hypertension
Introduction
Introduction to hypertension Hypertension is the most common chronic disease and the most important risk factor for cardiovascular and cerebrovascular diseases. Stroke, myocardial infarction, heart failure and chronic kidney disease are the main complications. In the absence of antihypertensive drugs, systolic blood pressure 140mmHg and / or diastolic blood pressure 90mmHg, according to blood pressure levels, high blood pressure is divided into 1, 2, and 3. Systolic blood pressure 140mmHg and diastolic blood pressure <90mmHg are listed as simple systolic hypertension. The patient has a history of hypertension and is currently using antihypertensive drugs. Blood pressure, although lower than 140/90mmHg, should also be diagnosed as hypertension. basic knowledge The proportion of illness: 12% (the probability of illness over 50 years old is 30%-50%) Susceptible people: no special people Mode of infection: non-infectious Complications: coronary heart disease, hypertensive encephalopathy, hypertensive crisis, stroke
Cause
Cause of hypertension
Genetic factors (30%):
About 75% of patients with essential hypertension have a genetic predisposition, and hypertensive patients in the same family are often concentrated. Essential hypertension is believed to be a polygenic genetic disease. It has been reported that hypertensive patients and patients with a family history of hypertension and normal blood pressure have transmembrane electrolyte transport disorders, and there is a hormone-like substance in the serum that inhibits Na+/K+-ATPase activity, resulting in a decrease in sodium-potassium pump function. The concentration of Na+ and Ca2+ in the cells increased, the contraction of SMC in the arterial wall was strengthened, the density of adrenergic receptors increased, and vascular reactivity was enhanced. These all contribute to the increase in arterial blood pressure. Recent studies have found that angiotensin (AGT) gene may have 15 defects, and normal blood pressure is dysfunctional, while hypertensive patients have the same variation in three specific parts of the AGT gene. A brother or sister with high blood pressure can obtain the same copy of the parent's AGT gene. In patients with hypertension with this genetic deficiency, plasma angiotensinogen levels were higher than those in the control group.
Dietary electrolytes (20%):
In general, people with high daily salt intake have a higher percentage of blood pressure or an average blood pressure higher than those with low salt intake. In the WHO measures to prevent hypertension, it is recommended that the daily salt intake per person should be controlled below 5g. A study of the relationship between electrolytes and blood pressure in a total of 53 centers in 32 countries showed that the average urine sodium level in Chinese population was 206 mmol/24 h, 43 mmol/24 h higher than other centers, and the urinary sodium/potassium ratio reached 6.7. More than twice the center. The highest sodium urate is Tianjin (242mmol/24h). This is related to the high sodium and low potassium of Chinese diet. Potassium can promote sodium excretion, and eating a lot of vegetables can increase potassium intake, which may protect the arteries from the adverse effects of sodium. Calcium can alleviate the effect of sodium on the pressurization. The general diet in China is low calcium, which may aggravate the effect of sodium/potassium on blood pressure. Intervention studies that increase dietary calcium intake have shown that an increase in calcium causes blood pressure to decrease in some patients.
Psychosocial stress (15%):
According to the survey, psychosocial stress is closely related to the onset of hypertension. Stressful life events include: early death, loss of love, widowhood, death of family members in car accidents, sickness, family breakdown, economic and political shocks, etc. The prevalence of hypertension in people who were motivated by life events was higher than that in the control group. It is believed that psychosocial stress can alter the hormone balance in the body and thus affect all metabolic processes.
Kidney factor (10%):
Renal medulla interstitial cells secrete antihypertensive lipids such as prostaglandins, antihypertensive neutral renal medullary lipids and other secretion disorders, and sodium dysfunction may be related to the onset of hypertension.
