What is the pathogenesis of hypertension

1. Definition of the pathogenesis of hypertension

In the early days, it was believed that hypertension in the elderly was a physiological phenomenon that blood pressure increased with age and did not need to be treated. However, long-term studies have shown that hypertension in the elderly is an important factor endangering the survival and quality of life of the elderly, and active treatment can significantly reduce the risk of stroke and other important cardiovascular events.

2. Causes of the pathogenesis of hypertension

The pathogenesis of hypertension in the elderly has not been fully elucidated. Is generally believed that with the increase of age, the aortic intima and middle thick, middle elastic fiber fracture and reduce, collagen, lipids and calcium salt deposition, undifferentiated transition through the elastic layer of vascular smooth muscle cells (VSMC) on proliferation and connective tissue generation increases, the structure change can lead to arterial lumen narrowing, hardness increases, The elasticity and self-compliance of the great arteries decreased, the elastic dilation ability decreased, and the vascular pressure was not buffered and significantly increased. In elderly patients with simple elevated systolic blood pressure (ISH), the decrease in aortic elastic retraction leads to a further decrease in diastolic blood pressure, resulting in ISH. In addition to aortic structural changes (large vessels), endothelial cell dysfunction, neurohumoral factor changes, changes in hemodynamics, environmental and genetic factors play an important role in the occurrence and development of hypertension in the elderly.

• 1. Simple systolic hypertension is more common: due to arteriosclerosis in the elderly, the elasticity and extension of the artery wall are reduced, the elastic expansion of the systolic period and the elastic retraction of the diastolic period are weakened, and the buffering capacity is reduced, resulting in increased systolic blood pressure, decreased diastolic blood pressure, and increased pulse pressure difference. So the elderly often have simple systolic hypertension.

• 2. High fluctuation of blood pressure, abnormal rhythm of diurnal fluctuation of blood pressure, great damage to target organs such as heart, brain, and kidney; The stress response caused by the change of environment makes the blood pressure in the clinic much higher than the self-measured blood pressure. Morning peak blood pressure is prone to increase, that is, the mean systolic blood pressure within 2 hours after getting up - the lowest systolic blood pressure during sleep at night (including the mean value of the lowest systolic blood pressure within 1 hour), ≥35mmHg is the morning peak blood pressure increase. It is suggested to measure 24 hours ambulate blood pressure to clarify the fluctuation of blood pressure and adjust the medication regimen. Advocate self-testing blood pressure at home.

• 3. Postural hypotension and postprandial hypotension are prone to occur.

• 4. Old people tend to eat very salty dishes because their taste sensitivity decreases. The kidney's ability to regulate water and salt decreased and the blood pressure was more sensitive to salt. Too much salt can raise blood pressure, making it harder to control and less effective with antihypertensive drugs.

• 5. Often associated with other cardiovascular risk factors, more prone to target organ damage and cardiovascular disease; Because of the coexistence of a variety of diseases and the number of drugs, easy to occur between the drug interaction, easy to cause adverse drug reactions.

3. How is the pathogenesis of hypertension diagnosed

Age ≥65 years, systolic blood pressure (SBP) ≥140mmHg, such as simultaneous diastolic blood pressure (DBP) < 90mmHg is simple systolic hypertension (ISH).

• Review the initial elevated reading at least three times, taking the average of more than two readings each time.
• Some diseases with increased cardiac output, such as aortic insufficiency, aortic fistula, patent ductus arteriosus, severe anemia, and hyperthyroidism, are not included.
• The blood pressure of the elderly is unstable and susceptible to the influence of mood, body position, and activities, and the blood pressure changes greatly in 24 hours. Blood pressure should be measured repeatedly in different body positions, and it should be quiet for more than 5 minutes before measurement.
• In addition, in terms of diagnosis, comprehensive diagnostic assessment should be made according to the patient's medical history, family history, physical examination, and laboratory examination, to comprehensively understand the causes of hypertension, the assessment of cardiovascular risk factors, and the damage degree of target organs, to guide the diagnosis and treatment measures and the prognosis.

4. How is the pathogenesis of hypertension prevented

• For the elderly, attention should be paid to eliminating the risk factors of cardiovascular disease, avoiding emotional arousal, quitting smoking, drinking less, and keeping the weight close to the normal range is beneficial to health.
• In daily life, pay attention to limit sodium intake and adhere to moderate physical exercise.
• Once antihypertensive therapy is started for senile hypertension, regular medication should be adhered to, and the dosage should not be arbitrarily reduced or stopped.

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National library of medicine

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