内科学中的高血压PPT.ppt

; 病因 发病机制 病理 临床表现 实验室检查 诊断标准 鉴别诊断 治疗;Epidemiology of Hypertension ;Define hypertension ;病 因(pathogeny);发病机制(mechanisms of essential hypertension)-3;;;病 理;临床表现;实验室检查;诊断标准(Diagnosis);正确的血压测量;类别;其他危险因素和病史;继发性高血压（secondary hypertension）;病因： chronic renal diseases Diabetic nephropathy Hypertension during chronic dialysis and after renal transplantation 发病机制： 肾单位大量丢失，导致水钠潴留和细胞外容量增加 RAAS激活与排钠激素减少 高血压又加重肾小球囊内压，加重肾脏病变;肾实质性高血压;治疗：(treatment) Sodium intake ＜3g/d Goal BP,130/80mmHg ACEI或ARB ; Two major forms:atherosclerosis, Fibromuscular dysplasias Clinical clues: onset of hypertension before 30 or after 50 years of age Abrupt onset of hypertension Severe or resistant hypertention Symptoms of AS disease elsewhere Smoker orsening renal function with ACEI Abdominal or flank bruit Tests: ultrasonography, magnetic resonance angiography, CT scan, Angiography. (gold standard test) ;治疗：treatment 经皮肾动脉成形术 手术治疗：血运重建；肾移植；肾切除 药物治疗:不适宜上述治疗的可采用药物治疗 双侧肾动脉狭窄、肾功能已受损或非狭窄侧肾功能较差的患者禁用ACEI或ARB;病因及发病机理： 肾上腺皮质增生或肿瘤分泌过多的醛固酮，导致水钠潴留所致(aldosterone-producing adenoma70-80%,idiopathic hyperaldosteronism 20-30%. 诊断：excessive production of aldosterone , sodium retention, weight gain, hypertension,hypokalemia and metabolic alkalosis, 多数患者长期低血钾，有无力、周期性麻痹、烦渴、多尿等症, 血压轻、中度升高 实验室检查低血钾、高血钠、代碱, 血浆肾素活性降低，血尿醛固酮增多（醛固酮/肾素 ）, 超声、放射性核素、CT可确定病变性质和部位。 治疗：首选手术治疗 肾上腺皮质增生术后仍需降压治疗，宜选择螺内酯和长效钙拮抗剂;病因：the 4th leading cause of congenital heart disease 诊断： Diminished femoral pulses and a systolic pressure gradient between BPs obtained in the arms and legs上肢血压增高而下肢血压不高或反而降低 A loud systolic murmur 肩胛间区、胸骨旁、腋部有侧枝循环的动脉搏动和杂音、腹部听诊血管杂音 3 sign :胸片见肋骨受侧支动脉侵蚀引起的切迹 Definite diagnosis requires aortography;主动脉造影可确定诊断 治疗：surgery ;发病机制： 90% arise from adrenal gland,嗜铬细胞间歇或持续释放过多肾上腺素、去甲肾上腺素、多巴胺 诊断： five Hs: hypertension , headache,hypermetabolism, hyperhydrosis,hyperglycemia,典型的发作表现为阵发性血压升高伴心动过速sinus tachycardia、头痛、出汗、面色苍白 24-hr urine for metanephrines,VMA,catec