Guidelines for Methods and Examination Items for Determining Organ Damage in Hypertension

How to determine if hypertension has damaged vital organs?

Because the effects of hypertension on the human body are slow and gradual, many people may have had high blood pressure for a long time without feeling it. However, the damage caused by hypertension has already occurred unnoticed. Therefore, once hypertension is diagnosed, a comprehensive examination of major organs is necessary to understand whether there is damage and certain clinical conditions. This is crucial for assessing the cardiovascular risk in hypertensive patients.

(1) Whether there is cardiac damage can be determined through the following methods:

① History of myocardial infarction, angina pectoris, or heart failure;

② Electrocardiogram (ECG) can reveal myocardial ischemia, cardiac conduction block, and arrhythmias;

③ Echocardiography can reveal left ventricular hypertrophy, cardiac structure, and myocardial motility, and is superior to ECG in predicting cardiovascular risk;

④ Chest X-ray can reveal the cardiac outline, aortic tortuosity, or pulmonary circulation;

⑤ Spiral CT angiography can non-invasively assess the coronary arteries, and its reliability is second only to coronary angiography.

(2) Presence of cerebrovascular disease:

① History of stroke or transient ischemic attack (TIA);

② Simple cognitive tests can be performed to assess brain damage;

③ Transcranial Doppler ultrasound can directly assess cerebrovascular conditions;

④ If necessary, head CT or MRI can be performed to assess conditions such as cerebral infarction.

(3) Presence of kidney disease and damage: Urinalysis and renal vascular ultrasound can be performed. The following conditions indicate kidney damage. ① Quantitative urine protein: 30–300 g/24h;

② Microalbuminuria: Male, albumin/creatinine ≥ 22 mg/g (2.5 mg/mmol); Female, albumin/creatinine ≥ 31 mg/g (3.5 mg/mmol);

③ Mildly elevated creatinine: Male 115–133 μmol/L (1.3–1.5 mg/dl), Female 107–124 μmol/L (1.2–1.4 mg/dl). Serum creatinine > 177 μmol/L (2 mg/dl) suggests renal failure;

④ Uric acid level > 416 μmol/L (7 mg/dl).

(4) Check blood lipids, blood glucose, and blood potassium levels. If multiple blood lipid and blood glucose tests show values ​​exceeding the following indicators, it suggests abnormalities in blood lipids and blood glucose:

① Total cholesterol (TC) ≥ 5.7 mmol/L (220 mg/dL);

② Low-density lipoprotein cholesterol (LDL-C) ≥ 3.4 mmol/L (130 mg/L);

③ High-density lipoprotein cholesterol (HDL-C) < 1.0 mmol/L (40 mg/dL);

④ Fasting blood glucose > 6.1 mmol/L (110 mg/dL) suggests impaired fasting glucose; ≥ 7.0 mmol/L (140 mg/dL) suggests diabetes;

⑤ Postprandial or oral glucose tolerance test 2-hour level 7.8–11.1 mmol/L suggests impaired glucose tolerance; ≥ 11.1 mmol/L suggests diabetes;

⑥ Blood potassium (K+): Normal range is 3.5–5.5 mmol/L. ⑦ C-reactive protein ≥10mg/L.

(5) The presence of atherosclerotic plaques or hardening in peripheral blood vessels is the most direct evidence for vascular arteriosclerosis or plaque formation. These examinations are simple and easy to perform, but are often overlooked.

① Vascular ultrasound: Carotid intima-media thickness ≥0.9mm or plaques in the arteries of the limbs.

② Fundus lesions: presence of hemorrhage, exudation, optic disc edema, etc.