Hypotension is a state in which the arterial pressure in the body circulation is lower than normal. Because hypertension often causes clinical damage to important organs such as heart, brain and kidney and is highly valued, the World Health Organization also has clear diagnostic criteria for hypertension, but there is no uniform standard for the diagnosis of hypotension. Generally, it is considered hypotension when the arterial blood pressure in the upper limbs of adults is lower than 90/60mmHg (12/8kPa). According to the etiology, it can be divided into physiological and pathological hypotension, and according to the form of onset, it can be divided into acute and chronic hypotension.
I. Etiology
1, physiological hypotension state
It means that in some healthy people, their blood pressure measurements have reached the standard of hypotension, but there are no conscious symptoms, and after long-term follow-up, except for low blood pressure, there are no abnormalities such as ischemia and hypoxia in the human system organs, and it does not affect the life expectancy.
2.Pathological hypotension disease
In addition to lower blood pressure, often accompanied by different degrees of symptoms and certain diseases.
(1) Primary hypotension refers to a state of hypotension without obvious causes, such as physiological hypotension (somatic hypotension), mostly seen in the elderly and women with a thin physique.
(2) Secondary hypotensive disorders refer to the lowering of blood pressure caused by a disease of an organ or system of the body. This hypotension can occur rapidly within a short period of time, such as a rapid decrease in blood pressure due to hemorrhage, acute myocardial infarction, severe trauma, infection, allergy, etc. In most cases, hypotension occurs slowly and can gradually worsen, such as hypotension secondary to severe tuberculosis, malignancy, malnutrition, cachexia, etc.
Second, common symptoms
Dizziness and weakness, indigestion, lack of blood supply to the heart and brain, fatigue, endocrine dysfunction, chronic headache, vague pain in the precordial region, low blood pressure in the lower extremities, and weakness of the waist and knees, which are divided into two categories: acute and chronic according to the form of the onset of hypotension.
1.Acute hypotension
Acute hypotension refers to a sudden and significant drop in blood pressure from a normal or high level. Clinically, dizziness, black eyes, limb weakness, cold sweat, palpitations, oliguria and other symptoms often occur due to ischemia of the brain, heart, kidneys and other important organs, and in severe cases, syncope or shock.
2.Chronic hypotension
Chronic hypotension is a state in which blood pressure is continuously below the normal range.
(1) Somatic hypotension is generally considered to be related to heredity and lean body mass, mostly seen in women and elderly people aged 20 to 50 years old, with no symptoms in mild cases and mental fatigue, dizziness, headache, and even fainting in severe cases. It is more obvious in summer when the temperature is higher.
(2) Postural hypotension occurs in some patients with postural changes (especially in the upright position) and is called postural hypotension. Postural hypotension is defined as a decrease in systolic blood pressure >20 mmHg or diastolic blood pressure >10 mmHg within 3 minutes of changing position to the upright position, accompanied by symptoms of hypoperfusion, which include: dizziness, lightheadedness, blurred vision, weakness, nausea, cognitive dysfunction, palpitations, and neck and back pain. Elderly people with simple systolic hypertension with diabetes mellitus, hypovolemia, application of diuretics, vasodilators or psychotropic drugs are prone to postural hypotension.
(3) Secondary hypotension Certain diseases or drugs can cause hypotension, such as spinal cavitation, high degree of aortic stenosis, mitral stenosis, chronic constrictive pericarditis, idiopathic or hypertrophic cardiomyopathy, hemodialysis patients and chronic malnutrition, as well as taking antihypertensive drugs and antidepressants. Hypotension caused by these diseases can also present with symptoms of low perfusion such as dizziness and lightheadedness.
Three, examination items
Blood pressure measurement, blood routine.
1.Electrocardiogram for changes in heart rate and rhythm, ST-T changes, and pathological Q waves.
2.Cardiac ultrasound and peripheral vascular Doppler ultrasonography can help to diagnose hypotension of cardiovascular origin.
3.Cardiac catheterization and angiography can clarify peripheral vascular disease and cardiac disease.
4.X-ray examination is performed by fluoroscopic chest X-ray to observe whether there is a mass compressing the peripheral great vessels.
5.Myelography to understand whether there is spinal cord cavity and other spinal cord lesions.
6.Laboratory tests should be done for hypotension suspected to be caused by endocrine diseases, and corresponding endocrine function and hormone tests should be done. Routine blood tests with changes in red and white blood cells can also help in the diagnosis.
Complications
1. Dizziness, fatigue, easy fatigue, reduced work capacity;
2, fainting, falls, fractures and other accidents and increased death;
3, triggering mood depression, depression and other mental disorders;
4, induce transient cerebral ischemia, cerebral infarction, myocardial ischemia;
5, hearing impairment, visual impairment;
6.Decreased quality of life.