Check items to be done in patients with hypertension
One, to determine whether there is no high blood pressure: the measurement of blood pressure should be continuous several times a few days to measure blood pressure, there are more than two blood pressure rise, it can be described as high blood pressure.
Two, identify the reasons for the high blood pressure: all patients with hypertension, should be asked in detail about the history, a comprehensive system to check, in order to eliminate the symptoms of hypertension.
Laboratory tests can help the diagnosis and classification of essential hypertension, understand the function of target organs, and the correct choice of drugs, hematuria, renal function, uric acid, blood lipids, blood glucose, electrolytes (especially blood potassium), electrocardiogram, chest X-ray and eye bottom examination should be used as routine examination of patients with hypertension.
(a) the blood red blood cells and hemoglobin generally no abnormalities, but hypertension may have negative Coombs test of microangiopathic hemolytic anemia, with abnormal red blood cells, hemoglobin high blood viscosity increased, prone to thrombosis complications (including cerebral infarction) and left ventricular hypertrophy.
(two) urine routine urine routine, renal function impairment, urine specific gravity is gradually decreased, can have a small amount of urine protein, red blood cells, even see tube type, with kidney disease progression, urine protein increased, in benign kidney sclerosis such as 24 hour urine protein in 1g above, suggest poor prognosis, red blood cell and tube type can also increase, tube type is mainly transparent and particles.
(three) renal function by blood urea nitrogen and serum creatinine to estimate renal function in patients with early renal damage check is no exception, to a certain extent can be increased, the adult creatinine >114.3 mu mol/L, the elderly and pregnant women >91.5 mol/L showed renal damage, phenolsulfonphthalein excretion test, urea creatinine clearance rate. The clearance rate could be lower than normal.
(four) the chest X-ray examination showed aortic arch, especially the lift, the lift, tortuous and prolonged, arch or descending part can expand, emergence of hypertensive heart disease with left ventricular enlargement, left heart failure with left ventricular enlargement is more obvious, heart failure or left ventricular and pulmonary congestion increases. Signs of pulmonary edema, pulmonary congestion was obvious, the butterfly shaped fuzzy shadow, routine radiography examination, in order to check before and after comparison.
(five) ECG left ventricular hypertrophy ECG showed left ventricular hypertrophy or a combination of strain, electrocardiogram in diagnosis of left ventricular hypertrophy of the standard is not the same, but its sensitivity and specificity are similar, false negative was 68% ~ 77%, 4% ~ 6% false positive, visible ECG diagnosis of left ventricular hypertrophy sensitivity is not very high. Due to decreased left ventricular diastolic compliance, left atrial diastolic load increases, ECG can appear P is wide, cutting concave, Pv1 terminal force increases, the performance can be found and left ventricular hypertrophy in ECG before, there may be premature ventricular arrhythmias such as atrial fibrillation, etc..
(six) echocardiography and the chest X-ray examination, electrocardiogram, echocardiography in diagnosis of left ventricular hypertrophy is the most sensitive and reliable means, based on two-dimensional ultrasound localization on record M ultrasonic curve or measured directly from the two-dimensional maps, and (or) or ventricular septal wall thickness after ventricular >13mm for left ventricular hypertrophy in essential hypertension left ventricular hypertrophy is symmetrical, but there are about 1/3 in septal hypertrophy (mainly interventricular septum and left ventricular posterior wall thickness ratio >1.3), ventricular septal hypertrophy is often appearing first, suggesting that the first impact of hypertensive left ventricular outflow tract, figure can observe other cardiac chambers echocardiography, valvular and aortic root and can be used for the detection of cardiac function, left ventricular hypertrophy, although the early heart function such as cardiac output, left ventricular ejection fraction is normal, but the left ventricular systolic and diastolic A period of adaptation decline, such as systolic maximum velocity (Vmax) decreased, prolonged isovolumic relaxation, mitral valve opening delay, in the presence of left heart failure after echocardiography can be found in the left ventricular and left atrial enlargement, left ventricular wall contraction weakened.
