Hypertension is one of the most common cardiovascular diseases and is a clinical syndrome manifested mainly by elevated arterial pressure in the body circulation. In clinical practice, hypertension is generally classified into two types: primary hypertension and secondary hypertension. In recent years, with the continuous research, it has been found that because some patients have special types of hypertension, the only way to get twice the result with half the effort is to treat the causes of these hypertension. The following 12 types of “alternative” hypertension are common in clinical practice.
1. Pseudohypertension
In elderly patients with hypertension, there are many people whose blood pressure is elevated only because of their brachial artery sclerosis, so that the measured systolic pressure is high, this phenomenon can be called pseudohypertension. In this case, patients can determine whether they have pseudohypertension by directly measuring their intra-arterial pressure. Patients are diagnosed with pseudohypertension when their intra-arterial pressure is significantly lower than the reading from the sphygmomanometer and is within the normal range.
Preventive measures: Since patients with this type of hypertension often have organ arteriosclerosis and are accompanied by low diastolic blood pressure and other conditions, patients should not be rushed into antihypertensive treatment, but should be treated for the patient’s arteriosclerosis and inadequate blood supply to the organs in order to reduce their systolic blood pressure.
2, white coat hypertension
In the process of researching hypertension, it was found that some patients have elevated blood pressure when measured only in the office, but normal blood pressure outside the office, a phenomenon known as “white coat hypertension”, also known as “clinic hypertension”. If blood pressure is also higher than normal outside the office, but higher inside the office, this is called the “white coat effect. At present, the diagnostic method and criteria for white coat hypertension are not uniform, but the more commonly used is the in-office incidental blood pressure value ≥ 140/90 mmHg, while the ambulatory blood pressure monitoring daytime average blood pressure < 130/80 mmHg. According to statistics: about 20% of patients diagnosed with mild hypertension by in-office incidental blood pressure values are white coat hypertensive, mostly seen in women, young people, thin body size, and patients with a shorter and milder disease duration.
Preventive measures: In general, white coat hypertension is not very dangerous and generally does not require medication, but it should be followed up frequently. In particular, people with a family history of hypertension should have their blood pressure measured more often at home, and preferably have ambulatory blood pressure monitoring once a year. Patients who have developed target organ damage should receive appropriate medication and undergo active lifestyle interventions, mainly including smoking cessation, weight reduction, salt restriction, balanced diet, elimination of stress, sleep, and timely correction of blood glucose and dyslipidemia.
3.Hidden hypertension
Covert hypertension, also known as “reverse white coat hypertension” or masked hypertension, refers to normal blood pressure measured in the office, but ambulatory blood pressure monitoring reveals elevated daytime average blood pressure levels (>135/
85 mm Hg). These patients present with a strong elevated blood pressure response to stressful situations or exercise in daily life. It is most commonly seen in men, older adults, patients with diabetes, patients with metabolic syndrome, and those with clinic-measured blood pressure at high normal values.
Preventive measures: If there is unexplained obvious target organ damage, such as rhinorrhea, fundus bleeding, or heart failure, there should be a high suspicion of occult hypertension and prompt ambulatory blood pressure monitoring. Occult hypertension has a poor prognosis and may be overlooked, so active antihypertensive treatment should be implemented.
4.Cervical hypertension
Cervical spondylosis can cause an increase or decrease in blood pressure, of which the increase in blood pressure is the most common, so it is called “cervical hypertension”. Cervical hypertension is mostly seen in vertebral artery type and sympathetic cervical spondylosis. It mostly occurs in the upper cervical segment because the upper cervical segment is adjacent to the medulla oblongata, and when the cervical joint is misaligned, the transverse processes of the cervical vertebrae are shifted to the left or right, or the osteophytes cause compression and stimulation of the medulla oblongata, it can cause serious disturbance of the vasomotor of the medulla oblongata. Cervical hypertension is mostly paroxysmal, with large fluctuations in blood pressure, and is triggered or aggravated by changes in head position. It is often accompanied by insomnia, forgetfulness, vertigo, tinnitus, headache and other symptoms of vertebral artery type or sympathetic cervical spondylosis.
Prevention and treatment measures: cervical hypertension is caused by cervical spondylosis, so appropriate treatment methods should be selected, such as traction, physical therapy, massage, etc.; if it is a cervical dislocation, fracture or trauma, then actively treat the trauma, dislocation and fracture of the cervical spine, the trauma is cured, and the blood pressure will return to normal. In short, the treatment of cervical hypertension is mainly the treatment of the primary disease, the treatment of hypertension, in addition to high blood pressure, generally do not rush to use antihypertensive drugs, but focus on the treatment of the primary disease, after the primary disease is cured depending on the situation and then further treatment.
