Blood pressure fluctuates greatly
Introduction
Introduction The blood pressure of a normal person is also fluctuating during the day. However, if the blood pressure fluctuates too much, it is very detrimental to the body. This is especially true for people with high blood pressure. Because of the high and low blood pressure, the blood vessels will be like rubber bands, sometimes tight and sometimes relaxed. Especially the hypertensive patients are usually accompanied by hardening of the arteries, so if the blood pressure fluctuates for a long time, the blood vessels will become very fragile. And even a break. At the same time, this kind of blood pressure with a large fluctuation has a great influence on the heart, brain, kidney and other vital organs of the patient, and often causes serious complications such as stroke, coronary heart disease and renal failure.
Cause
Cause
Causes of high blood pressure fluctuations
1. Human physiological activities: Generally, the blood pressure is low in quiet, rest, calm, and state; blood pressure can be increased in labor, emotional changes (such as happy, sad, nervous), eating, and defecation. Strenuous exercise can increase the systolic blood pressure by about 2.7 kPa (20 mmHg).
2, seasonal changes: According to the practice survey, the blood pressure of normal blood pressure and high blood pressure patients is high in winter and low in summer.
3, day and night changes: blood pressure within 24 hours of day and night, a biological clock rhythm fluctuations. Using a 24-hour automatic pressure gauge to record fluctuations in blood pressure, it is known that normal people have higher blood pressure at 9:00 am and 10:00 am, higher blood pressure at 3-5 pm, and lower blood pressure after sleep at night. The fluctuation range of blood pressure within 24 hours averaged 4±2 to 2.7 kPa (30±15 to 20 mmHg). It is generally believed that only stubborn patients with fixed hypertension have small fluctuations and their minimum values cannot reach the normal range. The cause of fluctuations in blood pressure within 24 hours is mainly related to the sensitivity of plasma norepinephrine levels and baroreceptor reflexes. Blood pressure fluctuations under physiological conditions are the self-regulation and adaptation process of the body, reflecting the stress response of normal humans. Such fluctuations are normal (except for fluctuations that are too high or too low), so don't worry.
4, age: from the age, the elderly blood pressure is more volatile, and the mental stimulation can also increase blood pressure.
5. Position: The blood pressure of a normal person varies with the body position. The standing position is high, the sitting position is second, and the lying position is low.
6, other: smoking, eating, drinking, drinking coffee, eating a large amount, eating categories and salty, taking drugs can cause blood pressure fluctuations.
Examine
an examination
Related inspection
Ambulatory blood pressure monitoring (ABPM) blood routine cold boost test
High blood pressure fluctuation check
Normally, after getting up in the morning (6 o'clock), the blood pressure rises sharply, reaches a peak at about 8 to 9 hours, and then falls. At 17 to 18 in the afternoon, the blood pressure rises again. At this time, it is the second peak. It starts to decrease slowly from 18 o'clock. At 2 o'clock in the night, the blood pressure is the lowest. The fluctuation of blood pressure between day and night is more than 10%. The systolic blood pressure fluctuates more than the diastolic blood pressure. The fluctuation is greater than the night. The 24-hour blood pressure measurement is drawn into a line, which resembles a long-handled soup, called sputum blood pressure. If the blood pressure peak change is less than 10%, and even the night is higher than the daytime, it is called non-sputum blood pressure or ruminant blood pressure, and they should all be regarded as abnormal changes. About 70% of the people meet the above-mentioned typical double-peak blood pressure fluctuations, and about 25% of them only have a peak in the morning or evening. As the age increases, the 24-hour blood pressure fluctuations become smaller.
The 24-hour blood pressure fluctuation curve of most patients with mild to moderate hypertension is similar to that of normal people. The blood pressure at night is significantly decreased during sleep, but the overall level is higher and the fluctuation is larger. The highest blood pressure is seen in the afternoon, but it can also appear in the morning. Severe hypertension or those with significant impairment of heart, brain and kidney, as well as sleep apnea syndrome and severe insomnia, blood pressure circadian rhythm is not obvious or disappears ("non-sputum type"). Even if the blood pressure curve is "squat", the overall blood pressure level is higher.
The 24-hour blood pressure fluctuation curve of severe autonomic dysfunction and some elderly with obvious arteriosclerosis is characterized by hypotension or orthostatic hypotension and elevated blood pressure at night.
The 24-hour blood pressure of secondary hypertension was lower than that of essential hypertension. The circadian rhythm of renal hypertension was significantly weakened, and the decrease of systolic blood pressure and diastolic blood pressure was significantly lower than that of essential hypertension. Hypertension caused by renal artery stenosis showed a sustained increase in blood pressure, no drop in blood pressure during nighttime sleep, and no significant reduction after drug treatment. The 24-hour blood pressure fluctuations of pheochromocytoma and a few essential hypertension are often characterized by elevated pacing blood pressure and orthostatic hypotension.
Diagnosis
Differential diagnosis
Symptoms of high blood pressure fluctuations
The following four reasons can cause blood pressure fluctuations to be large, and it is necessary to identify which causes:
1. Hypertensive patients who do not think that their blood pressure is ideally controlled are found after 24 hours of ambulatory blood pressure monitoring. Nearly half of the blood pressure is not stable. Some people get up early and have high blood pressure. Some people have elevated blood pressure in the afternoon. Some people have elevated blood pressure in the morning and afternoon. Some people have poor blood pressure control at night, and blood pressure will increase in people's activities. Therefore, clinically, although patients often take medication seriously, the usual effect is good, but there are still cardiovascular emergencies. The reason is to take short-acting antihypertensive drugs, and the second is not to use the blood pressure fluctuations.
2. Essential hypertension is associated with other diseases such as menopausal hypertension in women. In menopause, due to changes in estrogen in the body, symptoms of menopausal syndrome such as palpitation, chest tightness, sweating, etc., and blood pressure fluctuate greatly. When patients with essential hypertension are associated with diseases such as ureteral stones and cholecystitis, blood pressure will also increase.
3. Some hypertensive blood pressure fluctuations are the most prominent manifestations of some patients with secondary hypertension, such as a secondary hypertensive patient with pheochromocytoma, blood pressure recovery after surgical removal of pheochromocytoma normal.
4. Damage to target organs such as heart, brain, kidney, etc. When high blood pressure causes damage to target organs such as heart, brain and kidney, blood pressure fluctuations increase when cardiovascular and cerebrovascular diseases are caused. In a round of ward rounds, we found that a patient who felt chest pain during the activity had a large fluctuation in blood pressure. After an electrocardiogram, he found that his coronary artery was insufficiently supplied. After treatment with oxygen, nitroglycerin, etc., the patient's symptoms were relieved and blood pressure returned to normal. Some patients with unstable cerebrovascular disease have high blood pressure fluctuations.
