Hypertension is an independent risk factor for cerebrovascular disease, so we neurologists are very concerned about the blood pressure of our patients. Blood pressure can be divided into systolic pressure and diastolic pressure. Diastolic pressure is the pressure generated when the human heart is diastolic and the arterial blood vessels are elasticly retracted, which is the low pressure when we measure blood pressure. Now some young and middle-aged people, due to mental stress, poor rest, reduced activity, abdominal obesity, in the measurement of blood pressure found that the systolic pressure is normal (between 90-140mmHg), but the diastolic pressure is high (more than 90mmHg), or systolic pressure is only about 120mmHg, but diastolic pressure is as high as 100 ~ 110mmHg, and accompanied by dizziness, chest discomfort and other symptoms. For this condition, it is clinically called simple diastolic hypertension, which refers to a systolic blood pressure <140mmHg but diastolic blood pressure ≥90mmHg measured in the human body in the standard state, with a prevalent age of 35-49 years. In recent years, some clinical studies have found that if left untreated, it can lead to stroke, myocardial infarction, heart failure and kidney disease. What is the main cause of simple diastolic hypertension? All human behavioral activities are governed and coordinated by the brain, but there is another nerve in the body that is not directly governed by the brain, which is called the autonomic nerve (vegetative nerve), including sympathetic and parasympathetic nerves (vagus nerve). and so on. The imbalance of autonomic regulation plays an important role in the occurrence and development of hypertensive disease. When the sympathetic nerves are activated, the peripheral blood vessels contract, and because the elasticity of the aorta is better when the heart is discharging blood to the aorta, the elastic aorta is easier to expand, so the heart does not have difficulty in ejecting blood and the systolic pressure (high pressure) is not high, but when the heart is diastolic, the elasticity of the aorta retracts strongly, and the peripheral blood vessels are in a contracted state, the pressure generated at this time -The diastolic pressure is higher. This high diastolic pressure alone is often accompanied by symptoms such as dizziness and chest tightness and palpitations, which are due to sympathetic activation and constriction of the peripheral blood vessels. In the early stage of hypertension, the sympathetic nerves of young and middle-aged people are in a state of over-activation, which makes them prone to rapid heartbeat, peripheral vasoconstriction (resistance), short-temperedness, emotional instability, and large fluctuations in blood pressure and heart rate, manifesting as obvious tachycardia and elevated blood pressure when working under stress, and dropping to normal when resting. In addition, patients with elevated diastolic blood pressure tend to be obese, especially abdominal obesity (waist circumference greater than 90 cm in men and greater than 80 cm in women), and mostly combined with elevated metabolic indicators such as blood lipids, blood glucose and uric acid. In conclusion, elevated diastolic blood pressure is associated with poor lifestyle habits such as smoking, alcohol consumption, staying up late, unhealthy diet, obesity, high work stress and sympathetic excitation. Does diastolic hypertension alone require treatment? Epidemiological surveys in China have found that the growth rate of hypertension in elderly people from 65 to 75 years old is only 15-18%, while the growth rate of hypertension in young and middle-aged people from 35 to 45 years old is 62-74%. This means that the incidence of hypertension is getting younger and younger, and patients with pure diastolic hypertension are mostly young and middle-aged, which is a common type of hypertension in white-collar workers. Elevated diastolic blood pressure is extremely harmful to young and middle-aged people, significantly increasing the risk of coronary heart disease and being an independent risk factor for cardiovascular events. In untreated patients, an 11-year follow-up study showed that patients with diastolic hypertension alone had an increased risk of cardiovascular events by more than 75%. Although some studies have found that elevated diastolic blood pressure alone has a good prognosis, if left untreated, diastolic hypertension alone may turn into classical hypertension (i.e., high systolic and diastolic blood pressure), and with age, systemic atherosclerosis and even myocardial infarction or stroke may occur. Therefore, young and middle-aged patients with diastolic hypertension should start treatment as early as possible under the guidance of a doctor, including pharmacological and non-pharmacological treatment, and non-pharmacological treatment (such as weight reduction, low-salt diet, moderate potassium supplementation, smoking and alcohol cessation, moderate exercise, etc.) can be carried out in the early stage. Once you start taking antihypertensive drugs, do not stop them without authorization, but consider reducing the dosage under the guidance of a doctor after the blood pressure has been maintained at a normal level for a period of time. How to choose antihypertensive drugs for patients with pure diastolic hypertension? In my experience, long-acting calcium antagonists such as amlodipine, felodipine and nifedipine controlled-release tablets are preferred for peripheral vasodilatation; patients with faster heart rate can combine with beta-receptor antagonists such as betalactone extended-release tablets and bisoprolol to slow down the heart rate and lower diastolic blood pressure more effectively, but those who do not have a fast heart rate should avoid Use. Keep in mind: the specific medication should be selected by a professional doctor according to the individualization of the patient's condition to choose a suitable treatment plan. It is recommended to monitor blood pressure regularly based on lifestyle interventions and take antihypertensive drugs as prescribed by the doctor to control blood pressure at a reasonable level (120/80 mmHg). In addition, for patients whose diastolic blood pressure is found to be less than 95 mmHg for the first time, non-pharmacological treatment can be preferred, such as regular life, ensuring sleep, emotional relaxation, low salt and low fat diet, strengthening exercise, and reducing the effect of body weight on diastolic blood pressure is also effective.