The significance of secondary hypertension identification and blood biochemistry tests: in-depth diagnosis from kidney disease to endocrine disorders.

15. What is secondary hypertension? We have mentioned secondary hypertension many times before, including many tests, all of which are to rule out secondary hypertension. This is mainly because the treatment of secondary hypertension is very different from that of primary hypertension. If it is treated as primary hypertension without distinction and blood pressure is controlled by antihypertensive drugs alone, it will delay the diagnosis of secondary hypertension and cause great losses to patients. Common causes of secondary hypertension include the following: (1) Kidney diseases. Acute and chronic glomerulonephritis, kidney stones, kidney cysts, etc. can all cause hypertension. Symptoms include hematuria, proteinuria or urinary frequency, urgency, dysuria, abnormal kidney function, etc. (2) Renal vascular or large vessel diseases. Diseases such as renal artery stenosis, aortitis, and aortic coarctation can lead to elevated blood pressure. Vascular murmurs can be heard in the abdomen and neck, or the pulse in the limbs may be weakened or absent. Ultrasound may show that the two kidneys are different sizes, and isotope can detect reduced renal blood flow, etc. (3) Endocrine diseases, mainly caused by adrenal tumors or hyperplasia. If you experience weight loss, excessive sweating, palpitations, paleness, or paroxysmal hypertension, be alert to the possibility of pheochromocytoma. If you experience dry mouth, frequent urination at night, weakness or even flaccid paralysis of both lower limbs, or hypokalemia, be alert to the possibility of primary aldosteronism. If you experience central obesity, moon face, hirsutism, or sexual dysfunction, be alert to the possibility of Cushing's syndrome.

16. What is the significance of blood biochemistry tests? Many patients cherish their blood and are reluctant to have it tested, believing that blood tests are unnecessary for hypertension. In fact, blood biochemistry tests are crucial for identifying risk factors, monitoring adverse drug reactions, and selecting appropriate medications, making them essential for hypertension patients. Blood biochemistry tests involve many items, and for hypertension patients, at least the following should be included: serum potassium, serum sodium, blood glucose, blood lipids (including total cholesterol, triglycerides, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol), serum uric acid, liver function, and kidney function (including blood urea nitrogen and serum creatinine). Blood glucose, blood lipids, and blood uric acid levels can monitor the presence of cardiovascular risk factors, observe adverse reactions of some medications (such as different types of diuretics causing increases or decreases in blood potassium), guide adjustments to treatment plans, and preliminarily rule out secondary hypertension (e.g., low blood potassium may indicate primary aldosteronism, while high blood urea nitrogen and serum creatinine may indicate renal hypertension). Liver and kidney function tests help doctors select antihypertensive drugs based on the patient's condition and understand whether long-term use of antihypertensive drugs affects liver and kidney function.