Diagnosis and differentiation of hypertension

 According to the blood pressure standard recommended by the World Health Organization (who), the systolic blood pressure of a normal adult should be less than or equal to 140mmHg (18.6kpa), and the diastolic blood pressure should be less than or equal to 90mmHg (12kpa). That is, the systolic blood pressure should be 141-159mmHg (18.9- 21.2kpa), the diastolic blood pressure is between 91-94mmHg (12.1-12.5kpa), which is the borderline hypertension. When diagnosing hypertension, blood pressure must be measured multiple times. At least two consecutive diastolic blood pressures with an average value of 90mmHg (12.0kpa) or above can be diagnosed as hypertension. Patients with only one blood pressure increase cannot be diagnosed, but follow-up observation is required.

According to the difference in blood pressure, hypertension is divided into 3 levels:

Grade 1 hypertension (mild): systolic blood pressure 140~159mmHg; diastolic blood pressure 90~99mmHg.

Grade 2 hypertension (moderate): systolic blood pressure 160~179mmHg; diastolic blood pressure 100~109mmHg.

Grade 3 hypertension (severe): systolic blood pressure ≥180mmHg; diastolic blood pressure ≥110mmHg.

Isolated systolic hypertension: systolic blood pressure ≥140mmHg; diastolic blood pressure <900mmHg.

Stages of hypertension:

The first stage: blood pressure reaches the level of diagnosed hypertension, clinical carelessness, signs of brain and kidney damage.

Phase 2: People whose blood pressure has reached the level of confirmed hypertension and one of the following:

1. Physical examination, X-ray, ECG or echocardiogram showing left ventricle enlargement;

2. Fundus examination, general or local stenosis of fundus arteries;

3. The concentration of proteinuria or plasma creatinine is slightly increased.

The third stage: blood pressure reaches the level of confirmed hypertension, and one of the following:

1. Cerebral hemorrhage or hypertensive encephalopathy;

2. Heart failure;

3. Renal failure;

4. Fundus bleeding or oozing, with or without optic nerve head edema;

5. Angina pectoris, myocardial infarction, cerebral thrombosis.

Differential diagnosis

Primary hypertension, secondary hypertension, renovascular hypertension, white coat hypertension, and pregnancy-induced hypertension are differentiated.

Hypertension check

 1. Physical examination

(1) Measure blood pressure correctly. Because blood pressure is fluctuating, and emotional and physical activity can cause temporary blood pressure rise, it should be at least 2 times when the blood pressure rises in the resting state of different days before the diagnosis of hypertension, and the blood pressure value should be Calculated as the average value of 3 consecutive measurements. Careful physical examination can help find clues to secondary hypertension and target organ damage

(2) Measure body mass index (bmi), waist circumference and hip circumference.

(3) Check the arterial pulsation and nervous system signs of the extremities, auscultate the carotid artery, thoracic aorta, abdominal artery and femoral artery for murmurs.

(4) Observe for the presence of Cushing's disease face, neurofibromatous skin spots, hyperthyroidism exophthalmos, or lower extremity edema.

(5) Comprehensive cardiopulmonary examination.

(6) A comprehensive and detailed understanding of the patient's medical history.

2. Laboratory inspection

It can help determine the cause of hypertension and the functional status of target organs. Routine examination items include blood routine, urine routine (including protein, sugar and urine sediment microscopy), renal function, blood sugar, blood lipids, blood potassium, echocardiography, electrocardiogram, chest X-ray, fundus, ambulatory blood pressure monitoring, etc.

According to needs and conditions, the fundus and carotid ultrasound can be further checked. 24-hour ambulatory blood pressure monitoring helps to determine the severity of blood pressure rise, understand the circadian rhythm of blood pressure, monitor blood pressure in the morning, guide antihypertensive treatment and evaluate the efficacy of antihypertensive drugs.

Hypertension symptoms

 According to the onset and the course of the disease, it can be divided into slow-moving type and rapid-moving type, with slow-moving type more common.

