Hypertension

Hypertension是一种心脏慢性疾病,全身动脉血压升高. 它与低血压相反. Hypertension is classified as either primary (essential) or secondary. About 90-95% of cases are termed "primary hypertension", which refers to high blood pressure for which no medical cause can be found. 其余5-10%的病例(继发性Hypertension)是由其他影响肾脏的疾病引起的, 动脉, 心, 或者内分泌系统.

Persistent hypertension is one of the risk factors for stroke, 心肌梗死, 心力衰竭和动脉瘤, 是导致慢性肾衰竭的主要原因. Moderate elevation of arterial blood pressure leads to shortened life expectancy. 改变饮食和生活方式可以改善血压控制,降低相关健康并发症的风险, 尽管对于那些生活方式改变无效或不充分的病人来说,药物治疗可能是必要的.

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症状
Mild to moderate essential hypertension is usually asymptomatic.

加速Hypertension
Accelerated hypertension is associated with headache, 睡意, 混乱, 视力障碍, 恶心想吐, and 呕吐 symptoms which are collectively referred to as hypertensive encephalopathy. Hypertension性脑病是由严重的小血管充血和脑肿胀引起的, 如果血压降低,哪一种是可逆的.

孩子们
有些体征和症状在新生儿和婴儿中尤为重要,例如发育不良, 癫痫发作, 易怒, 精力不足, 呼吸困难. 在儿童, Hypertension会引起头痛, 乏力, 视力模糊, 流鼻血, 还有面瘫.

即使有上述临床症状,小儿Hypertension的真实发病率也不得而知. In adults, hypertension has been defined due to the adverse effects caused by hypertension. 然而, 在儿童, 类似的研究还没有彻底地将任何副作用与血压升高联系起来. 因此, 由于缺乏科学知识,儿童Hypertension的患病率仍然未知.

继发性Hypertension
一些额外的体征和症状表明Hypertension是由激素调节紊乱引起的. Hypertension combined with obesity distributed on the trunk of the body, accumulated fat on the back of the neck ('buffalo hump'), wide purple marks on the abdomen (abdominal striae), 或者最近出现的糖尿病表明这个人有一种被称为库欣综合征的激素紊乱. Hypertension caused by other hormone disorders such as hyperthyroidism, 甲状腺功能减退, 或者生长激素过量会伴随着这些疾病特有的额外症状. 例如, 甲状腺机能亢进会导致体重减轻, 震动, 心率异常, 手掌变红, 出汗增多. 与生长激素过量相关的体征和症状包括面部特征变粗, 下颚的突出, 舌头肿大, 毛发过度生长, 皮肤颜色变深, 出汗过多. 其他激素紊乱,如高醛固酮增多症,可能会引起麻木等不太具体的症状, 过度的排尿, 过度出汗, 电解质失衡和脱水, 血液碱度升高. 

怀孕
Hypertension in pregnant women is one symptom of pre-eclampsia. Pre-eclampsia can progress to a life-threatening condition called eclampsia, 尿液中蛋白质的形成过程是什么, 广义肿胀, 严重的癫痫发作. 其他表明大脑功能受损的症状可能出现在癫痫发作之前,如恶心, 呕吐, 头痛, 以及视力丧失.

除了, the systemic vascular resistance and blood pressure decrease during pregnancy. 身体必须通过增加心输出量和血容量来补偿,以提供子宫-胎盘动脉床足够的循环.

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成因及风险因素

原发性Hypertension
Essential hypertension is the most prevalent hypertension type, 影响90-95%的Hypertension患者. 尽管目前还没有确定直接原因, there are many factors such as sedentary lifestyle, 吸烟, 压力, 内脏肥胖, 缺钾(低钾血症), 肥胖(超过85%的病例发生在身体质量指数大于盐(钠)敏感性的人群中, 饮酒, and vitamin D deficiency that increase the risk of developing hypertension. 风险也随着年龄的增长而增加, 一些遗传基因突变, 并且有Hypertension家族史. 肾素升高肾素水平升高, 肾脏分泌的一种激素, 是另一个风险因素, 交感神经系统过度活跃也是如此. 胰岛素抵抗, which is a component of syndrome X (or the metabolic syndrome), 也会导致Hypertension吗. 最近的研究表明,低出生体重是成人原发性Hypertension的危险因素.

继发性Hypertension
Secondary hypertension by definition results from an identifiable cause. 认识到这种类型很重要,因为它与原发性Hypertension的治疗方法不同, by treating the underlying cause of the elevated blood pressure. Hypertension results in the compromise or imbalance of the pathophysiological mechanisms, 比如调节激素的内分泌系统, that regulate blood plasma volume and 心 function. Hypertension的病因有很多, some are common and well recognized secondary causes such as Cushing's syndrome, which is a condition where the adrenal glands overproduce the hormone cortisol. 除了, Hypertension是由其他引起激素变化的疾病引起的,比如甲状腺机能亢进, 甲状腺功能减退, 肾上腺髓质的某些肿瘤(如.g.嗜铬细胞瘤). 其他 common causes of secondary hypertension include kidney disease, 肥胖和代谢紊乱, 妊娠期先兆子痫, the congenital defect known as coarctation of the aorta, 以及某些处方药和非法药物.

