What is the relationship between heart rate and blood pressure？

Basic human signs cannot be separated from blood pressure, respiration, and pulse.

As to whether there is a relationship between blood pressure and heart rate, I cannot say that there is not, but it is not a direct effect. Our heart rate can be affected by emotions. If we are too emotional, it will lead to a faster heart rate, and blood pressure may rise at this time, but the effect of emotions is only short-lived, and for healthy people, they can recover quickly, probably within a few minutes. However, for people with high blood pressure, it is not advisable to be overly emotional. A moment of rapid heart rate may cause blood pressure fluctuations and bring damage to the relevant organs, and it is best to be concerned to avoid excess damage.

Then hypertensive patients, heart rate to maintain how much will be beneficial to health? 

It depends on the situation. The heart rate range for a normal person is 60-100 beats per minute. In the case of patients with high blood pressure, it depends on heart health. For people without heart problems, a heart rate of 60-65 beats would be more appropriate. For people with heart problems, the heart rate should be kept between 55-60. There is no need to be too nervous, just pay more attention in your daily life and develop good habits that will help to maintain a normal heart rate.

How to maintain a normal heart rate

1. To ensure balanced nutrition in the body, to reduce the phenomenon of anemia. 

If you have anemia, the blood supply will be affected and the oxygen will not be sufficient. If the heart does not have sufficient blood and oxygen supply, the heartbeat will be affected and the heartbeat and breathing rate will become chaotic, which will disturb the person's emotions and bad moods, which will also speed up the heart rate. If you don't want to be anemic, it is recommended to eat a reasonable diet every day to ensure a balanced nutritional intake and to eat less unhealthy food.

2. It is also important to get a good sleep. 

Having a good sleep is good for blood circulation and body metabolism, and it also allows the body organs to get a good rest. If you stay up late for a long time and do not get enough sleep, it will affect the normal operation of the body and stimulate the nerves, which will affect the heart rate. Usually, it is still necessary to develop good sleep habits, and all things that disrupt sleep and food should be avoided in time.

3. An appropriate increase in physical exercise will also be beneficial to stabilize the heart rate. 

But a word of caution, that is, do not have too strenuous exercise, aerobic exercise is very good. Do not make mistakes when doing aerobic exercise, do not think that the more the better, do too much can also cause a rapid heart rate, which is also very bad for regulating blood pressure. Be relevant to your situation and go for exercise. Suitable projects would be walking, jogging.

consequence of a fast or slow heart rate in patients with hypertension

Patients with hypertension whose heart rate is greater than 84 beats per minute have a 1-fold increased risk of developing coronary heart disease compared to patients whose heart rate is less than 65 beats per minute.

Patients with hypertension who have a heart rate greater than 79 beats per minute have an 89% increased risk of death than those with a heart rate less than 79 beats per minute.

This is the truth, and the main reason why many hypertensive patients take antihypertensive drugs for years, but still have coronary heart disease and even sudden unexpected death, so hypertensive patients should not only control their blood pressure but strive to stabilize their heart rate within the target range, which is as important as controlling their blood pressure.

What causes increased heart rate in patients with hypertension

The main cause of increased heart rate in hypertensive patients is the overexcitation of sympathetic nerves, the triggers are mainly excessive salt intake, smoking, obesity, and disorders of blood sugar and fat metabolism, mostly seen in young and middle-aged hypertensive patients, the result will cause an increase in blood pressure, which can be manifested as accelerated breathing, swelling of the lower limbs, headache and dizziness, blurred vision, gum enlargement, and other symptoms. The increase in blood pressure will cause endothelial dysfunction and atherosclerosis, resulting in cardiac hypertrophy, myocardial ischemia, and heart failure, which in turn will lead to an increased heart rate. As can be seen, the two are causal and affect each other, and the long-term existence of such a state will inevitably cause damage to the heart, brain, eyes, kidneys, and other important organs, and in serious cases can lead to sudden unexpected death. 

