Hypertension

Introduction Hypertension is a clinical syndrome characterized by elevated systemic systolic blood pressure (SBP) and/or diastolic blood pressure (DBP). It is one of the most common and important cardiovascular diseases in clinical practice. With the continuous improvement of people's living standards, the prevalence of hypertension is also increasing year by year. In China, since 1959, the prevention and treatment of hypertension has been carried out. At that time, the prevalence of hypertension in adults was 5.1%, to 1979- In the second hypertension sampling survey in 1980, the prevalence of hypertension in adults (including critical hypertension) has increased to 7.73%. The third national hypertension survey in 1990-1991 showed that the prevalence of hypertension was There has been significant growth in the decade, with an estimated 60 million hypertensive patients in the country at the time. According to the latest statistics, the prevalence of hypertension in China has risen to 11.68%, especially the damage of target organs such as heart, brain and kidney secondary to hypertension, which seriously affects the life and quality of life of patients, and has become a serious threat to humans. Health and life diseases.

Cause

The cardiovascular system is a closed transport system consisting of the heart, arteries, capillaries, and veins that is powered by the rhythmic contraction of the heart, pushing the blood to circulate. According to the different functions of blood vessels, they are often divided into the following six types:

1 Elastic reservoir blood vessel: including aorta, pulmonary artery and its adjacent aorta, which is characterized by large lumen and good elasticity of the wall, which can make the intermittent blood discharge of the heart become relatively stable and continuous through its elastic expansion and retraction. Blood flow.

2 Resistance vessels: including terminal arteries, arterioles and venules. Because of its small lumen and abundant smooth muscle wall, it can change the peripheral vascular resistance through its contraction and relaxation, which is one of the main factors determining blood pressure.

3 sphincter type blood vessels: refers to a section between the arterioles and capillaries, whose opening and closing determines whether blood flows through the capillaries.

4 exchange of blood vessels: refers to capillaries, a place for material exchange between blood and tissue.

5 volume blood vessels: mainly refers to the vein, its wall book, large lumen, can accommodate more blood.

an examination

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Laboratory and special inspection

Laboratory tests for hypertensive patients are mainly for the necessary reasons for common secondary hypertension, such as urine routine for renal hypertension, urinary bacterial culture, renal function test, ultrasound of kidney and renal artery. CT examination, renal cortex, medullary hormone determination, T3L measurement, blood electrolyte measurement, adrenal B ultrasound, CT, MRI, etc. for endocrine hypertension. In addition, electrocardiogram, echocardiography, fundus examination have also become routine examinations for patients with hypertension, which not only helps to find some clues about secondary hypertension, but more importantly, the degree of involvement of target organs can be determined by these tests. It is convenient for clinical use of hypertension.

(1) Urine routine: Urine routine is the simplest and most important one in the laboratory examination of hypertension, and should be given enough attention. Urinary red blood cells increase and protein-positive nephritis is likely, urinary white blood cells (especially pus) increased mainly suggestive of renal infectious diseases pyelonephritis, renal tuberculosis, etc.), painless hematuria is a characteristic of kidney tumors, urine Low relative density and fixed is one of the manifestations of renal insufficiency caused by advanced renal damaging diseases. Urine sugar positive is a strong evidence for the discovery or diagnosis of diabetes.

(2) Urine bacterial culture: repeated urinary bacterial culture in patients with suspected pyelonephritis, including hyperosmotic culture, not only helps to determine the nature of pathogenic bacteria, but also to select effective antibiotics, and it is also meaningful for understanding the outcome of the disease. .

(3) Blood biochemistry and radionuclide test: Patients with primary aldosteronism have low blood potassium and elevated aldosterone levels in the blood, while renin and angiotensin levels tend to be low. Plasma cortex in Cushing's syndrome Alcohol increased, urinary cortisol metabolites (17-hydroxycorticosteroids) also increased, blood levels of adrenaline and norepinephrine in patients with pheochromocytoma increased significantly, urine VMA within 24 hours after onset ( The determination of vanillyl mandelic acid is also positive. The determination of blood muscle and urea nitrogen is helpful in judging the degree of impaired renal function. In addition, the renin-angiotensin-aldosterone system test or angiotensin-converting enzyme assay determines the renin tumor. Or high-renin type hypertension also helps to induce the measurement of pin phage, etc., which has certain auxiliary value for the diagnosis of essential hypertension.

(4) Renal function test: In addition to the above-mentioned test of urea nitrogen and muscle complexation, the decrease of muscle clearance rate reflects the decline of glomerular function, and the phenol red excretion test is the best method for measuring proximal renal tubular function, concentrated dilution test To help understand distal glomerular function, abnormalities in hematuria microglobulin determination can reflect early damage to kidney function (including glomerular or tubular function).

(5) Imaging examination of the kidney and adrenal gland: including B-ultrasound and color Doppler ultrasound, mainly used to observe renal venous X-ray renal angiography, renal angiography, renal and adrenal CT, MRI and so on. These imaging studies are very helpful in identifying the causes of secondary hypertension.

(6) ECG examination: can be found with or without hypokalemia, myocardial ischemia, ventricular hypertrophy.

(7) Echocardiography: can help to understand the patient's ventricular wall thickness, heart chamber size, heart valve structure and changes in systolic and diastolic function.

Differential diagnosis

It should be differentiated from the following symptoms:

Obstinate hypertension

Most hypertensive patients can be controlled to a satisfactory level of blood pressure after antihypertensive drugs, while a few hypertensive patients continue to increase their diastolic blood pressure despite the combination of larger doses of drugs, maintaining at 15.2 kPa (115 mm). Hg) or more is called refractory hypertension.

2. With hypertension

Hypertension refers to the occurrence of certain diseases at the same time, producing high blood pressure, which occurs due to the occurrence of a disease or its complications are high blood pressure.

4. Emotional hypertension

In the daily life, the pressure is the most common. We often see that when some people are emotional, their complexion is red, white, blue, and even fainted in anger and a stroke will inject the drug life into the nerves. It is caused by a sudden increase in blood pressure caused by severe emotional changes.

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