The diagnosis of arterial hypertension is based on the average value of blood pressure, at least from 2 measurements obtained during the initial and repeated examinations of the patient. Blood pressure should be measured on both hands and, if necessary, legs, correctly position the arm and cuff, measure in an upright position and lying down.
Physical examination revealed an expansion of the boundaries of relative and absolute cardiac dullness to the left, increased apical impulse due to left ventricular hypertrophy, accent II tone over the aorta, which depends on the magnitude of blood pressure and the severity of atherosclerotic changes in the aorta.
Clinical manifestations are often due to the presence of IHD, atherosclerosis of the coronary or cerebral vessels. The ECG usually reveals signs of left ventricular hypertrophy: the deviation of the electrical axis of the heart to the left, an increase in the amplitude of the complex in leads V5-V6, the appearance of a characteristic ST segment depression and a T wave deformity. During an ophthalmoscope, the fundus pattern usually depends from etiological causes of arterial hypertension or diabetes complications (renal retinopathy, diabetic retinopathy). In hypertension, the phenomenon of Ca-lus-Gunn recurrence is noted (compacted arteries squeeze veins), arteriol sclerosis develops, their caliber is uneven, retinal edema, etc.
The symptoms of coronary artery disease in patients with diabetes and hypertension differs little from a typical painful attack, but much more often, according to various authors, in 20% -30% of cases, angina and myocardial infarction occur without pain and typical irradiation. According to the Joslyn Center, among patients with diabetes at the age of 35 to 50 years, myocardial infarction and sudden death account for 35% of causes of death.
In case of “silent” myocardial ischemia, there is a decrease in coronary reserve in the absence of signs of an increase in the mass of the left ventricle, which was shown in the clinic using intracoronary dopplerography. The features of IHD and myocardial infarction in diabetic patients are primarily associated with autonomic diabetic neuropathy, which causes serious impairment of the functional state of the myocardium and central hemodynamics, i.e. a decrease in stroke and minute blood volume, cardiac index, left ventricular power, increased heart rate and overall peripheral resistance. Constant tachycardia, the lack of difference in heart rate during the daytime and at night indicate a violation of parasympathetic innervation.
Patients with diabetes often take the position of IHD, cardiac neuropathy (autonomic neuropathy), and cardiomyopathy. This combination significantly changes the clinic, leads early with cardiovascular insufficiency, complicates diagnosis. The development of autonomous diabetic neuropathy entails a violation of the adaptive capabilities of the organism, a decrease in exercise tolerance.