What are the classifications of hypertension?

Hypertension is a chronic disease of the human body. Suffering from hypertension can affect physical health and easily lead to some cardiovascular and brain diseases, which is very harmful to physical health. Hypertension is divided into many types, generally divided into high-incidence hypertension and secondary hypertension. Suffering from hypertension can easily cause dizziness, physical fatigue, etc.

Classification

Clinically, hypertension can be divided into two categories:

1. Essential hypertension

It is an independent disease with high blood pressure as the main clinical manifestation and whose cause is not yet clear, accounting for more than 90% of all hypertensive patients.

2. Secondary hypertension

Also known as symptomatic hypertension, in this type of disease the cause is clear, hypertension is only one of the clinical manifestations of the disease, and blood pressure may rise temporarily or permanently.

Clinical manifestations

Symptoms of high blood pressure vary from person to person. There may be no symptoms or mild symptoms in the early stages. Common symptoms include dizziness, headache, stiff neck, fatigue, palpitations, etc. Blood pressure only rises after fatigue, mental stress, or emotional fluctuations, and returns to normal after rest. As the disease progresses, blood pressure continues to rise significantly, and various symptoms gradually appear. This is called slow-onset hypertension. Common clinical symptoms of slowly progressive hypertension include headache, dizziness, inattention, memory loss, limb numbness, increased nocturia, palpitations, chest tightness, fatigue, etc. The symptoms of hypertension are related to blood pressure levels. Most symptoms can be aggravated after stress or fatigue. Blood pressure can rise rapidly after early morning activities, resulting in morning hypertension, which causes cardiovascular and cerebrovascular events to occur more frequently in the early morning.

When blood pressure suddenly rises to a certain level, symptoms such as severe headache, vomiting, palpitations, dizziness, etc. may even occur. In severe cases, unconsciousness and convulsions may occur. This is a form of rapid hypertension and critical hypertension, which can cause serious damage and lesions to the heart, brain, kidneys and other organs in a short period of time, such as stroke, myocardial infarction, renal failure, etc. There is no consistent relationship between symptoms and the level of elevated blood pressure.

The clinical manifestations of secondary hypertension are mainly related to the symptoms and signs of the primary disease, and hypertension is only one of its symptoms. The increase in blood pressure in patients with secondary hypertension may have its own characteristics. For example, hypertension caused by aortic stenosis may be limited to the upper limbs; the increase in blood pressure caused by pheochromocytoma is paroxysmal.

examine

1. Physical examination

(1) Measure blood pressure correctly. Because blood pressure fluctuates and emotional excitement and physical activity can cause temporary increases in blood pressure, hypertension can only be diagnosed when elevated blood pressure is measured at rest at least twice on different days, and the blood pressure value should be calculated as the average of three consecutive measurements. A careful physical examination can help reveal clues to secondary hypertension and target organ damage.

(2) Measure body mass index (BMI), waist circumference, and hip circumference.

(3) Check the arterial pulses and neurological signs of the limbs, and auscultate the carotid arteries, thoracic aorta, abdominal arteries, and femoral arteries for bruits.

(4) Observe for the presence of Cushing's facies, neurofibromatous skin macules, hyperthyroidism exophthalmos, or lower limb edema.

(5) Comprehensive cardiopulmonary examination.

(6) Comprehensive and detailed understanding of the patient’s medical history.

2. Laboratory examination

It can help determine the cause of hypertension and the functional status of target organs. Routine examination items include routine blood test, routine urine test (including protein, sugar and urine sediment microscopy), renal function, blood sugar, blood lipids, blood potassium, echocardiogram, electrocardiogram, chest X-ray, fundus, dynamic blood pressure monitoring, etc.

Further examinations such as fundus and carotid artery ultrasound can be performed according to needs and conditions. 24-hour dynamic blood pressure monitoring helps to determine the severity of high blood pressure, understand the circadian rhythm of blood pressure, monitor morning blood pressure, guide antihypertensive treatment, and evaluate the efficacy of antihypertensive drugs.