (or weakening) of the pulse on one side or the asymmetry of the lesion. It is important to assess the nature of the pulsation in the carotid and brachial arteries. Asymmetry of blood pressure in the arms is typical (more than 30 mm), sometimes it is impossible to determine

* In the anamnesis there may also be information about long-term arterial hypertension, poorly amenable to therapy.

divide blood pressure on one (or both) arms. Another characteristic symptom- listening to systolic murmur on large vessels - carotid, subclavian. It is extremely important to detect a systolic murmur to the left (or right) of the umbilicus in individuals with elevated blood pressure. These findings indicate an undoubted lesion of the renal arteries. In addition, the detection of an increase in the pulsation of the abdominal aorta (in combination with a systolic murmur heard over it) also indicates damage to the abdominal aorta.

Significant is the detection of protodiastolic murmur over the area of ​​the aortic valve (at the Botkin point or in the second intercostal space to the right of the sternum), which indicates damage to the ascending aorta. In some patients, high arterial hypertension can be detected. The size of the heart in such patients is increased (due to the left ventricle).

In some cases, it is possible to detect signs of arthritis of large joints, skin lesions (erythema nodosum, urticaria or hemorrhagic rashes) simultaneously with the above symptoms. Thus, at the second stage of the diagnostic search, the most significant are the signs of damage to the arterial vessels. However, these symptoms may not be so pronounced, moreover, high arterial hypertension can lead the doctor's thoughts in a completely different direction. For the final confirmation of the diagnosis of NAA, information obtained at the III stage of the diagnostic search is required.

Information received on this stage, should be divided into the following, indicating: 1) damage to the arterial trunks; 2) damage to organs; 3) the activity of the pathological process (immune inflammation and nonspecific signs).

Damage to the arterial trunks is usually quite clearly determined by direct examination, however, rheovasography, especially Doppler sonography, makes it possible to reliably judge vascular damage. Sometimes, with damage to the vessels of the kidneys or vessels of the brain, angiography is used, which definitely indicates damage to the vessels (and the degree of its severity).

Among the symptoms of lesions internal organs the most important are the signs indicating the pathology of the kidneys and heart. With kidney damage in patients with NAA, proteinuria is detected (usually not more than 1 g / day), microhematuria; with the progression of renal damage, an increase in plasma creatinine is possible. Radionuclide renography confirms renal artery stenosis, but this method is less reliable than excretory urography, which in the case of renovascular hypertension reveals a decrease in the size of the kidney on the affected side.

Angiography of the kidneys is a more accurate method for detecting renal artery stenosis, which allows you to determine the location of the lesion, its nature and prevalence.

Heart damage caused by changes in the coronary arteries is determined on the ECG (which in some cases reveals large-focal changes characteristic of myocardial infarction), as well as on the echocardiogram, which reveals a decrease in the contractile function of the myocardium.

There are no specific laboratory signs of NAA. In the active phase of the disease, there is an increase in ESR, an increase in the level

(Hg-globulins, moderate hypochromic anemia. Significant immune shifts cannot be detected (despite the undoubted autoimmune nature of the disease).

By. nature of the course, NAA is a progressive disease with different options currents - from slowly developing to acute forms. Currently, there are several variants of the course of NAA.

Acute course - the disease begins with fever, articular syndrome, increased ESR, anemia. Ischemic signs occur during the first year of the disease and progress rapidly. Therapy is usually ineffective.

Subacute course- all signs of the disease develop rather slowly. The temperature is usually low, other laboratory parameters are changed moderately. Signs of ischemia of organs and systems are detected gradually. Laboratory signs(ESR, anemia, hypergammaglobulinemia are moderately expressed).

chronic course usually seen in people over 30 years of age. The clinical picture is dominated by symptoms of vascular lesions and ischemic syndromes. An increase in temperature, laboratory parameters changed unsharply.

The causes of death in patients with NAA are heart failure, cerebral disorders, acute myocardial infarction.

Diagnostics. The diagnosis of NAA is made on the basis of a complex of signs: asymmetry and disappearance of the pulse, vascular noises over the projection of large vessels, arterial hypertension in young people presenting characteristic complaints. However, in the process of diagnosis, it is necessary to differentiate with a number of diseases that have similar symptoms to NAA. Similarity with other diseases leads to the fact that the correct diagnosis of NAA is established on average 18 months after the onset of the disease, but in some cases this period can be equal to several years.

