Shulou(Shulou.com)11/24 Report--

This article comes from Weixin Official Accounts: SF Chinese (ID: kexuejiaodian), author: SF

Each person's physical condition is specific, and the diagnosis and classification of a disease is of great significance to the realization of precise medicine and "right medicine." Hypertension is a very common chronic disease, and measuring blood pressure is also a routine physical examination item. Out of our responsibility for our own health and the health of those around us, we need to understand the diagnostic thresholds and classifications of hypertension.

Wen| Wen Jing

Hypertension is the most common chronic non-communicable disease worldwide and an important cause of death in patients with cardiovascular and cerebrovascular diseases. There are approximately 1.28 billion adults with hypertension worldwide, but only 50% of patients have their blood pressure correctly diagnosed and controlled.

The medical community has been controversial about the diagnostic cut-off value of hypertension.

In 2017, the American College of Cardiology (ACC)/American Heart Association (AHA) issued hypertension guidelines, which revised the hypertension standard to ≥130/80 mmHg. However, no country or region has followed the US policy.

On November 13,2022, the first Clinical Practice Guidelines for Hypertension in China was issued, which lowered the diagnostic criteria for hypertension in adults and revised the original 140/90 mmHg to ≥130/80 mmHg.

Professor Zhao Dong, director of the Epidemiology Research Office of Beijing Anzhen Hospital, said at an online conference on November 13,"This guideline revised the diagnostic criteria for hypertension to ≥130/80 mmHg, which is not only supported by sufficient international and domestic evidence-based medical evidence, but also the majority of people with blood pressure levels of 130-139 mmHg and/or 80-89 mmHg are young and middle-aged. The downward adjustment of diagnostic criteria reflects the advancement of defense. Strengthen the concept of initial prevention, or we will miss a critical opportunity to reduce cardiovascular disease and other diseases caused by hypertension. "

Photo credit: pexels practice guide released quickly caused controversy. On the evening of November 15, the National Health Commission official Weixin Official Accounts "Healthy China" released an article saying that at present, the state has not adjusted the diagnostic criteria for adult hypertension, and the diagnostic criteria for adult hypertension are still 3 times blood pressure exceeding 140/90 mm Hg on the same day. At the same time, it is pointed out that there are standard procedure requirements for the formulation of diagnostic criteria for hypertension and other diseases in China. Guidelines, consensus, etc. issued by professional institutions, trade associations, individuals, etc. are the research results of experts and are not used as national disease diagnosis standards.

Professor Hu Dayi, director of the Institute of Cardiovascular Diseases of Capital Medical University and director of the Institute of Cardiology of Peking University People's Hospital, believes that the actual benefit of antihypertensive drugs for people with 130/80~140/90 mmHg is very low. To do so would add 240 million patients, increase side effects, cost and workload, and lead to other diseases.

From March 10 to 12,2023, the 2022 China Hypertension Annual Conference and the 24th International Symposium on Hypertension and Related Diseases were held, and the updated key points of the Guidelines for the Prevention and Treatment of Hypertension in China were announced, and the diagnostic threshold of hypertension was still determined as 140/90 mmHg. The meeting also proposed an "eight-part package" of therapeutic lifestyle interventions: a low-sodium, high-potassium diet (but potassium supplementation is not recommended), a reasonable diet, weight control, non-smoking, alcohol restriction, increased exercise, psychological balance, and sleep management.

Source: pixabay, unsplash The pathogenesis of six categories of hypertension is multifactorial. To achieve early diagnosis and appropriate treatment of hypertension, it may not be possible to modify the diagnostic threshold, but also need to refer to other diagnostic data.

Recently, Professor Zhang Yi's team from Shanghai City Tenth People's Hospital affiliated to Tongji University School of Medicine published an article in the academic journal Journal of Personalized Medicine, proposing REASOH classification hypothesis according to the etiology of hypertension, and explaining the definition, diagnosis and treatment suggestions of 6 categories of hypertension.

Source: Journal of Personalized Medicine website·Renin-dependent hypertension

Renin-dependent hypertension is defined as hypertension caused by elevated plasma renin activity (PRA). High PRA is common in hypertensive patients and is highly correlated with poor prognosis of cardiovascular diseases such as myocardial infarction.

