Uncle Ge is 58 years old this year and has been living in his hometown, where there is only a small clinic and a village doctor.
Two months ago, Uncle Ge began to feel headaches, dizziness, and swelling frequently, so he went to the clinic to see a doctor. The village doctor measured his blood pressure and found that his systolic blood pressure was 140mmHg and his diastolic blood pressure was 90mmHg, so he concluded that he had high blood pressure, prescribed him antihypertensive drugs, and told him to go home and rest.
Uncle Ge took blood pressure medication as prescribed by the doctor. For the first two days, he didn't feel anything, but after a few days, he developed symptoms such as headache, dizziness, nausea, vomiting, etc., and the whole person was so weak that even painkillers did not work. Uncle Ge's wife hurriedly called her son ** and sent Uncle Ge to the hospital.
The family thought it was caused by high blood pressure, but they didn't expect the doctor to tell them after the examination that Uncle Ge's symptoms were actually caused by taking blood pressure medication! What's even more surprising is that the doctor said that Uncle Ge actually doesn't have high blood pressure! Because he did not have high blood pressure but took blood pressure medication, his blood pressure was too low and he had these uncomfortable symptoms.
Uncle Ge didn't understand, when he measured his blood pressure at that time, didn't he show high blood pressure? Why do you say that you don't have high blood pressure now? The doctor explained that when measuring blood pressure, it will be affected by many factors, for example, to diagnose high blood pressure, it is necessary to measure blood pressure three times on different days without taking antihypertensive drugs, and if the blood pressure is above 140 90mmHg, it can be diagnosed with hypertension! And Uncle Ge only tested it once, which may be due to a moment of nervousness, excitement or other reasons, which led to an increase in blood pressure, but it does not mean that he really has high blood pressure, which is "misdiagnosis".
In addition, the doctor also told Uncle Ge that when measuring blood pressure, it is necessary to pay attention to some details, for example, the environment for measuring blood pressure should be quiet and warm, rest for at least 5 minutes before measurement, maintain a correct posture during measurement, do not stilt your legs, do not speak, do not move, the size of the cuff should be appropriate, the height of the cuff should be at the level of the heart, and the value of blood pressure and the time of measurement should be recorded after measurement. If you have insomnia, staying up late, drinking, smoking, exercising, etc., it will also affect the blood pressure measurement results.
Uncle Ge is not alone, and now many patients may be misdiagnosed with hypertension, or missed as normal blood pressure. Therefore, the doctor suggests that when measuring blood pressure, you must measure it many times, preferably in different time periods and occasions, and also pay attention to the methods and conditions of measurement, so as to avoid misdiagnosis or missed diagnosis like Uncle Ge.
Hypertension is a common chronic disease and an important risk factor for cardiovascular diseases such as heart disease and stroke. Timely detection and ** high blood pressure is very important for the prevention and control of cardiovascular diseases and the protection of health. However, the diagnosis of hypertension is not simple, and certain standards and procedures need to be followed, otherwise it is easy to misdiagnose and miss the diagnosis, which will bring unnecessary distress and harm to patients.
So, what is high blood pressure and how can it be properly diagnosed?
1. Definition and diagnostic criteria for hypertension
Hypertension is defined as a diagnosis of hypertension when blood pressure is measured three times on the same day without the use of antihypertensive drugs, with a systolic blood pressure of 140 mmHg and/or a diastolic blood pressure of 90 mmHg.
There are two important points to note here, one is that your blood pressure must be measured in the office, and the other is that your blood pressure must be measured 3 times on different days before you can finally diagnose hypertension. If you only measure your blood pressure at home, or only measure your blood pressure once a day, you think that you have high blood pressure, which is unscientific and may cause misdiagnosis.
2. Causes of misdiagnosis and missed diagnosis of hypertension
Sometimes, even if blood pressure is measured according to the above criteria and procedures, misdiagnosis and missed diagnosis may occur, because blood pressure is affected by many factors, and pseudohypertension or pseudonormal blood pressure may occur.
Pseudohypertension refers to the fact that the actual blood pressure is normal, but due to local arteriosclerosis, the blood pressure is measured with a high value, and is common in the elderly, diabetic patients, uremia patients, and severe arteriosclerosis patients. If these patients are blindly given antihypertensive drugs, it may cause low blood pressure, cause insufficient cerebral blood flow, and lead to complications such as dizziness, vertigo, and syncope.
