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Doctor, I measured high blood pressure today
What to do, is it high blood pressure?
None of my parents had high blood pressure.
How can I have high blood pressure?
Do you want to take medicine? Is it impossible to stop taking medicine for a lifetime?
In the hypertension clinic of the Department of Endocrinology of Run Run Shaw Hospital affiliated to Zhejiang University School of Medicine, doctors will encounter such a deadly serial question almost every time.
Hypertension is an important cause of cardiovascular and cerebrovascular diseases and death, in today's explosive epidemic, hypertension is very familiar to everyone. But about high blood pressure, in fact, many people still have a lot of misconceptions.
How is hypertension diagnosed?
Adult hypertension is defined as: multiple repeated measurements on the same day, systolic blood pressure greater than or equal to 140 mmHg and/or diastolic blood pressure greater than or equal to 90 mmHg, try not to make a diagnosis with 1 visit, at least 2 to 3 times blood pressure to meet the above criteria indicate hypertension.
If conditions permit, the diagnosis should be confirmed by monitoring blood pressure at home, and the criteria for diagnosing hypertension with home monitoring are:
01
The average home self-measured blood pressure ≥ 135/85mmHg;
02
24h ambulatory blood pressure monitoring, average blood pressure ≥ 130/80mmHg (main standard), daytime ambulatory blood pressure ≥ 135/85mmHg, nocturnal ambulatory blood pressure ≥ 120/70mmHg.
Is high blood pressure a diagnosis and a lifelong medication?
The answer is: NO! It cannot be generalized.
Hypertension is both primary and secondary.
For example, middle-aged and elderly onset, there is a family history of hypertension, there are hypertensive risk factors such as obesity, diabetes, hyperlipidemia, etc., essential hypertension is more likely. Once diagnosed, on the basis of improving lifestyle, blood pressure is still poorly controlled, and antihypertensive therapy should be initiated early to prevent or delay hypertension-related complications such as stroke, angina or myocardial infarction, hypertensive nephropathy, hypertensive eye disease and so on.
However, if some special conditions are found at the same time as hypertension: young (less than 35 years old), no family history of hypertension, hypertension with target organ damage (such as abnormal renal function, positive urine protein, visual impairment, stroke, angina, etc.), abnormal increase or contraction of kidney volume, hypokalemia, adrenal mass, poor antihypertensive efficacy of drugs, etc., it is important to consider the possibility of secondary hypertension.
What is secondary hypertension?
Secondary hypertension refers to hypertension caused by a specific etiology, accounting for 5 to 10% of all hypertensive patients, if the real cause of the increase in blood pressure can be identified and treated, some hypertension can be cured and controlled by surgery or special drugs.
On the contrary, if the secondary cause is not detected in time, it may lead to a continuous increase in blood pressure, which is difficult to control, and these high blood pressures are more likely to have damage to the function of the heart, brain, kidneys and other organs.
Secondary hypertension mainly includes hypertension caused by endocrine diseases, hypertension due to renal disease (renal parenchyma and renal vascularity), hypertension due to obese respiratory diseases (obstructive sleep apnea syndrome), hypertension caused by drugs (such as drugs such as hormones and licorice), and hereditary hypertension caused by some rare genetic mutations.
What symptoms of high blood pressure occur
Is screening necessary for secondary?
Endocrine disorders lead to high blood pressure
●Occasional discovery of adrenal nodules, tumors, and thickening.
●Hypokalemia and hypokalemia caused by taking a small amount of diuretics (some antihypertensive drugs contain a small amount of diuretics).
●Paroxysmal or persistent increase in blood pressure with palpitation, sweating, headache, and pallor (or redness).
●Weight gain is accompanied by rounded and reddened face, thicker fat in the back of the neck and abdomen, purple stripes on the abdomen,armpits/thighs, and ecchymosis on slight bumps.
●Hypertension with sexual dysplasia (indistinguishable sex, acne in women, hirsutism, thick body hair in men, short stature, large or too small penis, undeveloped or cryptorchidism).
●Symptoms of abnormal hormone secretion such as palpitations, sweating, and emaciation (hyperthyroidism), fatigue and cold intolerance (hypothyroidism), bloating and constipation, urinary stones (hyperparathyroidism), or enlargement of the hands and feet, and changes in the face (acromegaly).
Kidney disease leads to high blood pressure
●Hypertension with hematuria, proteinuria, and abnormal renal function.
●Young (
●Poor antihypertensive effect, such as the use of angiotensin receptor antagonists (...) Sartan)/Angiotensin II inhibitor (... Puly), diuretics (... Rapidly decreased renal function occurs after drug therapy with thiazide.
●Hypertension with bilateral renal inconsistencies and hypokalemia.
3
Sleep apnea leads to high blood pressure
●Combined with obstructive sleep apnea syndrome, such as obesity, nocturnal snoring, apnea, poor sleep quality, daytime sleepiness, dry mouth in the morning, etc.
4
Medications cause high blood pressure
● Such as glucocorticoids, cyclosporine, nonsteroidal anti-inflammatory drugs, etc. High blood pressure does rise after the use of certain drugs.
In short, although secondary hypertension is far less than primary hypertension, the harm it brings (mainly target organ damage) is much higher than that of primary hypertension!
Moreover, secondary hypertension can often be cured or controlled by surgery or special drugs after the cause is determined, and if it is not diagnosed and treated in time, the opportunity for hypertension to be cured is often lost.
Therefore, after the diagnosis of hypertension is confirmed, you can first self-control whether there are the above suspicious clinical clues, and if so, go to the hypertension clinic as soon as possible to identify whether it is secondary hypertension.
bibliography:
1． Guidelines for the Prevention and Treatment of Hypertension in China (Revised Edition 2018).
2．Unger T, Borghi C, Charchar F, et al. 2020 International Society of Hypertension Global Hypertension Practice Guidelines. Hypertension. 2020;75(6):1334-1357.
3．Rossi GP, Bisogni V, Rossitto G, et al. Practice Recommendations for Diagnosis and Treatment of the Most Common Forms of Secondary Hypertension. High Blood Press Cardiovasc Prev. 2020;27(6):547-560.
Source: Department of Endocrinology and Metabolism, Run Run Shaw Hospital
Author: Yuan Qin
Reviewer: Zheng Fenping
Original works, reprinted please indicate the source and source
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