Neuroendocrine factors (10%):
It is generally believed that the excitability of the sympathetic nerve fibers of the arterioles is an important neurological factor in the pathogenesis of this disease. However, there are two types of sympathetic ganglion fibers:
1. Vascular fibers, the neurotransmitters are neuropeptide Y (NPY) and norepinephrine.
2, vascular fibers, the transmitter is calcitonin gene related peptide (CGRP) and substance P. The imbalance of these two fibers, that is, the former is more powerful than the latter, causes blood pressure to rise. In recent years, the relationship between central neurotransmitters and neuropeptides, as well as various regulatory peptides and hypertension, has become a very active research field. It has been reported that CGRP may inhibit the release of norepinephrine in the hypothalamus of rats, and it may inhibit the release of norepinephrine when stimulated by adrenal nerves in the periphery. It has been reported that the isolation of natriuretic peptides (types A, B and C) from mammalian hearts and brains suggests that there is a family of natriuretic peptides in the human body. Recent advances in the local renin-angiotensin system (RAS) have made new progress. The mouse renin gene (Ren-2 gene) was injected into rat egg cells through a microinjection device to form a transgenic rat germline TGR (mREN2) 27, which has extremely high blood pressure. Northern blot hybridization confirmed that the Ren-2 transgene was expressed in the adrenal gland, blood vessels, gastrointestinal tract and brain, and could be expressed in the thymus, reproductive system and kidney. Due to its expression in the blood vessel wall, angiotensin formation in blood vessels may be increased, resulting in hypertension and vascular SMC hypertrophy.
Blood pressure regulation mechanism
A variety of factors can cause blood pressure to rise, the ability of the heart to pump blood (such as increased cardiac contractility, etc.), so that blood pumping per second increases, another factor is that the aorta loses its normal elasticity and becomes stiff when the heart When the blood is pumped out, it cannot be effectively expanded. Therefore, the blood flow pumped by each heart beats through a space smaller than normal, resulting in an increase in pressure. This is because hypertension often occurs in atherosclerosis leading to thickening and deformation of the arterial wall. The reason for the stiff elderly, due to the stimulation of hormones in the nerves and blood, the temporary contraction of the small arteries also causes an increase in blood pressure, and the third factor that may lead to an increase in blood pressure is the increase in fluid volume in the circulation. In kidney disease, the kidneys cannot fully discharge sodium salts and water from the body, and the blood volume in the body increases, resulting in an increase in blood pressure.
Conversely, if the heart's ability to pump blood is limited, vasodilation or excessive fluid loss can lead to a drop in blood pressure, mainly through kidney function and the autonomic nervous system (the part of the nervous system that automatically regulates many functions of the body). Change to regulate.
Prevention
Hypertension prevention
Precautions for hypertension
First, a reasonable diet
1, the importance of diet for high blood pressure: the people eat food for the day, a reasonable diet can make you not fat or thin, cholesterol is not high or low.
2, the diet of patients with hypertension should be taboo:
(1) Carbohydrate food:
Suitable foods - rice, porridge, noodles, noodles, arrowroot, soup, clams, soft beans.
Foods that should be avoided - sweet potatoes (foods that produce abdominal gas), dried beans, and strong biscuits.
(2) Protein foods --- beef, pork lean meat, white meat fish, eggs, milk, dairy products (fresh cream, yeast milk, ice cream, cheese), soy products (tofu, natto, soy flour, oil tofu).
Foods that should be avoided - fat foods (bovine, pork belly, pork ribs, whales, squid, tuna, etc., processed products (sausage).
(3) Fat foods.
Suitable foods - vegetable oil, a small amount of cream, salad dressing.
Foods that should be avoided - animal oil, raw lard, bacon, oil-impregnated sardines.
(4) Vitamins, mineral foods.
Suitable foods - vegetables (spinach, cabbage, carrots, tomatoes, lily roots, pumpkin, eggplant, cucumber) fruits (apples, oranges, pears, grapes, watermelons).
Seaweed, fungi should be cooked before eating.
Foods that should be avoided - fiber-hard vegetables (burd, bamboo shoots, beans).
Irritating vegetables (sweet vegetables, mango, mustard, onions, mustard).
(5) Other foods
Suitable foods - light tea, yeast milk drink.
Foods that should be avoided---spices (chili, curry powder), alcoholic beverages, salt-soaked foods (ingredients, caviar), pickles, coffee.
