The previous articles on hypertension talked about whether it is necessary to have no obvious discomfort due to increased blood pressure, the harm of high blood pressure, the severity of hypertension, why salt intake is strictly restricted, the reasons why blood pressure is still high, and whether Chinese medicine can ** high blood pressure. Today's article talks about the types of hypertension, the severity of each type, and the common clinical manifestations.
Clinically, hypertension is divided into slowly progressive hypertension, rapidly progressive hypertension and hypertensive crisis according to the severity of onset and progression of the disease and the length of the course of the disease. Slow-progressive hypertension accounts for the vast majority of these, also known as benign hypertension; Rapidly progressive hypertension and hypertensive crisis account for only a small number of hypertension and are also known as malignant hypertension.
1. Slow-progressive hypertension:
This type of hypertension usually occurs in young and middle-aged people, especially those with a family history of hypertension. In the early stage of elevated blood pressure, there is sometimes no obvious discomfort, so it is easy to be ignored, and the onset of this type of hypertension is mostly insidious, the course of the disease is long, and the disease progresses slowly. In the early stage, blood pressure fluctuates, often rising from normal to once, causing many people not to pay attention to it, and it is easy to increase blood pressure when mood swings, mental tension, and tiredness, and blood pressure returns to normal when resting well and being emotionally stable.
As the disease progresses, the time of blood pressure increase gradually becomes longer, and the discomfort symptoms you feel are not necessarily proportional to the degree of blood pressure increase, many people only find that their blood pressure is elevated during physical examination, and some people only find out that they have high blood pressure when they find complications of heart, brain, kidney and other organs.
In the early stage of hypertension, blood pressure often fluctuates greater, when the symptoms are more obvious, and even if the blood pressure is still high after long-term hypertension, there are some people who have no obvious discomfort at this time. Therefore, patients with high blood pressure cannot judge whether to measure blood pressure by whether they have symptoms or not, but need to monitor their blood pressure regularly regardless of whether they have symptoms or not, because whether they are uncomfortable or not, high blood pressure will cause damage to the human body.
Neuropsychiatric manifestations:
Common neurological manifestations of hypertension include dizziness, headache, and head swelling, and in some people a headrest or neck.
Tightening sensation. Headaches caused by high blood pressure usually appear in the morning, and are mostly frontal, temporal or occipital pain. Dizziness caused by high blood pressure can be persistent or temporary, generally not accompanied by a feeling of spinning, related to the inner ear labyrinth vascular disorder, and the symptoms can be improved after taking antihypertensive drugs**, but pay attention to make the blood pressure drop steadily, and it is easy to cause dizziness if the blood pressure drops too much and too quickly. Some patients with hypertension also have fatigue, insomnia, and reduced work ability.
High blood pressure is also a common factor in cerebrovascular disease, and cerebrovascular accidents are also known as strokes or strokes. It can be divided into two categories: ischemic cerebral infarction, which has various manifestations such as transient cerebral ischemia, embolism, interstitial infarction, atherosclerotic thrombosis, and undefined; Intracerebral hemorrhage, with parenchymal and subarachnoid hemorrhage. The severity and symptoms of intracerebral hemorrhage vary depending on the amount and location of the hemorrhage, with most cerebral blood vessels involving only one cerebral hemisphere affecting the activity of the other side of the body, and some bleeding occurring in the brainstem affecting both sides.
In patients with mild cerebral hemorrhage, there will only be temporary dizziness, vertigo, crooked corners of the mouth, difficulty swallowing, inability to speak, blindness, limited limb movement, etc., and in severe cases, hemiplegia, coma, and even death.
2.Cardiovascular system manifestations:
In the early stage of hypertension, heart disease becomes more common without corresponding clinical symptoms, and hypertension is generally prone to hypodiastolic function and left ventricular hypertrophy in the early stage. The clinical manifestations of cardiac insufficiency usually occur many years or more than 10 years after the onset of hypertension. In the compensatory phase of cardiac function, only intermittent palpitation is usually felt, and other cardiac manifestations are often not obvious. In the decompensated phase of the heart, clinical manifestations of left heart failure may occur, such as paroxysmal nocturnal dyspnea, palpitation, coughing, wheezing, and in severe cases, a sudden rise in blood pressure may occur due to pulmonary edema. Persistent or recurrent left heart failure may affect the function of the right ventricle and progress to total heart failure, manifested by oliguria and edema.
Doctors can also find corresponding abnormalities when performing physical examinations such as cardiac auscultation, because hypertension can easily lead to atherosclerosis, and some patients with hypertension may have angina pectoris, myocardial infarction and other conditions due to coronary heart disease. There are also some patients with hypertension who have arrhythmias such as premature contraction and atrial fibrillation.
3.Manifestations of renal impairment:
The worse the blood pressure control, the more severe the renal vascular lesions. Patients whose blood pressure is not well controlled will have renal lesions, but it is often difficult for them to feel uncomfortable in the early stage of kidney lesions, and with the progression of renal lesions, they can first manifest as microalbuminuria, and then proteinuria, but if there is no combined heart failure and diabetes patients, the total amount of protein in urine in 24 hours is more than 1 gram, and controlling blood pressure can reduce urine protein. Hematuria can also occur in some hypertensive patients, with microscopic hematuria being more common, and a few patients having hyaline and granular casts.