Therefore, patients with hypertension should control their blood pressure at least below 140/90mmHg, and at the same time, monitor their heart rate closely. Patients with hypertension combined with coronary artery disease and other cardiovascular diseases: start treatment immediately when the heart rate is greater than 70 beats per minute in a quiet state, and the treatment target is 55-60 beats per minute.

It should be reminded that the heart rate of hypertensive patients is not the slower the better, but too fast or too slow can increase the risk of cardiovascular disease.

What is the difference between hypertension and hypotension?

Blood pressure disorder has long been a common one in the category of diseases nowadays. The number of people with hypertension is getting younger and younger, and the total number is slowly increasing. And although hypotension is not as harmful as hypertension, it also creates confusion for some groups. And hypotension often occurs in women who are tender.

Hypertension may be asymptomatic or asymptomatic in its early stages, and may only increase after exertion, nervousness, or mood swings, and return to normal after rest. As the disease lengthens, the blood pressure continues to rise significantly, and various symptoms gradually appear, which is called bradykinetic hypertension.

The common clinical symptoms of bradykinetic hypertension include headache, dizziness, lack of concentration, memory loss, numbness in the limbs, increased nocturia, palpitations, chest tightness, and weakness. Insufficient blood supply to the brain due to prolonged hypertension is also a cause of dizziness.

The main symptoms of hypertension are dizziness, head swelling, headache, head fever, tinnitus, forgetfulness, memory loss, insomnia and dreaminess, neck pain, neck and back stiffness, panic, shortness of breath, chest tightness, chest and abdomen fullness, heavy legs, weakness of lower limbs walking, numbness of hands and feet, weakness of waist and knees, coldness of both feet, heat in the heart of hands and feet, excessive nocturnal urination, pain all over the body, red face and eyes, dryness of both eyes, eye blur, blurred vision, constipation, fatigue, sexual dysfunction, irritability, etc.

There are different types of hypotension, acute and chronic.

Acute hypotension means that the blood pressure suddenly decreases from all normal or high levels, and is more significant, and most of these conditions are due to ischemia of the brain, heart, kidneys and other human organs, appearing dizziness and black eyes, limbs soft and sweaty, palpitations and urine and other conditions, more serious will be shock.

Chronic hypotension means that the blood pressure is significantly lower than the normal category, and is a persistent condition. It is prevalent in women and the elderly, with mild cases of mian without all illnesses, and more severe cases of physical fatigue, dizziness, etc. It is more significant in summer when the average temperature is higher. A part of patients with hypotension patients dizziness when standing up, which is called postural hypotension.

The symptoms of hypotension may include: dizziness, headache, loss of appetite, fatigue, pallor, indigestion, seasickness, etc. Serious symptoms include: upright vertigo, cold extremities, palpitations, dyspnea, ataxia, slurred pronunciation, even fainting, and prolonged bed rest. These symptoms are mainly due to the drop in blood pressure, resulting in slow blood circulation and distal capillary ischemia, which affects the supply of oxygen and nutrients to tissue cells and the excretion of carbon dioxide and metabolic wastes. In particular, the blood supply to the brain and heart is affected.

Such a prolonged period of time makes the body function greatly reduced, and the main hazards include: vision, hearing loss, induced or aggravated senile dementia, dizziness, fainting, falls, and fracture incidence greatly increased. Weakness, mental fatigue, depression and melancholy always occur, which affects the quality of life of patients.

What is white coat hypertension?

Whitecoat hypertension is a condition in which some patients have elevated blood pressure when their blood pressure is measured in a doctor's office, but their blood pressure is normal when they self-test at home or do two or four-hour ambulatory blood pressure monitoring with a device carried by the patient themselves and no medical personnel present.

This may be due to the increased heart rate of the patient after seeing a doctor in a white coat, as well as the presence of excessive catecholamines in the blood, which also causes peripheral vasoconstriction and increased resistance, resulting in the so-called white coat effect, thus causing an increase in blood pressure.

With the progress of research on the diagnosis and prevention of hypertension, white coat hypertension is receiving more and more attention, and epidemiological surveys have found that white coat hypertension accounts for 9% to 16% of patients with hypertension.

