pseudohypertension
Introduction
Introduction to pseudohypertension Pseudohypertension refers to the blood pressure value measured by the normal cuff pressure measurement method and the blood pressure value measured directly by the transarterial puncture. basic knowledge The proportion of sickness: 0.002%-0.003% Susceptible people: no specific population Mode of infection: non-infectious Complications: high blood pressure
Cause
Cause of pseudohypertension
(1) Causes of the disease
More common in the elderly, uremia, diabetes, severe arteriosclerosis patients.
(two) pathogenesis
1. Physiological and technical factors
Direct measurement of upper limb blood pressure and simultaneous measurement of aortic blood pressure are significantly different, the systolic blood pressure of the elbow and wrist is higher and the diastolic blood pressure is lower. This progressive change from proximal to distal is related to wave reflection intensity and time course. This difference will increase due to exercise and nitroglycerin, sodium nitroprusside caused by vasodilation, arteriosclerosis caused by age and hypertension will narrow this difference, the blood from the aorta into the small artery, the average pressure is reduced, not directly measuring the fingertip blood pressure Significantly lower than the radial and radial arteries, the sensor is attached to a cannula containing fluid, and the tip is placed into the wall of the artery to measure the accuracy of blood pressure, but some technical details limit the accuracy of the measurement results, such as: sensor standards The diameter, the exact position of the sensor relative to the heart, the entire monitoring system reflects the sufficiency of the frequency and the openness of the cannula.
The Kodak method is the standard method for indirect blood pressure measurement in the clinic. When measuring blood pressure, pay attention to the technical details: the length of the cuff; the position of the arm; the scale of the pressure gauge; the speed of balloon release and the criteria for determining the diastolic pressure, many The researchers found that cuff manometry would overestimate blood pressure, SBP, DBP were about 5 mmHg and 5-10 mmHg, respectively, and DBP deviation was independent of blood pressure and age.
2. Pathophysiology of contractile/diastolic pseudohypertension
It is due to thickening and hardening of the intima of the radial artery, and occasionally fibrous fibrosis, causing "serious tight pressure" on the arterial wall, causing errors in related auscultation readings.
3. Mechanism of diastolic pseudohypertension
Because the cuff pressure has not reached the intra-arterial diastolic pressure, the Korotkoff sound disappears ahead of time. This is because the Korotkoff sound is related to the "slipping swing" of the arterial wall. If the arterial wall hardness increases, it will reduce the mechanical stimulation. Swing, when the cuff is deflated, the artery wall swing will stop at a higher pressure, resulting in auscultation at diastolic pressure higher than the intra-arterial diastolic pressure.
4. The principle of cuff inflation hypertension
Compression of the lower extremities in dog and human experiments can cause elevated blood pressure, a phenomenon that is mediated by nerves and is equivalent to blood pressure responses caused by isometric exercise, a phenomenon that occurs only in a few people.
Prevention
Pseudohypertension prevention
Pseudohypertension is more common in elderly, uremia, diabetes, severe arteriosclerosis, when hypertensive patients have antihypertensive drug therapy and long-term high blood pressure or suspected severe hypertension and lack of target organ damage, be alert to false high The possibility of blood pressure should be further checked for early diagnosis.
Complication
Pseudohypertension complications Complications
When patients with hypertension have ineffective antihypertensive drugs and long-term high blood pressure or suspected severe hypertension and lack of target organ damage, be alert to the possibility of pseudohypertension, and further examination should be carried out for early diagnosis.
Symptom
Pseudohypertension symptoms common symptoms
The clinical manifestation of pseudohypertension refers to the blood pressure value measured by ordinary cuff pressure measurement is higher than the blood pressure value directly measured by venipuncture, and is clinically divided into three clinical types:
Systolic/diastolic pseudohypertension
In a blood pressure auscultation study of simulated arteries, Sacks et al found that the auscultation readings associated with serious tight-fitting pressure on the arterial wall were incorrect, and a one-fold thickening of the arterial wall caused a blood pressure measurement error of approximately 32 mmHg, which was tested. The determination of the model.
2. Diastolic pseudohypertension
It is generally believed that the standard of diastolic blood pressure auscultation is the disappearance of Korotkoff sound. When the cuff pressure has not reached the intra-arterial diastolic pressure in diastolic pseudohypertension, the Korotkoff sound disappears in advance, and pseudohypertension is in elderly hypertensive patients. Common, especially in those with senile systolic hypertension, whose arterial compliance is reduced.
3. Cuff inflatable high blood pressure
Compression of the lower extremities in dogs and humans can cause an increase in blood pressure. This phenomenon is caused by a nerve-mediated blood pressure response caused by isometric exercise. When the cuff is inflated, the blood pressure rises, defined as a pseudohypertension. Because of its similar physiological basis, this phenomenon occurs only in a small number of patients but the mechanism is unknown.
Examine
Examination of pseudohypertension
1.Osler technique
When the cuff method is used for pressure measurement, when the cuff pressure exceeds the patient's systolic pressure, if the patient's radial artery or radial artery is clearly visible, the Osler method is positive, and vice versa.
Messerli reported that in another group of elderly hypertensive patients, the systolic and diastolic blood pressures measured by the cuff were higher than the transarterial pressure (SBP + 15.8 mmHg, DBP + 16.4 mmHg), which is different from the Osler-negative patient ( SBP-3.0mmHg, DBP+5.3mmHg), 65% sler positive patient cuff diastolic pressure is 10mmHg higher than transarterial pressure, therefore, the 0sler technique is important for detecting pseudohypertension, but recently there are multiple Studies have shown that Osler sign positivity is quite common in the elderly and tends to increase with age, and Osler's technique is not an effective method of detection.
2. Automatic infrasound blood pressure detector
It has been reported abroad that it can better reflect intra-arterial blood pressure.
3. Direct pressure measurement
Direct measurement of arterial blood pressure using a catheter inserted into the artery is an invasive procedure that is not suitable for routine medical work and clinical trials, but is a gold indicator for the diagnosis of pseudohypertension. Currently there is a small probe at the tip of the catheter. It can be directly inserted into the radial artery for measurement.
4. Angiography shows calcification of the forearm artery.
Diagnosis
Diagnosis of pseudohypertension
Diagnostic criteria
1. Clinical diagnosis
Pseudohypertension is more common in elderly, uremia, diabetes, severe arteriosclerosis, when hypertensive patients have antihypertensive drugs, and long-term high blood pressure or severe hypertension and lack of target organ damage, it is highly suspected of false hypertension.
2. Diagnostic criteria
Most authors have found that the systolic blood pressure measured by the Coriolis cuff is 5 mmHg lower than the direct measurement of systolic blood pressure in the arteries, and the diastolic blood pressure is 5 to 10 mmHg. According to the above situation, the standard for the diagnosis of systolic pseudohypertension is cuff. The systolic blood pressure measured by direct arterial internal measurement was 10 mmHg, while the standard for the diagnosis of diastolic pseudohypertension was 15 mmHg higher than the diastolic blood pressure measured by the cuff.
It is distinguished from clinically common essential hypertension and secondary hypertension.