When the kidney function is damaged to a certain extent, decompensation can lead to impaired renal concentration function, polyuria, nocturia, thirst, polydipsia, etc., and the specific gravity of urine gradually decreases, and finally fixed at 1Around 010, it is called isotonic urine.
When renal function is further impaired, urine output decreases, renal function abnormalities (eg, elevated serum creatinine, serum urea nitrogen, decreased glomerular filtration rate), which worsen with worsening renal lesions, and eventually uremia.
However, most of the patients with slow-progressive hypertension have died of cardiovascular and cerebrovascular diseases before reaching the point of uremia.
4.Other: Acute aortic dissection may present with severe chest or abdominal pain depending on the location of the lesion; Patients with peripheral vascular lesions of the lower extremities may present with intermittent claudication.
2. Rapidly progressive hypertension:
There are a very small number of patients with essential hypertension who are not timely, and they will present with acute hypertension, which has a rapid onset, and some patients have slow-progressive hypertension with different courses before the onset of the disease, which is typically characterized by a significant increase in blood pressure, and diastolic blood pressure often persists at 130-140mmHg or higher. This type is more common in young and middle-aged men, and this type of hypertension has gradually decreased in recent years, which is considered to be related to the timely detection of hypertension.
The common manifestations of this type are similar to those of slow-progressive hypertension, but the symptoms and headaches are more pronounced, and the disease is severe, rapidly progressing, retinopathy, and renal failure is very fast. Severe brain, heart and kidney damage, cerebrovascular accident, heart failure and uremia occur within a few months to 2 years. Blurred vision or blindness are common, and retinal hemorrhages, exudates, and papilledema may occur. And the kidney damage is often very serious, manifested as persistent proteinuria, 24-hour urine protein can reach 3 grams, and can be accompanied by hematuria and casts of urine, if not received in time, often due to uremia death.
3. Hypertensive crisis:
Hypertensive crises include hypertensive emergencies and hypertensive emergencies, with the difference being that hypertensive emergencies involve acute damage to target organs. Because the severity of the two is different, the clinical management ideas are not exactly the same.
Hypertensive emergency refers to the sudden and significant increase in blood pressure in patients with primary or secondary hypertension stimulated by some triggers, generally exceeding 180 120 mmHg, and at the same time there is progressive impairment of the function of important target organs such as the heart, brain, and kidney. Hypertensive emergencies include aortic dissection, acute coronary syndrome, acute heart failure, pulmonary edema, intracranial hemorrhage, cerebral infarction, hypertensive encephalopathy, eclampsia, etc., but the level of blood pressure is not necessarily proportional to the degree of acute target organ damage.
The blood pressure value of some hypertensive emergencies is not necessarily particularly high, such as those complicated by pregnancy or some patients with acute glomerulonephritis, but if the blood pressure is not controlled within a reasonable range in time, it will cause serious damage to organ function and even life-threatening, which needs to be paid great attention to and treated carefully.
Patients with hypertension complicated by aortic dissection, myocardial infarction, and acute pulmonary edema, even if the blood pressure is only moderately elevated, need to be treated as a hypertensive emergency.
Manifestations of common hypertensive emergencies include: Exacerbated malignant hypertension. Diastolic blood pressure higher than 140mmHg, accompanied by fundus papilledema, hemorrhage, exudation, and may be accompanied by headache, drowsiness, vomiting, confusion, blindness, oliguria and even convulsions; Significant increase in blood pressure is accompanied by serious lesions such as heart, brain and kidney and other emergency conditions, such as acute heart failure, acute myocardial infarction, acute arterial dissection, hypertensive encephalopathy, stroke, traumatic brain injury, acute nephritis, eclampsia, postoperative hypertension, pheochromocytoma, severe burns, etc.
Hypertensive encephalopathy, when the average blood pressure reaches more than 180mmHg, it is easy to develop cerebral edema, severe headache, dizziness, nausea, vomiting, irritability, slow and strong pulse, dyspnea or slowed breathing, visual impairment, blackness, convulsions, consciousness disorders, and even coma, and can also appear temporary hemiplegia, inability to speak, hemisensory impairment, etc. Seizures can last only a few minutes in short cases and can last for hours or even days in older cases.
Hypertensive emergencies should be treated with intravenous antihypertensive drugs as soon as possible to control blood pressure at an appropriate level, otherwise it is easy to cause serious consequences and even life-threatening.
Hypertensive urgency refers to a situation in which blood pressure rises significantly, but there is no deterioration of the important target organs mentioned above in a short period of time, such as no fundus changes, and no impairment of the function of organs such as the heart, brain, and kidneys. Current clinical data suggest that emergency antihypertensive drugs do not necessarily benefit patients from hypertensive emergencies, so urgent intravenous medication is generally not required, but oral antihypertensive drugs should be given as soon as possible to effectively control blood pressure within a few days and be closely monitored to prevent a hypertensive emergency.
More knowledge about hypertension will be talked about later, and interested friends can continue to pay attention.