Blood pressure disease

Introduction to blood pressure disease Blood pressure can be divided into high blood pressure and low blood pressure. Hypertensive disease (hypertensive disease) is a chronic disease characterized by continuous increase in arterial blood pressure, which often causes lesions of important organs such as heart, brain and kidney and has corresponding consequences. 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). If the adult systolic blood pressure is greater than or equal to 160 mmHg (21.3 kPa), the diastolic blood pressure is greater than or equal to 95 mmHg (12.6 kPa) for hypertension; the blood pressure value is between the above two, that is, the systolic blood pressure is 141-159 mmHg (18.9-21.2 kPa). Between, the diastolic blood pressure is between 91-94mmHg (12.1-12.5kPa), which is a critical hypertension. When diagnosing high blood pressure, blood pressure must be measured multiple times. At least two consecutive diastolic blood pressures with an average 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. The initial symptoms of hypertension are mostly fatigue, dizziness, memory loss, and disappear after a break. When the blood pressure is significantly increased, dizziness may increase, headache or even nausea and vomiting. Symptoms are obvious especially when the blood pressure rises rapidly due to fatigue or emotional agitation. However, some patients have no symptoms even if their blood pressure is high. This requires special attention. Hypertension (cardiology), the main clinical manifestations of continuous increase in systemic arterial blood pressure with progressive damage to the structure and function of the heart, brain, kidney and blood vessel wall, onset and slow, and ultimately the cause of death is heart failure Kidney failure and cerebrovascular accident. The disease is the most common cardiovascular disease, and the WHO has published a prevalence of 15% in adults. The prevalence of this disease in China is about 7-10%. With the increase of age, the incidence has a clear upward trend. The incidence of blacks, obesity, smoking, and mental workers is higher. Long-term, systematic, and regular antihypertensive treatment can help slow the progression of the disease, prevent target organ damage, and improve quality of life. Hypotension refers to a state in which the systemic arterial pressure is lower than normal. Because hypertension often causes damage to important organs such as heart, brain and kidney, it is highly valued. The World Health Organization also clearly defines the diagnostic criteria for hypertension, but there is no uniform standard for the diagnosis of hypotension. It is generally believed that lower extremity arterial blood pressure in adults is lower than 12/8 kPa (90/60 mmHg). According to the cause can be divided into physiological and pathological hypotension, according to the onset form can be divided into acute and chronic hypotension. basic knowledge Proportion of disease: according to different blood pressure diseases, the proportion of illness is different Susceptible people: no special people Mode of infection: non-infectious Complications: hemorrhagic stroke ischemic stroke hypertensive encephalopathy myocardial infarction heart failure chronic renal failure

Cause of blood pressure

hypertension

The incidence of hypertension has a more obvious family agglomeration. The concentration of plasma norepinephrine and dopamine in normal blood pressure children (children or adolescents) with high blood pressure in both parents is significantly higher than that in the control group without family history of hypertension. The proportion of blood pressure is also high. Domestic surveys found that compared with those without a family history of hypertension, the prevalence of hypertension in hypertensive patients was 1.5 times higher, and those with hypertension in both parents were 2 to 3 times higher, and the children of hypertensive patients were born. Although the living environment is the same as that of adoptive children, the former is more susceptible to high blood pressure. Animal models of genetically hypertensive rats (SHR) have been screened in animal experiments. Molecular genetic studies have been performed on hypertensive animals with successful gene transfer. The above materials all suggest the role of genetic factors.

diet

1. The most closely related to salt and hypertension is Na+. The average blood pressure level of the population is related to the intake of salt. In people with higher salt intake, reducing the daily intake of salt can lower blood pressure. There are reports that the prevalence of hypertension is positively correlated with nocturnal sodium content, but there are also different opinions, which may be related to salt-sensitive and non-salt-sensitive types in hypertensive people. High sodium promotes elevated blood pressure and may be caused by increased peripheral vascular resistance by increasing sympathetic tone. Insufficient intake of K+ and Ca++ in diet and high risk of Na+/K+, high K+ high Ca++ diet may reduce the incidence of hypertension, and similar findings in animal experiments.

2. Fatty acids and amino acids reduce the total amount of fat intake, increase the content of unsaturated fatty acids, and lower the proportion of saturated fatty acids to lower the average blood pressure of the population. Animal experiments have found that the intake of fish protein containing sulfur-containing amino acids prevents blood pressure from rising.

