11/18/2012

My blood pressure ambulatory capacity ( 140/84 ) and sitting volume (120/78) how so much difference.

Patients: the onset of hypertension two years hospital ( the first people's Hospital of Changshou City ) diuretics and Hua antagonist class medicine used the morning ( bed volume ) systolic blood pressure frequently in 142 diastolic pressure in about 84 days (sitting volume ) blood pressure normal recently found accidentally in the same time in bed than sitting systolic blood pressure to the amount of 16-20 high mercury diastolic blood pressure 4=6 higher mercury and orthostatic hypertension symptoms on the contrary please experts about blood pressure ambulatory capacity than sitting systolic to diastolic blood pressure is high also is how a matter? Is the bed out correct or sitting out right? Hope the doctor busy detail reply to the next grateful!!

Henan Academy of traditional Chinese Medicine Hospital Cardiovascular branch Wang Yumin:

Suggest you measuring standing blood pressure level, the best being a 24 hour ambulatory blood pressure, to determine whether it is really like what you said is orthostatic hypotension. If it is low, we should go to the hospital to check, is a neuroendocrine regulation of blood pressure of dysfunction. Orthostatic hypotension due to postural changes, such as from a supine position suddenly turns into a long time standing upright, or occurrence of hypotension. Usually think, standing systolic pressure than the supine position and by 20 mm Hg or diastolic blood pressure lowering of 10 mm Hg, i.e. as orthostatic hypotension. Orthostatic hypotension is divided into sudden and secondary two. Sudden because the plant nerve function disorder, caused by orthostatic arteriolar contractile dysfunction. The main manifestations are upright when low blood pressure, but also accompanied by unstable, blurred vision, be dizzy, weak and feeble, incontinent, serious will happen when the syncope. Secondary common in spinal disease, acute infectious disease or severe infections ( such as lobar pneumonia ), endocrine disorders, chronic malnutrition or the use of antihypertensive drugs, sedatives after.

Orthostatic hypotension is a common disease of the elderly, according to statistics, 65 years of age or older orthostatic hypotension accounted for about 15%, 75 years of age or older can be as high as 30% ~50%. The elderly due to heart and blood vessel system gradually hardening, vascular elastic fibers can also be reduced, sympathetic enhancement, can make the elderly isolated systolic blood pressure elevation. Chronically high blood pressure, not only impaired baroreceptor ( located in the carotid artery. ) sensitivity, also affect vascular and ventricular compliance. When the position changed suddenly or antihypertensive drugs, in a sudden drop in blood pressure at the same time, ischemia danger increases greatly. In addition, the elderly poor tolerance to insufficient blood volume energy, may be related to ventricular diastolic filling disorder. Therefore, any of the acute disease leading to loss of excessive or insufficient, oral liquid, or taking antihypertensive and diuretic, and usually less activity and long-term bedridden patients, standing after easily cause orthostatic hypotension.

Causes of orthostatic hypotension are common reasons: 1 systemic diseases: dehydration, adrenal insufficiency; 2 pure autonomic nervous dysfunction; 3 central nervous system diseases: Shy-Drager syndrome, brain stem lesions of Parkinson disease, spinal disease, multiple cerebral infarction; 4 peripheral and autonomic neuropathy: diabetes mellitus, starch degeneration, bone marrow tuberculosis, tumor syndrome, alcohol and nutritional diseases; 5 drugs: phenothiazine and other antipsychotics, monoamine oxidase inhibitors, tricyclic antidepressants, antihypertensive drugs, levodopa, chlorpromazine. Vasodilators, such as nitrates, beta blockers, calcium channel blockers, such asα - receptor blocker prazosin and other central antihypertensive agents, such as methyl dopa, clonidine. Diagnostic methods: older people such as orthostatic dizziness complaints and mild is fuzzy, the clinician cannot believe that he is suffering from orthostatic hypotension. Should let the patient supine for at least 5 minutes after measuring blood pressure and pulse rate, and then quiet standing after 1 minutes of measuring blood pressure and pulse rate, continue to stand for 3 minutes, and then measured the blood pressure and pulse rate. Hypotension may be standing immediately or after a delay of appearance. In order to detect the performance of hypotension may be prolonged duration of standing up or tilt test. Before beginning treatment, blood pressure measurement should be repeated to confirm the orthostatic hypotension persisted. Symptomatic patients should not be fasting for taking blood pressure lowering drug, postprandial to prostrate. Reduce the antihypertensive drug dose and use Shaoshiduocan method eating may also help. Recent data suggest that in some patients after eating walking can help restore normal circulation, but such therapy should only under strict monitoring implementation.

Treatment: due to drug-induced, severe orthostatic hypotension should be under the guidance of a doctor's medication adjustments. On the autonomic nervous dysfunction in patient studies show, indomethacin 50mg every 6 hours 1, caffeine in 250mg with or without using dioxygen ergotamine 6~ 10mg/kg subcutaneous injection or somatostatin 12~ 16mg subcutaneous injection before meals may improve after eating hypotension. In the morning caffeine should only be given, so that its role in night disappear, so as not to affect the sleep of patients and to avoid the occurrence of drug tolerance. In general medicine for functional abnormalities resulting in orthostatic hypotension effect is not good, and Chinese traditional medicine treatment has a good effect, and no side effects. Hypotension due to body neuroendocrine function leads to traditional Chinese medicine has a good effect. Recommend taking traditional Chinese medicine treat.



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