Speaking of pale, the first thing we think of is anemia, because anemia can cause the skin to appear pale due to ischemia. But at the same time, the pale complexion may also be related to high blood pressure, and this type of high blood pressure is “associated with anemia” and is clinically called white hypertension.
Anemia and high blood pressure are not contradictory
White hypertension, as the name implies, refers to high blood pressure with a pale complexion, which is usually characteristic of renovascular and renal hypertension. Renal vascular hypertension is mainly caused by the stenosis and occlusion of the main or branch of the renal arteries on one or both sides; while renal hypertension refers to kidney diseases, such as acute and chronic glomerulonephritis, pyelonephritis, Hypertension caused by polycystic kidney disease. The two diseases have their own differences, but both can lead to renal insufficiency and cause nephrogenic anemia.
In the cognition of many people, anemia means less blood and insufficient blood volume, while high blood pressure is too high blood pressure caused by more blood. It is believed that anemia will definitely not cause high blood pressure. In fact, this is a misunderstanding.
First of all, hypertension and anemia are two different diseases. Hypertension is caused by the increase in the pressure of blood in the arteries, and anemia refers to the decrease of red blood cells and hemoglobin in the blood. In order to compensate for the maintenance of blood oxygen, the patient’s blood volume is increased, and the increase in blood volume will also Increase blood pressure. Therefore, people with high blood pressure will suffer from anemia, and people with anemia may also suffer from high blood pressure, but not necessarily low blood pressure. In clinical practice, many patients, even some young doctors with inexperience, often regard hypertension and anemia as two unrelated diseases, and as a result, they lose the chance of correct diagnosis and treatment.
White hypertension usually has a process of development. In mild cases, the symptoms are usually not obvious. Some people occasionally experience dizziness, tinnitus, insomnia, forgetfulness, and loss of appetite. In severe cases, symptoms such as swelling and dry hair may appear. Found, but the key is to be sufficiently vigilant about the disease. In other words, if a person has both high blood pressure and signs of anemia, in addition to careful checking of hemoglobin and red blood cell counts, blood muscle drunkenness and urea nitrogen should also be checked. If there is a large amount of protein in the urine, coupled with a significant increase in blood creatinine and urea nitrogen, it indicates renal hypertension; if the above-mentioned examinations are not abnormal, a B-ultrasound examination of the renal artery should be performed. If renal artery stenosis is found, it is a renal blood vessel Sexual hypertension. Therefore, if the patient has a chronic history of hypertension, usually has symptoms of anemia, or has problems such as reduced urination, edema, nausea and vomiting, it is a high-risk group and should be highly vigilant against white hypertension.
High blood pressure is often “cooperating with kidney disease”
Regardless of renovascular hypertension or renal hypertension, it is actually the result of nephropathy and hypertension. The human body has a large blood circulatory system, and the kidney is an organ made up of tiny blood vessels, which is a typical epitome of the blood vessel condition of the whole body. Long-term hypertension, as a general environment, can lead to slow changes in the small environment of the kidneys, such as renal ischemic changes, glomerular and tubular function damage, etc. The degree of change is related to the length and severity of the hypertension. The degree is related. Even some sudden and sudden development of hypertension can also cause diffuse renal disease, leading to rapid deterioration of renal function and life-threatening. At present, clinical related studies have found that the vast majority of patients with hypertension can have varying degrees of renal changes. With age, glomerular sclerosis also worsens.
Conversely, when the human body has early kidney damage, there will only be mild proteinuria. However, as the course of the disease further progresses, glomerular fibrosis will intensify, and then renal function will gradually decline, and renal hypertension will appear. If the disease progresses and deteriorates rapidly, the patient will have headache as the most prominent symptom, accompanied by nausea, vomiting, lack of appetite, enlarged heart, heart failure, blurred vision or even blindness and neurological abnormalities. The laboratory examination will also show that the patient’s urine test will show increased urine protein, red blood cells, white blood cells, and a few patients have gross hematuria. For these patients, to save the kidney, one of the core issues is to control blood pressure.
