Guidelines for the identification and prevention of hypertension in adolescence, old age and high altitude

Adolescent hypertension: Adolescent hypertension, as the name suggests, refers to hypertension occurring during adolescence. Although not a common disease, it is not uncommon.

(1) Systolic blood pressure (commonly known as high blood pressure) is high while diastolic blood pressure (commonly known as low blood pressure) is not high. Systolic blood pressure can reach 140-150 mmHg, while diastolic blood pressure does not exceed 85-90 mmHg.

(2) There are usually no uncomfortable symptoms, only after excessive fatigue or strenuous exercise, such as dizziness and chest tightness. Because the symptoms are not obvious, they are often overlooked by adolescents, parents, and medical staff.

(3) Part of the cause is related to the dramatic changes in neuroendocrine function during adolescence, accelerated heart development, and the inability of blood vessels to keep up with heart development. After adolescence, blood pressure gradually returns to normal levels. To prevent hypertension in adolescents, firstly, teenagers should be educated to actively participate in school-organized physical examinations to understand their blood pressure levels, enabling timely detection, further diagnosis, and identification of the cause for prompt treatment. Secondly, general principles of hypertension prevention should be followed, such as maintaining a balance between work and rest and avoiding excessive fatigue. Thirdly, emotional stability should be maintained to prevent blood pressure fluctuations caused by emotional changes. Fourthly, appropriate physical exercise, especially activities beneficial to heart health such as swimming and running, is recommended. Additionally, avoiding smoking and excessive alcohol consumption, maintaining good lifestyle habits, and paying attention to dietary adjustments are all crucial.

Hypertension in the Elderly: The World Health Organization defines hypertension in the elderly as those aged 65 and over (60 and over in my country), with a sustained or three separate blood pressure measurements on different days showing a systolic blood pressure ≥160 mmHg and/or a diastolic blood pressure ≥95 mmHg.

These patients exhibit clinical manifestations of arteriosclerosis, such as copper-wire or silver-wire-like changes in the fundus arteriovenous crossings, calcification of the aorta and abdominal aorta (clearly visible on X-ray), systolic murmurs in the aortic area on auscultation, and the presence of senile rings. Chest and abdominal X-rays, and cardiac and abdominal ultrasound examinations are very useful for evaluating the prognosis of these patients. Elevated systolic blood pressure in elderly patients is closely related to cerebrovascular accidents, coronary heart disease, and congestive heart failure. For antihypertensive treatment of hypertension in the elderly, it is recommended to maintain systolic blood pressure at 160–175 mmHg and diastolic blood pressure at 90 mmHg, while simultaneously improving quality of life.

High-altitude hypertension: High blood pressure (especially diastolic hypertension) is characterized by elevated blood pressure in people who have lived in high-altitude areas for a long time, without other underlying causes of hypertension. Upon returning to low-altitude areas, blood pressure quickly returns to normal without antihypertensive treatment. The overall incidence rate is not precisely statistically determined, but it is much higher than the prevalence rate in non-high-altitude areas.

High-altitude hypertension clinically manifests primarily as symptoms and signs of general cardiovascular and cerebrovascular diseases, such as palpitations, shortness of breath, cardiomegaly, arrhythmia, and heart failure, accompanied by elevated systolic blood pressure, and sometimes hypertensive crisis. Its pathogenesis involves the combined effects of multiple factors. High-altitude hypoxia reduces arterial blood oxygen levels, leading to vasoconstriction and spasm, and increased peripheral circulatory resistance; hypoxia increases sympathetic activity, accelerates heart rate, and shortens circulation time; hypoxia secondary to erythrocyte proliferation leads to increased blood volume and blood viscosity; simultaneously, increased renin secretion and adrenal hyperfunction all contribute to elevated blood pressure, resulting in a series of clinical symptoms and signs.

Treatment of high-altitude hypertension, in addition to routine administration of cardiotonics, diuretics, vasodilators, and infection control, should include antihypertensive therapy. For patients with persistently poor response to aggressive treatment or those with severe organ damage, timely transfer to non-high-altitude areas for treatment is also crucial.