3, high blood pressure patients should pay attention to the eating habits:
(1) First of all, we must control the intake of energy, and advocate the consumption of complex sugars such as starch, corn, and less glucose, fructose and sucrose. These sugars are monosaccharides, which may cause high blood lipids.
(2) Limit the intake of fat. When cooking, use vegetable oil to eat more sea fish. Marine fish contain unsaturated fatty acids, which can oxidize cholesterol, thereby lowering plasma cholesterol, prolonging platelet aggregation, inhibiting thrombosis and preventing stroke. It also contains more linoleic acid, which has a certain effect on increasing the elasticity of microvessels, preventing vascular rupture and preventing complications of hypertension.
(3) Appropriate intake of protein. The daily protein content of hypertensive patients is 1g per kilogram of body weight. Eating 2-3 times of fish protein per week can improve blood vessel elasticity and permeability and increase urinary sodium excretion. Lowering blood pressure, such as hypertension and renal insufficiency, should limit protein intake.
(4) Eat more foods containing potassium, rich in calcium and low in sodium, such as potatoes, eggplant, kelp, lettuce, foods high in calcium: milk, yogurt, shrimp skin, eat less broth, because the meat contains nitrogen Increased leachables can promote the increase of uric acid in the body and increase the burden on the heart, liver and kidneys.
(5) Limit the intake of salt: It should be gradually reduced to 6g or less per day, that is, after the ordinary beer cover is removed from the rubber pad, the salt of a flat lid is about 6g, which means that the salt content includes cooking salt and other foods. The total amount of sodium contained in the synthetic salt, appropriate reduction of sodium intake can help lower blood pressure and reduce sodium retention in the body.
(6) More fresh vegetables and fruits, no less than 8 two fresh vegetables per day, 2 to 4 fruits.
(7) Appropriate increase in seafood intake: such as kelp, seaweed, seafood and so on.
Second, the right amount of exercise
The importance of exercise for high blood pressure: There is a saying: "In youth, use health for money, when you are old, use exercise for health," in addition to promoting blood circulation, lowering cholesterol production, and strengthening muscles and bones. With the occurrence of joint stiffness, exercise can increase appetite, promote gastrointestinal motility, prevent constipation, improve sleep, have the habit of continuous exercise: it is best to do aerobic exercise, it will help, aerobic exercise can reduce blood pressure like weight loss Such as walking, jogging, Tai Chi, cycling and swimming are all aerobics.
1. Precautions for exercising:
(1) Do not overdo it or be too strong or too tired. Take a step-by-step approach to increase the amount of activity.
(2) Pay attention to the surrounding environment and climate: Summer: avoid the time of high sun at noon, winter: pay attention to keep warm and prevent stroke.
(3) Wearing comfortable and sweat-absorbing clothes: It is necessary to choose cotton fabrics, sports shoes, etc.
(4) Choose a safe place: such as a park, school, not in the roadway, on the side of the road.
(5) When exercising, do not fasting, so as to avoid hypoglycemia, should be 2 hours after meals.
2. Taboos of exercise:
(1) Stop exercising when you are sick or uncomfortable.
(2) It is not advisable to exercise during hunger or one hour after a meal.
(3) Do not stop immediately during exercise. Follow the steps of the exercise program.
(4) Any discomfort during exercise should stop immediately.
Third, smoking cessation limit
Smoking can lead to high blood pressure. Studies have shown that heart rate increases by 5-20 beats per minute and systolic blood pressure increases by 10-25 mmhg after smoking a cigarette. Why is this? Because nicotine (nicotine) in tobacco leaves excites the central nervous system And sympathetic nerves, which speed up the heart rate, and also promote the release of a large amount of catecholamines from the adrenal glands, causing the arteries to contract, leading to an increase in blood pressure. Nicotine also stimulates chemoreceptors in the blood vessels, causing a rise in blood pressure reflexively.