3. The prevalence of hypertension in long-term drinkers is high, and it is proportional to the amount of alcohol consumed. May be related to drinking alcohol to promote elevated levels of corticosteroids and catecholamines.

Occupational and environmental epidemiological materials suggest that people who are subject to high concentration of attention, long-term mental stress, long-term environmental noise and poor visual stimuli are prone to hypertension.

Other smoking and obesity have a high prevalence of hypertension.

Hypotension

Physiological hypotension

In some healthy people, the blood pressure measurement 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 span.

2. Pathological hypotension

In addition to lowering blood pressure, there are often varying degrees of symptoms and certain diseases.

(1) Primary hypotensive disease refers to a hypotensive state with no obvious cause, such as physiological hypotension (physical hypotension), which is more common in elderly and women with weak constitution.

(2) Secondary hypotension refers to a decrease in blood pressure caused by a disease in an organ or system of the human body. This hypotension can occur rapidly in a short period of time, such as major bleeding, acute myocardial infarction, severe trauma, infection, allergies and other reasons caused by a sharp drop in blood pressure. In most cases, hypotension occurs slowly and can gradually worsen, such as hypotension that is secondary to severe tuberculosis, malignancy, malnutrition, cachexia, and the like.

Blood pressure prevention

In modern society, prevention of hypertension, from adolescents, should be noted in the prime of life. Controlling obesity is an extremely important part. Because hypertension and coronary heart disease are directly related to obesity. Don't let obesity be ignored because some obese people do not have high blood pressure. Mild hypertensive patients, if the symptoms are not heavy, you can not take antihypertensive drugs, pay attention to work and rest, keep enough sleep, exercise properly, you can return blood pressure to normal. From the current treatment conditions, hypertension is basically controllable and does not require mental stress. Take antihypertensive drugs, take them continuously, keep your blood pressure in a normal state, use stop and stop, and when you rise or fall, it is prone to accidents. However, taking any kind of antihypertensive drugs must be easy for people and follow the principle of individualization. People with long-term high blood pressure should prevent emotional excitement and mental excitement to avoid cerebrovascular and cardiovascular accidents. Quitting smoking and not drinking heavily have a direct impact on high blood pressure. If you have a sphygmomanometer, you or your family will use it. It is good for taking proper medicine and observing blood pressure changes.

Patients with hypotension should have regular life and prevent excessive fatigue, because extreme fatigue can lower blood pressure. To maintain a good mental state, properly strengthen exercise, improve physical fitness, improve the regulation of nerves and blood vessels, accelerate blood circulation, and reduce the onset of orthostatic hypotension. Elderly exercise should choose sports according to environmental conditions and physical conditions. Such as Tai Chi, walking, aerobics, etc.

Blood pressure disease complications Complications hemorrhagic stroke ischemic stroke hypertensive encephalopathy myocardial infarction heart failure chronic renal failure

According to the harm of hypertension, the various complications that are easily caused by hypertension are classified as follows.

1. Cardiac complications such as left ventricular hypertrophy, angina pectoris and myocardial infarction, heart failure

2. Stroke such as hemorrhagic stroke, ischemic stroke, hypertensive encephalopathy

3. Large and small arteries such as arteriosclerosis, aortic dissection

4. Hypertensive renal damage such as slow-moving arteriolar atherosclerosis, malignant small arteriosclerosis, chronic renal failure

5. Fundus such as retinal arteriosclerosis, fundus changes

The slow-moving arteriolar atherosclerosis refers to benign hypertension 5-10 years, beginning with renal arteriolar lesions, followed by renal parenchymal damage; malignant small arteriosclerosis refers to kidney damage caused by malignant hypertension, Includes renal artery lesions and renal parenchymal damage.

Patients with hypotension can have dizziness, darkness, dizziness, and even syncope, often occurring when the body position is suddenly changed, and complications such as angina, hypoglycemia, or sexual decline may occur.

Symptoms of blood pressure disease Common symptoms Hypertension Secondary hypertension Ocular blood pressure fluctuations Heart palpitations Low blood pressure Limb numbness Blood pressure drop

Hypertension can be divided into primary and secondary. Essential hypertension refers to high blood pressure, also known as hypertension, whose cause is not yet well defined. An increase in blood pressure caused by other known diseases is called secondary or symptomatic hypertension. There are many other divisions in the classification of hypertension. For example, according to age can be divided into elderly hypertension and children with hypertension; according to the degree of rapid onset can be divided into rapid and slow-onset hypertension.

