Classification and definition of the etiology of hypertension

Classification and definition of the etiology of hypertension

Classification and definition of the etiology of hypertension. hypertension is divided into three categories: Essential; secondary hypertension; special type of hypertension;

1. What is the cause of hypertension?

According to the etiology, hypertension is divided into three categories:

• Essential;
• secondary hypertension;
• special type of hypertension;

2. What is essential hypertension?

Hypertension of unknown cause is essential hypertension, which is what we usually call hypertension. Essential hypertension is the most common cardiovascular disease. Most of the blood pressure began to increase significantly after the age of 40, so it is more common in middle-aged and elderly people. Regarding the cause of the disease, most scholars believe that it is based on a certain genetic basis, coupled with the combined effects of a variety of acquired factors, that cause the body’s blood pressure regulation function to be abnormal and a group of symptoms dominated by blood pressure rise. It is an independent disease with hypertension as the main clinical manifestation, accounting for about 90% of all hypertensive patients.

3. What is secondary hypertension?

Hypertension secondary to other diseases, that is to say, a disease with a clear primary disease and accompanied by symptoms and signs of increased blood pressure is also called symptomatic hypertension. It is common in acute and chronic kidney disease, endocrine disease, vascular disease, brain disease and pregnancy poisoning. In secondary hypertension, if the cause is clear and treated properly, it can be completely cured. For example, adrenal cortical adenoma is also called aldosteronoma, and blood pressure can return to normal after surgery. If the underlying disease is not cured, the symptoms of hypertension will persist. In this case, the clinical manifestations and complications caused by hypertension are similar to those of primary hypertension. Therefore, when a patient with hypertension undergoes regular treatment for a period of time and the blood pressure control is not satisfactory, the possibility of secondary hypertension must be considered.

4. What is a special type of hypertension?

Clinically, it is difficult to attribute primary hypertension or secondary hypertension to special hypertension. Its characteristic is that only symptomatic treatment for the causes of these hypertension can effectively reduce blood pressure.

5. seven special types of hypertension are common clinically?

1). Pseudo-hypertension:

It is more common in the elderly. The reason for the increase in blood pressure is that the brachial arteriosclerosis makes the measured systolic blood pressure higher. When the patient’s arterial blood pressure value is significantly lower than the reading measured by the sphygmomanometer and is within the normal range, it can be diagnosed as pseudohypertension. Because patients with this type of hypertension often have organ arteriosclerosis and low diastolic blood pressure and other symptoms, the patient cannot rush to reduce blood pressure, and should be treated for the patient’s arteriosclerosis and organ insufficiency;

2). Obesity hypertension:

For some hypertensive patients, their body mass index = weight (kg) divided by the square of height (m) (more than 27 or obesity [overweight weight (kg) / standard weight (kg) × 100%) greater than 25%. By controlling calories Ingestion and weight reduction, the patient’s blood pressure can be significantly reduced or close to normal. This type of hypertension is called obesity hypertension;

3). Orthostatic hypertension:

Some patients have normal blood pressure in the supine position (diastolic blood pressure ≤90 mmHg) and elevated blood pressure in the standing position (diastolic blood pressure>90 mmHg, systolic blood pressure>150 mmHg), and secondary hypertension is excluded may. This type of hypertension can be called orthostatic hypertension;

4). Sleep-disordered breathing hypertension:

People with sleep-disordered breathing can have repeated apneas during sleep. Generally, each apnea can last for about 10 seconds, with more than 30 episodes per night, and is accompanied by periodic blood pressure increases. This type of hypertension can be called sleep apnea hypertension;

5). High altitude hypertension:

Some patients have elevated blood pressure while living in the plateau area, and their blood pressure quickly returns to normal after leaving the plateau area without treatment for blood pressure. This type of hypertension can be called altitude hypertension;

6). Hypertension during pregnancy:

The blood pressure before pregnancy is normal or low, and the diastolic blood pressure can rise as high as 85 mmHg after pregnancy, and the possibility of secondary hypertension is ruled out. This type of hypertension can be called pregnancy-induced hypertension;

7). Pulmonary hypertension:

After suffering from respiratory diseases such as bronchial asthma, chronic bronchitis or lung infection, blood pressure will increase. However, after the application of antibiotics, cough suppressants or bronchodilators, their blood pressure will be significantly reduced. This type of hypertension can be called pulmonary hypertension.

