Secondary hypertension

Introduction to secondary hypertension Secondary Hypertension (SH) is a high blood pressure with a clear cause. When the cause is detected and the cause is effectively removed or controlled, hypertension as a secondary symptom can be cured or significantly relieved; secondary hypertension accounts for 5-10% of the hypertensive population; Endocrine, renovascular hypertension, and sleep apnea syndrome, as well as high blood pressure caused by mental and psychological problems are often seen. In the past, because of insufficient knowledge, the number of diagnosed cases was small. The risk of cardiovascular disease, stroke, proteinuria, and renal insufficiency is often higher in patients with secondary hypertension, and the cause is often overlooked to delay diagnosis. Increasing awareness of secondary hypertension, promptly identifying the cause and actively addressing the cause will greatly reduce the high lethality and disability caused by hypertension and complications. In recent years, the identification of secondary hypertension has become an important aspect of the diagnosis and treatment of hypertension. basic knowledge Sickness ratio: 0.5% Susceptible people: those over 40 years old Mode of infection: non-infectious Complications: cerebrovascular disease, heart failure, hypertensive heart disease, renal failure, hypertensive crisis, hypertensive retinopathy

Cause of secondary hypertension

Caused by primary aldosteronism, pheochromocytoma, renal vascular hypertension, renin secretory tumors, etc.

Related factors

1. Age: The incidence rate increases with age, and the incidence rate is higher in those over 40 years old.

2. Salt: Ingestion of salt, the incidence of hypertension is high, salt <2g / day, almost no high blood pressure.

3. Weight: The incidence of obesity is high.

4. Genetics: About half of hypertensive patients have a family history and may be associated with hereditary renal sodium deficiency.

5. Environment and occupation: A noisy working environment, excessive stress and mental work are prone to high blood pressure.

a disease that causes secondary hypertension

1. Renal parenchymal lesions: polar glomerulonephritis, more common in adolescents, history of acute onset streptococcal infection, fever, hematuria, edema history, identification is not difficult. Chronic glomerulonephritis and primary hypertension with renal dysfunction are not easy to distinguish, but repeated edema history, obvious anemia, low plasma protein, early appearance of proteinuria and relatively low blood pressure, fundus lesions are not obvious for chronic kidney Diagnosis of glomerulonephritis. Diabetic nephropathy, whether type 1 or type 2, can cause renal damage and hypertension, glomerular sclerosis, glomerular capillary basement thickening as the main pathological changes, early renal function is normal, only a small amount of white Proteinuria, blood pressure may also be normal; the disease develops, blood pressure rises when there is significant proteinuria and renal insufficiency.

2. Renal artery stenosis: can be unilateral or bilateral. The nature of the lesion may be congenital, inflammatory or atherosclerotic, the latter being seen in the elderly, the first two being mainly found in adolescents. Hypertension or high blood pressure, which is rapidly progressing, is suddenly aggravated, showing malignant hypertension, and drug treatment is ineffective. The disease should be suspected. This disease has a moderate and severe increase in diastolic blood pressure, and can detect vascular murmurs in the upper abdomen or back ribs during physical examination. High-dose tomography pyelography and radionuclide kidney map are helpful for diagnosis, and renal angiography can confirm the diagnosis.

3. Pheochromocytoma: pheochromocytoma tumors such as adrenal medulla or sympathetic ganglia can intermittently or continuously secrete excessive amounts of adrenaline and norepinephrine, resulting in paroxysmal or persistent elevated blood pressure. Antihypertensive fluctuations are obvious, paroxysmal blood pressure is increased with tachycardia, headache, sweating, pale symptoms, ineffective for general antihypertensive drugs, or high blood pressure with elevated blood glucose, hypermetabolism and other manifestations should be suspected and the disease.

4. Primary aldosteronism: This disease is caused by adrenal hyperplasia or excessive secretion of aldosterone by the tumor. Clinically, long-term high blood pressure is associated with stubborn hypokalemia, which may include muscle weakness, periodic paralysis, polydipsia, and polyuria. Blood pressure is mostly mild and moderate. Laboratory tests have hypokalemia, hypernatremia, metabolic alkalosis, decreased plasma renin activity, and increased urinary aldosterone excretion. The positive test of spironolactone (safety dredging) has diagnostic value. Ultrasound, radionuclide, this can be used for localization diagnosis.

5. Cushing's syndrome: caused by adrenal cortical tumors or excessive secretion of glucocorticoids. In addition to high blood pressure, there are characteristics such as centripetal obesity, full moon face, buffalo back, purple skin, increased hair, and elevated blood sugar. Diagnosis is generally not difficult.

