What examinations to undergo to detect hypertension

Collection of complaints, hereditary and life history

An increase in the level of blood pressure in the first stages is asymptomatic, it is detected by random examination. When the disease has lasted for some time, there are signs of damage to the target organs. At first, the changes are reversible (since only the function is disturbed), then it becomes impossible to reverse them: the walls of the vessels undergo restructuring, the structure of the tissues of the blood-supplied organ changes.

Signs of target organ damage

If arterial hypertension has caused functional or structural changes in the vascular wall at the periphery or in centrally located organs, this will lead to the appearance of clinical symptoms.

1. Brain damage is manifested by the following symptoms:
   • headache - one of the first complaints at the prehospital stage;
   • dizziness;
   • transient ischemic attacks (clouding of consciousness up to fainting);
   • impaired sensory function of nerve endings (numbness, paresthesia);
   • movement disorders (transient or persistent loss of muscle control);
   • to an extreme degree - signs of a stroke (circulatory disorders of the brain).
2. The pathological effect of hypertension on the heart is manifested:
   • pain behind the breastbone as a result of myocardial ischemia (as an option - a feeling of discomfort);
   • the extreme option is acute coronary syndrome (pain is gaining intensity, necrosis of cardiomyocytes and fear of death join);
   • violations of the frequency and depth of respiratory movements, possibly a subjective feeling of lack of air;
   • heart attacks;
   • arrhythmias;
   • fainting (due to systolic dysfunction).
3. The effect of increased pressure on the kidneys is manifested as follows:
   • constant thirst (night awakenings are characteristic in order to drink water);
   • nocturia - the need to wake up at night to urinate (while the volume of daytime urine is two-thirds or less of the daily urine output);
   • hematuria - the appearance of red blood cells in the urine (the patient notices a pinkish tint of the discharge).
4. Symptoms of peripheral arterial disease:
   • cold skin of the limbs;
   • leg pain that increases with walking and goes away at rest (called intermittent claudication).
5. Respiratory system changes:
   • night snoring;
   • stimulation of the development of chronic lung diseases;
   • apnea (lack of breathing) sleep.

Indicators indicating the secondary genesis of hypertension

When questioning the patient, the following facts are found out:

• a family member with chronic kidney disease (polycystic);
• the patient had kidney problems, frequent urinary tract infections, blood appeared in the urine (episodes of hematuria);
• the patient used the following means:
  • oral contraceptives;
  • licorice preparations;
  • decongestants (vasoconstrictor drugs for the common cold);
  • non-steroidal anti-inflammatory drugs (in uncontrolled amounts);
  • amphetamines;
  • cocaine;
• there were repeated attacks, accompanied by increased sweating, anxiety, heart palpitations and headache (characteristic of pheochromocytoma);
• cramps and muscle weakness periodically appear (this is how hyperaldosteronism manifests itself);
• symptoms of thyroid lesion - tremor, palpitations, hyperthermia, addition of changes in the eyes.

SCORE - risk assessment

If we talk about international standards, experts have developed a model for the systematic assessment of coronary risk (SCORE). It is adapted to the needs of the population in different regions. The tables come in two flavors: for countries with high and low complication rates. The score helps assess the likelihood of a fatal cardiovascular event in the next decade. The following parameters affect the result of the assessment:

• age;
• the level of systolic blood pressure;
• floor;
• nicotine addiction (smoking);
• total cholesterol level.

The risk is higher than that calculated in people with the following characteristics of a life history (habits, daily routine):

• sedentary work;
• passive recreation;
• central obesity or overweight (the appearance of this symptom at a young age increases the risk of a cardiovascular event with an unfavorable outcome many times greater);
• social disadvantage.

The development of cardiovascular diseases and hypertension, in particular, is influenced by family predisposition. The burdened heredity is evidenced by the appearance of diseases in blood relatives under the age of 65 in women and 55 in men.

Patient examination

At the first glance at the patient, the doctor may not detect changes, especially at the initial stage of the disease. During a crisis, there is a reddening of the face, swelling of the vessels in the neck. Sometimes hypertension is diagnosed only for this symptom.

An important part of the examination is palpation of peripheral vessels: it is necessary to determine the strength and symmetry of the pulsation at the points of contact with the bone structures.

Examination and palpation of the chest, percussion and auscultation of the pulmonary fields reveal concomitant diseases of the bronchopulmonary system that are not associated with arterial hypertension by the mechanism of development.

Diagnostics of the boundaries of the heart with the development of myocardial hypertrophy will reveal their expansion. In this case, during auscultation, the accent of the second tone is heard above the aorta. Subsequently, with a deterioration in the pumping function of the organ and dilatation of the walls of the left ventricle, a systolic murmur at the apex will be revealed due to relative mitral insufficiency.