It can be seen that hypertension and kidney disease are often causal to each other. If they are not controlled, they will interact and create a vicious circle. The ultimate goal of hypertension prevention and treatment should be to control risk factors and protect target organs. Emphasis on both antihypertensive and target organ protection, both are indispensable. Therefore, patients and clinicians not only need to realize what the normal blood pressure target is, but also strictly control blood pressure from the perspective of kidney protection. It is generally required that patients with simple hypertension be controlled at around 130/80mmHg, while patients with diabetes or chronic kidney disease are best controlled at around 125/75mmHg. For those patients who already have hypertension, the current anti-hypertensive drugs such as angiotensin-converting enzyme inhibitors, calcium antagonists, diuretics, etc., can reduce blood pressure while protecting the kidneys. of. Under the careful guidance of clinicians, taking effective drugs for reasonable treatment can well control blood pressure and prevent and control the occurrence of kidney disease.
Prevention and treatment of white hypertension focuses on controlling the primary disease
The treatment of white hypertension is mainly etiological treatment, including diet therapy to correct water and electrolyte disorders and acid-base balance disorders, control infections, dialysis and traditional Chinese medicine treatment, and supplemented by antihypertensive drugs. For renal vascular hypertension and renin-dependent hypertension in renal hypertension, the effects of captopril, propranolol (propranolol hydrochloride), and long lanidine (minoxidil) are better; For the volume-dependent hypertension in renal hypertension, with appropriate diuretics, it is necessary to supplement erythropoietin, iron, folic acid and vitamin B12 in time. Because blood transfusion often inhibits the production of erythropoietin, and the transfused red blood cells are often destroyed quickly due to the influence of toxic substances in the patient’s body, blood transfusion is generally not treated for mild to moderate renal anemia, unless severe anemia is accompanied by chest tightness, shortness of breath, Heart failure etc.
To prevent white hypertension, you need to do the following: 1. Control the primary disease and do anti-hypertensive treatment; 2. Quit smoking and lose weight, women with lighter weight should limit daily drinking; 3. More potassium and less sodium, reduce Sodium intake (the daily salt intake should not exceed 6 grams of salt), and eat more potassium-containing foods every day (the recommended potassium intake is 3.5 grams per day, about 3 bananas and 3 cups of orange juice per day) 4. Eat more fruits and vegetables, and get enough calcium (you should take about 1300 mg of calcium per day); 5. Limit the intake of saturated fat and cholesterol; 6. Increase exercise (30-40 minutes of walking and other activities a day) ).
>>Related Links Patients with chronic renal failure may also have white hypertension
Because hypertension and anemia are risk factors that are likely to occur in patients with chronic renal failure during the development of the disease, white hypertension may also appear in patients with chronic renal failure. However, whether hypertension has an effect on chronic renal failure anemia has not been reported in the literature.
Relevant epidemiological surveys show that 80% of patients with chronic renal failure have hypertension, and the degree of anemia in patients is often consistent with the severity of chronic renal failure. When the glomerular filtration rate is less than 35-40ml/min, almost All patients with chronic renal failure will develop anemia. Clinically, the cause of anemia in patients with chronic renal failure is usually attributed to the reduced production of erythropoietin in the damaged kidney, increased production of toxic substances such as methylguanidine and aromatic amines, accelerated destruction of red blood cells, lack of hematopoietic substances, blood loss, and bleeding Wait.
Long-term anemia in patients with chronic renal failure can lead to tissue oxygen transport and utilization disorders, increase cardiac output, angina pectoris, heart failure, and weaken the body’s immunity and decline in cognition and response, so the treatment of anemia in patients with chronic renal failure appears More important.
Cecilia LW Chan chief physician, Professor, MD, director of the Department of Medical History, Master Instructor. Mainly engaged in the teaching and research of medical history and Chinese medicine culture, etc., clinically good at TCM cardiovascular internal medicine.