Causes of non-compliance in patients with hypertension

To understand the reasons why patients with hypertension do not follow the medical diet

I surveyed 190 patients with hypertension, and the results are reported as follows:

1. Eligibility conditions:

A. It meets the DIAGNOSTIC criteria of WHO for hypertension and has no cognitive dysfunction.

B. A total of 190 patients were enrolled, including 86 males and 104 females, aged 18-81 years.

C. Educational level: 53 cases were junior middle school, 77 cases were senior high school, and 60 cases were junior college or above;

D. Place of residence: 102 in cities, 88 in towns;

E. 118 cases with duration ≤10 years, > 72 cases at 10 years;

F. Access to health education: 62 cases had received systematic health education, 93 cases had learned some relevant information by reading newspapers and magazines and watching TV, and 35 cases had not received health education or only knew some simple knowledge.

2. Questionnaire survey 

The self-designed questionnaire was used for the survey.The questionnaire consists of two parts. 

• The first part is the general information of the patients, that is, gender, age, education level, and time of illness. Health education and compliance with the medical diet. 
• The second part is the questionnaire about the reasons why hypertensive patients do not follow the medical diet. 

The questionnaire includes 8 items, each item is answered by "yes" and "no". The full-time nursing staff will issue the questionnaire, and the patients will fill in the form independently or with the assistance of their family members under unified guidance. For those who cannot complete the form, the full-time nursing staff can ask each item listed in the questionnaire and fill it out. 190 questionnaires were issued, all of which were effectively recovered.

2. Questionnaire Survey Results
Among 190 patients with hypertension, 17 (8. 9%) followed the medical diet, 173 (91. 1%) did not follow the medical diet. The reasons for non-compliance are shown in the table below.

• Don't know the reasonable diet can prevent, treat high blood pressure ,87  patients, accounting for 50.3 %

• Not knowing that proper diet can eliminate potential risk factors for high blood pressure, 91 patients, accounting for 52.6 %
• They believe that changing diet has little effect on blood pressure and do not pay attention to dietary conditioning.  99 patients, accounting for 57.2 %
• Don't know that obesity is hypertension risk factors,49 patients, accounting for 28.3 %
• Family members can't or cooperate unconditionally diet ,74 patients, accounting for 42.8 %
• Poor eating habits, 118 patients, accounting for 68.2%.
• lack of self-control, 120 patients, accounting for 69.4%.
• Not receiving formal education on hypertensive diet,112 patients, accounting for 64.7%.

3. Analysis of causes of hypertension patients not complying with medical diet

The results showed 

17 (8. 9 %) patients with hypertension could follow the medical diet.

173 (91. 1 %) patients did not follow the medical diet. 

64.7 % of the patients did not receive diet education for hypertension. 50.3% of the patients did not know that a reasonable diet could prevent and treat hypertension, 

52.6% of the patients did not know that improper diet was a potential risk factor for hypertension, 

57.2% of the patients thought that changing diet had little effect on blood pressure and did not pay attention to diet conditioning, 

28.3% of the patients did not know that obesity was a risk factor for hypertension.

The follow reasons are  :

• 1. Factors of the cultural level of patients. Non-knowledge-based elderly patients have few information sources, weak awareness of health care, little demand for health, too much reliance on the medical staff, only require the relief of superficial pain. However, some young and middle-aged people with low education levels have poor acceptance ability and do not attach importance to the role of patients. In addition, the residents to the basic knowledge of diet and nutrition are still at a low level, the lack of important knowledge of basic nutrition and health care needs to cause widespread attention.
• 2. Lifestyle factors of patients. Most elderly patients develop bad habits of smoking, drinking, and a high-salt diet for a long time, which cannot be changed in a short time. Middle-aged and young people because of busywork, pressure, social engagements, and can not very well quit smoking, avoid alcohol, low salt, and low-fat diet, and adhere to long-term medication. At the same time, obesity is also a major cause of hypertension. There are many reasons for obesity, such as genetic factors, lack of exercise, overeating and intemperance. When the condition is stable, patients with hypertension tend to relax their requirements and satisfy their cravings for certain foods and do not control their appetite, which affects the control of blood pressure.
• 3. The patient's family was not involved. The family members of the patients lack knowledge of hypertension, lack of understanding of the disease, and lack of care for the patients, especially for the elderly patients. If the family members have mastered the knowledge of diet, activities, medication and so on, and played the role of cooperation and supervision, the patients are easier to grasp and accept.

4. Improved method

1. Establish a reasonable diet for patients with hypertension

A reasonable diet can promote a healthy life for patients. First of all, we should control the intake of energy, advocate eating complex sugars, such as starch, corn, and eat less glucose and sucrose, which are easy to cause elevated blood lipids and limit the intake of fat for patients. When cooking, choose vegetable oil, can eat more Marine fish, to increase the elasticity of microvascular, prevent vascular rupture, prevent hypertension complications have a certain effect. Eat protein in moderation. A daily protein intake of 1g per kilogram of body weight is recommended for patients with hypertension. Eating fish protein two to three times a week can improve the elasticity and permeability of blood vessels, increase the excrement of urinary sodium, and thus reduce blood pressure. If hypertension is combined with renal insufficiency, protein intake should be limited. Eat foods rich in potassium, calcium and low in sodium, such as potatoes and eggplant. Contain calcium high food: milk, sour milk. Limit salt intake: it should be reduced gradually to <6g a modest reduction in sodium intake can help lower blood pressure. Eat more fresh vegetables and fruits.

            

2. The patients are required to change their unhealthy lifestyle and dietary habits.

The diet diagnosis and treatment of hypertension patients should pay attention to filling calcium and potassium, eating more vegetables and fruits, quitting smoking and drinking alcohol, and drinking water scientifically.

 

3. To improve the participation of patients' family members in the disease control of patients with hypertension, which should be completed jointly by the family members and patients.

Let the family members of the patient understand the knowledge of hypertension, cooperate with the patient to arrange life reasonably, pay attention to the combination of work and rest. Family members are required to regularly measure the patient's blood pressure and keep it close to normal to prevent further damage to the organs. Do not add or discontinue medications at will. Supervise proper rest to eliminate excessive stress. Improve social adaptability, maintain psychological balance, avoid the influence of various adverse stimuli, patients can not wear tights, neckline or tie too tight, will compress the jugular sinus, so that the blood pressure rise. Prevent constipation, hold breath defecate can make abdomen pressure rise, can cause blood pressure to rise sharply, when necessary take purging agent. Proper participation in activities such as walking, walking, cycling and swimming can lower blood pressure. If the patient's blood pressure continues to rise or symptoms such as dizziness, headache, or nausea occur, seek medical attention immediately.

Non-compliance behavior not only affects the control of hypertension, but also affects the quality of life of patients, so prevention is very important. We believe that in the process of treatment, we should grasp the relevant factors of non-compliance behavior, take corresponding measures, through targeted health education, increase patients' knowledge of disease prevention, treatment and life extension, and promote their compliance behavior.

