头晕头痛常见高血压症状 降压找准适合自己的药
来源：大洋网-广州日报
（Gettyimages供图）
　　●偶然一次血压超标不一定是高血压，高血压的诊断需在不同时间测三次血压，取其平均值才能确诊
　　●高血压治疗应遵循四大原则：小剂量开始、优先选择长效制剂、联合用药、个体化治疗
　　“全国高血压日”
　　医学指导/广州红十字会医院心血管内科主任、博士研究生导师吴同果教授
　　文/记者黎蘅 通讯员崔艳玲
　　血压偶然一次超过正常值是不是高血压？医生开的降压药为何每次都有两种？刚开始吃降压药，感觉浑身不舒服，能停药吗&&统计显示，我国高血压患病率已超过30%，3亿多的高血压患者面对自己的病情，有着无数的困惑和疑问。为此，从今天起，本报每日保健版将连续推出“高血压专家问答实录”，整理出令最多人感到疑惑、最容易陷入误区、最需要注意的高血压问题，请来心血管病专家逐一解答。今天，就先从高血压的诊断和治疗开始吧。
　　头晕头痛是最常见症状
　　问：高血压有什么症状？
　　答：1.头晕：头晕为高血压最多见的症状。有些是一过性的，常在激动、用力或血压波动时出现，有些是持续性的。
　　2.头痛：头痛亦是高血压常见症状，多为持续性钝痛或搏动性胀痛，甚至有炸裂样剧痛。常在早晨睡醒时发生、起床活动及饭后逐渐减轻。疼痛部位多在额部两旁的太阳穴和后脑勺。
　　3.烦躁、心悸、失眠：高血压病患者性情多较急躁、遇事敏感，易激动。心悸、失眠较常见，失眠多为入睡困难或早醒、睡眠不实、噩梦纷纭、易惊醒。
　　4.注意力不集中，记忆力减退：早期多不明显，但随着病情发展而逐渐加重。因颇令人苦恼，故常成为促使病人就诊的原因之一，表现为注意力容易分散，近期记忆减退，常很难记住近期的事情，而对过去的事如童年时代的事情却记忆犹新。
　　5.肢体麻木：常见手指、足趾麻木或皮肤如蚊行感或项背肌肉紧张、酸痛。部分病人常感手指不灵活。一般经过适当治疗后可以好转，但若肢体麻木较顽固，持续时间长，而且固定出现于某一肢体，并伴有肢体乏力、抽筋、跳痛时，应及时到医院就诊，预防中风。
　　6.出血：较少见。由于高血压可致动脉硬化，使血管弹性减退，脆性增加，故容易破裂出血。其中以鼻出血多见，其次是结膜出血、眼底出血、脑出血等，据统计，在大量鼻出血的病人中，大约80%患高血压。
　　这些都是高血压的常见症状，如果你有以上的症状出现，请你一定要引起重视。
　　九成患者为原发性高血压
　　问：高血压怎么分级？
　　答：高血压分为四个等级：轻度高血压、中度高血压、重度高血压和临界高血压。一般情况下，理想的血压为120/80mmHg，正常血压为130/85mmHg以下，130~139/85~89mmHg为临界高血压；140~159/90~99mmHg为高血压Ⅰ级；60~179/100~109mmHg
　　为高血压Ⅱ级，此时有左心室肥厚、心脑肾损害等器质性病变；180/110mmHg以上为高血压Ⅲ级，此时有脑出血、心力衰竭、肾功能衰竭等病变，已进入失代偿期，随时可能发生生命危险。
　　问：高血压有几种类型？
　　答：从病因上分，高血压分为原发性高血压和继发性高血压。高血压患者中约90%为原发性高血压，约10%为继发性高血压。前者病因尚未完全阐明，临床上以动脉血压升高为主要表现。后者是指继发于某一种疾病或某一种原因之后发生的血压升高，其中大多数可通过手术等治疗技术去除病因而使其高血压得到治愈。
　　怎样才能确诊高血压？
　　问：高血压怎样才能确诊？偶尔一次血压超过正常值算高血压吗？
　　答：高血压的诊断需在不同时间测三次血压，取其平均值，如果收缩压超过或等于140毫米汞柱或舒张压超过或等于90毫米汞柱，方能诊为高血压。对偶尔超过正常范围者，宜定期重复测量以确诊。
　　问：除了测量血压，高血压通常还需要做什么检查？
　　答：正确的诊断高血压不是一件轻而易举的事情，除了要清楚患者是否有遗传史或不良的生活方式，还要通过一些必要的检查方法来确定高血压患者的病情进展程度，这样才能为采取有效的治疗措施提供有力的依据。
　　（1）血液生化检查：这是高血压患者在诊断病情的过程中不可或缺的一项检查，包括尿素氮或肌酐、电解质、血脂、血糖、血尿酸、血黏度等，帮助明确高血压是否由肾脏疾病引起，判断高血压对肾脏的影响程度，是否存在某些危险因素。
　　（2）眼底检查：随着高血压患者病情的进展，高血压会危及到患者的眼部健康，所以进行眼底检查是非常必要的。通过眼底检查了解小动脉病损情况，以便对高血压病患者分期。高血压性视网膜病变能反映高血压的严重程度及客观反映周身小血管病变的损伤程度。
　　（3）尿常规检查：这是高血压患者确诊时必经的一项常规检查，对于正确诊断病情非常重要。了解有无早期肾脏损害，高血压是否由肾脏疾患引起，以及是否伴有糖尿病等。若尿中有大量尿蛋白、红细胞，则应考虑慢性肾炎或肾盂肾炎所致的继发性高血压；若仅有少量尿蛋白、少量红细胞，提示可能是原发性高血压所致的肾损害。
