low blood pressure
Introduction
Introduction to hypotension Hypotension is a general term for systemic arterial pressure lower than normal. Generally speaking, when the adult brachial artery blood pressure is lower than 90/60 mmHg (12.0/0.8 kPa) according to the conventional measurement method, it can be called hypotension. Hypotension can be roughly divided into pathological hypotension and physiological hypotension. The pathogenesis of primary hypotension has not been known so far, and most scholars believe that it is related to central nervous system dystonia. basic knowledge Sickness ratio: 0.2%-0.5% Susceptible population: People whose blood pressure has reached the low blood pressure standard. Mode of infection: non-infectious Complications: dizziness, syncope, angina
Cause
Cause of hypotension
Physiological hypotension status (25%):
Physiological hypotension state refers to the blood pressure measurement of some healthy people, which has reached the low blood pressure standard, but without any self-conscious symptoms. After long-term follow-up, except for low blood pressure, there are no abnormalities such as ischemia and hypoxia in various system organs of the human body. Does not affect life.
Pathological hypotensive disease (35%):
In addition to blood pressure reduction, often accompanied by varying degrees of symptoms and certain diseases, hypotension can be divided into: (1) primary hypotension: refers to hypotension without obvious causes, such as physiological hypotension (physical Hypotension) and pathological hypotension (hypotension). (2) Secondary hypotension: refers to the decrease in blood pressure caused by a disease of an organ or system in the human body. This hypotension can occur rapidly in a short period of time, resulting in signs of collapse and shock, called acute hypotension. Such as massive bleeding, acute myocardial infarction, severe trauma, infection, allergies and other reasons caused by a sharp drop in blood pressure, and in most cases, hypotension occurs slowly, can gradually increase, such as secondary to severe tuberculosis, malignant tumors, nutrition Poor, cachexia and other low blood pressure, its prevention and treatment is mainly for the primary disease.
Pathogenesis
The pathogenesis of primary hypotensive disease has not been known so far. Most scholars believe that it may belong to the central nervous system dystonia-related diseases. Due to the imbalance of the excitation and inhibition processes of the central nervous system, the inhibition process of the vasomotor center is strengthened, and vasoconstriction Obstacles with diastolic dynamic balance, vasodilation predominate, eventually leading to lowering of arterial blood pressure, in addition, endocrine dysfunction, imbalance of certain blood pressure regulating substances in the body, such as angiotensin-renin-aldosterone system, catecholamines, etc. The secretion of compressed substances is reduced, and the increase of vasodilators such as bradykinin, histamine and serotonin may also be involved in the formation of hypotensive diseases. As for genetic factors, some infectious diseases have occurred in youth, chronic tonsillitis, pharyngeal gorge Inflammation, nutritional disorders such as vitamin C, vitamin B, vitamin B1 and vitamin B6 deficiency, as well as climate, geographical environment, customs, occupations, etc. may also be related to the development of hypotension.
Prevention
Hypotension prevention
1. Sleeping at night will raise the head to reduce the symptoms of hypotension.
2, when getting up in the morning, you should slowly change your position to prevent a sudden drop in blood pressure. When you stand up, you should not suddenly. You should turn around slowly. The flexion and extension of your limbs should not be too fast, such as lifting, lifting heavy objects or standing up after defecation. Be slower.
3, bath water temperature should not be overheated, too cold, because heat can make blood vessels dilate and lower blood pressure, cold will stimulate blood vessels and increase blood pressure. Always shower to speed up blood circulation, or wash your feet alternately with cold water and warm water.
4, for the elderly with lower extremity varicose veins should wear elastic socks, tight pants to strengthen the venous return. Those who are physically thin should drink plenty of water every day to increase their blood volume.
5, do not stand in the sultry or oxygen-deficient environment for too long to reduce the incidence.
6, asymptomatic hypotension does not require special treatment, can participate in physical activity to enhance physical fitness, improve the ability to regulate blood pressure changes, but also take Chinese medicine to replenish qi and blood.
Complication
Hypotension complications Complications vertigo syncope angina
Syncope.
Symptom
Hypotension symptoms Common symptoms Inability to fatigue, mental wilting, pre-heart area, dull pain, orthostatic hypotension, syncope, erectile dysfunction, memory impairment, pre-existing golden flower sleep disorder, loss of appetite
1. Physiological hypotension
It refers to the blood pressure measurement of some healthy people has reached the low blood pressure standard, but there is no self-conscious symptoms. After long-term follow-up, except for the low blood pressure, the human system organs have no abnormalities such as ischemia and hypoxia, and do not affect the life. According to statistics, those who have the above-mentioned hypotensive state account for about 2.5% to 3.5% of healthy people. They are common in people who often engage in large exercise, such as sports athletes and heavy physical workers, while young women with slim bodies are not uncommon. Physiological hypotension can have a familial tendency and has no important clinical significance.