Infective endocarditis is usually diagnosed at the onset of the disease in its acute course due to high fever, articular syndrome, and the presence of aortic valve insufficiency. However, further observation reveals damage to the main vessels and the absence of the effect of massive antibiotic therapy.

Arterial hypertension, previously treated as hypertension (often malignant course), can be rejected on the basis of signs of damage to the renal arteries and the abdominal part of the aorta, a history of episodes of fever and the effectiveness of non-steroidal anti-inflammatory drugs (and corticosteroids), the presence of indicators of the inflammatory process (primarily increase in ESR).

Arthritis, including rheumatoid arthritis, must be differentiated from NAA. However, with rheumatoid arthritis, there are no distinct lesions of the arterial vessels. The greatest difficulties are noted in the differentiation of arterial hypertension due to fibromuscular dysplasia of the renal vessels from arterial hypertension in NAA. Unlike NAA, with fibromuscular dysplasia of the renal vessels, there are no general inflammatory signs (fever, changes in acute phase parameters), lesions of the aortic arch and its branches.

The most important differential diagnostic signs of NAA are the prevalence of arterial lesions, more often several vascular areas, clinical and laboratory signs of nonspecific inflammation.

Treatment. NAA therapy has the following objectives: 1) impact on the activity of immune inflammation; 2) fight against ischemic complications; 3) drug correction of arterial hypertension.

At high degree activity of the pathological process (acute course of NAA), prednisolone at a dose of 30 mg / day should be prescribed in combination with azathioprine at a dose of 100 mg / day. However, if there is high hypertension, then the dose of prednisone should not exceed 15 mg/day.

Treatment with overwhelming doses of drugs is carried out for 1 - 1 1/5 months. With the improvement of the patient's condition (normalization of temperature, elimination of arthralgia, decrease in ESR and other non-specific indicators of the activity of the inflammatory process), the dose of prednisolone is gradually reduced to a maintenance dose of 10 mg / day; maintenance therapy is carried out for at least 2 years. Azathioprine at a dose of 50 - 75 mg / day is prescribed for 1 year.

In the subacute course of the disease, the dose of drugs is less (prednisolone 15–20 mg/day, maintenance dose 5–7.5 mg/day). In a chronic course, non-steroidal anti-inflammatory drugs (Voltaren, indomethacin) are usually prescribed in combination with antiplatelet agents (curantil, dipyridamole, persanthin, pentoxifylline) and indirect anticoagulants. With an exacerbation of the disease and the appearance of laboratory indicators of the activity of the process, prednisolone in low doses (10-15 mg / day) should be combined with voltaren (indomethacin).

At rapid development ischemic disorders (myocardial infarction, thrombosis of cerebral and peripheral vessels) are treated with heparin, antiplatelet agents, thrombolytic drugs (fibrinolysin, streptokinase, urokinase). With the subsidence of acute phenomena and the transition of the disease to chronic condition prescribe angioprotectors (prodectin at a dose of 0.75-1 g / day) in combination with antiplatelet agents (chimes) and vascular drugs (pentoxifylline).

With high arterial hypertension, treatment is carried out mainly with ACE inhibitors (in the absence of bilateral renal artery stenosis), calcium antagonists and diuretics are less effective.

Surgery indicated for renovascular hypertension, severe ischemic phenomena of the brain, extremities.

Forecast. Life expectancy depends on the presence of complications, the activity of the pathological process and the success of treatment (conservative and surgical). Causes of death of patients - heart failure, myocardial infarction, cerebrovascular accident.

/ / / Asymmetry of auscultatory indicators of blood pressure

Asymmetry of auscultatory indicators of blood pressure

The only condition leading to true asymmetry of blood pressure in the brachial arteries may be a mechanical obstruction in the area of ​​the aortic arch or its large branches: high coarctation of the aorta (above the origin of the left subclavian artery), "no pulse" disease (aorto-arteritis obliterans, Takayasu's disease), thromboembolism of the innominate, subclavian, axillary or brachial artery, and finally, their pressure.

The reason for the differences in maximum and (and) minimum pressure, which are so often found when measuring blood pressure on different arms, should not be sought in the differences in true intra-arterial pressure. To a greater extent, they are due to the inaccuracy of the auscultatory method for determining blood pressure and the influence of the surrounding conditions on the formation of Korotkovsky tones.

The asymmetry of auscultatory blood pressure indicators increases with age, with atherosclerosis, and with hypertension it is more pronounced, the higher the pressure, and that is why it attracts excessive attention from both patients and some doctors.

