Second, make clear the cause of hypertension: anyone who encounters hypertension should ask about the medical history in detail and conduct a comprehensive and systematic examination to rule out symptomatic hypertension.
Laboratory examination is helpful to the diagnosis and classification of essential hypertension, to understand the functional state of target organs, and to choose drugs correctly during treatment. Routine hematuria, renal function, uric acid, blood lipid, blood sugar, electrolyte (especially potassium), electrocardiogram, chest X-ray and fundus examination should be used as routine examinations for patients with hypertension.
(1) There is generally no abnormality in routine red blood cells and hemoglobin, but rapid progressive hypertension may cause microangiopathic hemolytic anemia, and Coombs test is negative. Patients with abnormal red blood cells and high hemoglobin have increased blood viscosity and are prone to thrombosis complications (including cerebral infarction) and left ventricular hypertrophy.
(2) In the early stage of urine routine, the patient's urine routine was normal. When the kidney concentration function is damaged, the urine specific gravity gradually decreases, and there may be a small amount of urine protein and red blood cells, and occasionally cast. With the progress of nephropathy, the amount of urine protein increases. If the 24-hour urinary protein in patients with benign renal sclerosis is above 1g, the prognosis is poor. Red blood cells and casts can also increase, and casts are mainly transparent granules.
(3) Renal function is mostly estimated by blood urea nitrogen and creatinine. There is no abnormality in the early patient's examination, and the renal parenchyma can start to rise when it is damaged to a certain extent. Adult creatinine > 1 14.3μmol/L, elderly and pregnant women >: 9 1.5μmol/L, suggesting renal damage. Phenol red excretion test, urea clearance rate and endogenous creatinine clearance rate can be lower than normal.
(4) Chest X-ray examination shows that the aorta, especially the ascending and descending arches, is tortuous and prolonged, and the ascending or descending arches can be expanded. When hypertensive heart disease occurs, the left ventricle is enlarged, especially when there is left heart failure. Both left and right ventricles can be enlarged when there is total heart failure, and there are signs of pulmonary congestion. When pulmonary edema occurs, there is obvious congestion between the two lungs, showing a butterfly-shaped fuzzy shadow. Routine photographic examination should be carried out before and after the examination for comparison.
(5) ECG When left ventricular hypertrophy occurs, ECG can show left ventricular hypertrophy or both of them are strained. ECG has different diagnostic criteria for left ventricular hypertrophy, but its sensitivity and specificity are similar, with false negatives of 68% ~ 77% and false positives of 4% ~ 6%. It can be seen that the sensitivity of ECG in diagnosing left ventricular hypertrophy is not very high. Due to the decrease of left ventricular diastolic compliance and the increase of left atrial diastolic load, P wave broadening, notch notch notch and negative terminal potential of Pv 1 increased in ECG, even before left ventricular hypertrophy was found in ECG. Arrhythmias such as ventricular premature beats and atrial fibrillation may occur.
(VI) Echocardiography At present, compared with chest X-ray examination and electrocardiogram, echocardiography is the most sensitive and reliable means to diagnose left ventricular hypertrophy. M-mode ultrasound curve can be recorded on the basis of two-dimensional ultrasound localization or measured directly from two-dimensional images. The thickness of interventricular septum and/or posterior wall of ventricle is >: 1.3 mm, which means left ventricular hypertrophy. Hypertensive left ventricular hypertrophy is mostly symmetrical, but about 1/3 is mainly ventricular septal hypertrophy (thickness ratio of ventricular septum to left ventricular posterior wall >; 1.3), ventricular septal hypertrophy often appears at the upper end first, suggesting that hypertension first affects the left ventricular outflow tract. Echocardiography can also observe other cardiac chambers, valves and aortic roots, and can be used to detect cardiac function. In the early stage of left ventricular hypertrophy, although the overall functions of the heart, such as cardiac output and left ventricular ejection fraction, are still normal, the left ventricular systolic and diastolic compliance has decreased, such as the decrease of the maximum myocardial systolic velocity (Vmax), the prolongation of isovolumic diastolic period and the delay of mitral valve opening. After the occurrence of left heart failure, echocardiography can find that the left ventricle and left atrial cavity are enlarged and the systolic activity of left ventricular wall is weakened.
(VII) Increased central retinal artery pressure can be found by fundus examination, and the following fundus changes can be observed at different stages of disease development:
Grade I: retinal artery spasm.
Grade Ⅱ A: mild sclerosis of retinal artery.
B: The retinal artery is obviously hardened.
Grade III: Grade II plus retinopathy (bleeding or exudation)
Grade ⅳ: Grade ⅲ plus papillae edema.
(8) Other patients may be accompanied by an increase in serum total cholesterol, triglycerides and low-density lipoprotein cholesterol, a decrease in high-density lipoprotein cholesterol and a decrease in apolipoprotein A-I, as well as frequent hyperglycemia and hyperuricemia. The plasma renin activity and angiotensin ⅱ level increased in some patients.
Patients should also develop the habit of self-examination in their daily lives. It is suggested to monitor blood pressure regularly with electronic sphygmomanometer. Experts especially recommend Jiu 'an electronic sphygmomanometer, which adopts MOTOLORA's world-leading dedicated microcomputer chip and high-tech pressure sensor, overcomes the human error in the measurement process of mercury sphygmomanometer and greatly improves the accuracy of occasional blood pressure measurement. At the same time, the convenience of electronic sphygmomanometer makes it possible to measure regularly, so as to accurately and timely grasp the fluctuation of blood pressure.