Recently, Mr. Yang felt dizzy and headache often, and always thought he was too tired from work, because his mother had a history of hypertension and stroke, Mr. Yang was very worried that he would follow his mother’s footsteps, so he came to the hospital for medical consultation. The doctor took his blood pressure and found that there was blood pressure as high as 160/120mmHg. Considering that Mr. Yang was only 35 years old and his parents both had a family history of hypertension, the doctor diagnosed primary hypertension and gave Mr. Yang antihypertensive medication after urine routine, kidney function, bilateral kidney and bilateral renal artery ultrasound examinations also ruled out secondary hypertension. However, nearly 3 months later, Mr. Zhang’s blood pressure was still poorly controlled, especially the diastolic blood pressure hovered between 100-120 mmHg, for which Mr. Yang sought medical advice from specialists in the cardiovascular department and hypertension department of several tertiary hospitals in Shanghai, successively replacing what calcium antagonists, angiotensin-converting enzyme inhibitors, betablockers, diuretics, etc. Now he takes 3-4 kinds of antihypertensive drugs every day. Now he takes 3-4 kinds of antihypertensive drugs every day, both traditional Chinese medicine and western medicine, the second and third generation products, but still feels dizzy with headache and low energy, and Mr. Yang has lost confidence in controlling his blood pressure to normal. One day I met Mr. Yang in the heart and blood clinic, he measured his blood pressure of 155/115mmHg, so I asked him with concern, “blood pressure control is not very good ah, recently eat what antihypertensive drugs?” Mr. Yang sighed, “I’ve taken all the good and expensive drugs, my blood pressure is now higher than my parents’, and I’m taking better drugs than they are, but it just won’t come down. “So you have serious insomnia? How long has it been?” “I’ve had insomnia for almost 5 years, and recently it’s been particularly bad, sometimes I can’t sleep all night, and only at dawn can I sleep in a daze. I’m afraid of taking sleeping pills with side effects, so I’ve been afraid to take them!” Mr. Yang’s answer caught the author’s attention, so I asked a detailed medical history, as well as the patient’s life and work situation and personality characteristics, trying to find out the reasons for the patient’s poor treatment of hypertension. It turns out that the 35-year-old Mr. Yang’s family is happy and harmonious, and his career is also smooth, since 5 years ago founded a logistics company, the business is booming, and then opened a number of branches. Mr. Yang is a perfectionist, hardworking, aggressive, decisive, strict on people and things, today’s things must not be delayed until tomorrow to solve, that is, belong to the so-called A-type personality of people. However, the mall like a battlefield, increasingly fierce competition, Mr. Yang for the development of the company dedicated, day and night work, almost no rest days, recently because of the preparation of field branches is not smooth, feel worried, anxious, upset, often reprimanded subordinates, but also feel chest tightness, panic, shortness of breath, like sighing, sweaty hands and feet, weakness, dizziness, headache, sleep more bad. After understanding the above situation, the author gave Mr. Yang a HAD scale test (a psychological scale for general hospital patients to test anxiety and depression disorders), the results were anxiety score of 10 (normal less than 7 points). The author then pointed out that Mr. Yang was now in an anxiety state, and that the reason why his blood pressure was not under control was related to the lack of relief from anxiety, which can directly lead to an increase in blood pressure. The reasons for his anxiety may include long-term overload, recent work failure, and prominent Type A personality traits. The author suggests that Mr. Yang, in addition to actively taking blood pressure-lowering drugs on time, must also address anxiety issues. Specifically, one, pay attention to the combination of work and rest, the work schedule can not be full, must leave themselves free time. Second, pay attention to character self-regulation, to people and things can not be too much pursuit of perfection, give yourself and others to leave some room. Third, go to the gym every day to jog for 30 minutes, through the expansion of arterial blood pressure after exercise to reduce blood pressure, in the gym can temporarily leave work, relieve mental stress, fatigue after exercise can also promote sleep. Fourth, the recent stage of taking appropriate sleeping pills to interrupt the vicious cycle of insomnia – poor rest – increased blood pressure – anxiety – insomnia again, while the author recommended to Mr. Yang pure Chinese medicine preparations, made from natural mushrooms and plants extracted from the active ingredients of the Wu Ling capsule, can improve sleep and control anxiety. Mr. Yang happily accepted the author’s suggestion. Two weeks later, his blood pressure was measured at 145/95 mmHg at the follow-up clinic, which gave Mr. Yang hope, and the author encouraged him to continue his treatment as prescribed. Now the follow-up for more than 2 months, Mr. Yang sleep improved, chest tightness, panic, shortness of breath, weakness, dizziness, headache is also much better, feel more energetic, emotional stability, now only need to take a conventional antihypertensive drugs can be satisfactory to lower blood pressure. Long-term psychological stress is one of the important pathogenic factors of primary hypertension Hypertension is divided into primary hypertension and secondary hypertension, the latter is often caused by certain diseases to a certain stage of hypertension, that is, hypertension is one of the consequences of the starting lesions, such as chronic nephritis, renal artery stenosis, pheochromocytoma, primary aldosteronism, multiple aortitis, etc., can be identified by laboratory tests of urine, blood, check the kidneys, renal arteries B ultrasound, abdominal CT, etc. to identify, of course, more than 95% of them are primary hypertension. In addition to the genetic factors, it is believed that hypertension is not only a genetic condition, but also a disease of the blood, which usually develops in middle and old age. It is believed that in addition to genetic factors, hypertension is mainly related to high calorie, high fat, high salt diet, obesity, lack of exercise, diabetes, smoking, etc. Now the incidence of hypertension has increased significantly, and there is a trend of early age