At present, the mechanism of the disease is not too clear, and most people believe that it is related to mental stress, which may be related to the stress response and or alertness response generated by the patient.

It has been found that this white coat hypertension may be an intermediate state between normal blood pressure and persistent hypertension, and the incidence is higher in young women and non-smoking people, so this white coat hypertension should be strengthened with follow-up observation.

Whitecoat hypertension is when blood pressure is measured in the hospital due to mental tension, anxiety, and sympathetic excitement, resulting in elevated blood pressure, while blood pressure is normal when measured at home because it is very relaxed. 

The following methods can defeat white coat hypertension.

1. You should communicate with your doctor before taking your blood pressure.

2. Do your psychological adjustment, do deep breathing, rest for 20 minutes, and then test your blood pressure.

3. Eat some calming and calming food beforehand, such as bananas, milk, sour dates, etc. If necessary, take some sedatives, such as Valium, etc.

4. Severe cases can see a psychiatrist for psychological guidance.

5. Further do ambulatory blood pressure monitoring to clarify whether there is hypertension or not.

Although white coat hypertension is not high blood pressure, some studies have confirmed that people with white coat hypertension are more likely to suffer from hypertension after years than normal people, so we should pay attention to white coat hypertension. Adjust your emotions in time and actively improve your lifestyle to avoid developing true hypertension.

What is differential pulse pressure

The differential pressure between systolic and diastolic pressure is called the pulse pressure difference.

the normal value 40 mm Hg. Greater than 60 mm Hg is called excessive differential pressure, and less than 20 mm Hg is called too small a differential pressure. Whether the differential pressure value is too large or too small, there may be some kind of abnormal body changes.

What is the cause of a large blood pressure differential?

• 1. large blood pressure differential, mainly arterial valve closure insufficiency, aortic sclerosis, hyperthyroidism, severe anemia, rheumatic heart disease, some congenital heart disease with hypertensive heart disease, etc.  

• 2. hypertension and atherosclerosis, resulting in weakened arterial wall elasticity, increased systolic pressure, and decreased diastolic pressure.  

• 3. long-term hypertension, resulting in myocardial overload, resulting in heart enlargement, or arterial valve closure insufficiency.  

• 4. hyperthyroidism (hyperthyroidism) or severe anemia.

A small pulse pressure difference is most often seen in patients in the early stages of hypertension.

Due to the increased sympathetic excitability of the patient, the whole body surface small blood vessel spasm, so that the systolic pressure is not high, the diastolic pressure is relatively high, the pulse pressure difference becomes small.

(1) Any factor that can affect systolic and diastolic blood pressure can affect the pulse pressure difference. When the output per beat increases, systolic blood pressure is high, while diastolic blood pressure changes less, increasing pulse pressure difference; conversely, when the output per beat decreases, systolic blood pressure decreases and pulse pressure difference decreases. Heart rate slows, diastolic ejection time is prolonged, less residual blood in the diastolic unartery, diastolic pressure decreases, and pulse pressure difference increases; conversely, when the heart rate is accelerated, diastolic pressure increases and pulse pressure difference decreases.

(2) Common diseases that cause large pulse pressure differences include aortic valve insufficiency, aortic sclerosis, hyperthyroidism, severe anemia, rheumatic heart disease, syphilitic heart disease, some congenital heart disease, and hypertensive heart disease, bacterial pericarditis, etc. Common diseases that cause a decrease in pulse pressure difference include massive pericardial effusion, constrictive pericarditis, severe mitral stenosis, aortic stenosis, severe heart failure, peripheral circulation failure, shock, as well as due to obesity, increased blood viscosity or combined with diabetes, hyperlipidemia, etc.

(3) Common pulse pressure difference is mostly caused by a decrease in systolic blood pressure (high pressure), of which there are physiological factors, but also pathological reasons. Of the former systolic blood pressure decline is mostly seen in the body wasting or weak, the latter category is seen in shock, myocardial infarction, cardiac insufficiency, pericardial tamponade, hyperalgesia, and other diseases. Other organic lesions that cause a decrease in pulse pressure difference include pericardial effusion, constrictive pericarditis, severe mitral stenosis, and aortic stenosis.