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诊断
Hypertension is generally diagnosed on the basis of a persistently high blood pressure. Usually this requires three separate sphygmomanometer measurements at least one week apart. Often, this entails three separate visits to the physician's office. 对Hypertension患者的初步评估应包括完整的病史和体格检查. 异常, 如果海拔非常高, 或者,如果出现器官损伤的症状,则可以立即进行诊断和治疗.

一旦诊断出Hypertension, 医生将尝试根据危险因素和其他症状来确定潜在的原因, 如果存在. Secondary hypertension is more common in preadolescent children, 多数病例由肾脏疾病引起. 原发性或原发性Hypertension在青少年中更为常见,具有多种危险因素, including obesity and a family history of hypertension. 还可以进行实验室检查以确定继发性Hypertension的可能原因, and determine if hypertension has caused damage to the 心, 眼睛, 和肾脏. 通常还会对糖尿病和高胆固醇水平进行额外的检查,因为它们是心脏病发展的额外风险因素,需要治疗.

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治疗方案

生活方式的修改
治疗Hypertension的第一步和预防生活方式的改变是一样的,比如改变饮食习惯, 体育锻炼, 还有减肥, 这些都被证明能显著降低Hypertension患者的血压. If hypertension is high enough to justify immediate use of medications, lifestyle changes are still recommended in conjunction with medication. 药物处方应考虑到患者的绝对心血管风险(包括心肌梗死和中风的风险)以及血压读数, in order to gain a more accurate picture of the patient's cardiovascular profile. Different programs aimed to reduce psychological 压力 such as biofeedback, relaxation or meditation are advertised to reduce hypertension. 然而, in general claims of efficacy are not supported by scientific studies, 总的来说,哪些是质量较低的.

关于饮食的改变, a low sodium diet is beneficial; A Cochrane review published in 2008 concluded that a long-term (more than 4 weeks) low sodium diet in Caucasians has a useful effect to reduce blood pressure, both in people with hypertension and in people with normal blood pressure. 也, DASH饮食(停止Hypertension的饮食方法)是由国家心脏协会推广的一种饮食, 肺, 和血液研究所(国立卫生研究院的一部分), a United States government organization) to control hypertension. A major feature of the plan is limiting intake of sodium, and it also generally encourages the consumption of nuts, 全谷物, 鱼, 家禽, fruits and vegetables while lowering the consumption of red meats, 糖果, 和糖. It is also rich in potassium, magnesium, and calcium, as well as protein.

药物

抗Hypertension药物
几类药物, collectively referred to as antihypertensive drugs, 目前是否可用于治疗Hypertension. 某一类药物通常具有相似的药理作用机制, and in many cases have an affinity for similar cellular receptors. 这个规则的一个例外是利尿剂, 为了简单起见,将它们组合在一起,但实际上是通过许多不同的机制发挥作用的.

Reduction of the blood pressure by 5 mmHg can decrease the risk of stroke by 34%, 缺血性心脏病的发病率降低了21%, 减少患痴呆症的可能性, 心脏衰竭, 心血管疾病的死亡率. The aim of treatment should be reduce blood pressure to <140/90 mmHg for most individuals, 患有糖尿病或肾脏疾病的人更低(一些医学专家建议将水平保持在120/80毫米汞柱以下)。. 如果没有达到血压目标, 应改变治疗方法,因为治疗惯性是控制血压的明显障碍. Comorbidity also plays a role in determining target blood pressure, with lower BP targets applying to patients with end-organ damage or proteinuria.

Often multiple drugs are combined to achieve the goal blood pressure. 常用的处方药包括:

  • ACE抑制剂(e).g.卡托普利)
  • 受体阻滞剂(e.g.哌唑嗪)
  • 血管紧张素II受体拮抗剂.g.洛沙坦)
  • 受体阻滞剂(e.g.普萘洛尔)
  • 钙通道阻滞剂(e.g.维拉帕米)
  • 利尿剂(e.g. 氢氯噻嗪)
  • 直接肾素抑制剂.g.aliskiren)

Some examples of common combined prescription drug treatments include:

  • A fixed combination of an ACE inhibitor and a calcium channel blocker. One example of this is the combination of perindopril and amlodipine, 它的功效已经在患有葡萄糖耐受不良或代谢综合征的个体中得到证实.
  • 一种利尿剂和ARB的固定组合.

Combinations of an ACE inhibitor or angiotensin II-receptor antagonist, 利尿剂和非甾体抗炎药(包括选择性COX-2抑制剂和非处方药,如布洛芬)应尽可能避免,因为有很高的急性肾功能衰竭风险. 

在老年人中
用处方药治疗中度至重度Hypertension可以降低80岁以下人群的死亡率,但80岁以上人群的死亡率没有下降. Even though there was no decrease in total mortality, the results showed similarities between cardiovascular mortality and morbidity.

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先生,Sateesh C., MD
Sateesh先生,医学博士
主治医师,血管外科
  • 血管Surgery
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戈亚尔,阿伦,医学博士
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伊戈尔·拉斯科夫斯基., MD
  • 血管Surgery
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马特奥,罗密欧., MD
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