World Hypertension Day - Summary of serum markers of hypertension

At present, there are about 330million people with hypertension in China. The epidemic status of hypertension in China can be summarized as "three highs" and "three lows". Three highs mean high incidence rate, high disability rate and high mortality rate; Three low means low awareness rate, low treatment rate and low control rate. Due to the lack of attention, the awareness rate and treatment rate of hypertension were only 42.6% and 34.1%, and the control rate was less than 10%.
 
The main influencing factors of hypertension are blood volume and the ability of vasoconstriction. Hypertension is just a value that we can measure directly. It is just an appearance, but elevated blood pressure will affect our heart, brain, kidney and many other organs.
China cardiovascular disease health and disease report 2019 emphasizes that at present, cardiovascular disease death accounts for the first place in the total death causes of urban and rural residents, accounting for 45.91% in rural areas and 43.56% in urban areas.
 
The report said that with the development of social economy, the national lifestyle has undergone profound changes. Especially with the acceleration of population aging and urbanization, the prevalence trend of cardiovascular disease risk factors in China is obvious, resulting in a continuous increase in the number of cardiovascular diseases. In the next 10 years, the number of cardiovascular diseases will still increase rapidly.
 
Cardiovascular and cerebrovascular diseases have the characteristics of high prevalence, high disability rate, high recurrence rate and high mortality, which has brought a heavy social and economic burden.
 
Studies have shown that hypertension, dyslipidemia, diabetes, obesity, smoking, lack of physical activity and unhealthy eating habits are the main and modifiable risk factors for cardiovascular and cerebrovascular diseases. Hypertension is a common chronic disease. It is a clinical syndrome with functional or organic damage of heart, brain, kidney and other organs. Renin angiotensin aldosterone system (RAAS) is the most important blood pressure regulation system in human body, which is composed of a series of hormones and corresponding enzymes. The system can regulate blood pressure, water and electrolyte balance, maintain a constant internal environment, and promote the growth and metabolism of myocardium and vascular smooth muscle.
The human body has two endocrine systems that determine the blood pressure level - renin angiotensin aldosterone system (RAAS) and hypothalamus pituitary adrenal cortex axis (HPA axis). The seemingly stable blood pressure value of our healthy people is actually the result of coordination and balance between multiple organs such as heart, brain, liver, kidney, adrenal gland and large blood vessels!
 
Five items of hypertension detected in the laboratory are the five markers in these two systems:
Renin angiotensin aldosterone system (RAAS): plasma renin (renin), plasma angiotensin (AII), plasma aldosterone (ALD)
Hypothalamus pituitary adrenal cortex axis (HPA axis): plasma cortisol, plasma ACTH
 
Each marker has different clinical guiding significance. In general, it can be summarized as follows:
 
Angiotensin Ⅱ
Angiotensin (ANGⅡ)
 
Angiotensin Ⅱ is an octapeptide produced by the hydrolysis of angiotensin I by angiotensin converting enzyme. It widely exists in capillary endothelial cells and is widely distributed in various tissues of the whole body. It is mainly used for the monitoring of hypertension medication, coronary heart disease, sarcoidosis and other diseases.
 
Adrenocorticotropic hormone
 Adrenocorticotropic Hormone (ACTH)
 
Adrenocorticotropic hormone (ACTH) is a kind of micro polypeptide hormone secreted by adenohypophysis under the action of corticotropin releasing hormone (CRH). The determination of ACTH level is mainly used for the differential diagnosis of primary and secondary adrenal insufficiency.
 
Renin renin
 
Renin is a proteolytic enzyme released by the paraglomerular cells of the paraglomerular apparatus. Renin, angiotensin and aldosterone are linked to each other, called renin angiotensin aldosterone system, which promotes the growth and metabolism of myocardium and vascular smooth muscle.
 
Aldosterone ALD
 
Aldosterone promotes the reabsorption of sodium and the excretion of potassium by the epithelial cells of the distal convoluted renal tubule. The secretion of aldosterone is similar to that of cortisol, which is lower in the morning than at night. Compared with lying position, standing position increased, and its plasma concentration also changed correspondingly.
Each of the above markers has different clinical guiding significance. At present, it has become an important indicator for the classification, diagnosis, treatment and research of primary and secondary hypertension. It is of great significance for the diagnosis, treatment and pathogenesis of the disease.