　　（4）心电图：心电图是非常必要的确诊高血压的检查方法。通过心电图可以判断高血压患者的心脏功能状况，并判断是否有心脏肥大，是否存在心肌损伤或合并冠心病等。
　　治疗篇
　　药物治疗高血压 切忌吃吃停停
　　1.问：确诊为高血压，但没有症状是否也要治疗？
　　答：如果已经确诊为高血压，不管有无症状，都必须进行降压治疗，愈早愈好。
　　2.问：一经确诊就要开始药物治疗吗？
　　答：药物治疗也要看时机：高危、很高危或3级高血压患者，应立即开始。确诊的2级高血压患者，应考虑开始药物治疗；1级高血压患者，可在生活方式干预数周后，血压仍≥140/90 mmHg时，再开始药物治疗。
　　3.问：为什么医生通常会开两种降压药？
　　答：因为高血压治疗要遵循联合用药的原则。目的是增加降压效果又不增加不良反应，因此在低剂量单药治疗疗效不满意时，可以采用两种或多种降压药物联合治疗。事实上，约60%的2级以上高血压患者为达到目标血压常需联合治疗。
　　除了联合用药，降压治疗药物应用还应遵循以下原则，
　　小剂量：初始治疗时通常应采用较小的有效治疗剂量，并根据需要，逐步增加剂量。
　　尽量应用长效制剂：尽可能使用一天一次给药而有持续24小时降压作用的长效药物，以有效控制夜间血压与晨峰血压，更有效预防心脑血管并发症发生。
　　个体化：根据患者具体情况和耐受性及个人意愿或长期承受能力，选择适合患者的降压药物。
　　4.问：药物治疗会出现哪些不良反应？怎么应对？
　　答：降压药对不同人可能存在不同的不良反应。有些高血压病人在第一次服用降压药时，会感到心慌、气短、心前区不适、焦虑、不安、面红、头晕等。尤其是老年人、基础血压较高、长期高血压未经治疗的患者，会对压力反射不敏感，或者脑血管自动调节功能下降，更容易出现上述情况。
　　为了避免出现上述症状，也可选用长效降压药。较小的剂量即可达到与多次服用大剂量的普通制剂相同的效果，所以降压更为平稳，血压的昼夜变异小，还可以避免清晨血压的突然升高。而在长期治疗过程中，部分患者应用某些降压药如利血平、可乐宁、甲基多巴、心得安时，有可能会产生中枢神经系统不良反应，可使一些患者出现嗜睡、乏力、倦怠、失眠、多梦、记忆力下降、反应迟钝等表现；又比如干咳是血管紧张素转换酶抑制剂卡托普利等最常见的不良反应，但一般症状较轻或连续服药后逐渐减轻。此外，还有些不良反应包括性功能受影响、低血钾症、体位性低血压等。
　　患者既要按医嘱服药，也要注意预防不良反应的发生。遇到不良反应千万不要擅自停药或胡乱更换其他药物，应尽快与医生沟通，在医生指导下寻求解决办法。
　　5.问：连吃几天降压药后收缩压就会降到130mmHg以下，再吃药就头晕眼花，难以忍受，请问这药还该不该继续吃？
　　答：这是典型的药物不良反应，说明这种药物可能不适合这位患者。药物选择和避免副反应没有通行和绝对的做法，一定要尽快与医生沟通，根据个体情况更换降压药物。如果血压降得太低了，出现较严重的不良反应，应在最短时间内就诊。
　　6.问：治疗高血压要终身服药吗？
　　答：是的。选择降压药应以西药为佳，不要看到说明书上写着副作用就惶恐不安，过分紧张，切忌相信所谓无副作用、一剂根除的偏方、秘方。要知道迄今为止，还没有哪种药可以“根治”高血压。
　　降压的目的是为了减少心脑血管疾病的发生、延长寿命、提高生活质量，因此高血压是一种需要终身治疗的疾病。有些患者血压恢复正常后擅自停药，药物吃吃停停，结果没过多长时间血压又回升，甚至会出现头痛、失眠、出汗、等症状，严重时危及生命，因此，降压药不能随便停用。
(责任编辑：董海扬)
原标题：高血压问答之一 降压 找准适合自己的药
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客服邮箱：现在高血压已经是很多人都比较容易出现的一个健康的问题了，对于很多人来说，高血压的一个主要的症状就是头晕的厉害，其实面对高血压的头晕的问题，我们可以试试用食疗的方法来改善一些。
1、甘菊粳米粥
取甘菊新鲜嫩芽或者幼苗15～30克，洗净，与粳米60克、冰糖适量煮粥，早晚餐服用，每日1次，连服7日。适用于高血压、肝火亢盛之头晕。
2、芹菜苦瓜汤
芹菜500克、苦瓜60克，同煮汤饮用。或用芹菜250克、苦瓜30克，用沸水烫2分钟，切碎绞汁，加砂糖适量，开水冲服，每日1剂，连服数日。适用于高血压、阴虚阳元之头晕。
3、葛根粳米粥
鲜葛根适量洗净切片，沙参、麦冬各20克，经水磨后澄取淀粉，晒干，每次用葛根沙参麦冬粉30克与粳米60克煮粥吃，每日一剂，可以常食。适用于高血压阴阳两虚之头晕。
4、车前粳米粥
车前子15克(布包)煎水去渣，入粳米60克煮粥，玉米粉适量用冷水溶和，调入粥内煮熟吃，每日1剂，常吃。适用高血压痰湿壅盛之头晕。
也许我们上面的粥是我们很多人都没有听过的，但是上面这些确实是能帮助我们化解高血压带来的头晕的问题的。
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