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Updated: June 9, 2025
This hypertension is generally improved under proper treatment. He found that in seriously ill patients this high diastolic pressure is of bad prognosis. He also found that a lower systolic pressure with a lower diastolic pressure is not a sign that the heart is weakening, but only that the visceral tone is growing less.
It has long been known that altitude increases the heart rate and tends to lower the systolic and diastolic blood pressures; that these conditions, though actively present at first, gradually return to normal, and that after a prolonged stay at the altitude may become nearly normal for the individual. Biol., 1913, lxi, 379. Jour.
In aortic regurgitation this low diastolic pressure is constantly in evidence, and, if the systolic pressure is not below normal, does not signify that the circulation is insufficient. If the systolic pressure is not very low but the diastolic is high, vasodilator drugs, by lowering the diastolic and increasing the pulse pressure, are often of benefit.
On the other hand, a high systolic pressure without a high diastolic pressure should not be rapidly lowered, else depression will be caused. In hypertension, as long as the heart, which is probably hypertrophied, remains perfectly competent, there are few symptoms, and the person does not seek advice until he notices one or more of several possible conditions.
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.
A patient with coronary disease should certainly not go to any great altitude, while patients with compensated valvular lesions, he found, were not injured by ordinary heights. He found that altitude seemed to decrease high systolic and diastolic pressures, while it even elevated those which were below normal, and caused these patients to feel better.
However, for general use, unless one is particularly expert, it is better to read the diastolic pressure at the beginning of the fifth phase. There can rarely be a doubt in the mind of the person who is auscultating as to the point at which all sound ceases. There is frequently a good deal of doubt, even after large experience, as to just the moment at which the fourth phase begins.
A distinctive murmur of this insufficiency would be diastolic and accentuated in the second intercostal space on the left of the sternum. It should be remembered that aortic murmurs are often more plainly heard at the left of the sternum. Sooner or later, if this lesion is actually present, the right ventricle dilates and cyanosis and dyspnea occur. Digitalis would therefore be indicated.
On the other hand, when the diastolic pressure rises while the systolic falls, this is a sign of failing heart. Int. They found that "low systolic pressures are not invariably of evil omen."
Caffein may be used as a drug as well as given in coffee and tea. Atropin may be of value in some forms of hypotension. At times with a low systolic pressure, but a relatively high diastolic pressure, nitroglycerin is valuable. More or less actite hypotension may occur in hot weather or with overheating, often termed heat exhaustion.
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