·Senile arteriosclerosis hypertension

According to the American College of Cardiology and American Heart Association 2017 Clinical Practice Guidelines for Hypertension, senile atherosclerotic hypertension is defined as hypertension in people ≥65 years of age with systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg. In pathophysiological features, atherosclerotic vessels will develop vasodilation and stiffness with age, manifested as vasomotor dysfunction. In addition, neurohormones, autonomic nervous disorders and renal aging are also associated with the occurrence of senile arteriosclerosis hypertension.

Image source: unsplash Elderly hypertension is characterized by elevated systolic blood pressure, elevated pulse pressure (PP), hypertension variability, and orthostatic hypotension. Among them, PP difference is often considered as a representative of arterial stiffness in the elderly. However, since PP differences are influenced by cardiac and arterial function, a more accurate criterion for assessing arterial stiffness is arterial pulse wave velocity (PWV). Carotid-femoral pulse wave velocity (cf-PWV)>10 m / s or brachial-ankle pulse wave velocity (ba-PWV) ≥18 m / s was defined as arterial stiffness.

Sympathetic hypertension

Sympathetic activity hypertension (SAH) is characterized by activation and enhancement of sympathetic activity (SA). It has a variety of clinical phenotypes, including borderline hypertension, senile systolic hypertension, white coat hypertension, latent hypertension, obstructive sleep apnea-related hypertension, psychological stress-related hypertension, hyperactivity-induced adolescent hypertension, etc.

Currently, SAH is thought to be associated with a range of pathophysiological mechanisms, such as stress response, RAAS hyperactivation, metabolic dysfunction, inflammatory immunity, arterial baroreceptor and chemoreceptor dysfunction, and neuroregulatory abnormalities.

In addition, SAH is strongly associated with a number of cardiovascular risk factors such as a high-salt diet, obesity and smoking.

·Secondary hypertension

Secondary hypertension has a variety of etiological types. At present, in addition to dietary and drug causes, the most common causes include aortic coarctation, renal artery stenosis, renal parenchyma disease, primary aldosteronism, pheochromocytoma, Cushing syndrome, aortic valve stenosis, obstructive sleep apnea, and thyroid disease.

The distribution of underlying causes of secondary hypertension varies with age. Renal parenchymal disease and aortic coarctation are the most common causes of hypertension in adolescents under 18 years of age. For younger patients aged 19-39, thyroid function screening is required. For patients aged 40-64, it is necessary to screen for primary aldosteronism (PA), thyroid dysfunction, obstructive sleep apnea-hypopnea syndrome (OSAHS), Cushing syndrome, and pheochromocytoma. Renovascular hypertension, PA, OSAHS, and renal parenchymal hypertension are common subtypes of secondary hypertension in patients older than 65 years of age.

·Salt-sensitive hypertension

Salt-sensitive hypertension (SSH) is defined as a significant increase in blood pressure caused by increased salt intake, according to the American Heart Association's scientific statement. There is currently no optimal standard for diagnosing SSH, and two methods are usually used.

The first is the chronic salt load test, which measures changes in blood pressure in subjects who alternate between low-and high-salt diets.

The second method is the acute salt loading test. The subject received saline for sodium load and then a low sodium diet in combination with diuretics for sodium and hypovolemia. Mean arterial pressure was measured for both periods to determine SSH.

·Hyperhomocysteinemia Hypertension

Hypertension with elevated homocysteine (Hcy≥10 umol / L) was defined as hyperhomocysteinemic hypertension. Mechanically, elevated homocysteine decreases the vasodilatory properties of nitric oxide, increases oxidative stress, impairs vascular wall function, and alters vascular wall elasticity.

For hyperhomocysteinemic hypertension, experts recommend that all patients with hypertension should test serum homocysteine levels. In addition, plasma folate content and MTHFR 677TT genotype should also be examined.

Image source: pixabayREASOH classification is mainly applicable to untreated hypertension patients without specific treatment indications. The research team also said that this hypothesis can only roughly estimate the pathogenesis of hypertension in patients, which may be a step forward for hypertension treatment in the era of precision medicine. However, it is impractical to apply too complex a test protocol clinically.

Welcome to subscribe "Shulou Technology Information " to get latest news, interesting things and hot topics in the IT industry, and controls the hottest and latest Internet news, technology news and IT industry trends.