Etiology of hypertensive crisis
In patients with primary hypertension and some patients with secondary hypertension, some inducing factors can cause hypertensive crisis. There are many reasons for its occurrence, the common ones are: ① slow or rapid hypertension, which can occur in both primary and secondary patients. ② All kinds of renal hypertension include hypertension caused by renal artery stenosis, acute and chronic glomerulonephritis, chronic pyelonephritis and renal connective tissue lesions. ③ Endocrine hypertension, including pheochromocytoma and renin secreting tumor. ④ Pregnancy-induced hypertension syndrome and porphyria (purpura disease). ⑤ Acute aortic dissection hematoma and cerebral hemorrhage. ⑥ Head trauma, etc. On the basis of the above-mentioned hypertension diseases, hypertensive patients are prone to hypertensive crisis if the following factors exist.
At present, the induced factors confirmed by the research are: ① cold stimulation, mental trauma, bad external stimulation, emotional fluctuation and excessive fatigue. ② Use monoamine oxidase inhibitors to treat hypertension, or eat some foods rich in tyrosine such as cheese, lentils, pickled fish, beer, red wine, etc. ③ After applying sympathomimetic drugs, the sympathetic nerve endings release catecholamine. ④ Hypertensive patients suddenly stop taking some antihypertensive drugs such as clonidine. ⑤ Endocrine dysfunction in menstruation and menopause.
In addition, the excessive excitement of sympathetic nerve and the excessive secretion of vasopressor active substances not only make renal arterioles contract, but also cause vasospasm around the whole body, which leads to a sudden increase in peripheral vascular resistance and further increase in blood pressure. At this time, hypertension crisis happened.
At present, most scholars believe that the mechanism of hypertensive crisis is due to the sudden and sharp increase of vasoactive substances such as renin, angiotensin ⅱ, norepinephrine and arginine vasopressin in blood circulation, which leads to the contraction or expansion of afferent and efferent arterioles of kidney.
Symptoms of hypertensive crisis
This disease was originally called hypertensive emergency. According to the needs of treatment, 1984 International Joint Committee divides it into two types: requiring immediate treatment and allowing it to fall to the required target level in a short time. 1997 JNCVI is unified as hypertensive crisis, which can be divided into hypertensive emergency and sub-emergency according to the degree of target organ damage and whether it needs immediate antihypertensive treatment.
Hypertensive emergency: refers to hypertension accompanied by acute progressive target organ damage, and the diastolic pressure is often ≥ 18.3kPa( 130mmHg), which requires immediate antihypertensive treatment (but does not need to be reduced to the normal range) to prevent or alleviate target organ damage, and intravenous medication is often needed. It mainly includes: ① hypertensive encephalopathy; ② Acute/malignant hypertension with heart, brain, kidney and fundus damage; ③ Hypertension complicated with intracranial hemorrhage/subarachnoid hemorrhage; ④ Hypertension complicated with acute renal failure; ⑤ Hypertension complicated with acute left heart failure/pulmonary edema; ⑥ Hypertension complicated with unstable angina pectoris and acute myocardial infarction; ⑦ Acute aortic dissection aneurysm; 8 eclampsia; Pet-name ruby pheochromocytoma, etc.
Hypertensive sub-emergency: also known as hypertensive emergency, refers to a sharp increase in blood pressure without acute target organ damage. It is allowed to lower blood pressure within a few hours. It is not necessary to use intravenous drugs, but oral drugs can be allowed. It mainly includes: ① acute/malignant hypertension with unintentional brain, kidney and fundus damage; ② Preeclampsia; ③ Perioperative hypertension, etc.
The pathogenesis of hypertensive encephalopathy is quite complicated, and it is not very clear at present. At present, most scholars believe that it is related to the dysfunction of cerebral circulation self-regulation. Under normal circumstances, cerebral blood flow remains constant within a considerable range of blood pressure fluctuations. The diameter and dynamic changes of cerebral artery have their own characteristics, which do not depend on the regulation of autonomic nervous system, but the wall of cerebral artery relaxes and contracts directly in response to blood pressure.
