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.
Examination of patients with hypertension.
Newly diagnosed patients with hypertension, in addition to blood pressure, there are some physical indicators need to be clear. Because hypertension is often combined with other chronic diseases, and blood pressure on the body’s harm is systemic, through a number of tests can determine whether the high blood pressure has caused damage to the body. The following examination is needed to be done in newly diagnosed patients with hypertension.
Abnormal blood routine, suggesting increased disease secondary hypertension, hyperthyroidism can also indicate the real red blood cell; hypertension is very serious, has caused renal failure, leading to renal anemia.
Urine routine. Abnormal urine routine, secondary hypertension suggests the presence of glomerulonephritis, chronic pyelonephritis caused by. If the urine of the patients with proteinuria, suggesting that the high blood pressure combined with early renal damage, the treatment of key in addition to blood pressure, should improve renal function.
Fasting blood glucose. The significance of the examination lies in the timely detection of diabetes, if the patient has diabetic nephropathy, newly diagnosed hypertension may be caused by diabetes. Hypertension combined with diabetes is a dangerous combination, the occurrence of cardiovascular risk is the general population of 4 to 8 times, the total mortality increased by 4 ~ 5 times.
Lipids. If the exception, it is suggested that hypertension may be combined with coronary heart disease, cerebral infarction, easy to induce cardiovascular and cerebrovascular events, it is recommended that this part of the patient detailed examination, even after the examination did not find cardiovascular and cerebrovascular disease, should also be given antihypertensive treatment, coronary heart disease, stroke will be high.
Blood potassium. Hypertension and hypokalemia prompt primary aldosteronism, and with hyperkalemia prompted abnormal renal function, can according to the diagnosis, selection of special treatment.
Serum uric acid. Hypertension associated with high blood uric acid may be caused by gout nephropathy. It should be noted that high blood uric acid may increase the risk of cardiovascular disease. At the time of treatment, do not use double hydrogen chlorothiazide increased uric acid drugs.
Serum creatinine. Hypertension associated with creatinine abnormalities suggest that patients with abnormal renal function, showing that high blood pressure at high risk or high risk. If the patients with uremia, the effect is poor, the need to help dialysis treatment.
Homocysteine levels. Hypertension with high homocysteine also known as H type hypertension, suggesting that the risk of stroke is high, at the same time, can take folic acid, combined treatment can achieve good results.
Electrocardiogram. This examination can be found in the early detection of high blood pressure on heart injury, and through the observation of myocardial ischemia, arrhythmia, evaluation of risk.
Read out accurate blood pressure reading skills
Lead to mispronounce the readings from one of the most important reasons is to neglect the cuff size. Size does not fit the cuff back causing false readings. Cuff air bags should be wide enough to cover the whole area from the armpit to the elbow. Sleeve length with air bags a week to fully wrap around your arm, to allow room for a few centimeters. When you buy a home blood pressure monitor, to determine whether there is a suitable for your arm cuff air bags. Cuff air bags are listed in the following table of standard size, it will help you pick out the sphygmomanometer cuff with air bags is most suitable.
Cuff size airbags standard
Distance between shoulder and elbow cuff air bag size
< 33.0 cm 13.0~23.0 cm 33.0~40.0 cm 15.0~33.0 cm >40.0 cm 18.0~35.5 cm
Blood pressure readings you need to think about what to wear. Wear short sleeves or sleeves f-sudden easy to roll up the clothes best. Measurements under the sleeve must be rolled up, otherwise it may affect blood pressure readings.
Normally, blood pressure readings, stand, sit or lie down Park row is nothing. Elderly, diabetic or taking certain medications (such as antihypertensives and drugs for the treatment of Parkinson’s disease) who stand measuring blood pressure blood pressure readings may be lower. This is called orthostatic hypotension. Doctors often measure the blood pressure of patients in different postures to determine whether this is a causal factors. However, the blood pressure is measured in the calmness when sitting.