(seven) fundus examination and measurement of retinal artery pressure can increase, in different stages of the development of the disease can see the following changes in fundus:
Class I: retinal artery spasm
Class II A: mild sclerosis of retina
Class II B: retinal artery was significantly hardened
Grade II: Grade 2 and retinopathy (bleeding or leakage)
Grade IV: Grade III and optic nerve papilla edema
(eight) other examination patients may be associated with serum total cholesterol, triglyceride, low density lipoprotein cholesterol and high density lipoprotein cholesterol lowering, and apolipoprotein A- I decreased, also often have blood glucose increased and hyperuricemia, some patients with plasma renin activity, angiotensin II levels increased.
How to measure blood pressure
Blood pressure was first in seventeenth Century, a scientist found a glass tube inserted into the horse’s arteries, fortunately, after this design a dangerous and less blood pressure measurement method.
When measuring the blood pressure, the doctor will first be connected to a blood pressure cuff bag slightly tightly wrapped in the forearm to be measured. Then squeeze the attached to the cuff air bag inflated balloon. This temporarily blocks the flow of blood in the aorta (the brachial artery) to the test.
And then the doctor will stethoscopic put in to be measured of the inside of the elbow (placed directly in the artery, the cuff air bag in the air is slowly released. When the blood flow through the artery will hear a beat sound from the stethoscope.
When a doctor hears a sound of first pulses, a reading is recorded on the blood pressure gauge, which is the systolic pressure, and the first reading of the two reading. Systolic blood pressure represents the highest pressure in the arteries. The unit of this reading is a thousand.
With more air gradually from the cuff air bag release, artery will eventually be completely relaxed, intravascular blood flow returned to normal. The pulsing sound would gradually disappear, and after the doctor heard the last sound, the other reading was recorded on the blood pressure meter. Diastolic blood pressure readings represent the lowest pressure in the arteries. It appears in every heartbeat. Diastolic blood pressure is second of the two readings. For example, if your blood pressure readings were 18.7, 1 =7.5 mm Hg, and 12, the 18.7 one was a systolic blood pressure.
Blood vessels in the body will be destroyed by high blood pressure, and the pressure of the blood to push the human artery can strain or tear the cell wall of the artery. The injured arteries can repair itself, but when the damage is too large or too frequent, the repair process will produce a bulge of the fat, cholesterol, and dead cells (also known as fat plaques). For people with elevated blood cholesterol levels, especially those with low density lipoprotein cholesterol, the risk of the fatty plaques is the most dangerous. High blood pressure will speed up the process, and the fat spot will continue to grow until it is long enough to block the flow of blood. This process is the process of atherosclerosis, which may occur from childhood and has been sustained for several years 1-. Do the same in the hypertension, atherosclerosis caused enough damage to cause obvious symptoms before is soundless and stirless. In nearly 1/5 of patients with atherosclerosis, fatal heart attack is the only symptom.
In addition to accelerate artery plugging, hypertension can accelerate atherosclerosis (hardening of the arteries) process. Arterial blood is thick and stiff, and it will cause the arteries to narrow and make the arteries lose their elasticity, so that the process of atherosclerosis is accelerated. The results are less and less blood in the blood vessels through the blood vessels.
Hypertension accelerates the process of atherosclerosis by causing tissue damage to the arterial wall. When blood pressure is too high, excessive blood pressure can be struck on the fragile artery wall, which can cause damage to blood vessels. Other arteries are also hurt by the harmful chemical substances in cigarettes and the low density lipoprotein cholesterol (chemical change). Foods rich in antioxidant vitamins (especially vitamin A, vitamin C, and vitamin E) can reduce the amount of oxidized LDL cholesterol in the blood, which is contained in foods such as citrus fruits, leafy vegetables, Cereals, and low fat dairy products.
Attract impaired movement in the event a called white Xirun mononuclear cells, they are inflammatory attack the blood of bacteria and other foreign substances of white blood cells, these mononuclear cell attachment in the damaged area to complete their work, and eventually drilling in the inner lining of the arteries of the internal.