Hypertension crisis examination
During the attack, a small amount of protein and red blood cells appeared in the urine, and blood urea nitrogen, creatinine and blood sugar increased.
Fundus examination showed retinal hemorrhage and exudation.
Auxiliary examination of hypertensive encephalopathy;
1. Fundus examination showed fundus features of hypertension, including diffuse or localized spasm of retinal artery, sclerosis or bleeding, exudation and optic disc edema.
2, EEG examination can appear local abnormalities or bilateral synchronous sharp slow waves, sometimes showing poor rhythm. Because of brain edema, extensive slow waves often appear.
3, cerebrospinal fluid examination pressure increased significantly. The test results are mostly normal, with a few red blood cells or white blood cells occasionally, and the content of protein is slightly increased.
Blood pressure measurement: within 2 minutes after the patient lies flat, and within 1 ~ 3 minutes after quickly standing up from the lying position, the blood pressure in the lying position, working position and standing position were measured respectively, and the heart rate was recorded at the same time. If the systolic blood pressure drops by at least 20mm Hg (or the diastolic blood pressure drops 10mm Hg) within/kloc-0 ~ 3 minutes after standing up from the supine position, it can be defined as postural hypotension, which is a typical manifestation of sympathetic vasoconstrictor nerve failure. You can also do an upright tilt test if conditions permit.
Normal value of blood pressure measurement:
Ideal blood pressure: systolic blood pressure
Normal blood pressure: systolic blood pressure should be
Above normal:
High normal blood pressure or prehypertension: systolic blood pressure 130~ 139mmHg and/or diastolic blood pressure 85 ~ 89 mmHg.
Hypertension: systolic blood pressure ≥ 140mmHg and/or diastolic blood pressure ≥90mmHg.
Critical hypertension: systolic blood pressure140 ~160mmhg (18.6 ~ 21.3kpa), diastolic blood pressure 90 ~ 95mmhg (12.0 ~12.6kpa).
Kaplan proposed the following diseases: acute left heart failure, uremia, cerebrovascular accident, subarachnoid hemorrhage, brain tumor, craniocerebral injury, post-epileptic seizure, lupus erythematosus, encephalitis, acute anxiety disorder with hyperventilation syndrome. Before the diagnosis of acute hypertension and malignant hypertension, the above diseases that cause hypertension must be ruled out.
Treatment of hypertensive crisis
Blood pressure crisis can occur in both primary hypertension and secondary hypertension. Hypertensive crisis is a special clinical phenomenon, which has many reasons and different prognosis methods. The treatment of hypertensive crisis should follow certain principles.
First, the initial dose of antihypertensive drugs should be small and gradually increase, and the blood pressure will reach normal level after 1 ~ 2 weeks. The hemodynamic effects of antihypertensive drugs on hypertensive emergencies can be attributed to the damage of hypertension to heart, brain and kidney. It has been proved that effective control of hypertension can prevent or reverse these damages, which is achieved by lowering blood pressure and improving hemodynamics of hypertensive emergency patients.
Second, hypertension emergency needs immediate blood pressure reduction, and hypertension sub-emergency can gradually drop to a safe level within a few hours to 24 hours.
Thirdly, the choice of antihypertensive drugs not only requires fast onset and exact antihypertensive effect, but also can not cause major organ damage due to hemodynamic changes during antihypertensive process. Commonly used antihypertensive drugs include sodium nitroprusside, phentolamine, nitroglycerin, etc., which can achieve good antihypertensive effect when applied properly.
Fourth, appropriately determine the target level of blood pressure reduction. The elderly or people with heart, brain and kidney damage should avoid sudden hypotension. The safe level of hypotension is between160 ~180/100 ~110mmhg, or the average arterial pressure is reduced by 20% ~ 25%, and the blood pressure is reduced in the first 48 hours.
In the treatment of senile hypertensive crisis, we should pay attention to the speed and degree of blood pressure reduction, and we don't have to unilaterally pursue rapid blood pressure reduction or achieve complete normality. We must abandon the concept of seldom considering the functional state of heart, brain and kidney and their blood perfusion, and emphasize the individualization of blood pressure reduction. The following factors affect the choice of drugs, route of administration, dosage and the goal of lowering blood pressure.
