Overview
Hypertensive disorders are systemic diseases characterized by organ remodeling due to increased arterial systolic and/or diastolic blood pressure (>=140/90 mmHg) at rest, often associated with disorders of fat and glucose metabolism and functional or organic changes in the heart, brain, kidneys and retina. Blood pressure >= 140/90 mmHg measured on more than 2 non-same days at rest for more than 5 minutes can be diagnosed as hypertension.
Clinically, many hypertensive patients, especially the obese type, are often associated with diabetes mellitus, and diabetes mellitus is also more often associated with hypertension, so the two are referred to as homogenous diseases. Diabetic patients are prone to hypertension due to increased blood glucose, increased blood viscosity, damaged blood vessel walls, and increased vascular resistance. It can be seen that both hypertension and diabetes are related to high blood lipids, so the prevention and treatment of hypertension and diabetes should be accompanied by lowering blood pressure and regulating blood lipids.
Hypertension symptoms
Six dangerous symptoms
Headache: Mostly in the back of the head, accompanied by nausea and vomiting. If you have frequent and severe headaches, along with nausea and vomiting, you may have a headache.
If you have frequent headaches that are severe and accompanied by nausea and vomiting, it may be a sign of transformation to malignant hypertension.
Vertigo: It occurs more often in female patients and may come on when they suddenly squat or stand up.
Tinnitus: Tinnitus in both ears that lasts for a long time.
Palpitations and shortness of breath: Hypertension can lead to myocardial hypertrophy, heart enlargement, myocardial infarction, and cardiac insufficiency, all of which are symptoms leading to palpitations and shortness of breath.
Insomnia: mostly difficulty in falling asleep, early awakening, unstable sleep, easy to have nightmares, and easy to wake up. This is related to cortical dysfunction and autonomic dysfunction.
Numbness in the limbs: numbness in the fingers and toes or skin like an ant-like sensation, and inflexibility in the fingers are common. Numbness may also occur in other parts of the body, and there may also be abnormal sensation and even hemiplegia.
Complications
Hypertension itself is not terrible, and diagnosis and treatment are easy. What is terrible is the various complications of hypertension: Patients with hypertension become complications of hypertension due to persistent elevation of arterial pressure, which triggers hardening of small arteries throughout the body, thus affecting the blood supply to tissues and organs and causing various serious consequences. Common complications of hypertension include coronary heart disease, diabetes, heart failure, hyperlipidemia, nephropathy, peripheral artery disease, stroke, and left ventricular hypertrophy. Among the various complications of hypertension, the damage to the heart, brain and kidney is the most significant. The most serious complication of hypertension is stroke, and the probability of stroke is 7.76 times higher than that of normotensive people.
Heart failure: The heart (mainly the left ventricle) works intensively to overcome the increased peripheral resistance caused by systemic small artery sclerosis, and compensatory hypertrophy of the myocardium occurs. When the compensatory function is insufficient, the heart becomes hypertensive heart disease, and the contractility of the heart muscle is severely weakened and causes heart failure. Because hypertensive patients are often accompanied by coronary atherosclerosis, the burdened heart is in a state of ischemia and hypoxia, making it more prone to heart failure.
Cerebral hemorrhage: The muscle layer and outer membrane of the small arteries in the brain are not developed, and the walls are weak. If the sclerotic small arteries in the brain are accompanied by spasm, they are prone to bleeding or ruptured hemorrhage (i.e. cerebral hemorrhage). Cerebral hemorrhage is the most serious complication of advanced hypertension. The site of hemorrhage is mostly near the internal capsule and basal ganglia, which is clinically manifested as hemiplegia and aphasia.
Renal insufficiency: Due to the sclerosis of the small arteries entering the kidney, a large number of renal units (i.e., glomeruli and tubules), atrophy occurs due to chronic ischemia, followed by fibrous tissue proliferation (this lesion is called hypertensive nephrosclerosis). The remaining renal units then undergo compensatory hypertrophy and expansion. In nephrosclerosis, patients may have more protein and more red blood cells in the urine. In the advanced stage of the disease, due to the destruction of a large number of renal units, the renal excretory function is impaired, and the metabolic end products in the body, such as non-protein nitrogen, are not all excreted and retained in the body, and the water and salt metabolism and acid-base balance are also disturbed, resulting in autointoxication and uremia.
Diagnosis
The initial physical examination of a patient with hypertension should include the following, if possible.
1. Blood pressure. The blood pressure on both sides is compared and verified, and the value of the higher side is taken. If the difference in blood pressure between the two sides is greater than 20 mm Hg, the lower side is likely to have stenosis of the great vessels above the brachial artery, especially the subclavian artery, and the most common cause of stenosis is atherosclerosis and obstruction.
2.Height, weight and waist circumference. Obesity, especially centripetal obesity is an important risk factor for hypertensive disease, as the saying goes, the longer the waistband, the shorter the life expectancy.
3, using fundoscopy to observe retinal lesions. Changes in the retinal arteries can reflect the degree of peripheral small artery lesions in hypertension, the heavier the degree of peripheral small artery sclerosis, the heavier the load on the heart.
4.The presence of cervical vascular murmur, jugular venous anger or goiter, abdominal vascular murmur and mass, peripheral arterial pulsation, etc. to exclude secondary hypertension.
5. Cardiopulmonary examination as well as neurological examination, etc., to understand whether there are cardiovascular and cerebrovascular complications caused by hypertension.
Routine examination of hypertensive patients includes the following.
1.Blood and urine routine. If there is anemia, hematuria, protein, etc., renal hypertension should be considered, or hypertensive disease has led to serious kidney function damage.
2.Blood biochemistry. Such as blood potassium, blood sodium, liver and kidney function, blood sugar, blood lipids, etc. Low blood potassium has the possibility of secondary hypertension. The examination of liver and kidney function is helpful for doctors to choose antihypertensive drugs according to the patient’s condition, and the test of blood glucose and blood lipid can understand whether there are other risk factors of cardiovascular disease.
3.Electrocardiogram. It is useful to know whether the patient with hypertension has cardiac hypertrophy, arrhythmia or myocardial ischemia caused by hypertension.
Patients with hypertension who have the conditions, the following tests can be further selected.
1. 24-hour ambulatory blood pressure monitoring. This test not only can truly reflect the blood pressure condition at each time point, but also can reveal the characteristics of blood pressure fluctuations and the pattern of diurnal changes in hypertensive patients.
2. Echocardiography. This test can help us understand the structure and function of the heart.