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Expert in this article: Chen Luyuan, chief physician of the Cardiology Department of Guangdong Provincial People’s Hospital, vice chairman of the China Hypertension League, and deputy chairman of the China Geriatrics Society Hypertension Branch
If you are overweight or obese, constantly anxious, lack exercise, suffer from chronic insomnia, occasionally smoke or drink, have a high-salt and high-fat diet, even if you are in your early 30s, please monitor your blood pressure, especially if the diastolic pressure, also known as “low pressure,” is elevated. You are likely in the high-risk group for hypertension.
“Young age” is not a taboo for hypertension. High blood pressure, which has always been labeled as an “elderly disease,” is not uncommon in young and middle-aged people. It’s just that the “hidden symptoms” and factors like “being young” often lead many young people who have hypertension to be unaware of their condition. When it comes to the overall diagnosis and treatment of young and middle-aged hypertension patients, Professor Chen Luyuan mentions the most about how it’s “difficult to detect” and even “more difficult to manage.”
Atypical symptoms of hypertension in young adults
Most young and middle-aged hypertension patients have mild blood pressure anomalies with basically no obvious symptoms. Sometimes they may experience dizziness, headaches, or other discomforts but wouldn’t associate it with hypertension. Many cases of hypertension in young and middle-aged individuals are only discovered during physical examinations or random blood pressure measurements.
The hidden symptoms leave many young hypertension patients in a “high-risk but unaware” state. Professor Chen Luyuan warns that even without symptoms, if the diastolic pressure (low pressure) significantly rises, one should be more vigilant. This is also a characteristic of hypertension in young and middle-aged individuals.
He explains that young people, due to the lack of arteriosclerosis, have good aortic elasticity, allowing the arterial wall to effectively buffer the impact of blood flow during heart contraction. However, resistance increases in the smaller arteries, causing the systolic pressure to tend towards normal while the diastolic pressure tends to rise. Additionally, among young people with hypertension, the proportion of excessive activation of the sympathetic nervous system is higher than in elderly hypertensive patients, often accompanied by an accelerated heart rate.
Compared to the elderly, young people rarely have the habit of regularly measuring their blood pressure, thus may not promptly detect any abnormalities in blood pressure. For the diagnosis of hypertension in young and middle-aged individuals, Professor Chen Luyuan provides monitoring methods for three scenarios. A single measurement result is not enough to determine the presence of hypertension.
Clinical measurement: Measure blood pressure three times and take the average of the second and third readings. If it is ≥140/90 mmHg, hypertension can be diagnosed.
Home self-monitoring: Increased blood pressure from a single home measurement does not confirm hypertension. Continuous at-home monitoring for a week, calculating the average value. If it is ≥135/85 mmHg, hypertension can be diagnosed.
Wearing a 24-hour ambulatory blood pressure monitor: Measure blood pressure over 24 hours to calculate the average blood pressure for the day. If it is ≥130/80 mmHg, it can also be diagnosed as hypertension.
If the blood pressure is in the range of 130-139/80-89 mmHg, it is recommended to measure it every 3 months. For diagnosed hypertension with controlled and stable blood pressure within the target range, there is no need for daily blood pressure measurements at home. Once a week is sufficient, but measurements should be taken in the morning and evening. The key is for young and middle-aged individuals to have the habit and awareness of regularly monitoring their blood pressure to detect any abnormalities early and reduce cardiovascular damage.
Managing hypertension in young adults
“Among the patients I see, young and middle-aged hypertension patients have poor compliance,” Professor Chen Luyuan expressed. Poor hypertension management in young and middle-aged individuals is partly due to inadequate lifestyle interventions and a lack of proactive medication management.
1. Unhealthy lifestyle habits
In terms of lifestyle, there’s often no change in unhealthy habits, such as prolonged late-night activities, consuming high-fat and high-salt takeout foods, prolonged sedentary behavior, smoking, excessive drinking, working in high-pressure environments without releasing anxiety, which can lead to a low achievement rate in hypertension management.
2. Inconsistent medication intake
In medication management, young and middle-aged hypertension patients often show non-compliance with prescribed medications, self-adjustment of dosages, or discontinuation of medication. People may decide not to seek treatment if there are no immediate discomforts, and some are worried about the side effects of lifelong medication due to their young age.
Professor Chen Luyuan explains that for young and middle-aged hypertensive patients without complications, the commonly used five classes of antihypertensive drugs (diuretics, β-blockers, calcium channel blockers, ACE inhibitors, ARBs) can be used as initial treatment, especially considering the characteristic of elevated diastolic pressure in young and middle-aged individuals. β-blockers with alpha-receptor blocking action and RAS inhibitors can be preferred choices. If the heart rate is >80 beats/minute, β-blockers can be prioritized; otherwise, ACE inhibitors and ARBs can be preferred.
Many are concerned about the potential adverse reactions of long-term antihypertensive medication and are reluctant to maintain regular medication use. Bisoprolol hydrochloride is a fourth-generation and the latest generation of β-blockers that double block the mechanism of blood pressure elevation. It not only reduces blood pressure but also slows down heart rate. Even with long-term use, the occurrence of side effects like bradycardia and lipid metabolism abnormalities is relatively low.
In fact, for hypertensive patients with blood pressure exceeding 160/100 mmHg (Stage 2 or 3 hypertension), those with multiple cardiovascular risk factors, or those for whom monotherapy is ineffective, combination drug therapy can be initiated to avoid target organ damage caused by hypertension and reduce the occurrence of cardiovascular events.
To control blood pressure, start by improving lifestyle!
Professor Chen Luyuan emphasizes that the blood pressure target for all hypertensive patients should be <140/90 mmHg. If tolerated by the patient, the target can be lowered to <130/80 mmHg. However, detecting hypertension does not necessarily mean one must start taking medication.
For primary hypertension first discovered, where blood pressure is in the range of 140-159/90-99 mmHg, also known as mild hypertension, it is recommended to undergo three months of lifestyle intervention. Control your diet and exercise regularly; if the blood pressure is still not brought down after three months, then medication can be initiated.
For blood pressure in the range of 150-159/95-99 mmHg, a combination of lifestyle interventions and medication is required. In the case of blood pressure exceeding 160/100 mmHg (Stage 2 or 3) or for patients with high cardiovascular risk factors, medication treatment should be started immediately.
Lifestyle interventions include:
1. Limiting salt intake, increasing potassium-rich foods (fresh fruits, vegetables, and legumes), reducing fat and cholesterol intake;
2. Weight management (waist circumference: male <90 cm, female <85 cm);
3. Quitting smoking and limiting alcohol consumption;
4. Increasing physical activity, such as jogging, cycling, or swimming;
5. Reducing mental and psychological stress.¹
Reference: ¹ “Expert Consensus on the Management of Hypertension in Chinese Young and Middle-aged People,” Chinese Society of Cardiology Hypertension Group, October 2019