If the increase in blood pressure is of a secondary nature, then primary deviations will be noticed in the patient's body:

• asymmetric pulsation of large vessels - speaks of atherosclerosis in elderly people and aortoarteritis, when it comes to young women;
• systolic murmur during auscultation of the renal arteries (along the perrectal lines, in the middle of the segment between the xiphoid process and the umbilicus) - at a young age means vasorenal hypertension (fibromuscular stenosis of the walls of the renal vessels), after 50 years - atherosclerotic lesion of the arteries;
• if the blood pressure on the lower extremities is less than on the upper ones (normally - vice versa), this is a sign of coarctation of the aorta;
• abdominal obesity, round face, striae (white or purple stripes on the body), acne, signs of hirsutism (excess hair growth) - symptoms of Itsenko-Cushing's syndrome.

Physical development assessment

The patient's weight and height are assessed. Based on the data obtained, the body mass index (BMI) is calculated using the formula:

BMI = body weight (kg) / height (m) ²

In children and adolescents, the adequacy of the ratio of height and weight is determined using graphs and percentile tables.

These calculations are important for determining the risk of developing cardiovascular disease:

Scientists have found that each pound of excess weight lost reduces the level of systolic blood pressure by an average of 1.5-1.6 mm Hg.

In addition to weight, the ratio of the patient's waist to hips is important.If the type of subcutaneous fat deposition is closer to abdominal, this is an indicator of a high risk of developing cardiovascular diseases in general and arterial hypertension in particular. Volume measurement rules:

waist circumference - the narrowest circumference of the body between the navel and the hips;

hip circumference - the widest circumference measured across the most prominent part of the buttocks.

The index of the ratio of the waist circumference to the volume of the hips is calculated by the formula:

ITB = waist / hip circumference.

Interpretation of the obtained index values:

Blood pressure measurement

To diagnose arterial hypertension, the patient's diastolic and systolic pressure are taken into account. To measure, use mercury (a typical ambulatory device) or semi-automatic sphygmomanometers. To obtain a reliable result, observe the following rules:

• the cuff corresponds to the diameter of the patient's shoulder;
• measurements are taken after the person has calmed down and spent several minutes in a sitting position;
• the cuff is applied at the level of the heart in any position of the patient (sitting is considered the most reliable);
• measure blood pressure (BP) several times (at least two, with atrial fibrillation and other arrhythmias - repeated monitoring) with an interval of one to two minutes, take into account the highest or average result;
• measure the blood pressure level on two hands (later measured on one - the one where the indicator is higher);
• in the elderly and with concomitant diabetes mellitus, additionally check the blood pressure figures in the second and fourth minutes of standing (with this approach to the procedure, orthostatic hypotension is taken into account).

However, to make a diagnosis, the data obtained after measuring blood pressure in the doctor's office is not enough. The study is repeated three to four weeks later. They record the results and characterize their own state and actions (strong emotions or physical exertion that provoked the crisis). The indicator of the disease is a persistent increase in blood pressure numbers. With conflicting results, daily monitoring of blood pressure will be required.

It is important to have a working blood pressure monitor. Meter readings are trusted if they are serviced every six months.

Laboratory tests

Laboratory tests for hypertension are divided into groups depending on their importance:

1. Routine tests (done to all patients with high blood pressure):
   • determination of the level of hemoglobin (this indicator decreases with anemia);
   • analysis of hematocrit (the ratio of formed elements to blood plasma, density assessment);
   • fasting blood glucose (helps to determine diabetes mellitus, since it, together with hypertension and obesity, is included in metabolic syndrome - a group of diseases that often occur in the same patients);
   • lipid profile (total cholesterol, triglycerides, high and low density lipoprotein cholesterol) - to assess the risk of atherosclerosis;
   • blood sodium and potassium (electrolyte imbalance is a manifestation of the secondary genesis of the disease);
   • creatinine and uric acid of blood plasma (in addition, according to the formula, the filtration rate of the nephron glomeruli is calculated) - helps to assess the function of the kidneys, the target organ; with a hypertensive crisis and a sharp deterioration in urine excretion, they are carried out urgently, these indicators increase with glomerulonephritis and a secondary increase in blood pressure;
   • urinalysis with sediment microscopy, it is possible to use test strips to determine the protein (microalbuminuria is the first symptom of impaired renal function).
2. Analyzes that are carried out only when necessary:
   • glycated hemoglobin - an indicator of chronic hyperglycemia, is needed for diabetes mellitus or fasting glucose levels above 5.6 mmol / l;
   • the amount of protein in daily urine (if microalbuminuria is detected).

