Wide blood pressure: signs, symptoms, and causes

2021-08-30 06:18 AM

It should be noted that septic shock may present (especially in the early stages) as a cold shock with vasoconstriction and maintenance of peripheral vascular resistance.

Pulse pressure is calculated as systolic blood pressure minus diastolic blood pressure. The normal value is 40 mmHg. Each variation in vascular blood pressure has distinct clinical significance. The determination of pulse pressure is very complicated. The determining factors are arterial resistance, arterial properties, and stroke volume/cardiac output

Flowchart of Mechanism of wide blood pressure effect in the elderly

Flowchart of Mechanism of wide blood pressure effect in the elderly

 

Description

Blood pressure difference greater than 55-60mmHg.

Cause

Aged

Open aorta

Later stages of septic shock.

Increase cardiac output.

Hyperthyroidism.

Wide blood pressure and vascular hardening

Image. Wide blood pressure and vascular hardening

Mechanism

Aged

The factors that regulate the patient's voltage are complex and cannot be explained by a specific model. However, decreased vascular elasticity and increased pulse wave velocity are thought to be the predisposing conditions for the wide voltage gradient in the elderly.

With increasing age, the arterial endothelium is more likely to peel and break, and age changes the ratio of collagen/elastin. These changes make the arteries stiff and less elastic. Then the arteries lose the ability to adapt to the increased blood pressure during systole, so the blood pressure rises.

A second model shows that stiffening of the great arteries results in faster arterial waveform conduction because the vessel walls are less elastic to resist waves. As a result, the double pulse echoes more rapidly and the systolic blood pressure increases further, thus causing a wide effect.

In summary, it is conceivable that vascular stiffness/reduced elasticity and a more than normal increase in pulse velocity could explain the increased pulse pressure in the elderly.

Septic shock

In warm septic shock, the potentiating mechanism is vasodilation, increased endothelial permeability, and decreased peripheral vascular resistance.

In septic shock, the infection triggers an immune-inflammatory response. Humoral immunity and nonspecific immune responses are activated, leading to leukocyte recruitment and the release of cytokines, including TNF-α, IL-8, IL-6, histamine, prostaglandins, and nitric oxide. These cytokines increase vascular permeability and systemic vasodilation, decrease systemic vascular resistance and diastolic blood pressure and, therefore, exert a wide effect.

It should be noted that septic shock may present (especially in the early stages) as a cold shock with vasoconstriction and maintenance of peripheral vascular resistance.

Open aorta

The wide pressure gradient can be produced by the large volume of blood flowing from the left ventricle into the descending aorta during systole. Vascular insufficiency during diastole is due to reflux into the ventricles and backflow in the peripheral arterioles.

Hyperthyroidism

Thyroid hormone has many effects on the cardiovascular system, as well as other organ systems. Results include increased blood volume, increased myocardial contractility, and decreased vascular resistance, all of which result in a widening effect.

Excess thyroid hormone causes increased heat production in peripheral tissues, causing vasodilation and decreased systemic vascular resistance and diastolic blood pressure. Therefore, T3 also has a direct effect on reducing vascular resistance.

At the same time, thyroid hormone also has the effect of increasing contractility and increasing heart rate, increasing hematopoiesis and blood volume, thereby increasing cardiac output and systolic blood pressure.

Significance

Wide voltage is a very valuable symptom, depending on the clinical circumstances that may be encountered.

Pressure is an independent predictor of death and disability in normotensive and hypertensive patients.

Furthermore, many studies suggest that BP is a better indicator than systolic and diastolic blood pressure, although not all studies agree with this.

There is strong evidence that wide-range pressure increases the risk of atrial fibrillation and heart failure, and treatment of chronic wide-pressure or isolated systolic hypertension reduces the risk of adverse outcomes.

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