5, pulmonary hypertension
Some people suffer from bronchial asthma, chronic bronchitis or pulmonary infections and other diseases of the whistle system, blood pressure will be increased, and once the application of antibiotics, cough medicine or bronchodilators (without antihypertensive drugs), their blood pressure will be significantly reduced. This kind of hypertension can be called pulmonary hypertension, the formation of which is mostly related to the lack of oxygen and carbon dioxide retention in the patient’s body.
Prevention and treatment measures: this disease generally does not require antihypertensive treatment, when the whistling system disease remission, its blood pressure can mostly be reduced to normal levels.
6.H-type hypertension
The World Health Organization CDC CDC classification directory that healthy adults fasting plasma cysteine (HCY) levels in the 5-15umm / L, the average level of ≥ 16umm / L, when the HCY level of ≥ 10umm / L, belong to the high HCY blood pressure, accompanied by high HCY hypertension, known as “H-type hypertension The hypertension with high HCY is called “H-type hypertension”. According to incomplete statistics, the proportion of H-type hypertension among our hypertensive patients is as high as 75%, which cannot be ignored. H-type hypertension is the most important risk factor for stroke. Blood HCY is elevated by 5umm/L,
A 5umm/L increase in blood HCY increases the risk of cardiovascular disease by 59%; a 3umm/L decrease in HCY reduces the risk of cardiovascular disease by about 24%.
Prevention and treatment measures: The naming of H hypertension emphasizes the dual hazard of hypertension and hyperhomocysteinemia, so the treatment of H hypertension should also be two-pronged. The effect of antihypertensive drugs for stroke prevention is very clear. Clinical trial studies have shown that every 9 mmHg reduction in systolic blood pressure and/or every 4 mmHg reduction in diastolic blood pressure reduces the risk of stroke by 36%. Folic acid supplementation is currently considered to be the safest and most effective way to reduce HCY. 0.8 mg of folic acid daily in patients with H hypertension can effectively prevent cardiovascular disease.
7.Early morning hypertension
Early morning hypertension refers to a significant rise in blood pressure when waking up in the early morning, forming a morning peak in blood pressure, which is significantly associated with cardiovascular events. This early morning rise in hypertension is specifically called early morning hypertension. Early morning hypertension arises due to the change in the physiological rhythm of the body and the influence of people who have entered a rapid sleep state before waking up, when there is more mental activity, which makes the increase in norepinephrine and catecholamines and other vasoconstrictive substances, peripheral resistance and cardiac blood volume increase, and also indirectly increases water and nano retention, increasing the amount of body fluids, as a result of which blood pressure increases.
Preventive measures: Controlling the early morning rise in blood pressure in hypertensive patients can reduce the occurrence of cardiovascular events. Countermeasures are first of all to emphasize a healthy lifestyle. When elderly patients with hypertension get up in the morning, it is advisable to move slowly and have a small amount of activity, and it is better not to do morning exercises too early. Second, we should try to use stronger, longer-lasting and smoother antihypertensive drugs, and take them once a day immediately after waking up in the morning. Some beta blockers, angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists have a role in suppressing the morning peak of blood pressure. If, after the above treatment, there is still a significant morning peak phenomenon, you can change the time of administration to just before bedtime and add a long-acting a-blocker (such as doxazosin controlled-release tablets) to effectively curb early morning hypertension.
8. Nocturnal hypertension
The blood pressure of normal population and most patients with mild hypertension has the characteristics of circadian rhythm changes, i.e., it decreases at night when sleeping and increases when waking up in the early morning, which is manifested as higher blood pressure in the morning and gradually decreases in the afternoon to night. On ambulatory blood pressure monitoring, the main manifestation is a decrease of <10% in the average nighttime blood pressure compared to the average daytime blood pressure, called "spoon blood pressure". If the blood pressure does not drop or decreases at night, it is called "non-spoon blood pressure", also known as nocturnal hypertension. It is also believed that regardless of diurnal blood pressure changes, as long as the average nighttime systolic blood pressure is >125 mmHg and/or the average diastolic blood pressure is >75 mmHg, it is called nocturnal hypertension.
Prevention and treatment measures: Effective control of nocturnal blood pressure along with daytime blood pressure. Medication should be individualized, and long-acting antihypertensive drugs or an additional mid-acting drug at night should be chosen as much as possible. At the same time, patients should also be urged to develop healthy lifestyle habits.
