What to do if you have high blood pressure during mid-life crisis? Mid-life crisis, also known as “gray middle age”, usually occurs at the age of 39 to 50 years old, and is also known as “man forty syndrome” in men between 40 and 65 years old. Broadly speaking, it refers to the various hurdles and crises in career, health, family and marriage that may be experienced at this stage of life. When a person reaches middle age, he or she feels physically weaker than before. More and more young and middle-aged young people are being pestered by high blood pressure, how a disease common to the elderly is becoming more and more common in young and middle-aged people, and what to do if you suffer from high blood pressure in your middle-aged or young adulthood? Is it serious, should I take medication, can the medication be stopped 。。。。 It’s hard on the psyche to take medication for the rest of your life. In our daily work, we cardiologists are mostly very concerned about the management of elderly hypertensive patients. Various guidelines have also been introduced for cardiologists to operate. With the accelerated pace of life in our society, more and more young and middle-aged people are suffering from hypertension, and with the increase in life expectancy, young and middle-aged hypertensive patients have a high long-term cardiovascular risk. Coupled with the large number of middle-aged people and the accelerated prevalence, active and standardized management of the young and middle-aged hypertensive population is the focus of our cardiovascular disease prevention and treatment. There is an urgent need to improve the knowledge, treatment and control rates of hypertension in young and middle-aged people. According to the China Health and Nutrition Survey (2009-2010), the three rates of young and middle-aged hypertensive patients are not up to standard. Irregular medication taking, fear of medication side effects, and so on, are important factors contributing to the substandard blood pressure of young and middle-aged hypertensive patients. Clinical features of middle-aged hypertensive patients Sympathetic nervous system and renin angiotensin system are overexcited. SNS and RAS activation in middle-aged and young hypertension, application of drugs that inhibit SNS such as β-blockers and RAS blockers such as angiotensin-converting enzyme inhibitors or angiotensin receptor antagonists helps to control middle-aged and young hypertension. Clinical features of young and middle-aged hypertensive patients Diagnosis and assessment Accurate acquisition of blood pressure data is a prerequisite for initiating treatment, and patients are encouraged to undergo ambulatory and home blood pressure measurements. This helps young patients to participate in blood pressure management. In addition, we should also screen and manage the whole spectrum of risk factors in hypertensive patients with a new perspective of cardiovascular syndromes. Despite the milder symptoms and shorter duration of disease in young and middle-aged hypertensive patients, one study of 61,585 CVD-free U.S. adults aged 55 years and older showed that the lifetime risk of CVD in hypertensive patients was 42%-69%, compared with 22%-41% for those whose blood pressure was maintained or lowered to the normal range. When to Initiate Antihypertensive Therapy For those with grade 1 hypertension, pharmacologic therapy may be an option with the role of well-informed lifestyle modifications. Anyone with grade 2 hypertension (blood pressure above 160/100 mmHg) should initiate hypertension medication immediately. The goal of lowering blood pressure, although most guidelines recommend lowering blood pressure to below 140/90 mmHg, we recommend getting as close as possible to 130/80 mmHg. Non-pharmacological treatment Lifestyle modifications include the following: ① Limit sodium (including reducing the amount of salt in salt-containing condiments as well as processed foods, etc., with a total amount of salt of <6 g/d) and increase the intake of potassium ion-rich foods (e.g., fresh fruits, vegetables, and legumes) intake, reduce saturated fat and cholesterol intake; ② control body mass [body mass index (BMI) <24kg / m2; waist circumference of men <90, women <85cm]; ③ do not smoke (quit smoking and away from second-hand smoke); ④ limit the consumption of alcohol (alcohol intake of men <25, women <15g / d); ⑤ physical exercise (aerobic exercise, such as walking, jogging, cycling, swimming, etc.), Jogging, cycling, swimming, etc., physical activity time >30min/d, 5-7 times/week); ⑥ Reduce mental stress, maintain psychological balance, and seek professional psychological counseling if necessary. First, encourage the application of home blood pressure monitoring, ambulatory blood pressure monitoring and other “out-of-office” blood pressure measurement means for the diagnosis of hypertension. Second, cardiovascular disease risk factors should be actively screened, and comprehensive cardiovascular risk assessment and stratification should be conducted. Thirdly, general hypertensive patients should be reduced to <140/90mmHg, and those who can tolerate it can be further reduced to 130/80mmHg. For patients with comorbidities such as diabetes mellitus or heart failure, individualized blood pressure management should be carried out in accordance with relevant guidelines. Fourth, active lifestyle intervention is advocated as an effective means of hypertension management. Fifth, for hypertensive patients without cardiovascular complications, all five major classes of commonly used antihypertensive drugs can be used as initial treatment. Since over-activation of the sympathetic nervous system and renin-angiotensin system (RAS) is more common in young and middle-aged hypertensive patients, β-blockers and RAS inhibitors (ACEI/ARB) are effective in lowering blood pressure (especially diastolic blood pressure) in these patients and should be preferred. Among them, β-blockers are more suitable for patients with comorbid increased heart rate, coronary artery disease, and heart failure, while ACEI/ARB is more suitable for patients with comorbid metabolic disorders or chronic kidney disease. In addition, ACEI/ARB is also recommended for patients with coronary artery disease or heart failure (same priority as beta blockers). Sixth, combination therapy may be initiated in patients with grade 2 or 3 hypertension, as well as in high-risk patients with a combination of cardiovascular disease risk factors, or in patients for whom monotherapy is ineffective. It is recommended that ACEI/ARB be combined with dihydropyridine CCBs or thiazide diuretics, or beta-blockers can be used in combination with CCBs or diuretics; for patients with elevated diastolic blood pressure and heart rate, beta-blockers can be chosen in combination with ACEI/ARB. The combination of ACEI and ARB is not recommended. Seventh, for patients with hypertension accompanied by risk factors should adopt active and comprehensive prevention and treatment strategies.