If you are overweight or obese, always anxious and lacking exercise with chronic insomnia, occasional smoking and drinking, high-salt and high-fat diet habits, even if you are in your early thirties, make sure to monitor your blood pressure. Especially if the diastolic pressure, also known as “low pressure,” is elevated, you are likely in a high-risk group for hypertension.
“Youth” is not a taboo for hypertension. Hypertension, which has always been labeled as an “elderly disease,” affects a considerable number of young and middle-aged individuals. It’s just that “hidden symptoms” and factors like “youth” often result in many young people with hypertension being unaware of their condition. Regarding the overall diagnosis and treatment of young and middle-aged hypertension patients, Chen Luyuan, the Chief Physician of the Cardiology Department at the People’s Hospital of Guangdong Province, Vice Chairman of the China Hypertension League, and Vice President of the Hypertension Branch of the Chinese Geriatrics Society, emphasized the challenges of “difficult detection” and “difficult management.”
Young people with hypertension often have atypical symptoms. Most young and middle-aged patients with hypertension have mild blood pressure abnormalities and minimal symptoms. Occasionally, they may experience dizziness, headaches, or other discomforts that they might not attribute to hypertension. Many cases of hypertension in young and middle-aged individuals are detected during physical examinations or random blood pressure measurements.
The hidden symptoms place many young hypertension patients in a state of “being at high risk but unaware.” Chen Luyuan points out that even without symptoms, if the diastolic pressure (low pressure) rises significantly, vigilance should be heightened. This is a characteristic of hypertension in young and middle-aged individuals.
He explains that young people (due to the absence of arteriosclerosis) have good elasticity in their large arteries, allowing the arterial wall to buffer the force of blood flow during heart contraction effectively. However, there is increased resistance in small and medium arteries, causing the systolic pressure to trend towards normal, while the diastolic pressure often rises. Additionally, young hypertension patients tend to have a higher proportion of overactive sympathetic nervous system activation compared to older individuals with hypertension, often accompanied by an increased heart rate.
Compared to older individuals, young people rarely have the habit of regular blood pressure monitoring, leading to delayed detection of blood pressure abnormalities. Chen Luyuan suggests three monitoring methods for diagnosing hypertension in young and middle-aged individuals, emphasizing that a single measurement result is not sufficient to determine the presence of hypertension:
Clinic measurements:
Measure blood pressure three times, take the average of the second and third readings. If ≥140/90 mmHg, it can be diagnosed as hypertension.
Home self-monitoring:
A single measurement at home revealing elevated blood pressure is not sufficient for diagnosing hypertension. It should be measured continuously at home for a week, with the average value calculated. If ≥135/85 mmHg, it can be diagnosed as hypertension.
Wear a dynamic blood pressure monitor:
Monitor blood pressure for 24 hours, calculate the average blood pressure throughout the day. If ≥130/80 mmHg, it can also be diagnosed as hypertension.
For blood pressure readings of 130-139/80-89 mmHg, measurement every 3 months is recommended. For diagnosed hypertension cases where blood pressure is controlled within the target range and stable, daily home blood pressure monitoring is not necessary. Monitoring once a week is sufficient, but readings should be taken in the morning and evening. It is crucial for young and middle-aged individuals to develop the habit and awareness of regularly monitoring their blood pressure to detect abnormalities early, reducing cardiovascular damage.
Managing hypertension in young people is challenging. “In patients I have treated, the compliance of young and middle-aged hypertension patients is poor,” says Chen Luyuan. The management of hypertension in young and middle-aged individuals is hindered partly by inadequate lifestyle interventions and partly by a lack of proactive medication therapy.
Poor lifestyle habits:
In terms of lifestyle, poor habits remain unchanged. These include staying up late, consuming high-fat and high-salt takeout food, prolonged periods of sitting or lying down without exercising, smoking, excessive drinking, and being in high-pressure work environments. Failure to intervene and correct these risk factors often results in suboptimal achievement rates for hypertension targets.
Inconsistent medication adherence:
Regarding medication therapy, young and middle-aged hypertension patients often exhibit behaviors such as non-compliance with prescribed medication, self-reduction of dosage, or discontinuation of medication when they feel no discomfort. Some individuals believe that since they are young, they are reluctant to take medications for a lifetime due to concerns about the side effects of medications.
Chen Luyuan explains that for young and middle-aged hypertension patients without complications, the commonly used five classes of antihypertensive medications (diuretics, beta-blockers, calcium channel blockers, ACE inhibitors, and ARBs) can be used as initial treatment. Given the particular characteristic of young and middle-aged individuals having higher diastolic pressures, beta-blockers with alpha-adrenergic blocking properties and RAS inhibitors are preferred. If the heart rate is >80 beats/minute, beta-blockers can be prioritized; otherwise, ACE inhibitors and ARBs can be chosen first.
Many individuals worry about the adverse effects of long-term antihypertensive medication use and are unwilling to adhere to regular medication consumption. Bisoprolol hydrogen fumarate, as a fourth-generation and latest beta-blocker, with dual mechanisms of blood pressure reduction and heart rate slowing, has relatively low incidence rates of adverse reactions such as bradycardia and metabolic abnormalities even with prolonged use.
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 therapy may be initiated to prevent target organ damage caused by hypertension and reduce the occurrence of adverse cardiovascular events.
Controlling blood pressure starts with improving lifestyle habits!
Chen Luyuan emphasizes that the blood pressure target for all hypertensive patients should be <140/90 mmHg, which can potentially be lowered to <130/80 mmHg if tolerated by the patient. However, discovering hypertension does not necessarily mean immediate medication is required. For individuals with newly diagnosed Stage 1 hypertension, where blood pressure is between 140-159/90-99 mmHg, also known as mild hypertension, a three-month lifestyle intervention is recommended. Strategies such as diet control and physical activity should be implemented. If blood pressure does not decrease after three months, medication therapy can be considered. For blood pressure readings of 150-159/95-99 mmHg, lifestyle intervention and medication should be simultaneously initiated. Individuals with blood pressure exceeding 160/100 mmHg (Stage 2 or 3) or those at high risk of cardiovascular disease should start medication therapy immediately. Lifestyle interventions include: 1. Limiting salt intake, increasing consumption of potassium-rich foods (fresh fruits, vegetables, and legumes), reducing fat and cholesterol intake; 2. Controlling weight (waist circumference: males <90 cm, females <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. Source References:《Expert Consensus on the Management of Hypertension in Chinese Young and Middle-aged Population》, Hypertension Group of the 10th Committee of the Chinese Society of Cardiology, published in October 2019.