(4) The treatment of excessive or small pulse pressure difference is mainly causative treatment. If the aortic closure insufficiency that causes excessive pulse pressure difference must rely on cardiac surgery to solve; treatment of small pulse pressure difference, such as heart failure should correct heart failure, hyperlipidemia, diabetes caused by the main take lipid, sugar and other treatment. When the pulse pressure difference is found to be significantly reduced, various organic lesions should be excluded first, such as after detailed examination, failed to find a clear cause, should be considered to belong to the physical blood pressure reduction (mainly refers to systolic blood pressure), the treatment of physical hypotension, in addition to strengthening physical strength, appropriate nutrition, but also to prevent dizziness when upright, or fall. Drugs can be used to regulate the role of plant nerve function of glutamate, vitamins, etc. The phenomenon of small pulse pressure difference without discomfort does not need to be overly concerned, because it will not have much impact on health.

As seen above, a pulse pressure difference, whether too large or too small, indicates the presence of an underlying disease. If you once find your pulse pressure difference is normal, should enhance self-care awareness, prevention before it is too late: regular review of blood pressure, find problems in time to correct, to achieve regular life, normal living, pay attention to diet, active exercise, adhere to medication, find ways to control blood pressure within the more desirable range.

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

All images are from Pexels

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

All photoes from pexels

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

All images are from Pexels

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

All images are from Pexels

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

All images are from Pexels

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

What is high blood pressure

 1 minute to understand what is High Blood Pressure 

Through the video we have a preliminary understanding of hypertension, the next in several parts we will learn more about high blood pressure.

1. Definition of High Blood Pressure

Hypertension is a clinical syndrome characterized primarily by increased arterial blood pressure (systolic and/or diastolic) in the body circulation (systolic blood pressure ≥ 140 mm Hg and diastolic blood pressure ≥ 90 mmHg), which may be accompanied by functional or organic damage to the heart, brain, kidneys, and other organs.

2. High blood pressure damage

1 Causes cardiac hypertrophy.

• A continued increase in blood pressure will lead to greater resistance when the heart pumps blood outward, and the heart will work under high pressure for a long time will lead to myocardial hypertrophy and a decrease in myocardial contractility, which will lead to heart failure.

2 Damage to blood vessels.

• The human blood vessel wall should be smooth, if long-term hypertension, will lead to thickening of the vessel wall, causing great damage to the vessel wall, so that it is easy to suffer from various cardiovascular and cerebrovascular diseases.

3 Damage to the brain.

• High blood pressure can damage the human brain, resulting in a decline in brain function, making it impossible for people to carry out normal activities. It can also lead to ischemic stroke due to narrowing of the brain arteries, which can seriously threaten a person's life.

4 Damage to the eyes.

• High blood pressure can also cause great damage to the eyes. Long-term hypertension can lead to spasms and sclerosis of the retinal arteries, which can lead to vision loss and even blindness in severe cases.

5 Causes damage to kidney function.

• The kidneys and human blood pressure have a close relationship, long-term hypertension will cause great damage to the kidneys, resulting in renal hypertension, which will also lead to kidney failure.

6 Causes peripheral artery disease.

• Elevated blood pressure can cause the arteries of the lower extremities to undergo coronary artery sclerosis at a faster rate, thus making the arteries of the lower extremities ischemic and lack nutrients or even necrosis.