Pseudonormotensive refers to the actual increase in blood pressure, but due to the tension, anxiety, fear and other emotions during the office measurement, resulting in the illusion of normal blood pressure measurement, it is common in patients with white coat hypertension and occult hypertension. White coat hypertension refers to patients whose blood pressure is elevated only when measured in the office and normal when measured at home. Occult hypertension is defined as a patient whose blood pressure is elevated only when measured at home and normal when measured in the office. Ignoring the actual blood pressure levels in these patients and not giving timely blood pressure lowering** may increase the risk of cardiovascular disease.
3. Correct diagnosis of hypertension
In order to avoid misdiagnosis and underdiagnosis of hypertension, in addition to measuring office blood pressure according to the standards and procedures, it is also necessary to carry out out-of-office blood pressure measurement to confirm and evaluate the antihypertensive efficacy, and to identify white coat hypertension, occult hypertension and refractory hypertension. There are two main methods of blood pressure measurement outside the clinic, one is 24-hour ambulatory blood pressure monitoring, and the other is home blood pressure measurement.
24-hour ambulatory blood pressure monitoring refers to the use of a special blood pressure monitor in the normal daily life and work environment, which automatically measures blood pressure at certain intervals and records it to form a blood pressure change curve within a day. This method can reflect the patient's true blood pressure level, as well as the circadian rhythm and fluctuation of blood pressure, which is of great significance for diagnosing hypertension, assessing cardiovascular risk, guiding blood pressure**, and judging the effect of blood pressure.
Home blood pressure measurement refers to the use of an electronic blood pressure monitor at home or in a non-clinic setting, in accordance with certain specifications and methods, to measure blood pressure by yourself or by family members, and record it to form blood pressure change data over a period of time. This method can reflect the daily blood pressure level of patients, as well as the stability and reliability of blood pressure, and has a positive effect on diagnosing hypertension, evaluating the efficacy of antihypertensive therapy, and improving patient compliance. Based on the results of home blood pressure measurements, hypertension can be divided into two types, which are persistent hypertension and occult hypertension. Among them, occult hypertension refers to the situation where the blood pressure at home is higher than the blood pressure in the office, which is closely related to the occurrence of cardiovascular disease and the risk of death.
Blood pressure is an important indicator of cardiovascular health, but if you don't pay attention to some details when measuring blood pressure, it may affect the accuracy of the measurement, resulting in misdiagnosis or missed diagnosis. The American Heart Association reminds that there are 7 common mistakes to avoid when measuring blood pressure:
Blood pressure is measured when the bladder is not empty. This can raise blood pressure by 10-15mmHg because the pressure in the bladder affects the tone of the blood vessels. Therefore, you should go to the bathroom before taking your blood pressure.
Blood pressure is measured without support on the back or feet. This can raise blood pressure by 6-10 mmHg because an unsupported posture increases the burden on the heart. Therefore, when measuring blood pressure, you should sit in a chair with a backrest and your feet flat on the ground.
Blood pressure is measured without arm support. This can raise blood pressure by about 10mmHg because an unsupported arm can affect the flow rate of blood flow. Therefore, when measuring blood pressure, you should place your arm on a table so that your arm is at the same level as your heart.
Blood pressure is measured with the cuff wrapped around thick clothing. This can increase blood pressure by 5-50mmHg because thick clothing can increase the pressure on the cuff, which can affect blood pressure readings. Therefore, blood pressure should be measured with your upper arms bare, or with only a thin layer of clothing.
Blood pressure is measured in cases where the cuff size is inappropriate. This can increase blood pressure by 2-10mmHg because an inappropriate cuff size can affect the fit of the cuff and thus the measurement of blood pressure. Therefore, when measuring blood pressure, a suitable cuff should be selected, and in general, the width of the cuff should account for 40% of the circumference of the upper arm and the length should account for 80% of the circumference of the upper arm.
Blood pressure is measured in the case of stilted legs. This will increase blood pressure by 2-8mmHg because the stilted legs will affect the return of blood and thus the stability of blood pressure. Therefore, when measuring blood pressure, you should keep your feet flat on the ground and do not cross your legs.
Speak while your blood pressure is checked. This increases blood pressure by about 10mmHg because speaking affects the rhythm of breathing, which affects changes in blood pressure. Therefore, when measuring blood pressure, you should be quiet and do not talk or listen**.
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