Long-term large-scale smoking will also promote aortic atherosclerosis, the small intima of the small arteries will gradually thicken, and the whole blood vessels will gradually harden. At the same time, due to the increase of the content of carbon monoxide hemoglobin in the blood of smokers, the blood oxygen content will be reduced, and the endometrium of the arteries will be deficient. Oxygen, the increase in oxygen content in the arterial wall, accelerates the formation of atherosclerosis. Therefore, people who do not have high blood pressure can prevent high blood pressure, and people with high blood pressure should quit smoking.
Compared with smoking, the pros and cons of drinking alcohol are controversial. Various reports appear from time to time. Some say that drinking a small amount of alcohol is beneficial, and some say it is harmful, but it is certain that heavy drinking is definitely harmful, and high concentration of alcohol will be Causes arteriosclerosis and aggravates high blood pressure.
Fourth, psychological balance
The psychological manifestations of hypertensive patients are nervous, irritable, and emotionally unstable. These are the causes of elevated blood pressure. Patients can improve their ability to adapt to the natural environment and society by changing their behaviors. Excessive tension, anxiety, calmness and calmness when you are in trouble; when you have greater mental stress, you should try to release it, pour or encourage your friends, relatives to participate in a relaxed and enjoyable leisure activity, and pour your spirits into music or in love with flowers. To keep yourself in the best possible conditions to maintain a stable blood pressure.
Five, self-management
1. Regularly measure blood pressure, and measure at least once in 1-2 weeks.
2, treatment of high blood pressure should adhere to the "three hearts", that is, confidence, determination, perseverance, only to do so can prevent or delay the damage of important organs of the body.
3, regular use of antihypertensive drugs, do not arbitrarily reduce or stop the drug, can be adjusted under the guidance of the doctor and the current condition to prevent blood pressure rebound.
4, the conditions allow, you can bring your own sphygmomanometer and learn to self-test blood pressure.
5, with the appropriate medication, but also pay attention to work and rest, pay attention to diet, exercise, maintain emotional stability, adequate sleep.
6, the elderly can not be too fast to reduce blood pressure, blood pressure should be controlled at 140-159mmhg is appropriate, reducing the occurrence of cardiovascular and cerebrovascular complications.
7, the elderly and taking noradrenergic nerve endings blocking drugs to prevent orthostatic hypotension.
8, do not need to strictly prohibit sex: pay attention to the following situations, it is not suitable for sex: 1 do not immediately engage in sexual intercourse after 2; 2 should drink sex after sex; 3 if there is dizziness, chest tightness, etc. do not adapt to stop sex life, and timely Seek medical attention.
Complication
Hypertension complications Complications, coronary heart disease, hypertensive encephalopathy, hypertension, crisis, stroke
In China, the most common complication of hypertension is cerebrovascular accident, followed by heart disease with hypertensive heart disease, followed by renal failure, which has been described in the clinical manifestations section. Less common but serious complications are Aortic dissection aneurysm, its onset is often sudden, rapid chest pain, rapid radiation to the back or abdomen, accompanied by blockage of the aortic branch, so that the blood pressure and pulse of the two upper limbs are significantly different, one side from the carotid artery to the femoral artery The pulse disappeared or the lower extremity was temporarily paralyzed or hemiplegia. A small number of aortic regurgitation occurred. The blood pressure of the unblocked arteries increased. The aneurysm could rupture into the pericardium or pleural cavity and died rapidly. The chest X-ray showed a significant increase in the aorta. Wide, echocardiographic computed tomography or magnetic resonance tomography can directly show the dissection or extent of the aorta, and even can be found, aortic angiography can also establish a diagnosis, hypertension and lower extremity atherosclerosis, Can cause lower limb pain, lameness.
Disease hazard
1, heart problems: coronary heart disease, angina pectoris, myocardial infarction, heart rhythm disorder;
2, the brain: insufficient blood supply to the brain, cerebral infarction, cerebral thrombosis, cerebral hemorrhage, etc.;
3, kidney: proteinuria, nephritis, chronic renal failure;
4, eyes: decreased vision, fundus bleeding, cataract, blindness;
5, multiple organ failure, death.
