How to detect and manage high blood pressure in young and middle-aged people?

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Yimaitong works with clinicians from various disciplines to answer the "100,000 whys" of disease diagnosis and treatment, and provide medical guidance for patients and their families.

The author of this issue is Wang Yueyue

Attending physician of the Department of Cardiology, Chongqing Hospital, Jiangsu Provincial Hospital of Traditional Chinese Medicine (Chongqing Yongchuan District Hospital of Traditional Chinese Medicine).

Highlights of this issue

1. What is high blood pressure in young and middle-aged people?

2. How to treat hypertension in young and middle-aged people?

▍Introduction

At present, the number of people with hypertension is growing and showing a trend of "younger", especially the proportion of young and middle-aged people aged < 65 years old continues to increase, and this group of people is called young and middle-aged hypertensive people.

Hypertension in young and middle-aged people is mostly "insidious", often asymptomatic in the early stage, more than found in physical examination or accidental measurement, mainly mild hypertension or simple diastolic blood pressure increase, combined with overweight, obesity, high proportion of metabolic abnormalities, most of them have alcoholism, staying up late, lack of exercise and other unhealthy lifestyles.

Some patients are busy with work, neglect health management, lack of understanding of the dangers of hypertension, think that there is no need for treatment if they are asymptomatic, or even if they receive medication, it is often difficult to adhere to it for a long time due to excessive fear of adverse drug reactions.

▍Young and middle-aged people find high blood pressure, what should I do?

1. Identify the cause

Most young and middle-aged adults with hypertension are primary hypertension as soon as possible, but screening for secondary hypertension is still necessary before a diagnosis is established, especially in young people < 40 years of age or those with grade 2 or higher hypertension.

Secondary hypertension accounts for about 5% of hypertension, and common diseases include renal parenchymal disease, renal artery stenosis, primary aldosteronism, etc., such as renal parenchymal disease is often accompanied by proteinuria, edema, and abnormal renal function, while patients with primary aldosteronism often have significantly increased blood pressure and hypokalemia.

Therefore, once hypertension is diagnosed in young and middle-aged patients, selective screening for secondary causes is recommended.

2. Screen for risk factors

Young and middle-aged hypertensive patients mostly have mild (grade 1) hypertension, short course of disease, mild organ damage and few complications in the early stage of the disease, and short-term cardiovascular disease is not high within 5-10 years, but the long-term and lifetime risk is not low.

Moreover, in recent years, due to the gradual increase in the proportion of obesity and glucose and lipid metabolism disorders in young and middle-aged hypertensive patients, the risk of cardiovascular disease has increased.

Therefore, it is recommended that young and middle-aged patients with hypertension undergo routine urine testing, blood glucose, lipids, electrolytes, renal function and electrocardiogram examinations at the initial diagnosis, and should also evaluate hypertension-mediated organ damage, such as left ventricular hypertrophy and microproteinuria, as appropriate.

3. Monitor your blood pressure

At present, office blood pressure is still the "gold standard" for diagnosing hypertension, but only office blood pressure measurement cannot make accurate judgments on "white coat hypertension" and "occult hypertension".

Therefore, it is recommended to perform daily "home blood pressure monitoring (HBPM)" to understand the dynamic changes of blood pressure, and "ambulatory blood pressure monitoring (ABPM)" can be performed regularly if conditions permit, which can help eliminate treatment inertia from the patient level and timely adjust the treatment plan and treatment intensity from the doctor level.

Under normal circumstances, patients with stage 1 hypertension or low and intermediate risk can go to the hospital for follow-up once in 1~3 months, and patients with grade 2~3 hypertension or high-risk patients need to be followed up once every 2~4 weeks, and then appropriately extend the follow-up interval after the blood pressure is controlled and stabilized.