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The best diet for high blood pressure

1. Diet for hypertensive patients

• Breakfast, lunch , dinner

Eating arrangements should be small meals, to avoid being too full; People with high blood pressure are usually obese and must eat low-calorie foods. Dinner should be light and light, too much greasy food can cause a stroke. Edible oil should contain vitamin E and linoleic acid oil; Don't eat sweets. Eat high cellulose food, such as celery, green vegetables, Chinese cabbage, wax gourd, tomato, eggplant, onion, and a small amount of fish, shrimp, poultry, skim milk powder, egg white

• low salt

The amount of salt per person per day should be strictly controlled at 2-5 grams.

• high potassium

Foods rich in potassium enter the body to fight the pressure-boosting and vascular damage caused by sodium. These foods include beans, mushrooms, walnuts, peanuts, potatoes, lean meat, fish, poultry, root vegetables, fruits such as bananas, peaches, oranges, etc.

• Eat more fish 

Fish is preferred for all hypertensors because epidemiological studies have found that people who eat fish once a week have significantly lower death rates from heart disease than those who don't.

• fruit and vegetable

The human body needs B vitamins and vitamin C every day, which can be satisfied by eating more fresh vegetables and fruits. Eat 1-2 apples a day, good for health, fruit can also supplement calcium, potassium, iron, magnesium, and so on.

• Supplement trace element-valcium

Should eat more calcium-rich foods, such as soybeans, walnuts, milk, peanuts, fish, and shrimp.

• Supplement trace element-iron

The study found that the elderly patients with hypertension plasma iron are lower than normal, so eat more peas, agaric, and other iron-rich food, not only can reduce blood pressure, but also can prevent anemia in the elderly.

• Drink water

Natural mineral water contains lithium, strontium, zinc, selenium, iodine, and other essential trace elements for the human body.

2. The diet of hypertension patients should avoid

• Carbohydrate. Suitable for food, rice, noodles, taro, yams, beans should avoid food, dried beans
• Protein. Appropriate food - fat-less food (tender meat, beef, pig lean meat, white meat fish), eggs, milk and milk products (fresh cream, cheese), soy products.  Avoid food - fatty food (pork belly, pork ribs, whale meat, herring, eel, tuna, etc.), processed products (sausage, etc.).
• Fatty foods.  Suitable food - vegetable oil, a little cream, salad dressing.  Avoid food - bacon, sardines
• Vitamin and mineral foods.  Suitable food - vegetables (spinach, cabbage, carrot, tomato, pumpkin, eggplant, cucumber, and other fiber less), fruits (apple, peach, orange, pear, grape, watermelon, banana, etc.), fungi, fruits. Foods to avoid -- vegetables with hard fiber (bamboo shoots, corn)
• Other foods. Suitable food - light black tea, yeast milk drink. Avoid food - spices (chili, mustard, curry powder, alcoholic drinks, coffee, black tea, etc.), carbonated drinks.

3. Recipes for hypertension diet

(1) Celery porridge.

120 grams of celery, 250 grams of rice.

Wash the celery, cut into long sections, rice purity.

Celery, rice into a pot, add water to the appropriate amount, boil and then stew with a gentle fire until the rice rotten into porridge, then add a little salt and MSG, stir well that is.

(2) Chrysanthemum porridge.

Chrysanthemum powder 15 grams, 100 grams of rice.

Chrysanthemum remove the tips, steamed, taken out of the sun or shade dried, and then ground into a fine powder, set aside.

Put the rice into a pot, add water, boil it and cook it with a gentle fire until it is half-ripe, then add chrysanthemum finely, and continue to cook with a gentle fire until the rice is rotten into porridge. Dinner is served.

(3) Mung bean and kelp porridge.

Mung beans, kelp 100 grams each, the right amount of rice. Chopped kelp with the other 2 flavors cooked into a porridge. Can be eaten for a long time as dinner.

(4) lotus leaf porridge: 1 fresh lotus leaf, 100 grams of rice, a little rock sugar.

Wash the fresh lotus leaf and decoct the soup, then cook the congee with rice and rock sugar. Eat warm for breakfast and dinner.

(5) vinegar soaked peanut rice: soak raw peanut rice in vinegar, eat it after 5 days, eat 10 to 15 capsules every morning, it has the effect of lowering blood pressure, stopping bleeding and lowering cholesterol.

(6) Sugar and vinegar garlic: sugar, vinegar diffuse soak a number of garlic cloves for more than 1 month, eat 6 cloves of garlic every day, and drink 20 ml of its sugar and vinegar juice, even for 1 month, for stubborn hypertension.

(7) rooibos Wu Wei Zi tea: rooibos leaves 6 grams, Wu Wei Zi 5 grams, the amount of rock sugar, boiling water brewed as tea. Regularly drink this tea can lower blood pressure, improve the symptoms of hypertension, and can prevent coronary heart disease.

(8) He Shou Wu jujube porridge: 60 grams of He Shou Wu, add water to decoct thick juice, remove the slag and add 100 grams of rice, jujube 3-5, the amount of rock sugar, cooked together as a porridge, eat in the morning and evening, has the effect of liver and kidney, benefit essence and blood, hair, lowering blood pressure.

(9) Tamarind caper soup: Tamarind, caper or celery 10 ~ 30 grams each, daily soup, 15 days for a course of treatment, effective for lowering blood pressure

(10) carrot juice, about 1,000 ml per day, drink in divided doses. Medical research has proved that hypertensive patients drink carrot juice, has a significant antihypertensive effect.

(11) Lingzhi soup: cut Lingzhi into pieces, put it into a pot, add water, stew for 2 hours, take the soup with honey, take it once in the morning and once in the evening, it can lower blood pressure.

(12) Boiled eggs, peel off the egg white and eat it, put the egg yolk into a bowl, grind it, add the right amount of vinegar, stir it up and eat it. Long-term use, high blood pressure can be lowered.

(13) Carrot porridge: use 120g of fresh carrots chopped, cook with 100g of rice and eat the porridge.

(14) Garlic porridge: put 30g of garlic into boiling water and cook for 1 minute, then take 100g of rice and put it into the garlic cooking water to make thin porridge, then put the garlic back in and cook for a while to eat.

(15) Pueraria Mirifica Porridge: 30g of Pueraria Mirifica powder and 100g of rice are cooked together as porridge and eaten for breakfast.

If you need more information, you can also refer to the links below:

NCBI

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How to properly measure blood pressure at home

Definition of blood pressure

Blood pressure is defined as arterial blood pressure, which is the lateral pressure of flowing blood against the walls of blood vessels. It is the result of the interaction of two forces: cardiac ejection and peripheral resistance.

There are systolic and diastolic blood pressure. When the heart is in systole, the arterial blood pressure rises to its highest value, called systolic blood pressure; when the heart is in diastole, the arterial blood pressure falls to its lowest point, called diastolic blood pressure.

Equipment for measuring blood pressure

Mercury sphygmomanometers, and tabletop sphygmomanometers and electronic sphygmomanometers are commonly used to measure blood pressure.To measure blood pressure at home, it is recommended to choose electronic sphygmomanometers.