3. Causes of High blood pressure 

•  Genetic factors  Approximately 60% of patients with hypertension have a family history. It is now believed to be due to polygenic inheritance, with 30% to 50% of patients with hypertension having a genetic background.
•  ntal and environmental factors  Long-term mental tension, excitement, anxiety, exposure to noise or bad visual stimulation，and other factors can also cause the occurrence of hypertension.
•  Age factors  The incidence of hypertension tends to increase with age, with a high incidence in people over 40 years old.
•  Lifestyle factors  Irrational dietary structure, such as exces sodium, low potassium diet, heavy alcohol consumption, excessive intake of saturated fatty acids can increase blood pressure. Smoking can accelerate the process of atherosclerosis, which is a risk factor for hypertension.
•  The influence of drugs  Contraceptives, hormones, anti-inflammatory，and painkillers, etc. can affect blood pressure.
• The influence of other diseases  Obesity, diabetes mellitus, sleep apnea hypoventilation syndrome, thyroid disease, renal artery stenosis, renal parenchymal damage, adrenal occupational lesions, pheochromocytoma, other neuroendocrine tumors, etc.

4. Classification of High blood pressure

High blood pressure can be divided into two categories.

1. primary hypertension

It is an independent disease with elevated blood pressure as the main clinical manifestation but the cause is not yet clear, accounting for more than 90% of all hypertensive patients.

2. Secondary hypertension

Also known as symptomatic hypertension, in this type of disease the cause is clear, hypertension is only one of the clinical manifestations of the disease, blood pressure can be temporarily or persistently elevated.

5. High blood pressure symptoms

• The symptoms of hypertension vary from person to person. 
• In the early stage, there may be no or insignificant symptoms, commonly dizziness, headache, tight neck plate, fatigue, palpitations, etc. 
• An increase in blood pressure will occur only after exertion, mental stress, or mood swings and will return to normal after rest. As the course of the disease lengthens, the blood pressure rises significantly and continuously, and various symptoms will gradually appear, it is called bradykinetic hypertension. 
• The common clinical symptoms of bradykinetic hypertension include headache, dizziness, lack of concentration, memory loss, numbness in the limbs, increased nocturia, palpitations, chest tightness, and weakness. 
• The symptoms of hypertension are related to the blood pressure level. 
• Most of the symptoms can be aggravated after stress or exertion, and blood pressure can rise rapidly after early morning activities, resulting in early morning hypertension, leading to cardiovascular and cerebrovascular events occurring mostly in the early morning.

When blood pressure suddenly rises to a certain level even severe headache, vomiting, palpitations, vertigo, and other symptoms will occur, and in serious cases, confusion and convulsions will occur, which is the acute type of hypertension and hypertensive critical illness, and will mostly occur in a short period, serious damage and lesions of the heart, brain, kidneys and other organs, such as stroke, heart attack, kidney failure, etc. There is no consistent relationship between the symptoms and the level of elevated blood pressure.

The clinical manifestation of secondary hypertension is mainly about the signs and symptoms of the primary disease, and hypertension is only one of its symptoms. The elevation of blood pressure in patients with secondary hypertension may have its characteristics, such as hypertension due to aortic constriction may be limited to the upper extremities; the increase of blood pressure due to pheochromocytoma is paroxysmal.

6. What  tests should be done after the diagnosis of hypertension？

• The basic tests that need to be done after the diagnosis of hypertension include routine blood, urine, biochemistry, electrocardiogram, and chest X-ray. 

• If there is heart damage from hypertension, echocardiography and coronary angiography are needed. 

• With neurological damage, a cerebral angiogram, CT, or MRI of the brain is needed to check for brain bleeding or brain infarction.

• If you have hypertensive nephropathy, you need to have a kidney ultrasound, and 24-hour urine protein quantification or kidney function test to see what level of damage to the kidneys is caused by hypertension. 

• Because of the long-term high tension pressure, many patients will develop hypertensive macrovascular lesions in the advanced stage of hypertension and need to have an arteriovenous ultrasound. 

• When blood pressure is high, it can also damage the eyes, so a fundus examination is needed to check the condition of the retina. 

• When hypertension is diagnosed, in addition to understanding target organ damage, it is also necessary to know if there are any specific causes of hypertension, which requires adrenal CT, adrenal hormones, renal arteriography, respiratory sleep monitoring, and genetic testing to understand if hypertension is caused by specific causes.

You can also find more information at the links below:

1 jacc.org
2 nhlbi.nih.gov
3 all photoes from pexels