What is Hypertension?
Hypertension refers to the increase in systemic arterial blood pressure (systolic and / or diastolic blood pressure) as the main feature (systolic blood pressure 140 mmHg, diastolic blood pressure 90 mmHg), which can be accompanied by heart, brain, kidney, etc. Clinical Syndrome of Organ Function or Organic Damage. Hypertension is the most common chronic disease and the most important risk factor for cardiovascular and cerebrovascular diseases. Normal people's blood pressure fluctuates within a certain range with changes in the internal and external environment. In the general population, blood pressure levels gradually increase with age, and systolic blood pressure is more obvious, but diastolic blood pressure decreases after 50 years of age, and pulse pressure also increases. In recent years, people's understanding of the role of multiple risk factors for cardiovascular disease and the protection of target organs of the heart, brain, and kidney has continued to deepen. The diagnostic criteria for hypertension have also been adjusted. At present, patients with the same blood pressure level are considered to be at risk for cardiovascular disease. Different, therefore the concept of blood pressure stratification, that is, patients with different risks of cardiovascular disease, the appropriate blood pressure levels should be different. Evaluation of blood pressure and risk factors is the main basis for diagnosing and formulating a treatment plan for hypertension. Different patients have different goals for managing hypertension. Doctors determine the most appropriate blood pressure for the patient based on the reference criteria when facing the patient. Scope, using targeted treatments. On the basis of improving lifestyle, it is recommended to use long-lasting antihypertensive drugs to control blood pressure. In addition to assessing office blood pressure, patients should also pay attention to the monitoring and management of early morning blood pressure in the home to control blood pressure and reduce the incidence of cardiovascular and cerebrovascular events.
Basic Information
- English name
- hypertension
- Visiting department
- cardiology
- Multiple groups
- Middle-aged and elderly, obese, long-term drinkers
- Common causes
- Stress, high sodium, low potassium diet, heavy drinking, etc.
- Common symptoms
- Dizziness, headache, tight neck, fatigue, palpitations, etc.
- Contagious
- no
Causes of hypertension
Genetic factor
About 60% of patients with hypertension have a family history. At present, it is thought to be caused by polygene inheritance, and 30% to 50% of patients with hypertension have a genetic background.
2. Mental and environmental factors
Long-term stress, agitation, anxiety, and noise or adverse visual stimuli can also cause high blood pressure.
3. Age factor
Incidence tends to increase with age, with a higher incidence in people over 40 years of age.
4. Lifestyle Habits
Unreasonable dietary structure, such as excessive sodium salt, low potassium diet, heavy alcohol consumption, excessive intake of saturated fatty acids can increase blood pressure. Smoking can accelerate the process of atherosclerosis and is a risk factor for hypertension.
5. The effects of drugs
Contraceptives, hormones, anti-inflammatory and analgesics can all affect blood pressure.
6. Impact of other diseases
Obesity, diabetes, sleep apnea-hypopnea syndrome, thyroid disease, renal artery stenosis, parenchymal damage of the kidney, adrenal space occupying lesions, pheochromocytoma, other neuroendocrine tumors, etc.
Classification of hypertension
Clinically, hypertension can be divided into two categories:
Essential hypertension
It is an independent disease with elevated blood pressure as the main clinical manifestation and the cause of which is not yet clear, accounting for more than 90% of all patients with hypertension.
2. Secondary hypertension
Also known as symptomatic hypertension, the cause of this type of disease is clear, high blood pressure is only one of the clinical manifestations of this disease, and blood pressure can be temporarily or persistently elevated.
Clinical manifestations of hypertension
The symptoms of hypertension vary from person to person. Early symptoms may be asymptomatic or insignificant. Common symptoms include dizziness, headache, tight neck, fatigue, and palpitations. Blood pressure rises only after exertion, stress, and mood swings, and returns to normal after a break. As the course of the disease prolongs, blood pressure continues to rise significantly, and various symptoms gradually appear. This time is called slow-onset hypertension. Common clinical symptoms of chronic hypertension include headache, dizziness, inattention, memory loss, limb numbness, increased nocturia, palpitations, chest tightness, and fatigue. Symptoms of hypertension are related to blood pressure levels. Most symptoms can be aggravated after stress or exertion. Blood pressure can rise rapidly after early morning activities. Early morning hypertension occurs, leading to cardiovascular and cerebrovascular events occurring in the early morning.
