Check items to be done in patients with hypertension
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.