In addition to the different causes of hypertension, hypertension can also be classified according to “special populations” and some specific characteristics of hypertension, including the following.
1, elderly hypertension
Age ≥ 65 years, in the absence of antihypertensive drugs, non-same day three times to measure blood pressure, systolic blood pressure ≥ 140mmHg and (or) diastolic blood pressure ≥ 90mmHg.
Elderly patients who have been clearly diagnosed with hypertension and are receiving antihypertensive medication should also be diagnosed with geriatric hypertension although their blood pressure is <140/90 mmHg.
Blood pressure measurement chart for elderly patients
As can be seen from the data of previous data, the prevalence of hypertension in the elderly has several characteristics.
① The prevalence has generally shown an increasing trend in recent years.
In 1991, the National Sample Survey on Hypertension showed that the prevalence of hypertension among the elderly aged 60 years or older (including 60 years) was 40.4%.
In 2002, the National Nutrition Survey showed a prevalence of 49.1%.
Information from the National Cross-sectional Survey of Stratified Multi-stage Random Sampling of Hypertension from 2012 to 2015 showed a prevalence rate of 53.2%.
② The prevalence rate increased significantly with increasing age. The prevalence rate of men was 51.1% and that of women was 55.3%.
③The prevalence of hypertension in rural areas is increasing faster than in urban areas.
Why is hypertension more likely to be detected at an older age?
This is because with age, the elasticity of large arteries decreases and arterial stiffness increases; pressure receptor reflex sensitivity and beta-adrenergic system responsiveness decreases, and the ability of the kidneys to maintain ionic balance decreases.
Decreased neurohumoral regulation of blood pressure in the elderly is manifested by increased volume load and increased peripheral vascular resistance. And because of the decreased ability to regulate blood pressure in the elderly, it becomes more common for blood pressure levels to be easily influenced by various factors such as posture, meals, mood, season or temperature, etc. These are also known as abnormal blood pressure fluctuations. The most common ones are postural hypotension, postprandial hypotension and abnormal blood pressure circadian rhythm.
2.Children and adolescents with hypertension
The diagnosis of hypertension in children and adolescents needs to be based on different genders as well as age, so the values cannot be extracted accurately, but the simplified formula criteria can be used to make a preliminary judgment.
The simplified formula criteria are: for boys, systolic blood pressure = 100 + 2 × age (years), diastolic blood pressure = 65 + age (years); for girls, systolic blood pressure = 100 + 1.5 × age (years), diastolic blood pressure = 65 + age (years). After calculation by the above formula, it can be compared with the table below, and when the value is greater than or equal to the value in the table, further examination is recommended to clarify the diagnosis.
Simplified table of reference values for blood pressure in children and adolescents
Hypertension occurring in this age group is predominantly primary hypertension, mostly manifested as a mild increase in blood pressure levels (grade 1 hypertension), usually without discomfort and without obvious clinical symptoms. Unless blood pressure is measured during regular physical examinations, it is not easily detected.
According to the 2010 National Student Physical Fitness Study, the prevalence of hypertension among primary and secondary school students in China was 14.5%, with boys being higher than girls (16.1% vs. 12.9%). The prevalence of hypertension in children obtained after multiple time points of blood pressure measurement was 4% to 5%.
There are many factors influencing childhood essential hypertension, with obesity being the most highly associated risk factor, with 30% to 40% of childhood essential hypertension being associated with obesity; other risk factors, including parental history of hypertension, low birth weight, prematurity, excessive salt intake, lack of sleep, and lack of physical activity.
If a child is diagnosed with grade 1 hypertension, the main focus is on aggressive lifestyle interventions, including these.
– Weight control to ensure height development while slowing the upward trend of BMI and reducing body fat content.
– Increasing aerobic and resistance exercise and reducing time spent in static activity.
– Adjusting the dietary structure and diversifying the variety, controlling the total energy and fat supply ratio, controlling dietary salt and sugary drinks intake according to the WHO recommendations for children, and developing healthy eating habits.
– Avoid persistent mental stress and ensure adequate sleep.
If you are diagnosed with grade 2 hypertension, start medication with a small dose and a single medication, and adjust the treatment plan and treatment time frame individually.
3.Gestational hypertension
Gestational hypertension, a group of diseases in which pregnancy and hypertension coexist, with an incidence of 5% to 12%, is classified as gestational hypertension, preeclampsia, eclampsia, pregnancy combined with chronic hypertension, and chronic hypertension complicated by preeclampsia.
Blood pressure measurement chart for pregnant women
The appearance of hypertension during pregnancy is related to various factors such as age and genetics. Once present, it increases the risk of placental abruption, diffuse intravascular coagulation, fetal growth restriction, and stillbirth, and is an important cause of maternal and fetal death.
If a pregnant woman is diagnosed with gestational hypertension during pregnancy, doctors usually focus on ensuring the safety of the mother and child and the smooth progress of pregnancy and delivery, reducing complications, and decreasing the morbidity and mortality rate as the main treatment objectives. Depending on the severity of hypertension, different treatment measures are used.
4.H-type hypertension
Type H hypertension is hypertension with elevated homocysteine (blood homocysteine ≥ 10 μmol/L).
Folic acid deficiency and/or defects or genetic mutations in homocysteine and key enzymes in the folate metabolic pathway are the main causes of elevated blood homocysteine levels.
Patients usually diagnosed with H hypertension are recommended to eat as many folate-rich foods as possible, such as liver, green leafy vegetables, legumes, citrus fruits, and cereals, in addition to the general lifestyle interventions for hypertensive patients. In terms of medication, combined supplementation of folic acid with antihypertensive therapy will also be recommended for hypertensive patients without cardiovascular disease.
5.White coat hypertension
White coat hypertension refers to a phenomenon in which a patient has elevated blood pressure measured only in the office and normal blood pressure outside the office, also known as clinic hypertension.
The overall incidence of this type of hypertension is about 13% (fluctuating range: 9% to 16%), and the incidence in the hypertensive population is about 32% (fluctuating range: 25% to 46%).
The pathogenesis of white coat hypertension is unclear, but there is a tendency for
– A significantly higher incidence in women than in men.
– It is higher in non-smokers than in smokers.
– The prevalence is particularly high in the elderly.
– Patients with white coat hypertension often have concomitant metabolic disorders such as lipid and glucose disorders.
Clinically, white coat hypertension is common in patients who are often in a highly stressful neurological state with respect to the medical environment, as well as in healthy individuals with hyperadrenergic hypersecretion, or in those who are fearful of physician examination, fearful of multiple illnesses, and usually with autonomic dysfunction.
In the past, white coat hypertension was considered to be benign hypertension, unrelated to damage to target organs such as the heart, brain and kidney, and could be left untreated.
In recent years, the results of several follow-up studies and clinical studies on white coat hypertension have shown that patients with white coat hypertension have a significantly increased cardiovascular risk compared to the normal population and are more likely to develop sustained hypertension, thus increasing the need for more vigilance.
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