malignant hypertension
Introduction
Introduction to Malignant Hypertension Malignant hypertension refers to a significant increase in blood pressure (a common standard is diastolic blood pressure over 140 mmHg, but there are other criteria). And associated with vascular damage syndrome, vascular damage can be manifested as retinal hemorrhage, exudation and optic papilled edema, optic disc edema (KW eye grading grade IV), often accompanied by severe renal impairment, if not active antihypertensive treatment is very Coming soon. Rapid hypertension is a precursor to malignant hypertension. basic knowledge The proportion of illness: 0.004%-0.007% Susceptible people: no special people Mode of infection: non-infectious Complications: Hypertensive encephalopathy Hypertensive crisis
Cause
Cause of malignant hypertension
Improper diet and medication (35%):
Some hypertensive patients are caused by improper diet. That is, after suffering from hypertension, do not pay attention to control diet, such as eating and drinking, tobacco, alcohol, sugar, fatty meat, animal internal organs, etc., which aggravate arteriosclerosis, affecting blood vessel elasticity, causing vasospasm, blood pressure It is difficult to live high, so the effect of taking antihypertensive drugs is not good. Single medication, neglecting the comprehensive treatment of drugs, is often the reason for the long-term treatment of hypertension.
Obesity (5%):
For obesity-type hypertension, the degree of obesity is often balanced with the increase in blood pressure. If such hypertensive patients rely solely on antihypertensive drugs instead of losing weight, blood pressure drops are often unsatisfactory. In addition to treatment, you should also pay attention to weight loss.
Mental factors (10%):
Elevated blood pressure is closely related to poor mental state. Because of emotional instability, the sympathetic nerve is in a state of tension, which causes the secretion of catecholamines in the body to increase, the blood vessels are in a contracted state, and the blood pressure is not cured for a long time. Therefore, patients with hypertension should pay attention to themselves. Mediation, keep your mood happy, and overcome impatience.
Lack of exercise (8%):
Some hypertensive patients do not like activities, exercise is too small, eat asleep, sleep and eat, rely solely on drugs to reduce blood pressure, blood pressure is not cured for a long time, therefore, hypertensive patients should strengthen physical exercise. Sports activities can not only reduce blood pressure, but also remove fat and lose weight, regulate psychological balance, and improve mental stress.
Pathological factors
1, 1% to 5% of essential hypertension can develop into rapid (malignant) hypertension. Secondary hypertension is easy to develop into this type of disease: renal artery stenosis, acute glomerulonephritis, pheochromocytoma, Cushing's syndrome, pregnancy toxemia.
2. Inducing factors such as extreme fatigue, cold stimulation, nervous hypertonicity and segregation disorders during menopause are prone to this type of hypertension.
Prevention
Malignant hypertension prevention
1. Prevention and treatment of risk factors for hypertension, changing bad lifestyles, including reasonable diet, weight loss, smoking cessation and alcohol restriction, maintaining psychological balance and appropriate physical activity.
2. Regular physical examination, early detection of high blood pressure, and long-term treatment.
3. Rational use of drugs under the guidance of a doctor to control blood pressure within a reasonable and normal range.
Complication
Malignant hypertension complications Complications hypertensive encephalopathy hypertensive crisis
Easy complicated by hypertensive encephalopathy, hypertensive crisis, acute left heart failure and renal insufficiency.
Symptom
Symptoms of malignant hypertension Common symptoms Blood pressure, high azotemia, tinnitus, urinary neck hypertension, urea clearance disorder, proteinuria, nausea, hypertension
More common in young and middle-aged people, blood pressure suddenly increased significantly, systolic blood pressure, diastolic blood pressure increased, often continued above 26.6/17.3kPa (200/130mmHg), the disease progressed rapidly, can have severe headache, often accompanied by nausea, vomiting, Dizziness, tinnitus, etc., rapid vision loss, fundus hemorrhage, exudation or optic disc edema, sharp decline in renal function, persistent proteinuria, hematuria and tubular urine, azotemia or uremia, heart failure can occur in a short period of time, It is characterized by palpitation, shortness of breath, and difficulty in breathing. This type of hypertension is also prone to hypertensive encephalopathy, which is associated with a significant increase in blood pressure.
Examine
Examination of malignant hypertension
1. Urine routine: persistent proteinuria, hematuria and tubular urine.
2. Renal function test: serum creatinine continued to increase, urea nitrogen increased; CO2CP decreased.
3. Blood potassium: Increased blood potassium concentration indicates poor prognosis.
4. Fundus: retinal hemorrhage, exudation, optic disc edema; KW eye grading degree is often III ~ IV more prognosis.
5. Blood pressure monitoring: often lasts at 26.6/17.3kpa (200/130mmHg or more).
Diagnosis
Diagnosis and diagnosis of malignant hypertension
Diagnostic criteria
1. More common in young people.
2. There are often sudden headaches, dizziness, blurred vision, palpitations, shortness of breath and weight loss.
3. Often have a heart, the performance of renal insufficiency.
4. Arterial diastolic pressure often lasts over 130 mmHg.
5. Fundus examination often has bleeding, exudation and optic disc edema. If there is a corresponding clinical manifestation caused by secondary hypertension, critically ill patients may have diffuse intravascular coagulation and microangiopathic hemolytic anemia.
Differential diagnosis
1. Left heart failure caused by other causes may have high blood pressure in the early stage, but DBP will never reach 140mmHg level, and there is no corresponding fundus change.
2. Uremia caused by any cause is generally renal, pre-renal or post-renal lesions before hypertension.
3. Brain tumors are only mild if there is high blood pressure, and optic disc edema is generally limited to one side.
4. Others: Identification such as head trauma.