of onset, young patients have higher blood pressure than their parents, which is greatly related to people’s modern lifestyle compared to their parents have changed. These factors are well understood, but people often overlook the important role of psychological factors in the rise of blood pressure. In fact, in primary hypertension, long-term psychological stress is also one of the pathogenic factors, according to the analysis of psychosocial factors leading to or involved in the development of hypertension to account for more than 70% of all hypertensive patients, and hypertension has long been unanimously recognized as a psychosomatic disease, that is, mainly psychological factors to promote or participate in the physical disease. Modern neuropsychological research suggests that the mechanism by which psychological factors lead to hypertension is as follows: long-term mental stress leads to dysfunctional excitation and inhibition of the human cerebral cortex – an imbalance in the vasomotor regulatory center that regulates blood pressure – increased peripheral adrenergic activity, peripheral small artery vasoconstriction – increased peripheral resistance – resulting in increased blood pressure. Among these psychosocial factors, the main ones include adverse social life events (loss of a loved one, loss of love, divorce, layoff, unfair treatment, etc.), interpersonal conflicts, family disputes, economic pressure, chronic mental stress, and psychological personality traits. Among urban white-collar workers like Mr. Yang, the continuous increase in blood pressure is directly related to their long-term overload and psycho-emotional disorders caused by personality traits. Low diagnosis rate, low treatment rate – the vast majority of psychological disorders are not timely detection and treatment Now our society is in transition, social competition, interpersonal tension, work pace, the gap between rich and poor, and many other phenomena, making our social groups generally increased psychological pressure, and a long period of psychological pressure is bound to cause some members of society to produce emotional psychological disorders, anxiety, depression is the current Anxiety and depression are two prevalent mood disorders, especially in patients attending general hospitals, the incidence of these two mood disorders is higher. According to a large study published recently by the School of Public Health of Fudan University, “A study on the prevalence of depression, anxiety and depression combined with anxiety symptoms in Chinese urban non-psychiatric patients”, 20%-25% of patients in neurology, cardiovascular and gastroenterology outpatient clinics in general hospitals have depression/anxiety symptoms, while the diagnosis rate of anxiety is only 1.3-5.3% and the diagnosis rate of depression is only 3.7-15.3. However, the diagnosis rate of anxiety is only 1.3~5.3%, the diagnosis rate of depression is only 3.7~15.3, the treatment rate of anxiety is only 2.2~7.7%, and the treatment rate of depression is only 2.4~15.4%. There are many reasons for the low diagnosis rate and low treatment rate, such as the lack of knowledge of mental health in the whole society, patients and family members have a sense of stigma about the diagnosis of psychological disorders, psychological disorders are often confused with physical diseases or co-morbidities, and the most crucial is our current medical model that only focuses on the disease but not the person, and does not really implement the modern medical model of bio-psycho-social to solve clinical medical problems. Patients with psychological disorders who come to the departments of general hospitals often complain of such and such physical discomfort, in fact, this is a lot of psychological disorders patients psychological stress in the form of physical discomfort, that is, the so-called somatization symptoms, such as dizziness, headache, chest tightness, palpitations, shortness of breath, chest and back pain, somatic pain, dry mouth, foreign body sensation in the throat, sweating, numbness of the limbs, gastrointestinal disorders, etc., these symptoms are diverse These symptoms can involve multiple systems and often change, and are mostly normal on systemic examination or do not match the degree of symptoms complained by the patient, which often leaves clinicians at a loss. Most clinicians look at patients based on experience and their own subspecialty perspective, cardiovascular doctors are concerned about whether chest pain and chest tightness are coronary heart disease, gastroenterologists are concerned about whether abdominal rise and nausea are gastroesophageal lesions, which is certainly not wrong, but they neglect to look at the many symptoms of patients as a whole, not to mention in-depth understanding of whether there are abnormalities in the psychological and social factors of patients, not aware of the fact that patients are actually a variety of cross-system discomfort. They do not realize that the patient’s cross-system discomfort is actually a physical manifestation of the psycho-emotional disorder. As a result, many patients with psychological disorders, especially those with psycho-emotional disorders that are combined with various definite physical illnesses, are not found to have psychological problems that are hidden behind the physical illnesses. Many patients become more anxious and depressed because their illnesses remain untreated for a long time, producing more discomfort and making the condition long-term, chronic and complicated, and simple illnesses are almost becoming difficult to treat for many years, entering a vicious circle. The only correct choice is to give equal importance to the treatment of somatic diseases and psychological treatment Patients with somatic diseases and psychological problems or psychological disorders, this is a problem that we clinicians will have to face in the future, which requires us to start from the bio-psycho-social medical model in both diagnosis and treatment, pay attention to understanding the role that psychosocial factors may play in the pathogenesis of patients, more listening, more patience, which will also enable us to provide a better understanding of the patient’s psychosocial factors in their pathogenesis. More listening and patience will also make us gain more in the diagnosis and treatment of patients. For the majority of patients, eliminating concerns, facing their psychological problems openly, actively cooperating with clinicians, or seeking counseling from psychologists is also a good strategy to reduce the detours on the road to treatment.