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    Home > Active Ingredient News > Study of Nervous System > Cerebral infarction occurred twice in a year, and it turned out to be the culprit!

    Cerebral infarction occurred twice in a year, and it turned out to be the culprit!

    • Last Update: 2021-04-23
    • Source: Internet
    • Author: User
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    Author: Li Qing TEDA Tianjin University Hospital, it was a friend's advice.

    His mother was 68 years old.
    She had cerebral infarctions twice in May and November last year, but she couldn't find out the cause, so she consulted me.

    I asked his mother’s medical history.
    She did not smoke, did not have high blood pressure, diabetes, or hyperlipidemia, and she did not have high blood pressure measured in a community hospital.

    I am not a neurologist, but I know that cerebral infarction does not happen for no reason.

    Cerebral arteriosclerosis, in fact, is not only cerebral arteriosclerosis, other arteriosclerosis has four major risk factors: hypertension, hyperlipidemia, diabetes and smoking.
    Diabetes and hyperlipidemia are detected by blood.
    It is clear at a glance.
    The measurement of blood pressure is variable.

    His mother does not smoke, does not have diabetes or hyperlipidemia.
    It is possible that the problem lies in blood pressure.

    So my mother did an ambulatory blood pressure monitor.

    As I expected, his mother had high blood pressure.

    The results of ambulatory blood pressure showed that his mother's systolic blood pressure continued to exceed 135 mmHg, with a maximum of 150 mmHg during the day time period from 17:25 to 20:25; during the night time period from 22:27 to 6:00 the next day, the systolic blood pressure continued to exceed 130 mmHg.
    Maximum 157 mmHg, see figure.

    According to the diagnostic criteria of ambulatory blood pressure: 24-hour average systolic blood pressure/diastolic blood pressure ≥130/80 mmHg; or daytime blood pressure ≥135/85 mmHg; or night blood pressure ≥120/70 mmHg.
    Hypertension is diagnosed if one of them is met.

    The diagnosis of his mother's hypertension is certain.

    But why is there no problem with the doctor measuring blood pressure? This is the concealed hypertension we are talking about today: the office blood pressure measurement is normal or slightly higher, and ambulatory blood pressure monitoring finds high blood pressure.

    We have three methods to obtain blood pressure data: office blood pressure, family self-tested blood pressure, and ambulatory blood pressure monitoring.

    1.
    The blood pressure in the office The blood pressure in the office is measured by the doctor, and the measurement operation is standardized, but the measurement time is generally during the doctor's work time, and the blood pressure situation at other times is not known.

    In addition, many patients are mostly nervous when they come to the clinic, and the measured blood pressure is often higher than the actual blood pressure.

    Therefore, the blood pressure in the office cannot completely and objectively reflect the blood pressure of the patient.

    2.
    Self-tested blood pressure at home The self-tested blood pressure at home is measured by the patient, and there may be deviations in the operation.

    If the medical staff is simply trained and mastered the operating specifications, the family self-tested blood pressure can basically objectively reflect the patient's day-time blood pressure level.

    Therefore, self-testing blood pressure at home is the currently popularized blood pressure measurement mode.

    3.
    Ambulatory blood pressure monitoring.
    Some patients are nervous when measuring blood pressure in the office, and the blood pressure is high, while some patients have nocturnal hypertension.
    Neither the office blood pressure nor the family self-tested blood pressure will be measured at midnight, so they cannot accurately reflect the patient All blood pressure conditions for 24 hours.

    Ambulatory blood pressure monitoring is a special ambulatory blood pressure monitor worn by the patient to measure blood pressure 24 hours a day, 15 minutes during the day and 30 minutes at night.
    It can basically reflect the patient's blood pressure in a 24-hour normal life.
    .

    Therefore, ambulatory blood pressure monitoring is the gold standard for diagnosing hypertension.

    At present, domestic and foreign guidelines increasingly emphasize the necessity of ambulatory blood pressure monitoring.

    Tips: The day and night time periods of ambulatory blood pressure monitoring are defined in the guide: according to the time recorded on the ambulatory blood pressure monitoring diary card, the time period from falling asleep at night to waking up in the next morning is night, and other times are day and day.
    The time period between hours should be deducted from the nap period.

    If the work and rest time is not recorded, a narrow fixed time period can also be adopted according to the life>
     In addition, people's blood pressure is not static throughout the day, but fluctuates up and down.

    The blood pressure of most normal people shows the phenomenon of "two peaks and one valley", that is, the blood pressure gradually rises from 6 to 7 o'clock in the morning, reaches a peak at about 10 o'clock in the morning, and then gradually drops; it starts to rise again at 2 o'clock in the afternoon.
    It reached the second peak at about 5 in the afternoon, after which the blood pressure gradually decreased; at about 2 in the morning, the blood pressure dropped to the lowest valley of the day, and then the blood pressure began to rise gradually.

    This "two peaks and one valley" blood pressure curve looks like a spoon, so this type of blood pressure is called spoon blood pressure in medicine, as shown in the figure.

    Nocturnal hypotension has the least damage to the heart, brain and kidney and other important organs, so spoon blood pressure is a relatively healthy type of blood pressure.

    However, there are also some people whose blood pressure changes during day and night do not follow the above-mentioned rules, but show non-spoon-type blood pressure (there is no rule of two peaks and one valley) or even reverse-type blood pressure (night blood pressure is higher than daytime blood pressure).

    It can be found from the figure that the blood pressure curve of this friend's mother is similar to a straight line, which is non-spoon blood pressure.

    It was also because of ambulatory blood pressure monitoring that I discovered that my friend's mother had hidden hypertension, which basically clarified the cause of her 2 cerebral infarctions within a year.

    Studies have found that the risk of cardiovascular and cerebrovascular diseases in patients with hidden hypertension is similar to that of persistent hypertension, and both are significantly higher than those with normal blood pressure.

    According to statistics, the risk of cardiovascular and cerebrovascular diseases in patients with hidden uncontrolled hypertension is about 1.
    8 times that of patients with normal blood pressure.

    This kind of concealed hypertension with normal blood pressure measurement is more "deceptive", it is not easy to be found and can not be effectively controlled, so it is more prone to heart, brain and kidney complications.

    According to statistics, the prevalence of patients with occult hypertension in my country is about 10-18%, and the prevalence is comparable to diabetes, and it is not a minority.

    Therefore, ambulatory blood pressure monitoring and screening should be done for the following groups: 1.
    High-risk groups, such as men, obese, smokers, and those with metabolic syndrome, chronic kidney disease, etc.
    ; 2.
    The blood pressure in the office is normal and high, but it has appeared obvious Patients with heart, brain and kidney damage without other obvious risk factors for cardiovascular and cerebrovascular diseases.

    Once hidden hypertension is discovered, active life>
    It has been half a year since the second cerebral infarction of this friend's mother, and medical treatment for the cerebral infarction itself is of little significance.

    The purpose of current treatment is to actively control blood pressure, but also combined with statin lipid-lowering drugs to avoid recurrence of cerebral infarction.

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