Hypertensive crisis diet
1, abalone and bamboo shoot soup
It is characterized by nourishing yin and moistening dryness, calming liver and strengthening yang, benefiting qi and tonifying kidney, and reducing abdominal fat storage. Suitable for patients with hypertension and high cholesterol.
Ingredients: 50g canned abalone. Materials: bamboo shoots 15g, pea seedlings 50g. Seasoning: cooking wine, refined salt, monosodium glutamate, pepper, broth.
Production process ① Put bamboo shoots in a pot, soak them in warm water until they become soft, gently rub them a few times, wash the sediment, cut them into long strips, put them in a boiling water pot for a little scalding, take them out and put them in cold water, slice the abalone and wash the bean sprouts. (2) Put the broth in the pot and bring it to a boil. Blanch the boiled bamboo shoots and abalone slices, remove them and put them in a soup cup. Skim the soup and add salt, monosodium glutamate, cooking wine and pepper.
2, red dates and mushroom soup
Characteristics: benefiting qi and appetizing. It is suitable for treating deficiency syndrome, anorexia, hypertension, coronary heart disease, cancer, gastric and duodenal ulcer and other diseases.
The raw materials are 15 red dates, 15 dried mushrooms, ginger, cooked peanut oil, cooking wine, salt and monosodium glutamate.
In the production process, firstly, dry mushrooms are washed with sediment; Wash red dates and remove the core; Then put water, mushrooms, red dates, salt, monosodium glutamate, cooking wine, ginger slices and a little cooked peanut oil into a steaming bowl, cover tightly, steam in a cage for 60-90 minutes, and take out.
Take it with meals.
It can not only control blood pressure, but also reduce other diseases, so middle-aged and elderly people should often eat some dietotherapy and medicated diet for tonic.
3. Chrysanthemum porridge: chrysanthemum powder15g, japonica rice100g. Take off the stems of chrysanthemum, steam them in a cage, take them out to dry in the sun or in the shade, and then grind them into fine powder for later use. Wash the japonica rice, put it in a pot, add appropriate amount of water, boil it with strong fire, then cook it with slow fire until it is half cooked, add chrysanthemum fine powder, and continue to cook it with slow fire until the rice is rotten into porridge. Eat dinner twice a day to treat high blood pressure.
Prevention of hypertensive crisis
1. Avoid animal fat, high sugar, high salt and excessive drinking.
You must lose weight. In addition to controlling diet, we should also pay attention to walking and exercise properly to lose weight.
3, you must quit smoking, because smoking can lead to arteriosclerosis.
4, starting from the prevention of hyperlipidemia, adjust the diet structure.
When you encounter emotional excitement in your daily life, your blood pressure will suddenly rise. In order to make your blood pressure stable, you should pay attention to psychological balance and emotional adjustment.
6. Middle-aged and elderly people should keep in mind four principles: reasonable diet; Moderate exercise; Quit smoking and limit alcohol; Mental health care. This can effectively prevent the occurrence of hypertension.
Patients with hypertension should insist on taking medicine, and often go to the hospital to monitor blood pressure changes and adjust the drug dosage in time. Usually, you should arrange your work and rest reasonably, don't overwork, and ensure adequate sleep. Quit smoking, drinking, high-fat diet, and avoid big mood swings.
For hypertensive patients with impaired renal function, the use of antihypertensive drugs should not only consider the curative effect, but also pay special attention to the safety of drugs, otherwise it will affect drug excretion because of decreased renal function, so that it will accumulate too much in the body, which will not only further damage the kidney, but also increase adverse drug reactions, such as hypotension.
According to the national survey data of nutrition and health status of residents in 2002, the prevalence rate of hypertension in adults in China is 18.8%, while the prevalence rate of middle-aged and elderly people is as high as 39%. Professor Hu Dayi, Chairman-designate of Cardiovascular Branch of Chinese Medical Association, pointed out that smoking, hypertension and hypercholesterolemia are the top three risk factors leading to cardiovascular and cerebrovascular accidents, and for stroke, hypertension is second only to smoking. Therefore, caring for the health of the elderly cannot ignore the prevention and treatment of hypertension in the elderly.