When the blood pressure suddenly rises to a certain level, symptoms such as severe headache, vomiting, palpitations, and dizziness may even occur. In severe cases, consciousness and convulsions may occur. This is a type of progressive hypertension and hypertension critical illness, and most often in the short term Serious heart, brain, kidney and other organ damage and lesions occur, such as stroke, myocardial infarction, and renal failure. There was no consistent relationship between symptoms and elevated blood pressure.
The clinical manifestations of secondary hypertension are mainly related to the symptoms and signs of primary disease, and hypertension is only one of its symptoms. Elevated blood pressure in patients with secondary hypertension may have its own characteristics. For example, hypertension caused by narrowing of the aorta may be limited to the upper limbs; the increase in blood pressure caused by pheochromocytoma is paroxysmal.
Hypertension test
Physical examination
(1) Measure blood pressure correctly. Because blood pressure is fluctuating, and emotional, physical activity can cause temporary blood pressure rises, high blood pressure should be measured at least twice in a non-same day resting state before the diagnosis of hypertension, and the blood pressure value should be Based on the average of three consecutive measurements. Careful physical examination helps to identify clues to secondary hypertension and damage to target organs
(2) Measure body mass index (BMI), waist circumference and hip circumference.
(3) Check the arterial pulsation and nervous system signs of the extremities, and auscultate the carotid, thoracic aorta, abdominal and femoral arteries for murmur.
(4) To observe the appearance of Cushing's disease, neurofibromatous skin plaques, hyperthyroidism exophthalmia signs, or lower extremity edema.
(5) Comprehensive cardiopulmonary examination.
(6) A comprehensive understanding of the patient's medical history.
2. Laboratory inspection
Can help determine the cause of hypertension and target organ function. Routine examination items include blood routine, urine routine (including protein, sugar and urine sediment microscopy), renal function, blood glucose, blood lipids, potassium, echocardiography, electrocardiogram, chest X-ray, fundus, ambulatory blood pressure monitoring and so on.
You can further check the fundus and carotid ultrasound according to needs and conditions. 24-hour ambulatory blood pressure monitoring is helpful for judging the severity of blood pressure elevation, understanding the circadian rhythm of blood pressure, monitoring blood pressure in the morning, guiding antihypertensive treatment and evaluating the efficacy of antihypertensive drugs.
Hypertension diagnosis
According to the patient's medical history, physical examination and laboratory test results, hypertension can be diagnosed. The diagnosis should include: determining blood pressure levels and grades of hypertension; no risk factors for other cardiovascular diseases; determining the cause of hypertension, and clarifying whether there is secondary hypertension; assessing the condition of target organs such as the heart, brain, and kidney; judging the patient The risk of cardiovascular events.
At present, the diagnosis of hypertension in China adopts the standards recommended by the 2005 Chinese Hypertension Treatment Guidelines:
category | Systolic pressure (mmHg) | Diastolic blood pressure (mmHg) |
Normal blood pressure | <120 | <80 | |
Normal high value | 120 139 | 80 89 | |
hypertension | 140 | 90 | |
Grade 1 hypertension (mild) | 140 159 | 90 99 | |
Grade 2 hypertension (moderate) | 160 179 | 100 109 | |
Grade 3 hypertension (severe) | 180 | 110 | |
Simple systolic hypertension | 140 | <90 | |
If the patient's systolic and diastolic blood pressure belong to different levels, the higher classification standard shall prevail. Simple systolic hypertension can also be divided into grades 1, 2, and 3 according to systolic blood pressure levels.
Cardiovascular risk stratification criteria for patients with hypertension:
Other risk factors and medical history | Level 1 | level 2 | Level 3 |
No other risk factors | low | in | high |
1-2 risk factors | in | in | Very dangerous |
3 risk factors or diabetes or target organ damage | high | high | Very dangerous |
Have complications | Very dangerous | Very dangerous | Very dangerous |
Differential diagnosis of hypertension
Newly diagnosed hypertension should identify secondary hypertension. Kidney disease, renal artery stenosis, primary aldosteronism, and hypertension caused by pheochromocytoma are common. Most secondary hypertension can be improved by treatment or surgery of the primary disease.
