White coat hypertension; white coat hypertension; White coat hypertension refers to people who go to the hospital and have elevated blood pressure measured in the doctor's office but return home to their own blood pressure or 24-hour dynamic blood pressure monitoring (carried by the patient with a blood pressure measuring device and no medical personnel present). This is the patient to see the white coat after the doctor...
Outpatient hypertension causes:
What are the causes of hypertension in the clinic? Why meet outpatient hypertension? What reason is outpatient hypertension caused? What disease is outpatient hypertension caused?
1. The occurrence of WCH may be related to the "pressure stimulation" of the patients by the medical staff. In a specific place, the tone and mood of the medical staff talking with patients can affect the measured blood pressure.
2. Patients themselves have an enhanced response to stress. Weber found activation of the renin-angiotensin system in WCH patients with increased plasma renin and aldosterone levels, as well as increased norepinephrine levels.
3.WCH patients have the genetic characteristics of the stress-related stress response and are part of the pre-hypertension state. Follow-up results show that white coat hypertension is not only manifested in increased blood pressure in the clinic but also in daily life, so WCH is not a benign disease.
Outpatient hypertension diagnosis details:
Health at the beginning of the disease library to introduce you in detail outpatient hypertension is how to return a responsibility? Outpatient hypertension manifestations? How is outpatient hypertension diagnosed? How does outpatient hypertension deal with?
General diagnosis: Verdecchia proposed that WCH be defined as the 90th percentile of the D-ABPM distribution for those whose mean daytime dynamic blood pressure (D-ABPM) is below normal blood pressure (SBP 131mmHg for normal women and SBP 86mmHg for normal men and SBP 136mmHg and Diastolic blood pressure 87mmHg).
The reference diagnostic criteria in China were as follows: systolic blood pressure >140mmHg and/or diastolic blood pressure BBB>mmHg in WCH patients, and daytime dynamic blood pressure systolic blood pressure <135mmHg diastolic blood pressure <80mmHg; It also needs to be verified and evaluated clinically. When hypertension is suspected in the clinic alone, home blood pressure measurement or dynamic blood pressure measurement should be used to assist diagnosis.
Differential diagnosis of outpatient hypertension:
Defining hypertension: standard measurement method is adopted according to diagnostic criteria.
II. Differentiation between primary and secondary hypertension (P268)
(1) renal parenchymal hypertension: the most common acute, chronic glomerulonephritis, diabetic nephropathy
(2) Renal artery stenosis: common. Unilateral or bilateral
Cause: Adolescent: congenital, inflammatory
Older adults: Atherosclerosis
Characteristics: (1) Moderate and severe increase in blood pressure (DBP) and poor antihypertensive drugs;
② upper abdomen or back costal ridge horn smell and vascular murmur
(3) pheochromocytoma
Located in the adrenal medulla or sympathetic nerve node, etc., secreting catecholamines.
Characteristics: ① Paroxyminal or persistent hypertension accompanied by sympathetic nervous excitation; ② General antihypertensive drugs are ineffective.
(4) primary aldosteronism
Adrenal cortical hyperplasia or neoplasms secreting excessive aldosterone
Characteristics: persistent mild to moderate hypertension accompanied by intractable hypokalemia
(5) Cushing syndrome
Adrenal cortical hyperplasia or tumor has secreted polysaccharide corticosteroids
Characteristics: Hypertension with abnormal glycoester metabolism
(6) aortic coarctation
Causes: congenital vascular malformation (mostly), multiple arteritis
Characteristics:① upper limb blood pressure increased and lower limb blood pressure is not high or reduced
② the interscapular area, parasternal, axillary collateral circulation artery pulsation and murmurs or abdominal vascular murmurs.
(7) hypertension during pregnancy
Prevention:
1. Prevent the main risk factors for hypertension, eat properly, lose weight, limit alcohol consumption, and engage in appropriate physical activity.
2. Pay attention to the adjustment of life style and prevent tension, correctly treat and try to relieve all kinds of psychological pressure.