Factors affecting blood pressure

Blood pressure is in a state of dynamic equilibrium. Factors such as mood, environment, diet, temperature, temperature, and method of measurement may affect fluctuations in blood pressure. Alcohol, smoking, pain, anxiety, exercise, medications, urine and bowel movements (especially in emergency situations) may immediately cause blood pressure fluctuations.

Precautions for measuring blood pressure

1. Do not drink alcohol, coffee or smoke for half an hour before taking your blood pressure. Be calm, empty your bowels, and do not eat again.

2. Rest calmly for 15 minutes before taking your blood pressure.

3. The sphygmomanometer should be at the same level as the heart.

4. Avoid putting pressure on the arm with the cuff. A proper tightness should be maintained between the cuff of the sphygmomanometer and the anterior humeral artery.

5. The sphygmomanometer's air sac should be completely evacuated.

Measure blood pressure at least two to three times a day.

There are two peak periods of blood pressure each day. 

Most people have a distinct circadian rhythm to their blood pressure, meaning that it is high during the day when they are active and low at night after they go to bed. 

There are generally two peak periods for blood pressure during the day, from 6-10 p.m. and from 4-8 p.m. 

Therefore, by measuring blood pressure during these two hours, the highest blood pressure point of the day can be seen. 

The highest blood pressure values throughout the day are mostly during these two hours, then gradually drop to the lowest value throughout the day, the second low point, at 1:00-2:00 am, and finally gradually rise to the first visit the next day. 

The difference between high blood pressure during the day and low blood pressure at night is related to the body clock and is the result of a combination of neurological, humoral, and endocrine regulation. When the body clock changes, blood pressure also changes, such as nurses, workers, and shift workers who work night shifts, and whose peak blood pressure may occur at night.Take your blood pressure at home and keep a good time, not too short intervals.

The significance of the application of peak blood pressure time.

1. In order to understand a person's blood pressure, it is necessary to choose two peak periods to measure the body's blood pressure.

2. Three consecutive measurements should be taken during the peak blood pressure period and averaged. Hypertension can only be diagnosed when the systolic blood pressure is greater than or equal to 140 mmHg or the diastolic blood pressure is greater than or equal to 90 mmHg; measuring blood pressure at times far from the peak period may lead to a missed diagnosis of hypertension.

3. Measure blood pressure at the same peak times each day and compare the levels. If you measure blood pressure in the morning on one day and in the afternoon on another day, it is difficult to make comparisons.

4. Use antihypertensive medication before the peak blood pressure time to get a handle on the effectiveness of short-, medium-, and long-acting agents in lowering blood pressure. Conversely, there is no point in using the medication.

When you take your own blood pressure measurements at home, record your daily measurements for a week or so to find the right time to take your medication, and these records can be more accurate for your doctor to diagnose your condition.

 

In addition, it is necessary to find out the daily peak time of blood pressure, find out the pattern of blood pressure changes, and take appropriate treatment.

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Is High Blood Pressure an Incurable Disease?

Facts about high blood pressure

We should recognize the facts about hypertension. Clinical medicine and epidemiology have demonstrated that effective antihypertensive treatment of hypertension can reduce and minimize mortality and prevent and reduce the occurrence of cardiovascular and cerebrovascular complications. Although it is not difficult to control blood pressure at satisfactory levels, the medical community still believes that hypertension is a lifelong disease and that hope for a cure will rest on the results of future human genetic research.

Is hypertension an incurable disease?

No, it is a disease that medical science now understands a lot about. Hypertension is only a chronic disease. The dangers of hypertension can be controlled by lowering blood pressure enough to keep it in the normal range over time. That said, there are several non-drug and drug combinations that can control blood pressure and prevent the complications of hypertension. People with hypertension can achieve normal blood pressure and stay healthy through self-regulation (lifestyle modification and non-pharmacological methods) and medication. Therefore, we often see some elderly people who are already 80 or 90 years old and have been suffering from hypertension for decades, but they insist on life regulation and medication for a long time, and their blood pressure is relatively well controlled and their bodies are still very strong.

If hypertension is an incurable disease, I believe many people will be afraid.

Because in people's subconscious, the so-called incurable disease is very scary, and suddenly die. In fact, there is absolutely no need to worry because many antihypertensive drugs can control blood pressure. As long as you take your medication on time every day and adhere to a reasonable dosage, you can keep your blood pressure in an appropriate and stable range.

Many diseases that are incurable can be controlled by proper and reasonable medication, so that the quality of life can be improved. For example, diabetes, coronary heart disease, asthma, chronic obstructive pulmonary disease, hepatitis B, etc. Therefore, in the face of hypertension, one should keep a normal heart and not be afraid.

58 common terms for High blood pressure

 There are many terms commonly used for hypertension.

(1) Blood pressure. Blood pressure refers to the lateral pressure of the blood in the blood vessel to the blood vessel wall per unit area, namely pressure.

Since blood vessels are divided into arteries, capillaries, and veins, there is also arterial, capillary, and venous blood pressure. Blood pressure is usually referred to as arterial blood pressure. When blood vessels dilate, blood pressure drops; Blood pressure rises when blood vessels constrict.

(2) Factors affecting blood pressure. ① Increase or decreased blood volume. (2) contraction or expansion of blood vessels. ③ Contractility of the myocardium. What we say at ordinary times "blood pressure" refers to the blood pressure determination of blood vessels of arm fossa namely to upper arm brachial artery actually, it is an indirect determination to great artery blood pressure.

(3) Blood pressure was measured occasionally. The blood pressure of a subject was taken without any preparation.

(4) Ambulate blood pressure. An autograph is used to measure a person's blood pressure at regular intervals over 24 hours. Ambulate blood pressure includes systolic blood pressure, diastolic blood pressure, mean arterial blood pressure, and heart rate, as well as their maximum and minimum values.

(5) Hypertension. An abnormal increase in arterial blood pressure above normal.

(6) Systolic pressure. As the ventricles contract, the pressure of the aorta rises sharply, reaching a peak in the middle of the systole period. The value of the arterial blood pressure at this time is called systolic pressure, also known as "high pressure."

(7) Diastolic blood pressure. During ventricular diastole, aortic pressure drops, and the lowest value of arterial blood pressure at the end of cardiac relaxation is called diastolic blood pressure, also known as "low pressure".

(8) pulse pressure. The difference between systolic pressure and diastolic pressure.

(9) Mean arterial pressure. The average value of arterial blood pressure of every instant in a cardiac cycle, add about equal diastolic blood pressure 1/3 pulse pressure.

(10).KPa  Kilopascals are usually used to indicate blood pressure.

(11) mmHg. "Millimetres of mercury" is the height of the column of mercury used to measure blood pressure.

1mmHg = 0.133 kPa(kilopascals)

7.5 mmHg =1kPa(kilopascals)

(12) Ideal blood pressure Systolic blood pressure <120ramHg and diastolic blood pressure>80 MMHG.

