Definition of hypertension
Hypertension is a syndrome with elevated blood pressure (systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg) as the main clinical manifestation.
Hypertension is an important cause and risk factor of cerebrovascular diseases.
Hypertension affects the structure and function of important organs, such as the heart, brain and kidney, and eventually leads to the failure of these organs.
Hypertension is one of the leading causes of death from cardiovascular disease
Symptoms.
1.Most of them have a slow and progressive onset, and generally lack specific clinical manifestations
2, dizziness, headache, fatigue, palpitations, etc., not necessarily related to blood pressure levels
3, can appear blurred vision, rhinorrhea and other more serious symptoms
4.About 1/5 patients are found only when blood pressure is measured and complications occur
Physical signs.
Blood pressure fluctuates greatly with season, day and night, emotions and other factors
hyperacusis of the second heart sound in the aortic valve area during auscultation
Systolic murmur
Rarely, a vascular murmur can be heard in the neck or abdomen
Diagnostic criteria
The diagnosis of hypertension must be based on the average of two or more non-same-day blood pressure measurements without antihypertensive medication
Need to differentiate between primary and secondary
Risk stratification for hypertension
Other risk factors and medical history
Blood pressure
Class (systolic blood pressure 140-159 or diastolic blood pressure 90-99)
Class (systolic 160-179 or diastolic 100-109)
Class (systolic blood pressure ≥ 180 or diastolic blood pressure ≥ 110)
No other risk factors
Low risk
Moderate risk
High risk
~2 risk factors
Moderate risk
Moderate risk
Very high risk
More than one risk factor, or diabetes, or target organ damage
High risk
high risk
Very high risk
Complications
Very high risk
Very high risk
Very high risk
Risk factors used for stratification: men >55 years, women >65 years; smoking; blood cholesterol >5.72 mmol/L; diabetes mellitus; family history of early-onset cardiovascular disease (age of onset <65 years for women, <55 years for men)
Target organ damage: left ventricular hypertrophy (ECG or echocardiography); proteinuria and/or mildly elevated blood creatinine (106-177 μ mol/L); atherosclerosis confirmed by ultrasound or X-ray; focal or extensive stenosis of retinal arteries
Complications: cardiac disease; cerebrovascular disease; renal disease; vascular disease; severe hypertensive retinopathy
Secondary hypertension
Definition: elevated blood pressure caused by some defined disease or etiology
Primary Etiology
Substantial renal hypertension
Renal vascular hypertension
Primary aldosteronism
Pheochromocytoma
Cortisolism
Aortic constriction
Treatment of hypertension
Improve life behavior
Weight loss
Reducing sodium intake
Calcium and potassium supplementation
Reducing fat intake
Limit alcohol consumption
Increase exercise
Antihypertensive medication for
Hypertension grade 2 and above
Hypertension combined with diabetes mellitus, or already have heart, brain, kidney target organ damage and complications
Blood pressure has been consistently elevated for more than 6 months and is not effectively controlled after improving lifestyle behaviors
High-risk and very high-risk patients
Blood pressure control target value.
In principle, blood pressure should be reduced to a level that is maximally tolerated by the patient, and it is advocated that the target value of blood pressure control should be at least
Blood pressure control target values in patients with combined diabetes or chronic kidney disease
The target blood pressure control level for systolic hypertension in the elderly, systolic blood pressure 140-150 mmHg, diastolic blood pressure <90 mmHg but not less than 65-150 mmHg.
Major types of antihypertensive drugs
(1) Diuretics
(2) β-blockers
(3) Calcium antagonists
(4) Angiotensin-converting enzyme inhibitors
(5) Angiotensin II receptor antagonists
(6) Others: There are also some combination agents, including angiotensin-converting enzyme inhibitors + calcium antagonists, angiotensin II receptor antagonists + diuretics, etc.