9, sleep whistling disorder hypertension
Sleep whistle disorder can occur repeatedly during sleep inspiration pause phenomenon, generally each whistle pause can last about 10 seconds, each night can be more than 30 episodes, and accompanied by the symptoms of periodic increase in blood pressure. This kind of hypertension can be called sleep whistling disorder hypertension. The reason for this is the repeated pauses in inspiration during sleep, which cause a decrease in arterial oxygen saturation and an increase in carbon dioxide concentration, resulting in increased sympathetic excitability, which causes compensatory changes in the small peripheral arteries, such as wall thickening, luminal narrowing and increased responsiveness to vasoconstrictive reactive substances.
Preventive and curative measures: The treatment of this disease is mainly based on correcting airway obstruction, which can be done in a lateral or semi-recumbent sleep position, or by surgical methods, such as removal of the enlarged tonsils, in order to lower blood pressure.
10.Postural hypertension
Some patients have normal blood pressure in the prone position (diastolic pressure ≤ 90 mmHg) and elevated blood pressure in the standing position (diastolic pressure > 90 mmHg, systolic pressure > 150 mmHg), and the possibility of secondary hypertension is excluded. This type of hypertension can be called postural hypertension. Postural hypertension is mostly seen in mild hypertension. In general, in patients with normal or sustained hypertension, blood pressure changes with postural changes, but does not exceed 10 mm Hg. In contrast, postural hypertension can vary by more than 15 mm Hg and is often associated with symptoms such as postural tachycardia. Studies have confirmed that the formation of postural hypertension is mostly related to increased sympathetic excitability.
Preventive measures: Patients with postural hypertension may not need to use antihypertensive drugs urgently, but should promote the improvement of neuromodulation through physical exercise and psychotherapy. In addition, avoid standing for a long time, slow down as much as possible when changing position, and use elastic stockings is a more effective treatment aid.
11.Exercise hypertension
The increase in blood pressure caused by exercise is a common phenomenon, which can be seen not only in patients with hypertension, but also in those who have normal blood pressure in a quiet state. Exercise hypertension is a phenomenon in which the blood pressure rises reactively during or just after exercise under a certain exercise load. The diagnostic criteria for exercise hypertension are a systolic blood pressure >200 mm Hg during exercise, or a diastolic blood pressure that is 10 mm Hg higher than before exercise, or a diastolic blood pressure >90 mm Hg.
Preventive measures: When exercise hypertension occurs, active search for the presence of risk factors for hypertension, such as smoking, obesity, abnormal glucose metabolism, dyslipidemia, etc., and timely intervention.
12, salt-sensitive hypertension
The so-called salt sensitivity of blood pressure refers to the increase in blood pressure caused by relatively high salt intake. Salt-sensitive hypertensive patients have the following four characteristics: (1) this type of blood pressure is very closely related to too much salt, that is, too much salt is the environmental factor in its development; (2) the blood pressure of such patients rarely fluctuates within 24 hours, and is maintained at almost the same high level between day and night, while the blood pressure of general hypertensive patients is at least 10% lower at midnight than during the day; (3) because the blood pressure is continuously high, so The patient’s heart, brain and kidney important target organs will be damaged by continuous high blood pressure, more likely to cause ventricular hypertrophy, heart failure, renal insufficiency, uremia and stroke and other serious consequences; (4) such patients mostly have insulin resistance, so they are often complicated by diabetes, dyslipidemia and other metabolic diseases, eventually leading to atherosclerosis and coronary heart disease.
Prevention and treatment measures: Prevention and treatment of salt-sensitive hypertension must be targeted, and the key measure is to strictly limit salt intake and change the unhealthy habits of high-salt diet. (1) Reduce the intake of sodium salt in the diet. The average salt intake of our people is much higher than that of other countries, so it is advocated to reduce the sodium intake appropriately, especially in the north, and to reduce the daily salt intake to 100-150 mmol, that is, to reduce the existing salt intake by 1/2 to 1/3, which can help to reduce the incidence of hypertension. (2) Salt-sensitive people should increase the intake of potassium and calcium appropriately, which can prevent the pressure-raising effect caused by excessive dietary sodium intake. Moderate supplementation of calcium and potassium in children and adolescents can promote urinary sodium excretion in salt-sensitive children and adolescents, and significantly delay the increase in blood pressure with age in this group of children and adolescents. (3) The increase in alcohol consumption and obesity in China has made hypertension more likely and dangerous, so reducing alcohol consumption and weight is one of the measures that should not be neglected to prevent salt-sensitive hypertension.