1, primary hypertension

Essential hypertension, or hypertension, refers to a disease with elevated blood pressure as the main clinical manifestation, accounting for 95% of patients with hypertension. Most patients develop symptoms at 40-50 years of age, and early patients may be asymptomatic and may be found during physical examination. A few have symptoms such as headache, dizziness, palpitations and numbness of the limbs. Advanced hypertension can cause lesions and corresponding symptoms of heart, brain, kidney and other organs on the basis of the above-mentioned symptoms, resulting in arteriosclerosis, cerebrovascular accident, kidney disease, and easy to be associated with coronary heart disease; clinically only ruled out After high blood pressure, it can be diagnosed as hypertension.

2, secondary hypertension

Secondary hypertension refers to the increase in blood pressure in some diseases, which is only one of the symptoms of these diseases, so it is also called symptomatic hypertension, accounting for about 1%-5% of all hypertensive patients: for young people. High blood pressure patients with weak constitution or high blood pressure with obvious urinary system symptoms, or hypertension in late pregnancy, postpartum, menopause or high blood pressure with systemic disease should consider secondary hypertension. If the primary condition that causes symptoms of high blood pressure can be cured, then high blood pressure can disappear.

3, low blood pressure

Acute hypotension refers to sudden and significant decrease in blood pressure from normal or high levels. Clinically, symptoms such as dizziness, dark eyes, soft limbs, cold sweat, palpitations, and oliguria are common in the brain, heart, kidney and other important organs. Severe cases are manifested as syncope or shock.

Blood pressure check

Laboratory tests can help diagnose and classify essential hypertension, understand the functional status of target organs, and facilitate the correct selection of drugs during treatment. Hematuria, renal function, uric acid, blood lipids, blood sugar, electrolytes (especially potassium), electrocardiogram, chest X-ray and fundus examination should be routinely examined as patients with hypertension.

(1) There is no abnormality in blood red blood cells and hemoglobin. However, acute hypertensive patients may have microvascular hemolytic anemia with negative Coombs test. The blood viscosity of patients with abnormal red blood cells and high hemoglobin is increased, and thrombosis complications are easy. Cerebral infarction) and left ventricular hypertrophy.

(2) In the early stage of urine routine, the urine routine is normal, and the urine specific gravity is gradually decreased when the renal concentrating function is impaired. There may be a small amount of urine protein, red blood cells, and occasionally tube type. As the renal lesion progresses, the amount of urinary protein increases. In patients with benign renal cirrhosis, such as 24-hour urine protein above 1 g, the prognosis is poor. Red blood cells and casts can also be increased, and the casts are mainly transparent and granules.

(C) renal function using blood urea nitrogen and creatinine to estimate renal function. There was no abnormality in the early patient examination, and the renal parenchyma was damaged to a certain extent and began to rise. Adult creatinine >114.3mol/L, suggesting renal damage in the elderly and pregnant >91.5mol/L. The phenol red excretion test, the urea clearance rate, and the endogenous creatinine clearance rate may be lower than normal.

(4) The chest X-ray examination shows that the aorta, especially the ascending and arching, is prolonged, and the ascending, arching or descending part can be expanded. Left ventricular enlargement occurs in hypertensive heart disease, left ventricular enlargement is more pronounced in left heart failure, and left and right ventricles increase in whole heart failure, and signs of pulmonary congestion. When the pulmonary edema is seen, the lungs are obviously congested with a butterfly-shaped blurred shadow. It should be checked by routine photography for comparison before and after inspection.

(5) Electrocardiogram ECG of left ventricular hypertrophy may show left ventricular hypertrophy or both strain. The criteria for diagnosis of left ventricular hypertrophy by electrocardiogram are not the same, but the sensitivity and specificity are not much different. The false negative is 68% to 77%, and the false positive is 4% to 6%. It can be seen that the sensitivity of electrocardiogram in the diagnosis of left ventricular hypertrophy is not very good. high. Due to decreased left ventricular diastolic compliance, increased left ventricular diastolic load, P-wave broadening, incision, and negative end-potential potential of Pv1 may occur in the electrocardiogram. The above performance may even occur before ECG findings of left ventricular hypertrophy. . There may be arrhythmia such as ventricular premature beats, atrial fibrillation, and the like.