2, primary hypotension disease mainly has the following performance
(1) fatigue, weakness: especially in the morning, patients often feel weak, limbs are sore and weak, after nap or rest can be improved, but in the afternoon or evening, feeling tired, this kind of burnout and the actual work or activities of the patient The physical exertion is not commensurate, that is, the fatigue is not caused by excessive fatigue. This fatigue may be caused by the incompatibility of excessive muscle contraction caused by nervous system dysfunction and improper consumption of muscle strength.
(2) headache, dizziness: in patients with hypotension, headache can be the only complaint, their headaches are often more obvious after intense mental or physical activity, the nature and extent of headaches are different, mostly in the dome area or The suboccipital area is painful, and it can also be severely pulsating pain or numbness pain. The dizziness is light and heavy. The lighter ones are black and dizzy; the severe ones can be lost, and even fainting to the ground, often changing the position suddenly, especially It is most likely to occur when the squat is suddenly raised. In addition, it is prone to work under static and overburdened working conditions. Headache and dizziness may be associated with low blood pressure and cerebral hypoperfusion.
(3) Pain or discomfort in the precordial area: the pain and discomfort in the precordial area of patients with hypotension can not only occur during physical labor or intense mental work, but also in the case of quietness, and even cause angina-like episodes, especially in 40 In patients over the age of more than the same, this situation is not only seen in patients with hypotension and coronary heart disease, but also due to low blood pressure itself, resulting in insufficient coronary blood supply, causing myocardial hypoxia, ischemia and the above symptoms.
(4) neurological dysfunction: can be manifested as apathetic, memory loss, sleep disorders and insomnia, autonomic dysfunction can be manifested as hyperhidrosis, pale skin or mild hair, cold and hot, when there are ants crawling Feeling, numbness in hands and feet.
(5) The phenomenon of endocrine dysfunction: mainly characterized by insufficient substances such as adrenaline and norepinephrine, and some patients have decreased blood glucose and decreased sexual function.
(6) Others: It can be characterized by loss of appetite, abdominal discomfort, indigestion, and increased red blood cells, decreased white blood cells, and reduced resistance to infection.
Examine
Hypotension check
1. Whether the ECG has changes in heart rate and heart rate, whether there is a change in ST-T, and whether there is a pathological Q wave.
2, cardiac B-ultrasound and peripheral vascular Doppler ultrasonography, contribute to the diagnosis of cardiovascular disease-induced hypotension.
3, cardiac catheterization and angiography, can identify peripheral vascular disease and heart disease.
4, X-ray examination, through the chest X-ray examination, to observe whether there is a tumor to oppress the peripheral blood vessels.
5, myelography, to understand whether there are spinal cord lesions such as syringomyelia.
6, laboratory tests, for suspected hypotension caused by endocrine diseases, should do the corresponding endocrine function and hormone testing, blood routine tests such as red, white blood cell changes are also helpful for diagnosis.
Diagnosis
Hypotension diagnosis
The diagnosis of primary hypotension is mainly based on the arterial blood pressure measurement to the low blood pressure standard, except for the secondary hypotension and physiological hypotension, combined with the above clinical manifestations can make a diagnosis.
Pay attention to the following conditions for patients with hypotension to help diagnose and differentiate the diagnosis.
1. Inquire about other vascular symptoms, other vascular symptoms, and other systemic diseases in addition to hypotension. If not, consider primary hypotension.
2, ask whether there is acute or severe acute blood volume deficiency or acute cardiac function reduction, cardiac dysfunction.
3, ask whether there are cardiovascular diseases and peripheral vascular diseases that cause hypotension, whether there is a history of high altitude, whether there is endocrine system disease and clinical manifestations of hypotension, with or without metabolic diseases, spinal cord lesions.
4. Ask when the hypotensive state occurs, whether it has a significant relationship with the clinical appearance of the symptoms, whether there is a long history of bed rest, whether there is surgery, or trauma and cause autonomic nerve damage.
5, ask about the length of time when hypotension occurs, the relationship between clinical manifestations and taking drugs.
By asking in detail about the above situation, it can be clarified whether hypotension is primary or secondary, whether it is acute hypotension, combined with other clinical data, may clarify the primary cause.