High blood pressure in the morning than the afternoon or evening. Talk will elevate blood pressure and tension can elevate blood pressure before the measurement. If you’re in a hurry to a meeting, Han it immediately when you get there to measure blood pressure readings may be increased.
Smoking and drinking of caffeinated beverages (coffee, tea, and Cola) can affect blood pressure in 2-3 hours. Intake a lot of salt in the blood pressure will not change in the short term, but over time may affect blood pressure (http://healthy-girl.net/). In the elder’s blood pressure drops after meals.
Measuring blood pressure at home may be slightly lower than the blood pressure measured at a clinic. When you measure blood pressure at home (especially if you’re at home for the first time have detected blood pressure), there is a good way is to do 2 or 3 measurements. Doctor may pick out the ‘ told you at a different time of day (morning and evening) to measure their own blood pressure, to judge the impact of the drugs you use. When you were diagnosed with high blood pressure for the first time, or when you start your treatment options (especially drug treatment program) when you make any changes, or if you are receiving the treatment of another disease, you’d better always measure your blood pressure. In normal circumstances f, when after your blood pressure is well controlled, you need only checks the blood pressure every 1 week or each month.
In supermarkets, drugstores and other public areas and electronic blood pressure monitoring device is very convenient to operate, but they did not completely replace the old-style blood pressure monitor, because these instruments too sensitive on f the hand or arm movement, they measure the accuracy of blood pressure readings is not very high. But these instruments the yin to raise public awareness about blood-pressure monitor is still very useful. If you use this instrument measured i0i I sell is high, you should go to the doctor to check your blood pressure.
For some seniors, with any instrument measure blood pressure accurately is very difficult, because as they grow older, the artery will slowly harden, so that there will be false high blood pressure, not the arteries by the pressure standard blood pressure monitor and accurately measured. The arterial pulse faint (accurate reading difficult), lift the arms up (flush with the shoulders) before measuring the blood pressure may help.
To the arterial blood supply to the brain will because of chronic hypertension and suffered, and above the similar hurt Q vascular wall thickening and narrowing of the blood vessels, or the formation of a blood clot, prevent certain parts of the blood flow to the brain. The formation of blood clots in the brain called cerebral thrombosis, and can cause stroke. Depending on the different blood vessels, stroke patients may lose their ability to talk, walk or move up the body. Such as carotid artery off the blood clot with blood flow to the brain blood vessel blockage on the formation of the cerebral embolism from anywhere in the blood vessels in the body.
In addition, one or more projections are produced in the middle cerebral artery. These are cerebral aneurysms, which may eventually rupture, causing cerebral hemorrhage, and thus causing another type of stroke, which is usually caused by a more damage than the cerebral thrombosis. Stroke caused by cerebral hemorrhage is more likely to die from a stroke caused by a clot.
It is estimated that the United States has 50 stroke patients annually, of which about 25% -30% of people die, and in the United States, which makes the stroke has become the third common diseases caused by death. Even if there is no death after a stroke, the patient is usually very weak, stroke is the first cause of disability of the elderly in the United states. A stroke can cause paralysis, blindness, deafness, aphonia. Forgetful and a lot of other destructive effects.
80% a 70% of stroke patients with hypertension at the same time. The evidence suggests that a person with a blood pressure and untreated treatment, the probability of a stroke is almost 7 times those of a person who has a normal or high blood pressure. Even normal blood pressure and high blood pressure in patients with mild hypertension risk of stroke is also high. Controlling blood pressure is the best preventive measure to reduce the risk of stroke. Other preventive measures include not smoking, eating less fatty foods, more exercise and taking a small dose of aspirin.
