Outpatient hypertension

Introduction White coat hypertension (English name: white coat hypertension; alias: white coat hypertension) refers to some people go to the hospital for treatment, blood pressure is increased when measuring blood pressure in the doctor's office, but return to their own home to measure blood pressure or 24 hours dynamic Blood pressure monitoring (the blood pressure device is carried by the patient himself, and no medical staff are present) has normal blood pressure. This is the patient's nervousness after seeing the white coat doctor, the catecholamines that accelerate the heartbeat appear in the blood, and also cause some blood vessels to contract, increasing peripheral resistance, which leads to an increase in blood pressure. In the past, this kind of "white coat hypertension" was only mentally stressed, and my blood pressure was normal. It has now been found that this "white coat hypertension" may be an intermediate state between normal blood pressure and apparent persistent hypertension. Because the hypertension in early hypertensive patients has the characteristics of fluctuations, high blood pressure and normal alternation can occur. Therefore, this "white coat hypertension" should be followed up.

Cause

1. The production of WCH may be related to the "pressurized stimulation" of the patient by the pressure measurement of the medical staff. The tone and mood of the medical staff talking with the patient in a particular place can affect the measured blood pressure value.

2. The patient itself has an enhanced response to stress. Weber found that patients with WCH had an increased renin and aldosterone levels in WCH-activated WCH patients, and norepinephrine levels were also elevated.

3. WCH patients have the genetic characteristics of stress-related stress response and are part of the prehypertension state. The results of follow-up show that white coat hypertension is not only manifested in the clinic, but also in high blood pressure in daily life, so WCH is not A benign disease.

an examination

Related inspection

Ambulatory blood pressure monitoring (ABPM) blood pressure

General diagnosis: Verdecchia proposed WCH as the 90th percentile of d-ABPM distribution in patients with mean white blood pressure (d-ABPM) lower than normal blood pressure (normal standard female systolic blood pressure 131mmHg, diastolic blood pressure 86mmHg male systolic blood pressure 136mmHg) Diastolic blood pressure 87mmHg).

The reference diagnostic criteria in China are: WCH patient systolic blood pressure >140mmHg and/or diastolic blood pressure >90mmHg, and white blood pressure dynamic blood pressure systolic pressure <135mmHg diastolic blood pressure <80mmHg; this also needs clinical validation and evaluation, clinically doubtful Diagnosis of hypertension in the office should be assisted by home blood pressure measurements or ambulatory blood pressure measurements.

Differential diagnosis

Differential diagnosis of outpatient hypertension:

A clear hypertension: according to diagnostic criteria, standard measurement methods are used.

Second, identify primary or secondary hypertension (P268).

(1) Renal parenchymal hypertension: the most common acute, chronic glomerulonephritis, diabetic nephropathy.

(B) renal artery stenosis: common, unilateral or bilateral.

Cause: Adolescent: congenital, inflammatory.

Older people: atherosclerosis.

Features:

1 Severe increase in blood pressure (DBP), antihypertensive drugs are poor.

2 The vascular murmur is heard at the upper abdomen or the back rib angle.

(C) pheochromocytoma

Located in the adrenal medulla or sympathetic nerve knot, secreting catecholamines.

Features:

1 paroxysmal or persistent hypertension with sympathetic excitation.

2 general antihypertensive drugs are invalid.

(D) primary aldosteronism.

Adrenal hyperplasia or tumors secrete too much aldosterone.

Features: persistent mild to moderate hypertension with refractory hypokalemia.

(5) Cushing syndrome

Adrenal hyperplasia or tumor secretes polysaccharide corticosteroids.

Characteristics: Hypertension with abnormal metabolism of sugar esters.

(6) aortic coarctation

Cause: Congenital vascular malformation (majority), multiple arteritis.

Features:

1 The upper limb blood pressure is increased and the lower limb blood pressure is not high or decreased.

2 scapular region, sternum, sacral circumflex artery pulsation and murmur or abdominal vascular murmur.

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