Disease caused
1, coronary heart disease
Long-term hypertension can promote the formation and development of atherosclerosis. Coronary atherosclerosis can block or narrow the lumen of the blood vessels, or cause coronary heart disease due to myocardial ischemia, hypoxia, and necrosis due to functional changes in the coronary arteries. Coronary atherosclerotic heart disease is the most common type of organ disease caused by atherosclerosis, and is also a common disease that seriously endangers human health.
2, cerebrovascular disease
Contains cerebral hemorrhage, cerebral thrombosis, cerebral infarction, and transient ischemic attack. Cerebrovascular accidents, also known as strokes, are fierce and have a very high mortality rate. Even if they are not fatal, most of them will be disabled, which is the most ferocious one of acute cerebrovascular diseases. The higher the blood pressure in patients with hypertension, the higher the incidence of stroke. If the cerebral arteries of patients with hypertension are hardened to a certain extent, plus a moment of excitement or excessive excitement, such as anger, sudden accidents, strenuous exercise, etc., blood pressure will rise sharply, cerebral vascular rupture and bleeding, blood will be When the brain tissue overflows into the blood vessels, the patient will immediately stun and fall to the ground, so it is commonly called a stroke.
3, hypertensive heart disease
Cardiac changes in hypertensive patients are mainly left ventricular hypertrophy and enlargement, myocardial cell hypertrophy and interstitial fibrosis. Hypertension leads to heart hypertrophy and enlargement, called hypertensive heart disease. Hypertensive heart disease is an inevitable trend in which hypertension is not controlled for a long time. In the end, it may affect life safety due to cardiac hypertrophy, arrhythmia, and heart failure.
4, hypertensive encephalopathy
Mainly in patients with severe hypertension. Because the excessive blood pressure exceeds the automatic adjustment range of cerebral blood flow, brain tissue causes brain edema due to excessive blood perfusion. Clinically characterized by symptoms and signs of encephalopathy, manifested as diffuse severe headache, vomiting, disturbance of consciousness, mental confusion, severe coma and convulsions.
5. Chronic renal failure
Hypertension damage to the kidneys is a serious complication, with hypertension accounting for about 10% of renal failure. Hypertension and kidney damage can interact and form a vicious circle. On the one hand, high blood pressure causes kidney damage. On the other hand, kidney damage can aggravate hypertension. Generally, in the middle and late stages of hypertension, the renal arterioles are hardened, the renal blood flow is reduced, and the ability of the kidney to concentrate urination is reduced. At this time, polyuria and nocturia increase. Rapidly developing hypertension can cause a wide range of chronic lesions of the renal arterioles, leading to malignant renal arteriosclerosis, which rapidly develop into uremia.
6, hypertensive crisis
Hypertensive crisis can occur in both early and late stages of hypertension. Inducements such as stress, fatigue, cold, and sudden withdrawal of antihypertensive drugs can cause strong paralysis of small arteries, leading to a sharp rise in blood pressure. When a hypertensive crisis occurs, severe symptoms such as headache, irritability, dizziness, nausea, vomiting, palpitations, shortness of breath, and blurred vision may occur.
Symptom
Hypertension symptoms Common symptoms High blood pressure, dizziness, heart aortic regurgitation, heavy pressure, tightness... Dizziness, neurological vomiting, edema, eye, neck, pulsation
According to the onset of illness and the progression of the disease, it can be divided into a slow-moving type and a rapid-entry type.
First, slow-moving hypertension
1, early performance: early asymptomatic, occasionally physical examination found that high blood pressure, or mental distress, emotional or tired after feeling dizziness, headache, vertigo, tinnitus, insomnia, fatigue, inattention and other symptoms, may be advanced Due to mental dysfunction, early blood pressure only temporarily increased, and blood pressure continued to increase with the progress of the disease, and organs were involved.
2, brain performance: headache, dizziness is common, mostly due to emotional excitement, excessive fatigue, climate change or the withdrawal of antihypertensive drugs induced, blood pressure suddenly increased, severe headache, visual impairment, nausea, vomiting, convulsions, coma, a Over-biased, aphasia and so on.