A less common warning sign of a stroke is the so-called small stroke, which is a transient ischemic attack (TIA). Transient ischemic attack unlike explosive stroke that would cause permanent brain damage, small stroke stroke like symptoms lasts only a few minutes to several hours, and go away within 24 hours. Symptoms may include sudden weakness, clumsy, or upper hand. Feet or half face numbness. May also occur in visual impairment, visual acuity and can not speak or speak not coherent. If you have a transient ischemic attack, you should talk with their doctors about how to take preventive measures to prevent another attack, more important is how to prevent the outbreak of stroke onset.
As age increases, many people are worried that they may have to get Alzheimer’s disease, which mainly affects memory and other more advanced brain function, and that the blood supply to the brain may be reduced in older people with a memory disorder or a sudden onset of dementia (a mental decline). Multiple cerebral infarction dementia and Alzheimer’s disease, which can be stable by taking a small dose of aspirin and careful control of blood pressure.
No control of the development of severe hypertension in the course of the development of fiber protein like necrosis, and rapid rupture of blood vessels. This makes the blood and body fluid to leak into the brain, the intracranial pressure increased. Elevated intracranial pressure can cause symptoms such as headache and fatigue, if the pressure has not been reduced, the brain itself will be injured. However, with the great development of blood pressure control technology, this situation is now very rare.
Also, if the extremely dangerous to raised blood pressure, hypertension is a direct result of a called hypertensive encephalopathy of brain diseases. The symptoms of the disease include severe hypertension and disturbance of consciousness, intracranial (skull) with, damage to the retina and more lame attack.
Eyes are not involved in blood pressure regulation, but there are a lot of blood supply arteries in the eyes. These arteries can be seen in the Department of Ophthalmology when the doctor is examining the retina. If doctors find that these blood vessels rupture or shrink, then other arteries in the body may have similar damage. High blood pressure can lead to retinal (responsible for the reception of images from the lens) degradation, resulting in retinal diseases. The lesions of these ocular arteries showed a similar occurrence of the kidney.
Because the kidneys have to filter all the blood in the body, they are very susceptible to damage from untreated hypertension. The effects of hypertension on blood vessels, as discussed above, may occur in the renal arteries (arteries that supply blood to the kidneys). As discussed in the second chapter, renal artery constriction may cause a blood pressure, which can be treated by surgery.
Kidney tissue itself is also affected by severe hypertension. The ability to filter out the waste product will gradually weaken until the kidney is completely dead. Waste will be gathered in the blood, forming a toxic cord, which lead to uremia. Early symptoms of renal failure include fatigue, mental focus, and muscle cramps. If there is no early treatment of renal failure, there will be nausea, vomiting, gastrointestinal bleeding, bad breath and loss of appetite symptoms. Renal failure patients must be treated by dialysis, and the waste in the blood is filtered through dialysis. Some people may worry that drugs that control blood pressure may damage the kidneys, which actually protect the kidney.
Renal sclerosis occurs when small arteries and arteries become stiff and occluded in the kidney. Benign renal sclerosis is a process of gradual development of these vessels in the kidney and a long-term deterioration of the wall of the inner wall of the small artery wall will be gradually thickened. Then the fat will pile up on the wall of the degenerated tissue, and the sterile line is blocked. The rapid development of malignant kidney disease can cause bleeding (blood flow into the tissue), rupture and tissue swelling. Symptoms of kidney sclerosis include vision loss, hematuria, weight loss, and uremia. Treatment methods include the use of antihypertensive drugs, elimination of infection and obstruction, and other measures to mitigate chronic renal failure, such as dialysis. Progressive renal failure and all stages of hypertension are related, but more common in patients with grade 3, grade 2 and grade 4 hypertension.
Dangers of hypertension
Hypertension is often called. Silent killer. Because it does not produce obvious symptoms before the body has a serious injury. Hypertension if not controlled, it will damage the heart, arteries, kidney and brain. Eyes are also very sensitive to the effects of hypertension. Daily high pressure fluctuations (that is, the blood pressure during the day to be higher than in the evening) are more likely to have other health problems due to high blood pressure.
