常见的5. 继发性高血压筛查的时机与治疗.pptVIP

继发性高血压筛查 的时机与治疗 国家心血管病中心 阜外医院-高血压中心 国家心血管病中心高血压专病医联体天津市中心 目 录 1. 继发性高血压定义和流行病学 2. 继发性高血压病因 3. 继发性高血压筛查时机与治疗 继发性高血压(secondary hypertension) 是病因明确的高血压，当查出病因并有效去除或控制病因后，作为继发症状的高血压可被治愈或明显缓解。 继发性高血压在高血压人群中占5%-10%，但随着对高血压发病机制研究的深入以及诊断技术的不断提高，这比例正逐渐上升。 定义及流行病学 继发性高血压分类 继发性高血压筛查重点人群 2013 ESH/ESC Guidelines for themanagement of arterial hypertension Table 8 Personal and family medical history 1.Duration and previous level of high BP,including measurements at home. 2. Secondary hypertension a)Family history of CKD (polycystic kidney). b) History of renal disease,urinary tract infection,hematuria,analgesic abuse(parenchumal renal disease). c) Drug/substance intake, e.g.oral conteaceptives, liquorice, carbenoxolone, vasoconstrictive nasal drops, cocaine,amphetamines, gluco-and mineralocorticosteroids, non-steroidal anti-inflammatory drugs,erythropoietin,cycolsporine. d) Repetitive cpisodes of sweating, headache, anxiety, palpitations (pheochromocytoma). e) Episodes of muscle weakness and tetany (hyperaldosteronism). f) Symptoms suggestibe of thyroid disease. 3.Risk factors 病 史 2013 ESH/ESC Guidelines for themanagement of arterial hypertension Table 9 Physical examination fou secondary hypertension, organ damage and obesity Signs suggesting secondary hypertension Features of Cushing syndrome. Skin stigmata of neurofibromatosis (pheochromocytoma). Palpation of enlarged kidneys(polycustic kidney). Auscultation of abdominal murmurs(renocascular hypertension). Auscultation of precordial or chest murmurs(aortic coarctation;aortic disease;upper extremity artery disease). Diminished and delayed femoral pulses and reduced fenoral blood pressure compared to simultaneous arm BP(aoritic coarctation;aortic disease;lower extremity artery disease). Left-right arm BP difference (aortic coarctation;subclavian artery stenosis). Signs of organ damage 体格检查 常规 血红蛋白、红细胞压积。•空腹血糖 TC、LDL-C、HDL-C、TG•血清钾，钠。•血清尿酸。•血清肌酐（估测GFR）。•尿常规 微量白蛋白尿 12导ECG 附加 HbA1C（FBG5.6mM/L或患糖尿病）•