dangerous moments of high blood pressure

Core clew: patients with high blood pressure because long-term blood pressure is bigger, the blood vessels in the spasticity, so that blood vessel elasticity decreased, and the brittleness increases, if at this time due to some reason contributing to increased blood pressure suddenly, is easy to cerebral hemorrhage, cerebral vascular rupture and causing this for patients with high blood pressure, is undoubtedly the most fatal blow. Therefore, patients with hypertension should try to avoid a sudden rise in blood pressure, especially under the following circumstances, should be more cautious. Due to the long-term pressure on blood vessels, blood vessels are in a spasm state in patients with hypertension, resulting in decreased vascular elasticity and increased brittleness. If blood pressure rises suddenly due to some reason at this time, it is easy to cause cerebral vascular rupture and cerebral hemorrhage, which is undoubtedly the most fatal blow for patients with hypertension. Therefor

A Case of High Blood Pressure: A Caution

In the busy clinical work, we often fail to pay enough attention to some seemingly simple cases, which leads to our neglect of the most basic clinical foundation, that is, the collection of medical history and the interpretation of test results. Here, I would like to share with you a recent clinical encounter in the cause of hypertension.

 

The patient is an elderly male with repeated dizziness for more than 20 years and a history of hypertension for more than 20 years. He has been hospitalized in our hospital and is now taking "Nifedipine Controlled-Release Tablets 30mg QD" to control his blood pressure. His blood pressure is usually on the high side and generally fluctuates between 160 and 180/80 and 100 mmHg. This time I have been sent to our department for treatment due to dizziness. When entering the department, the main symptom is dizziness, showing drowsiness, without dizziness, recent sleep is still acceptable, accompanied by headache, showing blood vessel distension, and pain. Physical examination: blood pressure 192/80 mmHg, neurological examination, cardiopulmonary examination, and abdominal examination were not special.

 

Then treat it first according to primary hypertension, and then urgently check the biochemical, coagulation, and other indicators to see if there is any need for emergency treatment. Biochemical return on the day, serum potassium 3.01 mmol/L, did not think so much at that time, gave immediate oral potassium supplement, at the same time the next day biochemical review.

 

The director rounds the next day, the director asks: how much blood potassium checks? 2.95mmol/L, still low. Have secondary hypertensive expression at ordinary times? After immediately asking the medical history, I learned that I was accompanied by sweating, elevated blood pressure, and no facial flushing or palpitation when I had dizziness and headache in the afternoon. At the same time, the patient's previous hospitalization data were consulted, and it was found that there were also low levels of serum potassium. The director immediately instructed that 4 items of hypertension and 3 items of adrenal function should be improved. At the same time, the head MRI+MRA should be improved to detect cerebrovascular and substantive problems. Besides, aldosterone should be added and potassium should be supplemented appropriately.

 

Sure enough, after a few days, four hypertension (in the decubitus position) were reported: aldosterone/renin activity ratio 43.36, adrenal function 3, and no significant abnormality in cranial MR. Abdominal CT was arranged to locate the adrenal gland immediately. Results: Multiple adrenal nodules were found in bilateral adrenal glands and adenomas were considered. After years of perplexing patients with dizziness and high blood pressure, the cause has finally been found: primary aldosteronism.

 

Primary aldosteronism is caused by hyperplasia or tumor of the adrenal cortex resulting in excessive voluntary secretion of aldosterone, resulting in increased potassium excretion in the distal convoluted tubule of the kidney, sodium and water retention in the body, and thus increasing the effective blood volume and blood pressure. Clinically, it is characterized by long-term hypertension with hypokalemia, and some patients have normal serum potassium. Symptoms may include muscle weakness, periodic paralysis, dysphoria, polyuria, and other symptoms. Most of the blood pressure is mild to moderate elevation, about 1/3 of the performance of intractable hypertension. Laboratory tests showed hypokalemia, hypersodium, metabolic alkalosis, decreased plasma renin activity, and hyperaldosteronism in plasma and urine. The increase of plasma aldosterone/plasma renin activity ratio has higher diagnostic sensitivity and specificity. Ultrasound, radionuclide, CT, and MRI can determine the nature and location of the lesion.

 

This simple case of hypertension, also to our front-line clinicians put forward some "warning". First, attention should be paid to the integrity of the medical history collection, and should not ignore the detailed collection of relevant differential medical history because of the simple disease and mild disease. Second, the abnormal laboratory indicators should be more interpreted, do not miss the "small" indicators that may point to the information. At the same time, if the patient has previous hospitalization history, the abnormal information at that time should be examined in detail for our reference and to make an accurate judgment on the condition.

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