Diagnosis of hypertension

Diagnosis of hypertension

First, determine the measurement of blood pressure hypertension should be conducted in a quiet, the general admission seats, right upper limb measured blood pressure, when necessary, while the left upper and lower limbs measuring blood pressure. Measurement should be repeated several times until the blood pressure measured value, whichever is relatively stable. Diastolic blood pressure should prevail voice disappeared. Needless to continue if the voices, the sound can be value, and to specify. Sometimes inspections are due to mental or emotional tension, possible temporary response to pressure, high blood pressure should be measured several consecutive days of blood pressure, high blood pressure are more than twice, to be hypertension.

Second, identify the causes of hypertension in patients with hypertension who encounter should be asked in detail about history, a comprehensive and systematic examination, to exclude symptoms of hypertension.

(A) kidney disease kidney disease caused by hypertension, renal hypertension said. Symptoms of hypertension is the most common form, including renal disease and renal artery stenosis.

1. Renal disease glomerulonephritis, pyelonephritis, polycystic kidney disease, renal tuberculosis, kidney stones, and so cause kidney damage, caused renal ischemia, leading to high blood pressure.

① acute nephritis more common in young people, before the onset of Streptococcus infection, edema, hematuria, proteinuria. Fundus examination showed retinal artery spasm.

② chronic nephritis and hypertensive patients with advanced renal damage, sometimes difficult to identify, younger, a history of acute nephritis, or history of repeated swelling, proteinuria in hypertension, anemia obviously, to reduce plasma protein, azotemia , A relatively minor, such as increased blood pressure, chronic nephritis more of.

③ chronic pyelonephritis, women Most of the history of a urinary tract infection. A protein in urine, red blood cells, Nong Xibao, positive urine culture and support chronic pyelonephritis.

④ often family history of polycystic kidney disease, renal District palpable enlarged kidneys, ultrasound examination can be diagnosed.

2. Renal artery stenosis unilateral or bilateral, and more young people because of inflammation caused by artery, the elderly aged over 50, many of the renal artery atherosclerosis, renal artery stenosis hypertension clinical manifestations are as follows:

① shorter history.

② suddenly obvious hypertension, or high blood pressure suddenly increased the original.

③ no family history of hypertension.

④ effect of antihypertensive drug poor.

⑤ ridge on the waist or abdomen area rib and vascular noise can be heard.

⑥ waist injury history, further checks can be IVP, radionuclide kidney map, renin activity of renal vein, confirmed on renal angiography.

(B) of endocrine disease

1. Pheochromocytoma 90 percent in the adrenal medulla and the rest in sympathetic ganglia and in other parts of the pheochromocytoma organizations. As catecholamine secretion of tumor cells, can cause high blood pressure and metabolic disorder, paroxysmal or performance to add to the sustained burst性伴hypertension. Blood pressure increased dramatically, severe headache, palpitations, shortness of breath, sweating, looking pale, tachycardia, elevated blood sugar, nausea, fatigue, continued for a few minutes or a few days, intermittent seizures, blood pressure may be normal. Period of increased blood pressure in the urine of adrenaline, noradrenaline or its metabolites 3 - methyl-4-hydroxybutyric acid amygdalin (VMA), as was significantly higher, suggesting pheochromocytoma. Blood pressure can be increased during the trial phentolamine buck. Using phentolamine 5 mg, glucose 90 ml diluted, systolic blood pressure declined by more than 4.66 Kpa (35mmHg), diastolic blood pressure declined by more than 3.33 Kpa (25mmHg), and can maintain 3 to 5 minutes, as positive. Normal and hypertensive patients, the use of phentolamine blood pressure dropped after the general does not exceed 4 Kpa (30mmHg). Intermittent attacks, blood pressure normal, do histamine challenge test, using phosphoric acid histamine 0.01 ~ 0.02 mg intravenous injection, if no response, increase the dose. After injection, measured blood pressure every minute once, for 15 minutes. The patients in two minutes after the injection of blood pressure to rise. Such as the increase in systolic blood pressure greater than the level of 8 Kpa (60mmHg) above, elevated diastolic blood pressure greater than 5.3 Kpa (40mmHg), and continued for five minutes or more positive, suggesting that the disease may also do glucagon test, the morning Fasting, intravenous glucagon 1 mg, every minute measured blood pressure once, for 15 minutes, judgement and standards organizations to test the same. This means fewer side effects, fewer false positive. IVP and retroperitoneal inflatable contrast to the tumor site. B-examination or computer tomography (CT) have confirmed the diagnosis and tumor-targeted value.