Other studies are also prescribed (tests to assess the activity of pituitary hormones), especially in case of a disease - due to high blood pressure or differential diagnosis of arterial hypertension.

Read more about analyzes for hypertension here.

Instrumental research

The results of laboratory tests in most cases indicate the functional state of the organ. Instrumental methods help to further assess structural changes.

Electrocardiography is a mandatory method for examining patients with arterial hypertension. It is included in the algorithm for examining pregnant women, schoolchildren and employees of enterprises. With the help of an ECG, left ventricular hypertrophy (one of the characteristic lesions of target organs) is recorded. It is considered not very sensitive for detecting such a pathology, however, the following symptoms are recorded on the ECG:

• R wave in aVL> 1.1 mV;
• the Sokolov-Lyon index is calculated (the S wave (consider its voltage) in lead V1 in total with R in V5> 3.5 mV), in the modified version, the indicators of the most pronounced R and S waves are added;
• Cornell index (product of the amplitude and duration of the QRS complex> 244 mV x msec).

If, against the background of increased pressure, the patient shows arrhythmias or signs of ischemic myocardial damage, the ECG is recorded around the clock. This technique is called Holter monitoring and helps to record transient episodes of cardiac arrhythmias and attacks of angina pectoris.

Echocardiography

Ultrasound examination of the heart is more sensitive than ECG and makes it possible to carry out a more reliable stratification of the risk of cardiovascular events in hypertensive patients. It is prescribed for probable left ventricular (LV) hypertrophy (according to ECG results or according to the history of the magnitude of the numbers and the duration of the increase in blood pressure). With the help of echocardiography, the stage of hypertension is detected.

Subject to assessment (signs of hypertrophy are indicated):

1. LV posterior wall thickness (more than 1.1 cm).
2. The width of the myocardium of the interventricular septum (12 mm or more).
3. The dimensions of the LV during the end of diastole (its cavity exceeds 5.5 cm).
4. LV myocardial mass index (LVM), which is adjusted for height. The following indicators indicate obvious hypertrophy:
   • more than 95 g / m² among women;
   • over 115 g / m² in men.

5. The type of remodeling (the nature of changes in cavity volumes and wall thickness) of the LV is determined by the formula (concentric and eccentric hypertrophy).

Other additional methods

For the diagnosis of hypertension to be reliable, these methods are not required. However, they will help to fix peripheral changes in organs and blood vessels in time.

1. Sonography of the neck vessels with dopplerography.

With pathological changes in the carotid arteries, atherosclerotic plaques or wall thickening of more than 0.9 mm are detected.

2. Ultrasound examination of peripheral arteries. Indicates abnormal wall structure and blood flow velocity.
3. Pulse wave velocity measurement.

This parameter depends on the structure of the vascular walls. With fibrotic, atherosclerotic lesions, they lose elasticity, and the pulse wave passes between the cervical and femoral arteries at a speed of more than 12 m / s.

4. Ankle-brachial index.

This indicator also correlates with the degree of damage to the walls of peripheral vessels. Calculated based on the difference in blood pressure levels in the arms and legs. Normally, it is less than 0.9.

5. Fundus assessment.

At this point, small vessels, usually hidden in body tissues, are visible through the patient's pupil.Their condition correlates with the degree of damage to vessels of this caliber throughout the body. With the course of the disease, they change the diameter, the number increases, in the third stage of hypertension, hemorrhages are possible.

6. Magnetic resonance imaging of the brain (used to diagnose stroke, one of the complications of hypertensive crisis).
7. Ultrasound examination of the kidneys is prescribed for the nephrogenic pathogenesis of high blood pressure (symptomatic treatment in this situation is ineffective).

With concomitant pathology, the patient is prescribed a range of additional examinations. The list will grow if hypertension is secondary.

Examination of organs with increased pressure: how not to miss the problem

High blood pressure by itself is not dangerous. However, hypertension leads to damage to target organs and at a certain stage in the progression of the disease, their return to normal functioning becomes impossible. To prevent such a situation and to carry out timely prevention, it is necessary:

• do not miss planned visits to the doctor;
• report all complaints, do not hush up anything;
• undergo the prescribed examinations at the frequency recommended by the attending physician;
• report on the timely intake of medicines.

Examinations for hypertension: what and how often

Let's summarize the research review. To be sure of your own health and to track the dynamics of the course of the disease, methods of diagnosing arterial hypertension are used with the prescribed frequency of protocols:

Pregnant women should be examined more often, according to the prescriptions of the obstetrician-gynecologist and consulting therapist.