One, to determine whether the hypertension: measurement of high blood pressure should be days repeatedly to measure blood pressure, there are more than two times of elevated blood pressure, party is hypertension.
In two, the differential cause of hypertension: who met in hypertensive patients, should be asked in detail about the history, a comprehensive system of inspection, to the exclusion of symptomatic hypertension.
Laboratory examination can be helpful in diagnosis of primary hypertension and type, knowledge about the target organ function, is also beneficial to the treatment of proper selection of drugs. Blood and urine routine, renal function, blood lipid, blood glucose, uric acid, electrolyte ( especially potassium ), electrocardiogram, chest X-ray and fundus examination should be used as the routine examination in patients with hypertension.
( a ) blood red cell and hemoglobin in general no abnormalities, but accelerated hypertension can have Coombs test negative microangiopathic hemolytic anemia, red blood cell, hemoglobin with deformity of high blood viscosity increase, predisposing to thrombosis complications ( including cerebral infarction ) and left ventricular hypertrophy.
( two) urine routine early patient and normal urine, kidney function is impaired when concentrated urine specific gravity drops gradually, can be a small amount of urine protein, red blood cell, occasionally tube type. With the progress of renal lesions, urinary protein excretion increased, in benign nephrosclerosis as a 24 hour urine protein in 1g, prompting a poor prognosis. Red cells and tube type can also be increased, tube type is transparent and particles.
( three) renal function by blood urea nitrogen and creatinine to estimate renal function. Early patient examination no abnormalities, renal parenchyma damaged to a certain extent can begin to rise. Adult creatinine >114.3 μmol/L, the elderly and pregnancy >91.5μ mol/L tips with renal damage. Phenolsulfonphthalein excretion test, urea clearance rate, creatinine clearance rate may be lower than normal.
( four) chest X-ray examination showed aortic, especially the ascending, arch tortuous and prolonged, the ascending, arch or the descending part of the expansion. Emergence of hypertensive heart disease with left ventricular enlargement, with left heart failure left ventricular enlargement, heart failure is left and right ventricle were increased, and pulmonary congestion. Pulmonary edema is seen between pulmonary marked hyperemia, a butterfly shaped fuzzy shadow. Should routine radiographic examination, in order to check comparison before and after.
( five) electrocardiographic left ventricular hypertrophy EKG showed left ventricular hypertrophy or both. Electrocardiographic diagnosis of left ventricular hypertrophy of the standard are endless and same, but their sensitivity and specificity were 68% ～77%, false negative, false positive 4%～ 6%, visible electrocardiographic diagnosis of left ventricular hypertrophy sensitivity is not high. Due to left ventricular diastolic compliance decreased, left atrial diastolic load increased, ECG can appear P Bozeng broad, concave, Pv1 terminal potential negative increase, the performance may even appear in the electrocardiogram findings of left ventricular hypertrophy before. With arrhythmias such as atrial fibrillation, ventricular premature contraction.
( six) ultrasound heartbeat graph is considered, and the chest X-ray examination, electrocardiogram, ultrasound heartbeat graph is the diagnosis of left ventricular hypertrophy is the most sensitive, reliable means. In the two-dimensional ultrasound localization based on records of ultrasound M type curve or directly from the 2D image for measurement, the septum and ( or ) or ventricular posterior wall thickness >13mm to the left ventricular hypertrophy. Hypertension left ventricular hypertrophy is symmetrical, but there is about 1/3 ( mainly to septal hypertrophy of interventricular septum and left ventricular posterior wall thickness less than >1.3 ), the upper end of septal hypertrophy often appear first, the hypertensive effects of the left ventricular outflow tract. Ultrasonic heartbeat graph can be observed in other cardiac chambers, valves and aortic root and can be used for heart function test. Early detection of left ventricular hypertrophy while heart function such as the cardiac output, left ventricular ejection fraction is normal, but the left ventricular systolic and diastolic compliance decreased myocardial contraction, such as maximum rate (Vmax ) decreased, isovolumic extension, mitral valve opening delay. In left heart failure, ultrasound heartbeat graph examination can be found in left ventricular, left atrial ventricular enlargement, left ventricular contractile activity weakened.
( seven) the fundus examination measurement of retinal central artery pressure increased in the condition of visible, different stages of development of visible following fundus change:
Class I: retinal artery spasm
Class II A: retinal arterial sclerosis
B: retinal artery significantly hardened
Grade: Grade II and retinal lesions ( bleeding or exudation )
Ⅳ: III and papilledema
( eight) other examinations of patients with serum total cholesterol, triglyceride, low density lipoprotein cholesterol increased and high density lipoprotein cholesterol decreased, and apolipoprotein A-Ⅰreduction. But also have a high blood sugar and hyperuricemia. The part of the patient plasma renin activity, angiotensin II levels.
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