2. Primary Hyperaldosteronism the disease more common in adult women, a long-term high blood pressure accompanied by the intransigence of hypokalemia. As adrenal hyperplasia or tumors secreted aldosteronism, caused by hypertension, kidney and a large number of row K hypokalemia. Neuromuscular dysfunction, paroxysmal or persistent muscle weakness or paralysis. Long-term substantial loss of potassium can lead to renal vacuolar degeneration, kidney dysfunction enrichment, a more urine, nocturnal enuresis, Fan Ke, and more drinking. Hypokalemia ≤ 33.24 mmol/24h (12ug/24h), 17 hydroxyl steroids normal, plasma renin activity decreased, the Spironolactone test positive, adrenal scan or CT scan, the area can be found adrenal lesions, to the disease Diagnosis of the objective evidence.

3. Cushing because of adrenal hyperplasia or tumors, excessive secretion of glucocorticoids, Shuinazhuliu a result of high blood pressure, obesity concentric, one month after face, and more hair, thin skin and small purple profiling, increased blood sugar. There are special performance, the general diagnosis is not difficult to diagnosis of the disease, yet further evidence of excessive cortisol secretion or lose its normal rhythm, that is secreted higher than normal morning, evening and midnight is not lower than the production or Higher than the level of secretion of the afternoon. 24-hour urine in the 17-hydroxy steroids and 17 number ones steroid, dexamethasone suppression test and adrenocorticotropic hormone stimulation test positive, some cases of the proliferation of X-ray examination showed the skull to expand Butterfly amines. Kidneys can also be used around the inflatable contrast to the diagnosis.

(C) of pregnancy toxemia of pregnancy occurred in the latter part of three to four months or childbirth and post-natal period within 48 hours. To high blood pressure, edema and characterized proteinuria. Weight, convulsions, coma. If found early pregnancy on blood pressure, may be secondary to hypertension or hypertension with pregnancy. More than a history of hypertension, urinary protein lighter, we can identify. However, patients with hypertension, in the course of pregnancy, often have high blood pressure and urine to change the worsening statistics also showed that hypertensive patients with pregnancy, about 30% in toxemia of pregnancy, the time of diagnosis can be considered.

(D) of congenital vascular lesions coarctation of the aorta, more common in young people, men more than women. Clinical manifestations of high blood pressure for the upper and lower extremities to reduce blood pressure, abnormal formation of the高下low on the phenomenon. Because of lower limb blood supply shortage, can have lower limb weakness, Zhileng. Aortic auscultation and scapula between the Ministry of blood vessels can be heard noises, chest X-ray shows intercostal rib collateral circulation due to erosion caused by artery notch. Aortic contrast to the diagnosis. Multiple aortoarteritis aorta and its branches is the non-specific inflammation and vascular lesions may be caused by a narrow cavity. If the disease spread to the aorta, may also appear upper and lower extremities high blood pressure low. If the disease spread to the renal artery, caused by renal hypertension, the blood vessels narrow the corresponding parts, noise can be heard vessels, angiography can be diagnosed.

(5) brain tumor brain disease, encephalitis, brain trauma caused by increased intracranial pressure, can cause hypertension, because of the performance of the nervous system, in general it is not difficult diagnosis.