Blood pressure

“ The only way in which an increased blood supply can be obtained is by causing the blood to flow more rapidly. This is precisely what happens every time the blood pressure in the body rises. Whenever the vasoconstrictor center sends nervous discharges into the blood vessels of the skin and abdominal organs, causing them to contract, there is a diversion of blood from them directly into the skeletal muscles and also a rise in blood pressure due to the increase in resistance to the circulation, which causes blood to flow more rapidly through the brain. ”

“ Blood pressure is a valuable aid in diagnosis and of material help in many cases in prognosis, but it is not infallible neither can it be used alone to diagnose a case. Blood pressure is only one of many links in a chain of evidence leading to diagnosis. ”

“ In women there are variations due to menstruation. Muscular exercise raises the blood pressure markedly. The effect of a full meal is to raise the blood pressure. The explanation is that during and following a meal there is dilatation of the abdominal vessels. This takes blood from other parts of the body, provided that the other factors in the circulation [90] remain constant. A fall of pressure would necessarily occur in the aorta. To compensate for this, there is increased work on the part of the heart, which reveals itself as increased pressure and pulse pressure. ”

“ Return to normal pressure is commonly found in those who are cured. Continuation of hypotension seems never to accompany improvement. Prognosis can as safely be based on the alteration in the blood pressure as on changes in the pulse or temperature...."
There are a few drugs which lower the blood pressure, [120] but, as a rule, their effects are more or less transitory. We know of no drug, unless it be iodide of potassium, which has the property of causing changes in the blood (decrease in viscosity?) , which tends to reduce the blood pressure when it is excessive. ”

“ Exercise always raises blood pressure, the maximum much more than the minimum. In athletes the minimum pressure may actually fall, the maximum rise so that a greater volume output results from the greater pulse pressure. ”

“ A necessary consequence of this is that variations of blood-pressure and sap-pressure should be produced under parallel conditions. The most important factor in causing arterial pressure by the circulating fluid is the pumping activity of the heart. Under stimulating agencies this becomes enhanced with resulting increase of blood-pressure; under depressing conditions the pressure becomes decreased. The radial artery on the wrist is exposed and it is easy to feel the pulse-beat or record it by the Sphygmograph. ”

“ With the systole of the heart there is a sudden dilatation of the arch of the aorta, and a wave of expansion follows, which is transmitted to the periphery and is lost only in the capillaries.
The blood pressure is constantly changing. Physiologically there are relatively wide variations in the pressure in a perfectly normal individual. There are some persons who have hypotension, a blood pressure much below the normal. Such persons have usually small hearts, small aortas, and they seem to have but little resistance to disease. ”

“ The patient must remain absolutely quiet. Raising the head or the free arm causes the pressure to rise. Another important physiologic variation is produced by concentrated mental activity. This tends to hurry the heart and increase the force of the beat. In short, it may be stated as a general rule that any active functioning of a part of the body which naturally requires a great excess of blood tends to elevate the blood pressure. At rest the pressure is constant. Variations caused by the factors mentioned act only transitorily, and the pressure shortly returns to normal. ”

“ All states of hypertension are accompanied by more or less increase of pulse pressure. In other words the systolic pressure is always increased to greater degree than the diastolic pressure. In studies carried out in the wards and Pathological Laboratory of the Milwaukee County Hospital, Milwaukee, we found that in all of the cases of chronic high blood pressure with resulting high pulse pressure four correlated factors were found. ”

“ Often called the silent killer because it usually exhibits no symptoms, high blood pressure is an insidious condition that may lead to heart attack, stroke or kidney damage. Along with cigarette smoking and elevated blood cholesterol, it is one of three major risk factors for cardiovascular diseases.
High blood pressure can be detected quickly and painlessly by use of an inflatable arm cuff and stethoscope. All Americans should take advantage of the high blood pressure screening activities in their communities, their work places and their public health facilities. ”

“ Sometimes when the blood pressure is not lowered, there is relief of tension in the head from high pressure, and the patient feels better. There is also relief of the heart when it is laboring to overcome a high resistance. One drop of the official spirit of nitroglycerin on the tongue will cause a lowering in the peripheral pressure pulse, the radial pulse becoming larger and fuller. ”

“ It has been shown how poisonous substances absorbed from the intestines have some influence on the blood pressure. Anything that causes constant increase of pressure should be studiously avoided.
Mild exercise is an essential feature of prophylaxis. One may, by judicious exercise and diet, make of himself a powerful muscular man without, at the same time, raising his average blood pressure. The man who goes to excess and continually overburdens his heart, will suffer the consequences, [226] for the bill with compound interest will be charged against him. ”

“ Of course, it is necessary to be able to tell when the artery has actually been squeezed shut, so that the determination of blood pressure in human beings is the work of an expert. Furthermore, blood pressure, as should be clear from what has already been said, varies with every heartbeat. It is at its maximum the instant the heart finishes emptying itself into the artery, and falls off steadily, reaching a minimum just before the next beat comes. ”

“ The patient feels that he is about to die. The pulse is generally slowed, may be irregular, and may not be felt at the wrist. The blood pressure has been found at times to be increased. It could of course be taken only in those cases in which there were more or less continued anginal pains; the true typical acute angina pectoris attack is over, or the patient is dead, before any blood pressure determination could be made. When there is more or less constant ache or frequent slight attacks of pain, the blood pressure may be raised by the causative disease, arteriosclerosis. ”