6. Aortic coarctation: Most of them are congenital vascular malformations, and a few are caused by multiple arteritis. It is characterized by an increase in blood pressure in the upper limbs and a lowering or lowering of blood pressure in the lower limbs, and an abnormal phenomenon in which blood pressure is higher than that in the lower limbs. In the interscapular region, the sternum, and the ankle, there may be pulsation and murmur of the collateral circulation artery or abdomen auscultation with vascular murmur. Chest radiography can show the ribs caused by erosion of the collateral artery.

Secondary hypertension prevention

1. Avoiding alcohol and tobacco, and eating less salt is the minimum. The incidence of hypertension is directly proportional to the intake of salt.

2. Eat less fat and animal offal, because fat and animal viscera contain saturated fatty acids and cholesterol, and eating more will aggravate high blood pressure.

3. The law of scientific life: daily life, labor and leisure, diet and festivals, low salt and low fat, smoking cessation and alcohol restriction.

4. Maintain a good state of mind: learn self-psychological adjustment, self-psychological balance, self-creation of good mood.

5. Avoid excreting stools and avoiding the excitement that makes people happy and happy.

Secondary hypertension complications Complications cerebrovascular disease heart failure hypertensive heart disease renal failure hypertensive crisis hypertensive retinopathy

Hypertension can be impaired in multiple organ function. The most common complication of hypertension is cerebrovascular accident, followed by hypertensive heart disease, heart failure, renal failure, hypertensive crisis, and hypertensive retinopathy.

Secondary Hypertension Symptoms Common symptoms High blood pressure, dizziness, chest tightness, shortness of breath

Common symptoms include dizziness, headache, tight neck, fatigue, palpitations, etc., which are mildly persistent. Most of the symptoms can be relieved by themselves, and are aggravated after stress or fatigue. Heavier symptoms such as blurred vision and nosebleed can also occur. Symptoms are associated with blood pressure levels due to hypertensive vasospasm or dilatation. A typical high blood pressure headache disappears after a drop in blood pressure. Hypertensive patients can combine headaches of other causes at the same time, often independent of high blood pressure, such as mental anxiety headache, migraine, glaucoma and so on. If sudden dizziness and dizziness occur suddenly, it may be noted that transient ischemic attack or excessive blood pressure, orthostatic hypotension, which is prone to occur in patients with hypertension complicated with atherosclerosis and cardiac dysfunction. Hypertensive patients can also have symptoms of affected organs, such as chest tightness, shortness of breath, angina pectoris, and polyuria. In addition, some symptoms may be caused by adverse reactions of antihypertensive drugs.

Examination of secondary hypertension

Several tests should be done for secondary hypertension. Secondary hypertension should be checked in addition to regular blood pressure measurements:

1. Determine the level of cholesterol and triglyceride in the blood in order to understand the cardiovascular condition, and find the risk factors of arteriosclerosis and coronary heart disease. At the same time, ECG and echocardiography should be performed to understand the condition of the heart and judge Whether the myocardium is ischemic, whether the left ventricle is hypertrophy, taking X-ray chest orthotopic film, observing whether the aorta is dilated or prolonged to understand the blood vessels of the heart.

2, do cerebral blood flow map to understand the cerebral arteriosclerosis and blood supply, help prevent the occurrence of cerebrovascular complications.

3, check the kidney function, by checking the blood creatinine urea nitrogen, test urine to check whether there is protein to understand kidney function.

4, determine blood sugar, urine sugar and glucose tolerance test to understand whether there are concurrent sugar disease and early detection of sugar fast disease.

5. Determine the level of calcium and uric acid in the blood to understand the high blood pressure and high uric acid blood sugar caused by antihypertensive effect and diuretic.

Diagnosis and diagnosis of secondary hypertension

24-hour urinary 17-hydroxyl and 17-ketosteroids, dexamethasone inhibition test and positive adrenal cortex stimulation test are helpful for diagnosis.

Intracranial sellar X-ray, adrenal CT scan and radioactive iodinated cholesterol adrenal scan can be used for lesion localization. Aortic angiography can determine the diagnosis of aortic coarctation.

High-dose tomography pyelography and radionuclide kidney map are helpful for diagnosis, and renal artery angiography can clearly diagnose renal artery stenosis. Determination of catecholamine and its metabolite vanillyl mandelic acid (VMA) in blood or urine during high blood pressure increases, if significantly increased, suggesting pheochromocytoma. Ultrasound, radionuclide and computed tomography (CT), magnetic resonance imaging showed the location of the tumor.

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