But the asymmetry of blood pressure, in addition to the error of the method, can also be partly explained by a number of incoming mechanical factors due to the structure of the aorta and its branches. They affect the propagation of the pulse wave and the magnitude of the hemodynamic shock. For the same reason in normal conditions a significant difference in blood pressure is recorded when measured on the arms and legs, exceeding its asymmetry on the arms - the pressure indicators on the thigh are higher than on the shoulder.

Methodological errors in measuring blood pressure are also important (the cuff is not wide enough compared to the thickness of the arm; the cuff is not tightly applied and swells strongly when air is injected; the place for listening to Korotkovsky tones is unsuccessfully chosen).

"Arterial hypertension"
E.E. Gogin, A.N. Senenko, E.I. Tyurin

However, a true increase must always be distinguished from a false one.
In some cases, when performing tonometry, the doctor receives inflated numbers, which may be associated with the so-called white coat syndrome. Once in the doctor's office, many patients are worried and uncomfortable. When a specialist begins to measure pressure, a person experiences additional stress associated with waiting for results. All this can lead to a transient increase in blood pressure. In order to exclude this, it is necessary to repeat the tonometry three times - during this time the patient has time to calm down, the pressure returns to the usual numbers and the usual values ​​\u200b\u200bcharacteristic of this person are recorded. If this rule is neglected, it is possible to mistakenly diagnose arterial hypertension and prescribe the wrong treatment to the patient.
A true increase in pressure, which remains stable over time, speaks of primary or secondary hypertension. Primary is a disease in which an increase in blood pressure is manifested due to an imbalance in vascular tone and nervous system responsible for its regulation. In contrast, with secondary, or symptomatic, hypertension, the cause of the change in pressure lies not in the arteries or the brain, but in other organs - the kidneys, thyroid gland, adrenal glands, etc.
With an increase in blood pressure, an increase in systolic and diastolic pressure may occur unevenly. Systolic increases to a greater extent with increased thyroid function, hypertensive crisis, coronary heart disease, some defects, such as coarctation of the aorta or aortic valve insufficiency, etc. In contrast, diastolic pressure increases, for example, with hypothyroidism.

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If the increase in blood pressure occurs sharply, to large numbers and is accompanied by certain signs (headache, flashing "flies" before the eyes, a feeling of heat, vegetative symptoms), they speak of a hypertensive crisis.
Situations with a decrease in pressure are less common. Hypotension accompanies such conditions as some forms of vegetative-vascular dystonia, fever, intoxication, collapse, shock. When the pressure level drops, dizziness, nausea, coldness of the hands and feet, and a feeling of nausea are noted.
Blood pressure should be measured on both arms, and in some cases on the legs - while the cuff is applied to the lower thigh, and the stethoscope is placed in the popliteal fossa. Normally, the difference between blood pressure in the arms is about 5-10 mm Hg, and the difference between the upper and lower extremities is fixed at the level of 10-15 mm Hg. (on legs more). The asymmetry of blood pressure on the right and left hand may indicate in favor of vegetative-vascular dystonia or vasculitis.
Particular changes in blood pressure levels occur with a congenital defect called aortic coarctation. In this case, in the aorta in any area there may be a narrowing, which makes it difficult for blood to pass from the heart to the organs. Often this narrowing is located below the aortic arch, from which the vessels depart towards the head and arms, i.e., the blood passes normally to the upper limbs, and it is difficult to reach the lower ones. With such a defect on the hands, the pressure will be normal or increased, and on the legs its value will be reduced. This disease is quite rare, but it is easy to recognize - the correct measurement of pressure can lead to a correct diagnosis, which is important for the patient.
In older people, there is a violation of blood pressure, which is called the "failure symptom". This symptom is determined when, during tonometry, the doctor listens to the beginning and end of the sound of heart tones, determining, respectively, systolic and diastolic pressure. Normally, in a healthy person, tones begin to sound at about 120 mm Hg. Art. and finish at 80 mm Hg. If the measurement is carried out in an elderly patient, approximately in the middle between the upper and lower numbers, the tones may stop, and then resume again. This is the very "failure" due to the peculiarities of vascular tone in the elderly. If we take the "failure" for the moment of the disappearance of tones, then the doctor will receive more inflated figures for diastolic pressure, which will lead to an incorrect diagnosis. For this reason, blood pressure should be measured very carefully in the elderly.