McInnes G T, Semple P F
University Department of Medicine and Therapeutics, Gardiner Institute, Western Infirmary, Glasgow, UK.
Br Med Bull. 1994 Apr;50(2):443-59. doi: 10.1093/oxfordjournals.bmb.a072902.
Patients with mild to moderate hypertension require only a simple schedule of investigations, especially if there is a history of stroke or hypertension in first degree relatives. Tests are necessary to profile other cardiovascular risk factors and to detect target organ damage with only limited screening for secondary hypertension. Careful history, physical examination, repeated blood pressure measurements over months and measurements of body mass index, random cholesterol, routine blood chemistry and urinalysis using impregnated paper strips are all that are required. More detailed investigations can be reserved for special groups such as those with peripheral vascular disease or abnormal renal function before or after treatment with angiotensin converting enzyme inhibitors or significant proteinuria or hypokalaemia. Patients with essential hypertension who are smokers with lipid abnormalities may go on to develop superimposed renovascular disease. Severe hypertension at any age and especially if there is a reliable negative family history also merits special consideration. Resistance to antihypertensive treatment is more often due to non-compliance or non-steroidal anti-inflammatory drug use or alcohol abuse than to underlying secondary causes.
轻度至中度高血压患者仅需简单的检查方案，尤其是在一级亲属中有中风或高血压病史的情况下。进行检测以明确其他心血管危险因素，并仅对继发性高血压进行有限的筛查以检测靶器官损害。详细的病史、体格检查、数月内反复测量血压以及测量体重指数、随机胆固醇、常规血液化学指标和使用浸试纸条进行尿液分析，这些就是所需的全部检查。对于特殊人群，如患有外周血管疾病者或在用血管紧张素转换酶抑制剂治疗之前或之后肾功能异常者、有大量蛋白尿或低钾血症者，可进行更详细的检查。原发性高血压患者中，吸烟且伴有血脂异常者可能会继而发生叠加性肾血管疾病。任何年龄的重度高血压患者，尤其是有可靠的阴性家族史者，也值得特别关注。对抗高血压治疗的抵抗更多是由于不依从、使用非甾体抗炎药或酗酒，而非潜在的继发性病因。