“ It is obviously of the utmost importance that the heart should not be over-dilated by an increased filling pressure during the period of diastole.
When a man strains to lift a heavy weight he closes the glottis, and by contracting the muscles which are attached to the thorax raises the intrathoracic pressure. The rise of intrathoracic pressure aids the pericardium in supporting the heart, and prevents over-dilatation by resisting the increase in venous blood pressure. This increase results from the powerful and sustained contraction of the abdominal and other skeletal muscles. ”

“ A patient with simple hypertension and otherwise well, which means that his diastolic pressure is at least no higher than 110, should have his diet, tobacco, coffee and tea regulated; should have recreation periods one or more times a week, and vacations not too infrequently; should take some brisk purgative once or twice a week, and may receive one or other of the physical treatments for the reduction of blood pressure, whether Turkish baths or electric light baths. If he does not sleep well, there is no hypnotic drug so valuable in his case as chloral. ”

“ The minimum blood pressure is very uniform throughout the day, and is little affected by the ingestion and digestion of meals. When it is affected a rise or fall may take place. There is a tendency for a slight general lowering of the minimum pressure throughout the day. ”

“ It must be ever kept in mind that a blood pressure reading represents the work of the heart at the moment when it was taken. Within a few minutes the pressure may vary up or down. There is no normal pressure as such, but an average pressure for any group of people of the same age living under similar conditions. The habit of speaking of any systolic figure as normal should be broken. A pressure picture may be normal but a systolic reading, whatever it may be, is not accurately designated as normal. ”

“ When the artery is rolled under the finger, then it may seem that there is some thickening in its walls, though it is only heightened blood pressure from emotion that causes the feeling. This high blood pressure may, of course, of itself be an indication of danger whenever there is heart or kidney disease, but it often occurs as a passing event in nervous patients whose vasomotor control is so capricious that arterial tension and blood pressure may change at very short intervals as the result of excitement. ”

“ ETIOLOGY One of the most common causes of hypertension is clue to excess of eating and drinking. The products caused by maldigestion of proteins, and the toxins formed and absorbed especially from meat proteins, particularly when the excretions are insufficient, are the most frequent causes of hypertension. Whatever other element or condition may have caused increased blood pressure, the first step toward improving and lowering this pressure is to diminish the amount of meat eaten or to remove it entirely from the diet. ”

“ The heart walls are similarly weakened and yield more readily to the internal blood pressure in endocarditis, myocarditis, pericarditis, high fever, infectious diseases, poisonings, anæmia, and debilitating diseases generally. Debility and incapacity to resist the blood pressure is the essential prerequisite to dilatation. ”

“ It seems improbable that a change in blood pressure plays any very important rôle, if indeed it has an influence at all. There is much evidence to show that many glands consisting of cells resembling those of the intestine roughly, secrete their characteristic fluids quite independently of blood pressure. ”

“ People now suspect the condition, and they frequently seek their physicians to determine if the blood pressure is too high and, from reading health journals, more or less realize some of the things, at least, that must be done to decrease the pressure. ”

“ The mere lessening of the blood pressure is to be little considered, as it requires the abstraction of nearly one-third of the entire mass of blood to visibly affect this. The vascular walls at once adapt themselves to the lessened amount. ”

“ There is usually the enlarged heart and pulse of high tension with or without the trace of albumin in the urine. The lurking danger of this group of manifestations has so impressed the medical directors of several of the large insurance companies that a blood pressure reading must be made on all applicants over forty years of age. Should high blood pressure be found, the premium is increased, as the expectation of life is proportionately shorter in such men than in normal persons. ”

“ Normal blood pressure is 125 millimetres. Mr. Pitts shows a high pressure, very high. The large life insurance companies are now using this instrument. They would tell you that a high pressure like that indicates apoplexy. Mr. Pitts, young as he really is, is actually old. For, you know, the saying is that a man is as old as his arteries. Pitts has hardening of the arteries, arteriosclerosis—perhaps other heart and kidney troubles, in short pre-senility. ”

“ Psychic activity, especially when it is accompanied by worry, is a potent factor in the production of the increased blood pressure which is the chief factor in producing arterial disease. It has been suggested that sexual continence in high-strung men produces changes in the nervous system which can conceivably lead to the production of high tension and further to arteriosclerosis. This, however, I can not think has any foundation in fact except in so far as such men are prone to live at high speed and wear themselves out sooner than the normal person. ”

“ Should there be actual indications for reducing the blood pressure, I must admit that it can not always be done. The majority of cases will do well on the sodium nitrite or erythrol tetranitrate. However, these do not always lower blood pressure and keep it within normal limits. When a man has very high tension we do not wish to reduce it to what it should normally be for the age of the patient, as symptoms of collapse might set in at any time under such conditions. ”

“ Rising blood pressure is effective "in largely restoring in fatigued structures their normal irritability" and an increase of adrenin seems to raise blood pressure by driving the blood from the interior regions of the body "into the skeleton muscles which have to meet, by extra action, the urgent demands of struggle or escape." ”