(13) Normal blood pressure. Systolic blood pressure should be. 130mmHg, diastolic blood pressure >85 MMHG.

(14) High normal blood pressure or pre-hypertension. Systolic blood pressure ranges from 130 to 139mmHg and/or diastolic blood pressure ranges from 85 to 89mmHg.

(15) Hypertension. Systolic blood pressure ≥140mmHg and/or diastolic blood pressure ≥90 MMHG.

(16) Borderline hypertension. The systolic blood pressure was 140 ~ 160mmHg(18.6 ~ 21.3 kPa), and the diastolic blood pressure was 90 ~ 95mmHg(12.0 ~ 12.6 kPa).

(17)Creatinine. Creatine metabolites in the human body. Creatine is produced at a steady rate, proportional to muscle volume, and releases creatinine at a steady rate into the blood, where it travels to the kidneys and is excreted from the body in the urine. Long-term hypertension damages kidney function, make the kidney the excrement of blood creatinine is reduced, make blood creatinine rise.

(18) Ultrasound examination of the heart. Also called ultrasonic cardiogram, can reflect each valve is normal morphology, activity, size and shape of each atrial ventricular heart around the great vessels in and out of the heart, presence of congenital heart disease or heart damage rheumatic heart disease, pericardial effusion, all sorts of cardiomyopathy, detection caused by hypertension left ventricular hypertrophy and evaluate cardiac function.

(19) Essential hypertension. Hypertension of unknown cause, accounting for more than 90%, is currently difficult to cure but can be controlled. Also called hypertension.

(20) Secondary hypertension. Also known as symptomatic hypertension. Due to certain diseases (kidney disease, endocrine diseases such as adrenal tumor or hyperplasia, and other reasons) in the process of its development, after the cure of the primary disease, blood pressure will also drop, accounting for 5% to 10% of patients with hypertension.

(21) High blood pressure. People who live in the plateau area for a long time have increased blood pressure (especially diastolic blood pressure is more common), but there are no other conditions that lead to hypertension. After returning to the plain without antihypertensive treatment, their blood pressure soon returns to normal, which is called high blood pressure.

(22) Sleep hypertension. Blood pressure increases during or after sleep.

(23) Progressive malignant hypertension. Including progressive hypertension and malignant hypertension. Acute hypertension is a condition that begins as a rapid progression, or after several years of slow process suddenly rapid development. Malignant hypertension is the most serious stage of progressive hypertension.

(24) Progressive hypertension. Insidious onset, slow development of the disease, the course of the disease is long, up to decades, more in people over the age of 40.

(25) Refractory hypertension. In a small number of patients with hypertension, the diastolic blood pressure (DIastolic blood pressure) remained above 115mmHg(15.2kpa) despite receiving a large dose of 3 or more drugs, which is called refractory hypertension.

(26) Hypertension in the elderly. Systolic blood pressure ≥140mmHg and diastolic blood pressure I&gt; 90 MMHG.

(27) Simple systolic hypertension. A person's diastolic blood pressure is not high, only systolic blood pressure is outside the normal range. In 1999, the world Health Organization stipulated that the standard of simple systolic hypertension was systolic blood pressure ≥140mmHg and diastolic blood pressure>90 MMHG. If systolic blood pressure is 140 ~ 149mmHg, diastolic blood pressure &lt; 90mmHg is considered critical simple systolic hypertension.

(28) Renal vascular hypertension. A disease of narrowing or occlusion of the renal artery or its main branches, resulting in decreased renal blood flow or hypertension due to ischemia.

(29) Renal hypertension. Renal vascular or parenchymal diseases, such as renal artery stenosis, acute and chronic glomerulonephritis, pyelonephritis, polycystic kidney hypertension, etc.

(30) Iatrogenic hypertension. Doctors improper medication caused by patients with high blood pressure, beyond the normal value of hypertension, also known as drug-induced hypertension.

(31) White coat hypertension. An individual's blood pressure rises when measured in a hospital or clinic setting, but is normal in other Settings. This has also been defined in some ways as independent office hypertension.

(32) blood pressure restlessness. A condition characterized by excessive attention to one's blood pressure and the ability to calm down by repeatedly measuring it several times a day.

(33) Hypertensive encephalopathy. It is mainly due to the sudden increase of blood pressure based on original hypertension, as high as 200 ~ 260mmHg / 140 ~ 180mmHg. It causes cerebral edema and increased intracranial pressure, resulting in a clinical syndrome of sudden change.

(34) Hypertensive crisis. Based on hypertension, temporary contraction of peripheral arterioles leads to a sharp increase in blood pressure, which is a special clinical syndrome occurring in the process of hypertension.

(35) stroke. Also known as stroke, medical called cerebrovascular disease, divided into two categories, one is cerebral thrombosis, one is cerebral hemorrhage. 86% of strokes are caused by high blood pressure.

(36) Transient ischemic attack (TIA). Also known as transient cerebral ischemia, commonly known as "small stroke", refers to the carotid artery system occurs transient (transient) insufficient blood supply, resulting in transient ischemia of the brain tissue in the blood supply area, resulting in local neurological dysfunction, and the occurrence of corresponding symptoms and signs.

(37) Cerebral infarction (cerebral thrombosis). The cerebral artery is blocked due to some reasons, the blood vessel is interrupted so that the brain tissue that the blood vessel introduces loses blood flow supply and necrosis and produces corresponding clinical symptoms and signs, such as hemiplegia, hemianopsia, aphasia, etc.

(38) Cerebral hemorrhage. Cerebral artery blood vessel ruptures as a result of haemorrhage, blood flow person forms hematoma in brain tissue, cause the necrosis of brain tissue at the same time, also can produce the symptom and sign such as hemiplegia, partial body feeling disorder, hemianopsia, aphasia.

(39) High blood lipid. Also known as hyperlipidemia, it refers to the abnormal metabolism of fat in the body caused by the increase in blood lipid, or the change of blood lipid level beyond the normal range.

(40) hypercholesterolemia. Pure cholesterol (Tc) and low-density lipoprotein (LDL) were increased.

(41) Mixed hyperlipemia. Both cholesterol and triglyceride increased.

(42) heart. It is composed of two heart pumps: the right heart pumps blood to the lungs; The left side of the heart pumps blood to the body's organs. Each side of the heart is made up of the atria and ventricles.

(43) Circulatory organs. Including the heart, blood vessels, and lymphatic system, which are connected and form a closed "management system."

(44) Cardiovascular system. A closed transportation system consisting of the heart, arteries, capillaries, and veins.

(45) Coronary heart disease. When the coronary artery, the blood vessel that supplies heart blood produces apparent atheromatous sclerosis sex to narrow or block namely, or amalgamative spasm, thrombectomy is formed on this basis to cause lumen part or complete block, caused coronary heart disease when coronary artery supplies blood insufficient, the myocardium is ischemic or infarct is necrotic. It was divided into asymptomatic myocardial ischemia, angina pectoris, myocardial infarction, and sudden death.

