I. Distinguish whether it is primary or secondary hypertension.
After finding hypertension, you should go to the hospital as soon as possible and make some necessary examinations under the guidance of your doctor.
Among hypertensive patients, primary hypertension (i.e., hypertension of unknown cause, also known as hypertensive disease) accounts for about 90% or more, and secondary hypertension accounts for less than 10%. Most secondary hypertension has its own specificity of treatment or can be cured by surgery, so secondary hypertension should first be ruled out by medical history and physical examination.
The common causes of secondary hypertension are.
1, kidney disease. It is manifested as hematuria, proteinuria or frequent urination, urinary urgency, painful urination and abnormal kidney function.
2, renal vascular or macrovascular lesions. Vascular murmurs can be heard in the abdomen and neck, diminished or absent pulses in the extremities, ultrasound can see that the two kidneys are not the same size, and isotopes can find reduced renal blood flow, etc.
3.Endocrine disease. It is mainly due to adrenal tumor or hyperplasia. If there is wasting, sweating, palpitations, white face or paroxysmal hypertension should be alerted to the possibility of pheochromocytoma; if there is dry mouth, nocturnal urination, weakness of both lower limbs or even flaccid, hypokalemia should be alerted to primary aldosteronism; centripetal obesity, full moon face, hirsutism, sexual dysfunction should be alerted to the possibility of Cushing’s syndrome.
Second, the initial physical examination of hypertensive patients should include the following as far as possible.
1. Blood pressure on both sides. Compare and verify the blood pressure on both sides and take the value of the higher side. If the difference in blood pressure between the two sides is greater than 20 mm Hg, it is possible that the lower side has 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 hypertension disease, as the saying goes, the longer the belt, the shorter the life expectancy. To determine whether obesity can be based on height and weight to calculate the body mass index. Body mass index = weight (kg) / height (m 2), the normal body mass index of Chinese people is 19 ~ 23, greater than 23 that is overweight or obese.
3. Observe retinal lesions with fundoscopy. Changes in the retinal arteries can reflect the degree of peripheral small artery lesions in hypertension, and 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 and neurological examination, etc., to understand whether there are cardiovascular and cerebrovascular complications caused by hypertension.
Third, the routine laboratory tests for hypertensive patients include the following.
1, blood and urine routine. If there is anemia, hematuria, proteinuria, etc., it should be considered as renal hypertension, or hypertensive disease leading 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, or is a side effect of diuretic treatment in a few patients with hypertension. The examination of liver and kidney function is helpful for doctors to select antihypertensive drugs according to the patient’s condition and to understand whether long-term use of antihypertensive drugs has any effect on the patient’s liver and kidney function. The blood glucose and lipid test can understand whether there are other risk factors for cardiovascular diseases.
3.Electrocardiogram. It is useful to understand whether patients with hypertension have cardiac hypertrophy, arrhythmia or myocardial ischemia caused by hypertension.
Fourth, the condition of hypertensive patients, can be further selected for the following tests.
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 diurnal changes in hypertensive patients. Ambulatory blood pressure has many advantages compared with occasional blood pressure: it can help to screen critical hypertension and mild hypertension, identify “white coat hypertension”; predict the degree of target organ damage; evaluate the efficacy of antihypertensive drugs, and guide the rational use of antihypertensive drugs.
2.Echocardiography. This examination can help us understand the structure and function of the heart.
Based on the above examination results, doctors can understand the condition and determine the correct treatment plan. Early prevention can reduce the incidence of hypertension disease by 55%, and early treatment of hypertension disease can in turn reduce the incidence of stroke and myocardial infarction by about 50% again.