Many friends have this kind of confusion: watching some elderly people or elders take their blood pressure, they will find that their "high pressure" is relatively high, while the "low pressure" is often not too high or even low. But one's own blood pressure is the opposite, manifested as "high pressure is not high, but low pressure is high"

Many friends have this kind of confusion: watching some elderly people or elders take their blood pressure, they will find that their "high pressure" is relatively high, while the "low pressure" is often not too high or even low. But one's own blood pressure is the opposite, manifested as "high pressure is not high, but low pressure is high". What is the reason for this?

Indeed, in clinical practice, there are many hypertensive patients with the main manifestation of "low pressure and high pressure". Compared with patients with high blood pressure, the cardiovascular system of these patients is in a significantly different state; There are also significant differences in the required treatment methods and medications.

In this article, let's analyze carefully: What is the cause of hypertension, which is mainly characterized by "low pressure and high blood pressure"? Can these patients avoid taking antihypertensive drugs? And when medication is needed, which antihypertensive drugs are more suitable?

Three main reasons for "low pressure and high pressure"

The current medical philosophy believes that there are three main reasons for the phenomenon of "high pressure not high, but low pressure high".

Firstly, the arterial elasticity is good.

Generally, in clinical practice, the "difference" obtained from "systolic blood pressure (high pressure) - diastolic blood pressure (low pressure)" is called "pulse pressure difference". The larger the pulse pressure difference, the more often it represents a decrease in the elasticity of the arteries and a "hardening" of the blood vessels; The smaller the pulse pressure difference, the better the elasticity of the artery and the lower the degree of sclerosis.For patients like this who have low blood pressure but low blood pressure, there is no doubt that the pulse pressure difference will be normal or even low.

From another perspective, this conclusion can also be confirmed. This is why the degree of arteriosclerosis in elderly people is relatively high, so elderly hypertension often exhibits the characteristics of "high pressure, low pressure" and "large pulse pressure difference".The arterial elasticity of middle-aged and young people is still good, therefore, hypertension in middle-aged and young people is often manifested as "high pressure is not high, but low pressure is high".

From this perspective, hypertension, mainly characterized by "low pressure and high blood pressure," does not seem to be as bad.

Secondly, peripheral vascular resistance increases.

Peripheral vascular resistance "is an important indicator of hemodynamics, mainly reflecting the resistance of small arteries to blood flow and the degree of microcirculation patency.

Generally speaking, the greater the peripheral vascular resistance, the more blood will remain in the heart's diastole blood vessels, and the higher the diastolic pressure (low pressure) will therefore be.

The main factors that cause an increase in peripheral vascular resistance in the human body include:Obesity or overweight, long-term alcoholism, lack of exercise, mental stress, psychological stress, and insufficient sleep.

Simply put, these unhealthy lifestyle habits can cause hypertension, mainly characterized by "low pressure and high blood pressure," by increasing peripheral vascular resistance.

Thirdly, the heart rate is too fast.

Generally speaking, the faster the heart rate is, the shorter the interval between heartbeats will be, which will lead to more blood remaining in the diastole blood vessels, and the higher the diastolic pressure (low pressure) will be.

Overall, patients with a fast heart rate are prone to the phenomenon of "low pressure and high blood pressure"; Patients with slower heart rates tend to exhibit "high blood pressure".

So, what are the factors that can easily cause our heart rate to increase?

Bad habits such as frequent consumption of strong tea, excessive coffee consumption, smoking, mental stress, high psychological pressure, insufficient sleep, and lack of exercise are also common causes of increased heart rate.

That is to say, hypertensive patients with the main manifestation of "high pressure is not high, but low pressure is high" are generally mainly middle-aged and young people, and there are more cases of rapid heart rate increase, obesity or overweight, and various unhealthy lifestyle habits!

Can these patients avoid taking antihypertensive drugs?

After the previous analysis, we can see that:If you truly belong to the middle-aged and young population, with good vascular elasticity, and there are adverse factors that can be improved, such as obesity or overweight, lack of exercise, unhealthy diet, high psychological pressure, mental tension, and insufficient sleep, then it is indeed possible to achieve blood pressure reduction solely through intervention in a healthy lifestyle without relying on medication!

As long as one can persist in losing weight, quitting smoking and limiting alcohol, establishing healthy eating habits, reducing the intake of strong tea and coffee, strengthening regular exercise, relaxing the mood, and improving sleep conditions, then "low pressure" has every hope of returning to normal levels.

However, not all patients can avoid taking medication!When certain specific situations arise, in addition to achieving the above "non drug" control measures, it is still necessary to promptly initiate antihypertensive therapy.

For example, if the "low pressure" has exceeded 100mmHg, it is recommended to start taking antihypertensive drugs as soon as possible.

According to the 2020 edition of the National Guidelines for the Prevention and Control of Primary Hypertension:Only hypertensive patients with "low pressure"<100mmHg are suitable for simple healthy lifestyle interventions to reduce blood pressure.

For example,No matter what the "low pressure" level is, those patients who also suffer from diabetes, chronic kidney disease, coronary heart disease, stroke and other diseases also need to take antihypertensive drugs.Because for these patients, 'low pressure' often needs to be controlled to '<80mmHg' to be ideal.

In brief, if you belong to the young and middle-aged population, the "low pressure" does not exceed 100mmHg, and there are no other serious diseases such as diabetes, coronary heart disease, stroke, etc., then you can really postpone taking medicine, and first reduce blood pressure through the intervention of a healthy lifestyle.

Which antihypertensive drugs are more suitable for this type of patient?

If, after 3-6 months of healthy lifestyle intervention, your "low pressure" has not yet dropped back to within 90mmHg; Alternatively, you simply cannot persist in implementing these lifestyle interventions. So, you still need to use antihypertensive drugs!

However, in clinical practice, there are various types of antihypertensive drugs, and medical research has found that different types of antihypertensive drugs have certain differences in their effectiveness in controlling hypertension, which is mainly characterized by "low pressure and high blood pressure".

The 2020 version of the "Consensus of Experts on Hypertension Management in Middle and Young People of China" clearly states:In terms of controlling hypertension in middle-aged and young people, the efficacy of "ACEI"/"sartan" (ARB) drugs and "lol" drugs is superior to diuretics and "dipine" drugs (calcium antagonists).

The "lol like" drugs here are medically known as Receptor blockers "represent drugs such as metoprolol, bisoprolol, etc.The biggest feature of these drugs is that they can significantly slow down heart rate while lowering blood pressure.

For patients with a resting heart rate above 80 beats per minute, this type of medication should be given priority consideration.

Both "pril" and "sartan" drugs are drugs that act on the renin angiotensin aldosterone system. Representative drugs include captopril, perindopril, enalapril, as well as losartan, valsartan, irbesartan, and so on.

Renin angiotensin aldosterone system

Renin angiotensin aldosterone system

Therefore, for patients with a resting heart rate of less than 80 beats per minute, priority can be given to choosing one of the "pril" or "sartan" drugs.

Reference

1. National Guidelines for the Prevention and Treatment of Primary Hypertension, 2020 Edition. Chinese Journal of Medical Frontiers (Electronic Edition), Volume 13, Issue 4, 2021

2. Chinese Guidelines for the Prevention and Treatment of Hypertension (Revised 2018 Edition), Volume 24, Issue 1, Chinese Journal of Cardiology, February 2019

3. Consensus among Chinese middle-aged and young hypertension management experts "Chinese Journal of Hypertension", Volume 28, Issue 4, April 2020

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