(46) Angina. A clinical syndrome caused by coronary artery insufficiency, acute, and temporary myocardial ischemia, and hypoxia.

(47) Myocardial infarction. Myocardial ischemic necrosis, based on coronary artery disease, coronary artery blood supply dramatically reduced or interrupted so that the corresponding myocardial serious and lasting acute ischemia caused by.

(48) sudden death. She suffered a sudden cardiac arrest and died.

(49) Renal failure. Call renal function small full again, it is to point to the progressive kidney damage that all sorts of reasons include hypertension to cause, cause the kidney cannot maintain its basic function if cannot discharge the metabolic waste in the body, cannot adjust water-salt balance to wait. Clinical manifestations include oliguria, anuria, and systemic involvement.

(50) Heart failure. Heart failure has circumfluence of the blood of right amount in case, due to long-term overloaded heart or myocardial contraction force drops, the heart cannot enough blood satisfies eduction constituent metabolization need, so that the surrounding tissue perfusion inadequacy and pulmonary circulation or systemic blood, resulting in a series of clinical symptoms and signs, were heart failure gratified the function is not complete. The severity of the disease is divided into acute and chronic heart failure (CHF). Chronic heart failure is also known as congestive heart failure. It can be divided into left heart failure and right heart failure according to its site and clinical manifestations.

(51) Arrhythmia. Abnormal cardiac frequency and rhythm. There are slow type and fast type.

(52) Antihypertensive drugs. Also known as antihypertensive drugs, they can be divided into six categories: ① diuretics ② angiotensin-converting enzyme inhibitors ③ angiotensin ⅱ receptor (ATL) blockers ④B receptor blockers ⑤ calcium antagonists ⑥α receptor blockers.

(53) Compliance with medication. Refers to whether hypertensive patients can adhere to the treatment and control blood pressure according to the doctor's instructions.

(54) receptor. A special biomolecule in cell membrane or cell that can specifically bind to certain chemical substances (such as transmitters, modulators, hormones, etc.) and induce biological effects.

(55) Calcium antagonist. Drugs that selectively block the entry of Ca2 through voltage-dependent calcium channels on the cell membrane and reduce intracellular Ca2+ concentration, thereby affecting cellular function, are also known as calcium channel blockers, which can dilate arteries, reduce blood pressure, and also treat angina.

(56) Diuretics. A drug that acts on the kidneys and increases electrolyte and water excretion, resulting in increased urine production.

(57) Angiotensin-converting enzyme inhibitors (ACEI). It can inhibit the activity of angiotensin-converting enzyme (ACE) and thus reduce the formation of angiotensin ⅱ.

(58) The palm-to-peak ratio (T/P ratio) of antihypertensive drugs. The decrease in the lowest drug effect is divided by the decrease in the highest hypotensive effect

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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) &lt; 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.

If you need more information, you can also refer to the links below:

National library of medicine

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How to Prevent Hypertension in Pregnancy

The importance of blood pressure as a mandatory part of every pregnancy checkup speaks volumes about its importance. Clinically common hypertensive disorders in pregnancy will pose a great risk to the health of mother and child if not well controlled, so let's take a closer look at blood pressure during pregnancy today.

1. Definition of blood pressure and physiological factors affecting blood pressure fluctuations.

Definition of blood pressure.

Blood pressure is the lateral pressure of the flowing blood for a unit area of the vessel wall. Generally refers to the upper arm brachial artery normal for systolic pressure of 90-140 mm Hg, diastolic pressure of 60-90 mm Hg, under normal circumstances a person's blood pressure in the two upper extremities can be different, a difference of 10-20 mm Hg.

Physiologic factors of blood pressure variation

Blood pressure is not constant and is subject to physiological changes due to multiple factors, such as exercise, sleep, environment, season, age, gender, and emotion.

• The pattern of blood pressure changes throughout the day: 6-10 am, 4-8 pm the highest, evening or night the lowest, a double peak and a valley fluctuation trend. 

• Age: generally speaking, the older you are, the higher your blood pressure is. 

• Blood pressure rises after exercise and meals, and returns to normal after rest. 

• Mood swings: such as tension, fear, anxiety, happiness, anger, etc. can cause a sudden rise in blood pressure.

• Environment and season: blood pressure is higher in cold areas and winter, and lower in warm places and summer.

• Different parts of the same person have different blood pressure, for example, the blood pressure of the left and right upper limbs, and the blood pressure of both upper and lower limbs can be different.

The main factors affecting blood pressure

• Blood volume and volume ratio, the greater the ratio, the higher the blood pressure.

• Heart rate: the faster the heart rate, the higher the blood pressure.

• The elasticity of the large arteries. If the elasticity of blood vessels decreases in the elderly, the systolic pressure increases.

• Diastolic blood pressure increases when peripheral resistance increases.

• Cardiac output: the higher the cardiac output, the higher the blood pressure, all other factors being equal.

2. Changes in blood pressure during pregnancy

Pregnancy is a special physiological period for women in their reproductive years, the body will make some adaptations and most of them can go through pregnancy smoothly, therefore, the blood pressure of most pregnant women is in the normal range, and very few of them may have hypotension or hypertension.

Hypotension is mainly caused by the early pregnancy reaction and the decrease of peripheral resistance in the middle of placental blood circulation.

Some pregnant women may have elevated blood pressure, which may develop into gestational hypertension and systemic small artery spasm causing ischemia and hypoxia of important organs, endangering the health of mother and child, such as placental abruption, pulmonary edema, gestational hypertensive heart disease, acute renal failure, postpartum hemorrhage, etc. It may also cause intrauterine growth retardation, stillbirth, stillbirth, placental hypofunction, placental insufficiency of blood supply, etc.

3. How to self-monitor blood pressure at home

For those who have previous history of hypertension, family history of hypertension, obesity, diabetes, etc., or those who need to observe hypertension at home for the first time should advocate self-monitoring blood pressure at home.

• Choose a regular manufacturer's upper arm cuff electronic sphygmomanometer, avoid using a desktop mercury sphygmomanometer, and prepare a record book and pen.

• Before measuring blood pressure, take 15 to 20 minutes of calm rest, and use the same sphygmomanometer at the same time every morning and evening to measure in the same area, with the height of the sphygmomanometer in line with the position of the heart, and take the average of each measurement 2-3 times and record it well, and bring it to the doctor at the time of consultation.

4. Understanding hypertensive disorders in pregnancy

Hypertensive disorders in pregnancy are a disease specific to pregnancy and are a series of conditions mainly related to increased blood pressure, including the following types.

gestational hypertension: 

a systolic blood pressure ≥ 140 mm Hg and/or a diastolic blood pressure ≥ 90 mm Hg at 20 weeks of gestation, with a return to normal blood pressure and negative urine protein at 12 weeks postpartum, confirms the diagnosis.

Pre-eclampsia.

• Mild preeclampsia: systolic blood pressure ≥ 140 mm Hg and/or diastolic blood pressure ≥ 90 mm Hg after 20 weeks of gestation, accompanied by 24-hour proteinuria greater than or greater than 0.3 g.