(6) Echocardiography At present, echocardiography is the most sensitive and reliable method for diagnosing left ventricular hypertrophy compared with chest X-ray and ECG. M-mode ultrasound curves can be recorded on the basis of two-dimensional ultrasound localization or directly from two-dimensional maps. Left ventricular hypertrophy is measured in the ventricular septum and/or ventricular posterior wall thickness >13 mm. Left ventricular hypertrophy is mostly symmetrical in hypertensive patients, but about one-third of the ventricular septal hypertrophy (ventricular septum and left ventricular posterior wall thickness ratio > 1.3), ventricular septal hypertrophy often appears first, suggesting hypertension The first part of the left ventricular outflow tract is affected. Echocardiography can also observe the condition of other heart chambers, valves and aortic roots and can be used for cardiac function testing. In the early stage of left ventricular hypertrophy, although the overall function of the heart such as cardiac output and left ventricular ejection fraction is still normal, there is a decline in left ventricular systolic and diastolic compliance, such as a decrease in the maximum rate of myocardial contraction (Vmax), etc. Prolonged relaxation and mitral valve opening delay. In the presence of left heart failure, echocardiography revealed an enlargement of the left ventricle, left atrium, and decreased left ventricular wall contraction.

(7) Fundus examination to measure the increase of central retinal arterial pressure, the following fundus changes can be seen at different stages of disease development:

Grade I: Retinal artery spasm

Grade II: A: mild sclerosis of the retinal artery; B: marked hardening of the retinal artery

Grade III: Grade II plus retinopathy (bleeding or exudation)

Grade IV: Grade III plus optic papilledema

(8) Other examinations may be accompanied by an increase in serum total cholesterol, triglycerides, low-density lipoprotein cholesterol, and a decrease in high-density lipoprotein cholesterol, and a decrease in apolipoprotein A-I. Hyperglycemia and hyperuricemia are also common. Some patients have elevated plasma renin activity and angiotensin II levels.

If you suspect diabetes, you need to measure blood sugar and urine sugar. Cardiovascular disease requires electrocardiogram, echocardiography and even cardiovascular angiography. If necessary, blood routine, blood electrolyte, troponin, 24-hour dynamic electrocardiogram can be measured. Invasive electrophysiological examination, upright tilt test, transesophageal echocardiography, etc.; endocrine disease diagnosis requires evidence of pituitary, adrenal or thyroid function tests. If pulmonary embolism is suspected, blood gas analysis, pulmonary CT, and pulmonary ventilation perfusion scan can be performed. If intracranial lesions or focal neuropathy are suspected, EEG, skull and brain CT and magnetic resonance imaging should be performed.

Diagnosis of blood pressure disease

Diagnostic criteria for hypertension:

1. Systolic blood pressure 140mmHg or diastolic blood pressure 90mmHg, and persisted, can be diagnosed as hypertension; systolic blood pressure 140-160mmHg or / and diastolic blood pressure 90-95mmHg, is a critical hypertension.

2. The blood pressure is elevated, and the structural damage of any target organ such as heart, brain, kidney, etc. is one-stage hypertension; at the same time, the structural damage of any of the above organs is secondary hypertension; The functional failure or decompensation is a phase III hypertension.

3. Excluding various secondary hypertension.

Diagnostic criteria for hypotension:

Mainly based on arterial blood pressure measurements to achieve low blood pressure standards. At the same time, pay attention to the following conditions for patients with hypotension to help diagnose and differential diagnosis.

1. In addition to hypotension, there are other vascular symptoms, other systemic diseases, and if not, consider primary hypotension.

2. Ask whether there is acute or severe acute hypovolemia or acute cardiac dysfunction, cardiac dysfunction.

3. Ask if there are any cardiovascular diseases and peripheral vascular diseases that cause hypotension, and whether there is a history of high altitude living. Whether there is endocrine system disease and clinical manifestations that cause hypotension. There are no metabolic diseases, spinal cord lesions.

4. Ask when the hypotensive state occurs, and whether it has a significant relationship with clinical symptoms and position. Have a long history of bed rest. Whether there is surgery, trauma and cause autonomic nerve damage.

5. Ask about the length of time that hypotension occurs, the relationship between clinical performance and medication.

By inquiring about the above situation in detail, it can be clarified whether hypotension is primary or secondary, whether it is acute hypotension, and combined with other clinical data, the primary cause can be clarified.

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