6. Pay attention to the multiple manifestations of primary hypertension combined with secondary hypertension

Primary hypertension can be accompanied by secondary hypertension at the same time, mostly due to atherosclerotic renovascular hypertension, obstructive sleep apnea syndrome, diabetic nephropathy, pregnancy-induced hypertension syndrome and endocrine-induced hypertension Etc., can exist alone or in combination.

Therefore, it is very important to pay attention to the presence or absence of secondary hypertension in the diagnosis and treatment of primary and specific hypertension. This is helpful for doctors to evaluate the risk of hypertension patients and take corresponding treatment measures.

7. Case analysis (1)

On March 7, 2016, outpatient: male, age: 48 years old, chief complaint: intermittently found high blood pressure for half a year, dizziness from time to time, blood pressure fluctuation for 2 weeks, and went to the outpatient clinic.

The patient’s blood pressure was found to be elevated six months ago. The self-tested blood pressure was higher than 140/90mmHg for many times, and the highest blood pressure measured occasionally was 180/100mmHg. In the past 2 weeks, due to heavy work pressure, he developed dizziness, general discomfort, and daytime sleepiness.
The blood pressure was measured several times at home, and the fluctuation was around 140-180/90-110mmHg, and there was no numbness and movement disorders.
Since the onset of the disease, the patient has had no abdominal pain, diarrhea, periodic paralysis, polydipsia, polyuria, and no blackout or syncope. Poor spirit, diet, sleep, and normal urination.

• Past history: No clear history of heart or kidney disease, and no history of diabetes, but a history of intermittent dizziness.
• Family history: Both parents are alive and there is no clear history of hypertension and obesity.
• Physical examination: BP: 160/100mmHg, obesity (body mass index = 28.4), thick breath sounds in both lungs, a little phlegm, heart rate 82 beats/min, regular rhythm. A2> P2, no murmur was heard in the auscultation area of ​​each valve.

Peripheral vascular signs: negative; main auxiliary examination items:

• 1. ECG: sinus rhythm, the ECG is roughly normal;
• 2. Cardiac color Doppler ultrasound: the size of each compartment is normal, and the left ventricular ejection fraction is normal;
• 3. Sleep breathing monitoring: respiratory obstruction occurs during sleep, with more than 7 apneas per hour, and 35 apneas during 7 hours of sleep; laboratory examination: no abnormalities in blood, urine, and stool routines;
• 4. The serum total cholesterol content is significantly increased> more than 670 mmol/L, and triglycerides are normal, that is, triglycerides <1.70 mmol/L.

Clinical diagnosis: sleep apnea syndrome (sleep apnea syndrome), hyperlipidemia

Diagnose based on:

• 1. Middle-aged obese men, “found high blood pressure for half a year, dizziness, blood pressure fluctuations for 2 weeks”;
• 2. Physical examination: BP 160/100mmHg, obesity, thick breath sounds in both lungs, a little phlegm, and no abnormalities;
• 3. Electrocardiogram: sinus rhythm, roughly normal; echocardiogram: no obvious abnormalities; 4. sleep breathing monitoring: severe obstructive sleep breathing disorder.

Differential diagnosis: Mainly differentiated from essential hypertension: the patient has no clear family history of hypertension, obese body type, sleep monitoring results help to distinguish.

Treatment:

According to the patient’s clinical symptoms, signs and auxiliary examinations, the main treatment measures taken are as follows:

• 1) Develop and strictly implement a weight loss plan: reduce the current intake of breakfast and lunch by 1/3, and dinner by 1/2, and the total calorie intake per day is about 1,200 kcal. It is recommended to walk to and from get off work to ensure that efforts are made to achieve the goal of 10,000 steps per day;
• 2) Accept and adhere to continuous positive airway pressure (CPAP) machine therapy through the nose;

Follow-up:

I am very emotional that the patient actively cooperated with the above treatment plan. During the night sleep, the ventilator was treated while maintaining weight loss. After a week of ventilator application, the blood pressure fell below 140/90mmHg, the body mass index was 26.1 after three months and 24.7 after 6 months , It is less than 24 after two years. Blood pressure and blood lipids have also returned to normal, as shown in the figure below:

COMMENTS:

This is a very simple case, but in clinical work, patients who can adhere to ventilator therapy and have the perseverance to lose weight are really rare. Therefore, we hope that our doctors and patients must pay attention to the cause and clinical value of non-drug treatment when diagnosing and treating hypertension.

(source:internet, reference only)

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