• Severe pre-eclampsia: systolic blood pressure ≥ 160 mm Hg and/or diastolic blood pressure ≥ 110 mm Hg during pregnancy, 24-hour proteinuria greater than or greater than 3.0 grams, or impaired liver and kidney function and other organs.

Eclampsia: 

It is the most dangerous stage of hypertensive disorders in pregnancy and is the sudden onset of convulsions on top of preeclampsia that cannot be explained by other causes.

Chronic hypertension in pregnancy: 

A patient who was hypertensive before pregnancy and whose blood pressure did not significantly worsen during pregnancy; or hypertension first diagnosed after 20 weeks of pregnancy and fails to return to normal after 12 weeks postpartum.

Chronic hypertension complicated by preeclampsia

Chronic hypertensive pregnant women with 24-hour urine protein greater than or equal to 0.3 grams or random proteinuria (+) after 20 weeks of pregnancy; or proteinuria before pregnancy and significant increase in urine protein after pregnancy, blood pressure continues to rise, and thrombocytopenia.

5. Prevention of hypertensive disorders during pregnancy

During pregnancy, the mother must pay attention to a reasonable mix of coarse and fine, meat and vegetable balanced nutrition, abstain from high salt foods, the daily intake of sodium is not more than 6 grams, and the daily intake of calcium in the middle and late pregnancy is 600-1200 mg.

Have enough sleep and suitable physical exercise. Pregnant mothers should get 10 hours of sleep a day, especially a 2-hour lunch break. Appropriate exercise can promote blood circulation, improve appetite and facilitate sleep. For example, walking for about 30 minutes a day is the best way for pregnant women not to feel fatigued, and it is also good to do some household chores that you can do.

In conclusion, it is especially important for pregnant women to learn about blood pressure and hypertensive disorders in pregnancy to prevent and detect hypertensive disorders in pregnancy. It is necessary to take some preventive measures in order to avoid the health damage caused by hypertensive disorders in pregnancy to mother and child.

If you need more information, you can also refer to the links below:

NIH.US

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CDC

What Postural hypertension is

Definition of postural hypertension

Postural hypertension refers to a systolic blood pressure increase of at least 20mmHg after standing.The incidence of postural hypertension in various studies ranged from 8.7% to 16.3%.

Characteristics of postural hypertension

The characteristic of this disease is that it does not have the characteristic of hypertension generally, most are found in physical examination or accidental situation, its blood pressure is given priority to with diastolic blood pressure rise more, and fluctuation range is larger. 

The individual severe person may accompany palpitation, easily tired, fall asleep to wait quickly. Blood test plasma renin activity is higher than normal people, even more than the general hypertensive patients.

Causes of postural hypertension

The mechanism of postural hypertension is generally believed to be related to the excessive filling of the "gravitational vascular pool" of veins and sinus veins.

The veins and sinuses below the horizontal level of the human heart swell when they are affected by the gravity of the blood. Medically, these veins or sinuses are called gravitational vascular pools. When people lie low is not affected by what these vessels pool, but when standing or sitting position, as a result of clogged in droop too vein in the pool of blood vessels, reduce reflux flow of blood, decreased cardiac output, resulting in excessive sympathetic nervous excitement, systemic small blood vessels, especially small artery prolonged contraction or spasticity, causing increased blood pressure. Some people are particularly sensitive to this reaction, so can produce postural hypertension.

Treatment of postural hypertension

• For postural hypertension, generally do not use antihypertensive drug treatment. If the use of antihypertensive drugs, such as diuretics, not only can not reduce blood pressure but will stimulate blood pressure to further increase, therefore, the main treatment is to strengthen physical exercise, improve muscle fullness, individual symptoms are obvious, can be appropriate to take brain rehabilitation, inosine, vitamin B, glutamate, etc., to regulate the nerve can be.

• Postural hypertension also has an outstanding problem because its pathogenesis is different from that of general hypertension, so it can not be used to treat general hypertension to treat postural hypertension. Experiments have shown that the use of diuretics does not lower blood pressure, but encourages it to rise further. Position, therefore, main is to strengthen physical exercise for the treatment of high blood pressure, increase the degree of muscle fullness, generally do not need medication treatment, individual symptoms, appropriate neural function regulating drugs (such as oryzanol, etc.), the central and peripheral nerve nutrition preparation, stability and calm.

Postural hypertension generally has a good prognosis, without long-term adverse consequences, but in the diagnosis, it should be clear whether it is postural hypertension, so as not to use unnecessary or wrong treatment measures, affecting the physical and mental health of patients.

If you need more information, you can also refer to the links below:

NIH.US

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Not all high blood pressure patients must take antihypertensive drugs

Hypertension is a very common disease that is characterized by a persistent increase in arterial blood pressure above the normal range and can be accompanied by complications in target organs such as the heart, brain and kidneys. For patients with hypertension, because of the persistent elevation of blood pressure, they generally have to take long-term  antihypertensive drugs and reduce the occurrence of complications, but very few patients can do without long-term medication.

1. What are the specific hypertensive patients who can do without long-term  antihypertensive drugs?

• Some patients with secondary hypertension

Hypertension includes two categories: primary hypertension and secondary hypertension, of which secondary hypertension is the elevation of blood pressure caused by a clear cause, such as acute and chronic nephritis, pheochromocytoma, primary aldosteronism, aortic stenosis, hyperthyroidism, etc. For patients with secondary hypertension, when we treat the underlying disease, blood pressure can often return to normal, or even achieve a cure, without the need for long-term  antihypertensive drugs.

• some patients with primary grade 1 hypertension

Primary hypertension is the most common type of hypertension, and its specific pathogenesis is not clear. It is considered to be caused by multiple factors such as genetics and environment, and once diagnosed, it requires active lifestyle improvement and treatment  antihypertensive drugs. For newly diagnosed primary hypertension, if the blood pressure level does not exceed 160/100mmHg, both patients with grade 1 hypertension and no other cardiovascular risk factors or complications, they can suspend the use of antihypertensive drugs and first carry out lifestyle intervention for up to three months, if the blood pressure control reaches the standard, then the lifestyle intervention can be continued, if the blood pressure is still high, then the use of blood pressure lowering drugs must be started.

2. The most important pathological changes in hypertension occur in the small arteries throughout the body. 

Simply put, the small arteries are generally contracted, have thickened walls, narrowed lumens, and lost elasticity for various reasons, causing greater resistance to blood flow through them, and the normal pressure no longer allows blood to pass through these small arteries properly, and blood pressure rises.

The key is that these changes are qualitative and irreversible!  

Almost all contemporary formal treatments for hypertension are based on  antihypertensive drugs and are aimed at "control" rather than "cure".

3. Some people ask, why do I have to lower my blood pressure? 

Simply put, lowering blood pressure is not about the blood pressure itself, but about avoiding more serious problems.

This is because if blood pressure is poorly controlled over time, abnormally high blood pressure is extremely destructive to every organ in the body, especially the heart, brain, kidneys, and eyes. The result of all this damage can have a serious impact on life expectancy and quality of life. For every 20 mmHg rise in blood pressure, the risk of death doubles.