Once in the human arterial union internal, mononuclear cells will into another cell, called macrophages, macrophages in vivo play or doffer. Garbage collection. The role of macrophages in the phagocytosis of dead cells, so that they no longer block blood flow channel, but also to absorb low density lipoprotein cholesterol. Dolphin alliance of macrophages are not and animals by blood circulation, and so they will stay forever in the Ministry when low density lipoprotein in the blood of the finding in human atherosclerotic lesions of the pathway in macrophages will its absorption and expansion become foam cells. If low density lipoprotein cholesterol levels are elevated in the blood, LDL may be more prone to impaired blood vessel regions. So as to promote the formation of foam cells in the formation of macrophages. When the foam cells gathered together, a fat (i.e. fatty plaques) formed in animal dolphin house.
As the foam cells continue to grow, they begin to crush the arteries, making the injured area expand and prevent blood flow. This additional damage to the artery to attract other blood platelets — Tian Yu one. Platelets remain in the damaged site to release a chemical, which promotes the reverse growth of the fragile arteries. Smooth muscle in the arterial wall can also react to the chemical and begin to reverse its growth. By the accumulation of stem cells and the abnormal growth of tissue, the arteries will become narrower and eventually become completely blocked.
In the damaged site, the clot aggregates the calcium, fibrous tissue, and other debris in the blood that increases the risk of arterial blockage. Blood clots may be from the artery (especially in additional pressure exerted by hypertension) can clog arteries and cause stroke or myocardial infarction.
Coronary artery disease occurs when the arteries that supply blood to the heart are narrowed (usually due to the accumulation of plaques). Ischemic heart disease (ischemia) is the result of the occurrence of coronary artery atherosclerosis, or coronary artery spasm (due to the involuntary contraction of the arterial wall muscles) and the results of contraction. Sometimes, such a narrow narrow will not cause any discomfort, this situation is called asymptomatic ischemia. However, most people in the tissue ischemia and hypoxia will occur angina (chest pain). The position of angina occurs in the chest, but may spread to the neck, shoulders, arms, or jaw. Angina attack does not cause permanent damage, but the attack of angina pectoris is an important warning signal.
The condition of the arterial obstruction can occur in any part of the body. The leg artery coarctation can cause pain or cramps when you walk, this is called intermittent claudication. Like angina, the pain disappears after a break. However, severe untreated leg artery occlusion may eventually result in tissue necrosis of the toe (and leg). This is called gangrene, especially in some diabetic patients.
The arteries that supply blood to the arteries are narrowed, which can cause stomach and stomach cramps. This is abdominal pain, usually in the meal after the pain. The blood vessel that leads to the intestinal tract is completely blocked can cause blood in the stool, and eventually the blockage of the intestinal tract may be necrotic. If the bowel perforation occurs, the bacteria can enter the abdomen, causing abdominal infection (Fu Moyan) or death.
There is another danger, that is, that some of the blocks may fall off and into the blood. If such obstruction is attached to blood vessels and blocks the flow of blood, the tissue of the distal end may begin to necrosis by ischemia. If this occurs in the heart, it is likely to cause myocardial infarction $if the brain occurs in the brain, it will have a stroke.
If blood pressure rises sharply, the risk will be even greater. Extremely high blood pressure can cause the fragile blood vessels to rupture, and the blood flow out of the blood vessel can be seriously damaged by the blood. In the case of the brain, a fatal stroke occurs. The largest artery in the human body, the aorta, is swollen with a high blood pressure. This swelling is the aneurysm, which may rupture. However, the potentially fatal effects of these are caused by a rapid rise in blood pressure that are generally associated with symptoms such as headache, dizziness, nasal bleeding, blurred vision, occasional chest pain or abdominal pain.
Understanding of hypertension
About 95% of patients with high blood pressure without any definite cause, this is called essential hypertension. When we talk about high blood pressure, we often talk about the type of essential hypertension. And secondary hypertension is a kind of hypertension caused by the potential disease.
Risk factors for hypertension
Essential hypertension has the characteristics of family heredity. If your parents or brothers and sisters have high blood pressure, you may be more likely to get the disease. Many organs and systems are related to the regulation of blood pressure, and the genetic diseases of any one of them can promote the development of hypertension.