Studies have shown that people with high blood pressure and without control are about 3 times more likely to have coronary heart disease than those with a normal blood pressure, and 6 times more likely to have congestive heart failure, and 7 times more likely to have a stroke. However, the adverse effects of the discussion in this chapter are not inevitable. You can control your blood pressure by working closely with your doctor to prevent any health problems associated with hypertension.
As an organ that pumps blood to the body, the heart needs to work too much in order to fight blood vessels in order to fight the blood vessels. Like any muscle, when the heart is forced to work harder, the volume of the heart will become larger. The cardiac muscle wall becomes thicker and shorter, and the muscle loses its original elasticity. However, after the heart is enlarged, it is usually not enough to supply a blood supply with oxygen and nutrients. Also the heart increased and then also more easily produce irregular heartbeat. This is called arrhythmias, feel the heartbeat when less.
Left ventricular hypertrophy occurs when the largest Chamber of the heart – the left ventricle is abnormally dilated. As the wall of the ventricle becomes thick, the ventricles become harder to pump blood, which is filled with blood. Pump out of the blood less and less, resulting in breathing difficulties, angina (chest pain), heart palpitations and dizziness. Blood may flow back to the blood vessels in the lungs, causing greater pressure and causing a rapid breathing. If this process continues, and the pressure is very high, it will occur in the case of pulmonary edema, that is, pulmonary water. Pulmonary edema can lead to severe respiratory disease, which belongs to the emergency, if not treated in time may be fatal.
If hypertension is not controlled, the heart function will begin to weaken after many years. When this happens, the blood flow back into the lungs, which makes you feel like you’re in a state of congestion. The weak heart is unable to maintain blood circulation, thereby causing other parts of the body muscles will become weak from severe hypoxia, so it will happen congestive heart failure. People with congestive heart failure in the early stage of the disease has a respiratory problems, development to the late stage of patients with respiratory symptoms. When sitting upright, breathing becomes easier. In addition, there are some groups also have water. This is called edema, edema will cause legs because of too much water and swelling.
In a large study, which began in late 1940s, the Fleming Han heart research program, doctors found that about 40% of men and 60% of women in the case of congestive heart failure were caused by high blood pressure. In patients with congestive heart failure in the study, about 91% of people with hypertension, previously. Men with high blood pressure, the risk of congestive heart failure is about 2 times the normal blood pressure, and women with high blood pressure, the risk of congestive heart failure is about 3 times the normal people. Men with congestive heart failure, only less than 1/4 of people in the disease was diagnosed, the survival of more than 5 years, the survival rate of female patients is less than 1/3.
A coronary artery that supplies oxygen and energy to the heart is also affected by high blood pressure. When coronary artery is not for heart patients provide sufficient oxygen, patients in forced breathing will feel to pain, tightness or our Europe of tightness in the chest, this is angina pectoris. Like congestive heart failure, angina pectoris, early in the disease can feel, and then will be more frequent episodes, even at rest or is in the mood change commanded will occur.
Simple angina does not damage the heart, but it can be a warning sign of a heart attack (see chart below). A heart attack, the pain duration is longer than angina, and usually accompanied by other symptoms, such as nausea and sweating. In the heart attack, because of obstruction in the coronary artery, leading to the local heart blood supply is cut off, and then make this site due to the lack of blood supply and lead to cardiac death. If a large part of the heart is out of blood supply, the heart will stop unless it provides first aid.
Left ventricular hypertrophy can cause angina pectoris. Thickening of the left ventricular muscle will always pressure small blood vessels, small blood vessels were completely flattened until. The results will be caused by the small blood vessels to nourish the organization in a short period of time, thus causing the heart to angina. If hypertension is not always controlled, the left ventricular hypertrophy will further develop into myocardial atrophy (tissue death due to vascular damage), resulting in the loss of part of the heart pump blood function. When the heart can’t promote blood circulation to the body, it will lead to congestive heart failure.