4. High blood pressure needs to be lowered or you will face many dangers.

The effect of blood pressure lowering needs to be monitored by long-term standardized blood pressure measurement, not by feeling, but by looking at the numbers.

When the effect of lowering blood pressure is not good, it is necessary to see a doctor and adjust the treatment plan until the standard is reached.

The best way to lower blood pressure varies from person to person and from condition to condition, but for most people, systolic blood pressure is below 140 mmHg and diastolic blood pressure is below 90 mmHg. For patients over 60 years of age, or those with kidney disease or coronary heart disease, there are different goals for lowering blood pressure, as prescribed by the doctor.

5. Adhering to a good lifestyle, hypertensive patients can avoid taking  antihypertensive drugs?

Many people already know that exercise, weight loss, smoking cessation, low salt and low fat diet ...... which are good lifestyles, can help a lot in improving hypertension and preventing various cardiovascular and cerebrovascular diseases. So another view has emerged that by adhering to a good lifestyle, hypertensive patients can avoid taking antihypertensive drugs.

This argument is overly optimistic. In fact, the effect of these lifestyles is far from a "cure" for hypertension. Even a completely healthy lifestyle is only likely to return early, mild hypertension to normal. And, if you don't take your medication and exercise with very high blood pressure, you are also prone to cardiovascular emergencies! Lifestyle and antihypertensive drugs work in tandem, remember!

6. In fact, it is the fluctuations in blood pressure that are more harmful than high blood pressure.

Too many people with hypertension make a big deal out of this. Take antihypertensive medication for a while, take their blood pressure, see that it's normal, stop taking it, or take it again after a while.

This approach can lead to dramatic fluctuations in blood pressure. Patients with hypertension have poorer vascular elasticity and regulation than normal people, and dramatic fluctuations in blood pressure cannot be buffered like normal people, which is very dangerous, and their risk of brain hemorrhage/infarction can be as high as 6.2 times that of people with well-controlled blood pressure!

The newer contemporary antihypertensive drugs have minimal side effects when used regularly and are not a problem when taken for long periods of time under medical supervision. The consequences of interrupting treatment or reducing dosage are serious!

If you need more information, you can also refer to the links below:

NIH

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How is high blood pressure staged

Based on the current level of medical development and examination methods, can find the exact cause of blood pressure increase, called secondary hypertension; On the other hand, if the exact cause of increased blood pressure cannot be found, it is called Primary hypertension. The majority of people with hypertension are Primary hypertension,the classification of hypertension is actually the classification of primary hypertension.

1. Hypertension is divided into three stages.

Stage I Blood pressure reaches the level of confirmed hypertension, with diastolic blood pressure fluctuating between 12.0 and 13.3 kPa (90-100 mmHg) most of the time, and is able to return to normal after rest, with no clinical manifestations of heart, brain or kidney complications.

Stage II Blood pressure reaches the level of confirmed hypertension, with diastolic blood pressure exceeding 13.3kPa (100mmHg) or more, unable to drop to normal after rest, and with one of the following.

• (i) X-ray, electrocardiogram or echocardiogram examination with signs of left ventricular hypertrophy. 
• (ii) Funduscopic examination, which shows widespread or localized narrowing of the skull base arteries.
• (iii) Proteinuria and/or mildly elevated plasma creatinine concentration.

Stage III Blood pressure reaches the level of confirmed hypertension, with diastolic blood pressure exceeding 14.7-16.0 kPa (110-120 mmHg), and one of the following.

• (1) cerebrovascular accident or hypertensive encephalopathy.
• (2) left heart failure.
• (3) renal failure.
• (4) Bleeding or exudation from the fundus of the eye with or without optic papilloedema.

2. High blood pressure classification :

Grade 1 hypertension (mild): systolic blood pressure 140-159mmHg or diastolic blood pressure 90-99mmHg

Grade 2 hypertension (moderate): systolic blood pressure 160 to 179 mmHg or diastolic blood pressure 100 to 109 mmHg

Grade 3 hypertension (severe): systolic blood pressure ≥180mmHg or diastolic blood pressure ≥110mmHg

3. ACC/AHA Hypertension Guidelines 2017

The Seventh Report of the U.S. Joint National Commission on the Prevention, Detection, Evaluation, and Treatment of Hypertension, divides blood pressure levels into four categories.

• Normotensive: (≤120/80mmHg)
• Pre-hypertension :( 120-139/80-89mmHg)
• Stage 1 hypertension :( 140-159/90-99mmHg)
• Stage 2 hypertension :( ≥160/100mmHg)

On November 13, 2017, at the Annual Meeting of the American Heart Association(AHA), the 2017 American College Cardiology(ACC/AHA) guidelines for Hypertension in the United States were released. The guidelines abolish the original "pre-hypertensive" blood pressure classification and classify blood pressure into four grades: normal blood pressure elevated blood pressure, grade 1 hypertension, and Grade 2 hypertension (I/B).

In the new strategy for initiating antihypertensive therapy for hypertension, ACC recommends that antihypertensive therapy should be initiated when blood pressure is ≥130/80 mmHg (1 mmHg=0.133 kPa) in patients with pre-existing cardiovascular disease or 10-year risk of atherogenic cardiovascular disease (ASCVD) is ≥10%; No previous cardiovascular disease and 10-year risk of ASCVD. Antihypertensive therapy was initiated in <10% of patients with blood pressure ≥140/90 mmHg. ACC suggests that these changes strengthen blood pressure control in people at high risk of cardiovascular disease by emphasizing that antihypertensive treatment is based on a patient's cardiovascular risk assessment for patients with blood pressure ≥130/80 mmHg.

4. European Guidelines for the Management of hypertension 2018

The European Guidelines for the Prevention and Control of Hypertension 2003 present the criteria for the diagnosis of hypertension with different blood pressure measurements:

• clinic blood pressure of 140/90 mmHg.
• 24-hour ambulatory blood pressure of 125/80 mmHg.
• 135/85 mmHg for home self-measured blood pressure.
• The goal of antihypertensive treatment is to lower blood pressure to below 140/90 mmHg; diabetic patients should be lowered to below 130/80 mmHg.

At the 28th Annual European Conference on Hypertension and Cardiovascular Protection on 9 June 2018, Published the 2018 European Guidelines for the Management of Hypertension by the European Society of Cardiology(ESC) and The European Society of Hypertension(ESH), guidelines used the 2013 version of the guidelines for the classification of clinic blood pressure and the definition of hypertension grade.

The new European guidelines include blood pressure ≥140/90 mmHg as the diagnostic criteria for hypertension. Although the definitions are based on in-office blood pressure measurements, the new guidelines increase the role and role of 24 h ambulate blood pressure measurements (ABPM) and home blood pressure measurements (HBPM) in the diagnosis of hypertension.Although the new guidelines do not modify the diagnostic criteria for hypertension, they are more aggressive in the treatment of hypertension.

