With hypertension

Introduction Hypertension refers to the development of certain diseases while producing high blood pressure. Hypertension is the most common chronic disease and the most important risk factor for cardiovascular and cerebrovascular diseases. Stroke, myocardial infarction, heart failure and chronic kidney disease are the main complications.

Cause

Caused by cardiovascular disease, diabetes, etc. General hypertension diseases have a certain relationship with abnormalities of blood lipids and cholesterol. Abnormal blood sugar also has an effect on blood pressure. In addition, atherosclerosis has a certain effect on blood pressure. There is also hereditary hypertension. Kidney disease can also cause blood pressure to rise.

an examination

Related inspection

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First, determine whether there is high blood pressure: measuring blood pressure should be measured several times for several consecutive days of blood pressure, more than two times higher blood pressure, can be said to be high blood pressure.

Second, the reasons for the identification of high blood pressure: Where patients with hypertension, should be asked in detail about the medical history, comprehensive systemic examination to rule out symptomatic hypertension.

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.

(A) blood routine: red blood cells and hemoglobin are generally no abnormalities, but acute hypertensive patients may have Coombs test negative microvascular hemolytic anemia, with abnormal red blood cells, high hemoglobin increased blood viscosity, prone to thrombosis complications ( Including cerebral infarction) and left ventricular hypertrophy.

(B) urine routine: early patients with normal urine, kidney weight loss when the urine weight gradually decreased, there may be a small amount of urine protein, red blood cells, 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: blood urea nitrogen and creatinine are used 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) Chest X-ray examination: the aorta can be seen, especially the ascending and arching tendons are prolonged, and the ascending, arch 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: The electrocardiogram 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 of the diastolic stenosis, delayed mitral valve opening, etc. 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: The measurement of arterial pressure in the central retina is observed to increase, and the following fundus changes can be seen at different stages of the development of the disease:

Grade I: Retinal artery spasm

Grade II A: Mild sclerosis of the retinal artery. B: Retinal artery is significantly hardened. Grade III: Grade II plus retinopathy (bleeding or exudation). Grade IV: Grade III plus optic papilledema

(8) Other examinations: Patients 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.

Differential diagnosis

Identification with general hypertension:

Hypertension refers to an increase in arterial systolic and/or diastolic blood pressure (>=140/90 mmHg) at rest, often accompanied by disorders of fat and glucose metabolism, and organ function or function of the heart, brain, kidney, and retina. Sexual change, a systemic disease characterized by organ remodeling. Rest for more than 5 minutes, 2 times more than the same day measured blood pressure >= 140/90mmHg can be diagnosed as high blood pressure. Clinically, many hypertensive patients, especially obese, are often accompanied by diabetes, and diabetes is also associated with high blood pressure, so the two are called homologous diseases. People with diabetes have increased blood sugar, increased blood viscosity, damaged blood vessel walls, and increased vascular resistance, which may cause high blood pressure. It can be seen that both hypertension and diabetes are related to hyperlipidemia. Therefore, both hypertension and diabetes should lower blood pressure and regulate blood lipids.

First, determine whether there is high blood pressure: measuring blood pressure should be measured several times for several consecutive days of blood pressure, more than two times higher blood pressure, can be said to be high blood pressure.

Second, the reasons for the identification of high blood pressure: Where patients with hypertension, should be asked in detail about the medical history, comprehensive systemic examination to rule out symptomatic hypertension.

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) Blood routine

Erythrocyte and hemoglobin are generally not abnormal, but acute hypertensive patients may have Coombs test negative microvascular hemolytic anemia, with abnormal red blood cells, high hemoglobin increased blood viscosity, prone to thrombosis complications (including cerebral infarction) and left Ventricular hypertrophy.

(two) urine routine

In the early stage, the patient's urine routine was normal, and the urine specific gravity was gradually decreased when the renal concentrating function was impaired. There may be a small amount of urine protein, red blood cells, and occasional casts. 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.

(three) renal function

Blood urea nitrogen and creatinine are often used 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.

(four) chest X-ray examination

It can be seen that the aorta, especially the ascending and arching, is prolonged and the ascending, arching or descending 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

Electrocardiogram in left ventricular hypertrophy can 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

It is currently believed that echocardiography is the most sensitive and reliable means of 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

Measurement of central arterial pressure in the retina is seen to increase, and the following fundus changes can be seen at different stages of disease progression:

Grade I: Retinal artery spasm

Grade II A: mild retinal arteriosclerosis B: retinal arterial sclerosis

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

Grade IV: Grade III plus optic papilledema

(8) Other inspections

Patients 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.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.