The “three highs” we often say refer to high blood pressure, high blood sugar, and high blood lipids. After the age of 50, the incidence of the three highs increases significantly. The damage to the body from hypertension, diabetes and hyperlipidemia is comprehensive and multi-system. In particular, it has a great impact on the cardiovascular and cerebrovascular. It is a high-risk group of coronary heart disease, cerebral hemorrhage, cerebral infarction, etc. So, how should the three-high population choose the physical examination items in the annual physical examination?
1. Routine physical examination items
Height, weight, blood pressure, calculation of body mass index (BMI), measurement of waist circumference.
Body mass index (BMI) is the most common method recommended by WHO to judge overweight, and the calculation method is simple. The formula is BMI = body weight (kg)/m2. BMI≤18 is thin; 18-23.9 is normal; 24-27.9 is overweight; BMI≥28 is obese.
The abdominal circumference is directly measured with a tape measure. If the waist circumference is ≥90cm for men and ≥85cm for women, abdominal obesity is diagnosed. Abdominal obesity and metabolic abnormalities are closely related. Need to exercise to lose weight and reduce abdominal circumference.
2. Basic inspection items:
Blood and urine routine;
Liver and kidney function, blood lipids, blood sugar, glycosylated hemoglobin, homocysteine, electrolytes, etc.
Glycated hemoglobin can reflect the average blood sugar level 2-3 months before blood collection, and is currently the most effective and reliable indicator for evaluating blood sugar control. It is generally considered that less than 6.5% is well controlled.
For patients with high blood sugar or diabetes, blood is also required for islet function related tests (insulin, C-peptide) and diabetes antibody related tests.
3. Heart check
Includes ECG and echocardiogram. The electrocardiogram can find out whether the electrical conduction of the heart is abnormal. When the electrocardiogram shows severe arrhythmias such as frequent premature beats, cardiac arrest, atrial fibrillation, and conduction block of the second degree or higher, a dynamic electrocardiogram needs to be further clarified. Cardiac ultrasonography can detect structural abnormalities of the heart, whether there is valvular disease, and the diastolic and systolic function of the heart.
If you have high blood sugar, high blood lipids, and coronary heart disease at the same time, you should also check: exercise treadmill electrocardiogram; coronary CTA or coronary angiography.
4. Kidney examination
The primary diagnosis of hypertension needs to be checked for secondary hypertension. The common cause is renal hypertension. And if there is a long-term increase in blood pressure, the earliest organ damage may be kidney damage. Therefore, for people with high blood pressure, kidney examination is also very important.
In addition to blood tests to check renal function, kidney color Doppler ultrasonography is also required; color Doppler ultrasonography of both renal arteries. In addition, it is best to stay in the urine to check urine microalbumin/urine creatinine, 24-hour urine microalbumin, β2 microglobulin and other items.
5. Fundus examination
The fundus examination of hypertensive patients is of certain value in judging the disease stage and prognosis of hypertension. Hypertensive patients with normal fundus usually have almost no damage to the heart and kidneys. Therefore, patients with hypertension should routinely undergo fundus examination and physical examination.
While diabetic patients are more likely to develop diabetic retinopathy, for patients with diabetic fundus disease, fundus photography or fundus angiography should be regularly monitored every three months. For patients without diabetic fundus lesions, fundus photography or fundus angiography should be monitored once a year to observe the condition and guide treatment.