Being overweight has the characteristics of family heredity, which may also be part of the genetic causes of high blood pressure in the family. Studies have indicated that 6 of the 10 adult patients with high blood pressure were 20% or more overweight. If you are overweight, your blood pressure may be higher than normal. For young people, the impact of weight on blood pressure even more obvious, the age of 20 to 44 years of age over 5 times the risk of high blood pressure is normal, but 45 years of age and over weight of people think the disease is only 2 times the normal people. In a 5 year study of adults who had normal blood pressure or high blood pressure, it is likely that people who continue to raise blood pressure are likely to be overweight. And from the other side, only 5 kg of body weight can lower blood pressure.
The American Heart Association has officially moving column as a cause of hypertension, myocardial infarction and stroke the four highest risk factors. Even if you don’t have any weight, you can increase your chances of developing high blood pressure. Remember, whether you have been training in the gym, gardening, doing housework, jogging or walking, you are exercising your cardiovascular system, which will help you work more effectively and lower your blood pressure.
Black people with high blood pressure are almost 2 times more than whites. It affects more than 1/3 of African Americans, and they are more than 2/3 of the people are more than 60 years of age. The elderly black women had the highest incidence of hypertension. Hypertension is the second cause of death in more than 65000 African Americans every year. Black patients with high blood pressure are older than whites (especially in women), and are usually more severe. African Americans have higher rates of stroke, heart disease and kidney failure associated with high blood pressure. In the United States, black women live under the weight of a low income, high crime rate and high unemployment, so their blood pressure is higher than those living in a low pressure environment.
Blood pressure usually increases with age, especially in women. Women had less hypertension before menopause, and they were more likely to have hypertension after menopause. In the elderly, blood pressure is increased because of the deposition of the arterial elasticity and strength of the situation deteriorated, increase the arterial occlusion, reduce the body’s ability to maintain the balance of water and sodium, and caused a reduction in the physical function and the overall health level. Older people may also have other health problems, such as diabetes or high cholesterol. They often take one or more of the drug every day, and some of them may be up to high blood pressure. Many older people have a higher systolic blood pressure, but they are normal, which may make it difficult for them to realize the seriousness of the problem.
Smoking is associated with many serious health problems, so it’s likely that it will increase the risk of high blood pressure. Chemicals in tobacco can damage the inner wall of the arteries and make them more prone to clogging. And nicotine is a strong irritant, it will affect the control of the heart and blood vessels. When these cells are stimulated, the heart rate increases, and the arteries are contracting, leading to higher blood pressure. Smoking is associated with an increase in the number of total cholesterol and low density lipoprotein (LDL) cholesterol and a decrease in the number of high density lipoprotein (HDL) cholesterol.
Even smoking and tobacco can increase the risk of developing hypertension. Tobacco contains nicotine, sodium and licorice, all of which are raised in high blood pressure. Nicotine in tobacco smoke to more than ordinary cigarettes, each containing sodium 200-1200 milligrams per day (the doctor recommended that people do not consume more than 2400 mg of sodium per day), while the natural licorice will be through the body to protect sodium to raise blood pressure.
Alcohol can also lead to high blood pressure, especially if you’re taking a lot of alcohol. In a for more than 8, 000 adult studies, high blood pressure occurred in daily drink 1-2 glasses of wine of the male body, and for women, elevated blood pressure occurred three or more cups of wine drinking in some Yuan every day. 1 glasses of wine (350 grams of beer) about 13 grams of alcohol. And the study shows that if you take over 20-24 grams of alcohol per day, the blood pressure will continue to rise, which is not related to the type of alcoholic drinks.
In addition, a lot of people under the weight of the people will suffer from high blood pressure. Stress is a result of the imbalance in the material or spiritual needs and the ability to deal with these imbalances in your body. Stress can cause a number of chemical changes in the body, and blood pressure is a result of these chemical changes. General blood pressure is only temporary, and will return to normal after stress. And the nature of the relationship between stress and hypertension in some people is still under study.