The 2018 guidelines have significantly modified the above recommendations :

• (1) life intervention is recommended for high normal values , and antihypertensive drug therapy is considered when cardiovascular disease, especially coronary heart disease, is present at the same time ; 
• (2)age between 65 years old and 80 years old patients with grade 1 hypertension, if they can tolerate it, antihypertensive drugs should be used in addition to recommended lifestyle interventions ; 
• (3) Patients at high risk of grade 1 hypertension or with target organ damage caused by hypertension (HMOD) should immediately start antihypertensive therapy along with lifestyle intervention . In addition, antihypertensive therapy is recommended for patients with low and medium risk grade 1 hypertension without HMOD, whose blood pressure still fails to meet the standard after 3 to 6 months of a lifestyle intervention .

In the new European Hypertension Guidelines 2018, the timing of the initiation of antihypertensive therapy should not only consider blood pressure level but also consider the combination of cardiovascular disease, chronic kidney disease, diabetes, and other cardiovascular high-risk conditions. In addition, for age > 65-year-old patient with grade 1 hypertension was treated more aggressively than before.

American College Cardiology

European Society of Cardiology

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Secondary hypertension has a high probability of being cure

One minute to understand what is secondary hypertension

1. Definition of secondary hypertension

Secondary hypertension, also called symptomatic hypertension, is an increase in blood pressure due to some identified disease or cause. When the primary disease is cured, the high blood pressure, which is a secondary symptom, also decreases or returns to normal.

2. What is the most common cause of secondary hypertension?

Secondary hypertension is an increase in blood pressure caused by some specific diseases, and the main etiologies are as follows:

• Renal parenchymal hypertension. Renal parenchymal hypertension is the most common secondary hypertension, and the main etiologies include chronic glomerulonephritis, chronic pyelonephritis, congenital kidney lesions (polycystic kidney), diabetic nephropathy, and chronic tubulointerstitial nephropathy.

• Renal vascular hypertension. Renal vascular hypertension is hypertension caused by narrowing of the renal arteries, including aortitis, the poor myofibrillar structure of the renal arteries, and atherosclerosis, among other etiologies.

• Endocrine hypertension. It occurs mainly in young and middle-aged people and includes primary aldosteronism, adrenal adenoma, unilateral or bilateral adrenal hyperplasia, adrenal or ectopic adenocarcinoma, pheochromocytoma, Cushing's syndrome, hyper- or hypothyroidism, and menopausal syndrome.

• Hypertension due to cardiovascular lesions. These include aortic valve insufficiency, complete atrioventricular block, aortic stenosis, etc.

• Hypertension caused by craniocerebral lesions. These include brain tumors and traumatic brain injury, etc.

• Sleep apnea syndrome. Can cause ventilation disorders and cause hypertension.

• Drug-related hypertension. Hypertension is caused by the use of certain drugs, such as glucocorticoids, alcohol, herbal medicines, etc.

• Monogenic hereditary hypertension. Related to genetic factors, seen in certain hereditary diseases.

3. What are the types of secondary hypertension?

• Renal substantial hypertension, including hypertension caused by acute and chronic glomerulonephritis, chronic pyelonephritis, and other renal pathologies, is the most common secondary hypertension.

• Hypertension caused by primary aldosteronism is often associated with hypokalemia, muscle weakness, and peripheral paralysis.

• Hypertension caused by pheochromocytoma, which often occurs in the adrenal glands, is mostly benign and can be surgically removed.

• In hypertension caused by cortisol, patients tend to have features such as centripetal obesity, full moon face, and buffalo back.

• Hypertension caused by aortic constriction, which is usually congenital, can be treated with interventional or surgical procedures.

4. secondary hypertension symptoms

Typical symptoms

• Typical symptoms of hypertension such as dizziness, headache and tinnitus are mostly due to hypertensive vasospasm or dilation. Typical hypertensive headache disappears when blood pressure drops.

• Symptoms such as stiff neck, fatigue, palpitations, blurred vision and rhinorrhea may occur. Most symptoms are aggravated after stress or exertion and may resolve on their own. There is a correlation between the symptoms and the blood pressure level.

Other symptoms

• Severe dizziness and vertigo, chest tightness, shortness of breath, angina pectoris, polyuria, and other severe symptoms or symptoms of the affected organs may occur, or manifestations of the corresponding primary disease, such as significant impairment of kidney function, pulmonary edema, and hypokalemia.

5. What kind of person suffers from secondary hypertension easily?

Secondary hypertension occurs in people who are older, consume more salt, are obese, and have a family history of hypertension.

6. Secondary hypertension and complications

Cerebrovascular accident

• The sudden increase of blood pressure leads to cerebrovascular rupture and sudden fainting, followed by coma, flushed face, distorted mouth and eyes, gazing at the side of bleeding, paralysis of the limb on the opposite side of bleeding, clenching of fist, closed teeth, loud snoring, or pale face, open hand and mouth, and incontinence of urine and stool. Sometimes vomiting may occur, and in severe cases it may be accompanied by gastric bleeding and coffee-colored vomitus.

Hypertensive heart disease

• Long-term poor control of blood pressure in hypertensive patients causes changes in the structure and function of the heart, including early left ventricular diastolic hypoplasia and gradual development of left ventricular hypertrophy into myocardial hyposystole, which will eventually develop into heart failure.

Renal failure

• If hypertension is not treated promptly and correctly, it will destroy the blood vessels of the kidneys, leading to insufficient blood supply to the kidneys and causing damage to the kidney function. There will be manifestations of hypertension such as headache and head swelling; accompanied by nausea, vomiting, smell of urine in the mouth, water-electrolyte and protein metabolism disorders and other manifestations of kidney failure.

Hypertensive crisis

• Sudden and significant increase in blood pressure under the action of some triggers, and rapid deterioration of the condition, accompanied by progressive heart, brain, kidney, retina and other important target organ insufficiency manifestations.

7. Secondary hypertension diagnostic criteria

Presence of the following conditions highly suspicious of secondary hypertension.

• Poor response to treatment.

• Difficulty controlling blood pressure in a patient with previously stable blood pressure.

• Severe hypertension (SBP/DBP >180/110 mmHg).

• Hypertension occurring before age 20 or after age 50, significant hypertensive target organ damage.

• No family history of hypertension.

• Medical history, physical examination ,or laboratory tests suggesting secondary hypertension.

8. Three issues of concern to patients

• Can it be cured？Secondary hypertension is partially curable.

• How long you can live? The primary disease needs to be judged. Mild cases usually do not affect life expectancy.

• Follow-up examinations. Patients with secondary hypertension should have their blood pressure measured regularly even after they are cured, and should be followed up if necessary. Ultrasound examination is required after surgical treatment.

Most secondary hypertension has no effective preventive measures. Early detection of hypertension and aggressive identification of the cause and effective treatment is key to avoiding serious complications in cardiac, cerebral, and renal target organs. Genetic screening is required for patients with a family history of hereditary disease.

If you need more information, you can also refer to the links below:

1. U.S National library of medicine

2.All images are from Pexels