Hypertension treatment
(I) Treatment of Essential Hypertension
1. Purpose and principles of treatment
The main goal of hypertension treatment is to achieve blood pressure, and the ultimate goal of antihypertensive treatment is to minimize the incidence and mortality of cardiac and cerebrovascular diseases in patients with hypertension. Antihypertensive therapy should establish target values for blood pressure control. On the other hand, hypertension is often combined with other risk factors of heart and cerebrovascular diseases, such as hypercholesterolemia, obesity, diabetes, etc., and they jointly increase the risk of cardiovascular disease. The treatment measures should be comprehensive. Different people have different antihypertensive goals. Generally, the antihypertensive goal of patients is below 140 / 90mmHg. For high-risk patients with diabetes or kidney disease, they should be lowered as appropriate. For all patients, regardless of whether the blood pressure in other periods is higher than normal, early morning blood pressure monitoring should be paid attention to. Some studies have shown that more than half of the patients in the office have reached the standard blood pressure, but their morning blood pressure did not meet the standard.
(1) Improve life behavior Reduce and control weight. Reduce sodium salt intake. supplement calcium and potassium. Reduce fat intake. Increase exercise. Quit smoking and limit alcohol consumption. Reduce mental stress and maintain psychological balance.
(2) Individualized blood pressure control standards Due to different causes, the pathogenesis of hypertension is not the same. Clinical medication is treated separately, and the most appropriate drug and dose are selected to obtain the best effect.
(3) Coordinated control of multiple cardiovascular risk factors Although blood pressure is controlled in the normal range after antihypertensive treatment, a variety of risk factors other than elevated blood pressure still have an important impact on the prognosis.
2. Antihypertensive drug treatment
For detected hypertensive patients, the recommended antihypertensive drugs for initiation and maintenance treatment should be used, especially the drugs that can be controlled for 24 hours and reach the standard once a day. The four principles should be followed in particular, starting with small dose , Priority is given to long-acting preparations, combined use and individualization.
(1) Types of antihypertensive drugs Diuretics. beta blockers. calcium channel blocker. Angiotensin converting enzyme inhibitor. Angiotensin II receptor blocker.
According to the patient's risk factors, target organ damage, and combined clinical disease, a single drug or a combination of drugs should be selected. The principles for choosing antihypertensive drugs are as follows:
1) Use of drugs with a half-life of 24 hours or more once a day can control blood pressure drugs for 24 hours, such as amlodipine, to avoid poor iatrogenic early morning blood pressure control due to inappropriate choice of treatment plan;
2) Use drugs that are safe, long-term adherence, and capable of controlling every 24-hour blood pressure to improve patient compliance;
3) The use of cardio-cerebral benefit clinical trial evidence is sufficient and can really reduce long-term cardiovascular and cerebrovascular events, reduce cardiovascular and cerebrovascular events, and improve the quality of life of patients with hypertension.
(2) Treatment options Most patients without complications or comorbidities can use thiazide diuretics, -blockers, etc. alone or in combination. Treatment should start with a small dose and gradually increase the dose. In clinical practice, patients' cardiovascular risk factors, target organ damage, complications, comorbidities, antihypertensive effects, and adverse reactions will all affect the choice of antihypertensive drugs. Patients with grade 2 hypertension can be treated with two antihypertensive drugs at the beginning.
(B) the treatment of secondary hypertension
Mainly for the treatment of primary disease, such as hypertension caused by pheochromocytoma, blood pressure can be reduced to normal after tumor resection; renal vascular hypertension can expand renal artery through interventional treatment. For those whose primary disease cannot be cured radically or the blood pressure is still high after surgery, in addition to other treatments directed at the cause, appropriate antihypertensive drugs should be selected for antihypertensive treatment.
Hypertension prevention
Hypertension is a preventable and controllable disease. For those with normal high blood pressure levels of 130-139 / 85-89mmHg, overweight / obesity, long-term high-salt diet, and excessive alcohol consumption, it is important to intervene, regular health checkups, and actively control the risk factor.
For patients with hypertension, regular follow-up and measurement of blood pressure should be paid, especially the management of early morning blood pressure, active treatment of hypertension (both drug treatment and lifestyle intervention), slow target organ damage, prevent cardio-cerebral-kidney complications, and reduce disability Rate and mortality. [1-4]