3, cardiac performance: early, cardiac function compensation, symptoms are not obvious, late, cardiac function decompensation, heart failure occurs.
4, kidney performance: long-term hypertension caused by renal arteriosclerosis, renal dysfunction, can cause nocturia, polyuria, urine containing protein, cast and red blood cells, low urine concentration, phenol red excretion and urea clearance barrier, Nitrogenemia and uremia occur.
5. Arterial changes.
6, the fundus changes.
Second, acute hypertension
Also known as malignant hypertension, accounting for 1% of hypertension, can be suddenly changed from slow-advanced type, can also start onset, malignant hypertension can occur at any age, but the most common in 30-40 years old, blood pressure is significantly increased High, diastolic blood pressure is above 17.3Kpa (130mmHg), fatigue, thirst, polyuria and other symptoms, rapid vision loss, retinal hemorrhage and exudation in the fundus, often bilateral optic nerve head edema, rapid proteinuria, hematuria And renal insufficiency, heart failure, hypertensive encephalopathy and hypertensive crisis can occur, and the course progresses rapidly to uremia.
Examine
Hypertension check
First, determine whether there is high blood pressure: measuring blood pressure should be measured several times for several consecutive days of blood pressure, more than two times higher blood pressure, can be said to be high blood pressure.
Second, the reasons for the identification of high blood pressure: Where patients with hypertension, should be asked in detail about the medical history, comprehensive systemic examination to rule out symptomatic hypertension.
Laboratory tests can help diagnose and classify essential hypertension, understand the functional status of target organs, and are also conducive to the correct choice of drugs during treatment, hematuria, kidney function, uric acid, blood lipids, blood sugar, electrolytes (especially potassium ), ECG, chest X-ray and fundus examination should be used as routine examinations for patients with hypertension.
1, blood routine: red blood cells and hemoglobin generally no abnormalities, but hypertensive hypertension can have Coombs test negative microvascular hemolytic anemia, with abnormal red blood cells, high hemoglobin increased blood viscosity, prone to thrombosis complications (including Cerebral infarction) and left ventricular hypertrophy.
2, urine routine: early patients with normal urine, kidney weight loss when the urine weight gradually decreased, there may be a small amount of urine protein, red blood cells, occasional cast, with renal disease progression, increased urine protein, in patients with benign renal For example, if the 24-hour urine protein is above 1g, the prognosis is poor, and the red blood cells and casts can also be increased. The tube type is mainly transparent and granules.
3, renal function: blood urea nitrogen and creatinine are used to estimate renal function, early patient examination is not abnormal, renal parenchymal damage can begin to rise to a certain extent, adult creatinine >114.3mol / L, the elderly and pregnant > Kidney damage was suggested at 91.5 mol/L. The phenol red excretion test, urea clearance rate, and endogenous creatinine clearance rate were lower than normal.
4, chest X-ray examination: visible aorta, especially liter, bow flexion prolonged, its rise, bow or descending can be expanded, there is left ventricular enlargement in hypertensive heart disease, left ventricular left heart failure The increase is more obvious. When the whole heart is exhausted, the left and right ventricles are enlarged, and there are signs of pulmonary congestion. When the pulmonary edema is seen, the lungs are obviously congested, and the butterfly is blurred. It should be checked by conventional radiography so as to compare before and after the examination. .