1. Progressive hypertension

1. Early manifestation: early symptoms are mostly asymptomatic, occasionally increased blood pressure during physical examination, or dizziness, headache, vertigo, tinnitus, insomnia, fatigue, inattention, etc. symptoms may be senior Due to mental dysfunction, the blood pressure only temporarily rises in the early stage, and the blood pressure continues to rise as the disease progresses, and the organs are affected.

2. Brain manifestations: headaches and dizziness are common, mostly caused by emotional agitation, excessive fatigue, climate change or discontinuation of antihypertensive drugs, sudden increase in blood pressure, severe headache, visual disturbance, nausea, vomiting, convulsions, coma, one Transient hemiplegia, aphasia, etc.

3. Cardiac manifestations: In the early stage, the heart function is compensated and the symptoms are not obvious, and in the later stage, the heart function is decompensated and heart failure occurs.

4. Renal manifestations: long-term hypertension causes renal arteriole sclerosis. When renal function declines, it can cause nocturia, polyuria, urine protein, casts and red blood cells, low urine concentration, phenol red excretion and urea clearance disorders. There is azotemia and uremia.

5. Arterial changes.

6. Changes in the fundus.

2. Rapidly progressive hypertension

It is also called malignant hypertension, which accounts for 1% of hypertension. It can suddenly change from slow-moving type and can also onset. Malignant hypertension can occur at any age, but it is most common in 30-40 years old. Blood pressure rises significantly. High, diastolic blood pressure is more than 17.3kpa (130mmHg), symptoms such as fatigue, thirst, polyuria, rapid vision loss, retinal hemorrhage and oozing in the fundus, often bilateral optic nerve head edema, rapid proteinuria, hematuria And renal insufficiency, heart failure, hypertensive encephalopathy and hypertensive crisis can also occur. The course of the disease progresses rapidly and most of them die from uremia.

Introduction to Hypertension

 Hypertensive disease is a chronic disease characterized by continuous increase in arterial blood pressure, which often causes pathological changes in important organs such as the heart, brain, and kidneys with corresponding consequences.

According to the blood pressure standard recommended by the World Health Organization (who), the systolic blood pressure of a normal adult should be less than or equal to 140mmHg (18.6kpa), and the diastolic blood pressure should be less than or equal to 90mmHg (12kpa). That is, the systolic blood pressure should be 141-159mmHg (18.9- 21.2kpa), the diastolic blood pressure is between 91-94mmHg (12.1-12.5kpa), which is the borderline hypertension.

When diagnosing hypertension, blood pressure must be measured multiple times. At least two consecutive diastolic blood pressures with an average value of 90mmHg (12.0kpa) or above can be diagnosed as hypertension. Patients with only one blood pressure increase cannot be diagnosed, but follow-up observation is required.

[High blood pressure in different groups]

Pediatric hypertension: primary hypertension is rare in children, accounting for about 20% to 30%, but it has increased in recent years; secondary hypertension is more frequent, accounting for about 65% to 80%. In children secondary In hypertension, kidney disease accounts for 79%,

Hypertension is followed by cardiovascular disease, endocrine disease, nervous system disease and poisoning.

Pregnancy-induced hypertension: Pregnancy-induced hypertension syndrome, also known as pregnancy poisoning, preeclampsia, etc., is a peculiar disease of pregnant women. Most of them occur at 20 weeks of pregnancy and two weeks after delivery, accounting for about 5% of all pregnant women.

Elderly systolic hypertension: refers to the systolic blood pressure of the elderly over 60 years old is higher than the normal level and the diastolic blood pressure is normal. It is an independent type of disease and an independent risk factor for cardiovascular disease and stroke in the elderly. An important disease of human health.

[Primary and secondary hypertension]:

Essential hypertension: Hypertension can be divided into two categories: primary and secondary. In the vast majority of patients, the cause of hypertension is unknown, which is called essential hypertension, which accounts for more than 95% of the total hypertension.

Secondary hypertension: secondary to other diseases. The most common ones are caused by kidney and adrenal gland diseases, and endocrine hypertension.