Prognosis:
For WCH whether patients with poor prognosis and there is less agreement: a study that pure office blood pressure cannot be considered completely normal blood pressure and need to be careful follow-up another study suggests that WCH is the possibility of cardiovascular risk and lightweight close follow-up after a long time of severe hypertension, WCH increased risk of developing hypertension with the emergence of ambulatory blood pressure high blood pressure and cardiovascular risk probability also increases. A 54-year follow-up trial showed that more than half of WCH patients developed persistent hypertension, so WCH may be a predictor of the development of persistent hypertension. The incidence of cardiovascular disease and mortality in WCH is closely related to damage to the target organs of WCH and decreases with the antihypertensive treatment of WCH. Some studies have suggested that WCH blood pressure does not provide a good predictive value for prognosis. The Northwick Park study found that the 10-year cardiovascular risk rate was 7.9% in WCH and 22% in SH. Pradeep et al. believed that WCH had a lower incidence of cardiovascular events and less target organ damage. Compared with WCH, SH had a 4-fold higher incidence of cerebrovascular events and a 2-fold higher incidence of coronary heart disease, and a significantly lower mortality rate.
Diagnosis of hypertension by outpatient examination:
Health at the beginning of the disease library to your detailed introduction of outpatient hypertension should do what examination? An analog symptom of outpatient hypertension? Is outpatient hypertension easily confused with what symptom?
Guidelines for Outpatient Hypertension
Outpatient hypertension guidelines for outpatient hypertension patients to the hospital often appear to answer questions, such as outpatient hypertension hanging what department number? What disease may outpatient hypertension suffer from? Are symptoms easily confused with outpatient hypertension? What do doctors usually ask? And so on. The guideline for outpatient hypertension treatment aims to facilitate outpatient hypertension patients to seek medical treatment and solve the problems of outpatient hypertension patients.
Advice to the department
The psychological consultation:
Possible disease
1. Secondary hypertension, which may be accompanied by refractory hypertension, accompanied by hypertension, emotional hypertension, and other symptoms, should be referred to the Department of Cardiovascular Medicine.
2. Pregnancy poisoning, which may be accompanied by high blood pressure, pregnancy hypertension, ocular fundus changes, and other symptoms, should go to ophthalmology or obstetrics.
3. White coat hypertension may be accompanied by symptoms such as high blood pressure, consistently increased blood pressure measured in the diagnosis room, hypertension in the outpatient department, etc., and should be referred to the Department of Cardiology.
4. Senile systolic hypertension, which may be accompanied by high blood pressure, palpitation, fatigue, and other symptoms, should be referred to the Department of Cardiology.
5. Hypertensive encephalopathy, which may be accompanied by coma, dyspnea, death by overwork, and other symptoms, should be referred to the cardiovascular department or brain surgery department.
Confounding symptom
Recalcitrant hypertension, emotionality hypertension, cervical hypertension, decapitation hypertension, pregnancy hypertension
The related inspection
1. MRI, magnetic resonance imaging (MRI) has diagnostic significance for the lesions of the nervous system, spinal cord, and spine, the lesions of cardiac great vessels, the examination of abdominal pelvic organs, and joint soft tissue lesions.
2. Cardiovascular angiography, Cardiovascular angiography can understand the physiological and anatomical changes of the heart and blood vessels, and is a valuable method for the diagnosis of cardiovascular diseases.
3, ultrasonic diagnosis of cardiovascular diseases, Doppler echocardiography can be used to analyze the thickness of the heart wall, movement speed, amplitude, slope, valve and another high-speed movement of the trajectory and blood flow direction, blood flow properties.
4. Optometry. Optometry aims to examine the refractive interstitium of the eye (cornea, aqueous humor, lens, and vitreous body) and the fundus of the eye (optic disc, retina, and choroid).
5. Urine amygdalic acid and catecholamine are almost all metabolized in the body, and the product is VMA.