5, ECG: ECG in left ventricular hypertrophy can show left ventricular hypertrophy or both strain, ECG diagnosis of left ventricular hypertrophy standards are not the same, but its sensitivity and specificity are not much different, false negatives are 68% to 77%, False positive 4% ~ 6%, the sensitivity of ECG diagnosis of left ventricular hypertrophy is not very high, due to decreased left ventricular diastolic compliance, left atrial diastolic load increased, ECG can appear P wave widening, incision, Pv1 The negative end potential increases, etc., the above performance can even appear before the ECG found left ventricular hypertrophy, there may be arrhythmia such as ventricular early 6, echocardiography: currently considered, and chest X-ray examination, ECG comparison, echocardiography The figure is the most sensitive and reliable means of diagnosing left ventricular hypertrophy. The M-mode ultrasound curve can be recorded on the basis of two-dimensional ultrasound localization or measured directly from the two-dimensional map. The ventricular septum and/or ventricular posterior wall thickness is >13 mm. Left ventricular hypertrophy, hypertensive left ventricular hypertrophy is mostly symmetrical, but about 1/3 of the ventricular septal hypertrophy (ventricular septum and left ventricular posterior wall thickness ratio > 1.3), ventricular septal hypertrophy often appears first ,mention When showing hypertension, it first affects the left ventricular outflow tract. Echocardiography can also observe other heart chambers, valves and aortic roots and can be used for heart function detection. Although the overall function of the heart is like heart discharge in the early stage of left ventricular hypertrophy The left ventricular ejection fraction is still normal, but there is a decline in left ventricular systolic and diastolic compliance, such as a decrease in the maximum rate of myocardial contraction (Vmax), an increase in isovolumic diastolic phase, and a delay in mitral valve opening. After left heart failure, echocardiography revealed left ventricle, left atrial enlargement, and reduced left ventricular wall contractile activity. (7) Fundus examination: The measurement of arterial pressure in the central retina is observed to increase, and the following fundus changes can be seen at different stages of the development of the disease:
Grade I: Retinal artery spasm.
Grade II A: Mild sclerosis of the retinal artery.
Grade II B: Retinal artery is significantly hardened.
Grade III: Grade II plus retinopathy (bleeding or exudation).
Grade IV: Class III plus optic nerve head edema (8) Other tests: patients may be accompanied by serum total cholesterol, triglyceride, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol, and apolipoprotein A-I The decrease, often with elevated blood glucose and hyperuricemia, increased plasma renin activity and angiotensin II levels in some patients.
Diagnosis
Diagnosis of hypertension
According to the recommendations of the World Health Organization (Who), the blood pressure standard is: normal adult systolic blood pressure should be less than or equal to 140mmHg (18.6kPa), and diastolic blood pressure is less than or equal to 90mmHg (12kPa). That is, the systolic blood pressure is between 141-159 mmHg (18.9-21.2 kPa) and the diastolic blood pressure is between 91-94 mmHg (12.1-12.5 kPa), which is a critical hypertension. When diagnosing high blood pressure, blood pressure must be measured multiple times. At least two consecutive two consecutive diastolic blood pressures of 90 mmHg (12.0 kPa) or more can be diagnosed as hypertension. Only one elevated blood pressure can not be diagnosed, but need to be followed up.
According to the difference in blood pressure, hypertension is divided into 3 levels:
Grade 1 hypertension (mild): systolic blood pressure 140~159mmHg; diastolic blood pressure 90~99mmHg.
Grade 2 hypertension (moderate): systolic blood pressure 160~179mmHg; diastolic blood pressure 100~109mmHg.
Grade 3 hypertension (severe): systolic blood pressure 180 mmHg; diastolic blood pressure 110 mmHg.
Simple systolic hypertension: systolic blood pressure 140mmHg; diastolic blood pressure <900mmHg.
Staging of hypertension:
The first phase: blood pressure to diagnose the level of hypertension, clinical unintentional, brain, kidney damage signs.
The second phase: blood pressure to determine the level of hypertension, and one of the following:
1. Physical examination, X-ray, electrocardiogram or echocardiogram showing left ventricular enlargement;
2, fundus examination, general or partial stenosis of the fundus artery;
3. Proteinuria or plasma creatinine concentration is slightly increased.
The third phase: blood pressure to diagnose the level of hypertension, and one of the following:
1. Cerebral hemorrhage or hypertensive encephalopathy;
2, heart failure;
3. Renal failure;
4, bleeding or exudation of the fundus, with or without optic nerve head edema;
5, angina pectoris, myocardial infarction, cerebral thrombosis.
Differential diagnosis
Primary hypertension, secondary hypertension, renal vascular hypertension, white coat hypertension, and pregnancy-induced hypertension are identified.
