Postural and sleep-related hypertension: Identification and prevention of specific blood pressure fluctuations

Orthostatic hypertension: Orthostatic hypertension refers to a condition where blood pressure is elevated when standing or sitting, but normal when lying down. This type of hypertension accounts for approximately 4.2% of hypertension cases in China, and is reported to account for 10% internationally. A characteristic feature is that it generally does not present with typical hypertension symptoms and is often discovered incidentally during physical examinations. Blood pressure is predominantly elevated in the diastolic direction and fluctuates considerably. In severe cases, palpitations, fatigue, and rapid sleep onset may occur. Blood tests show higher plasma renin activity than normal, even exceeding that of typical hypertension patients. The mechanism of orthostatic hypertension is generally believed to be related to the overfilling of the "gravitational vascular pools" of veins and venous sinuses below the level of the heart. These veins and venous sinuses enlarge due to the influence of gravity, and are medically termed "gravitational vascular pools."

When a person lies down, these vascular pools are largely unaffected. However, when standing or sitting, excessive blood pooling in the venous pools of the drooping areas reduces blood flow back to the heart, lowering cardiac output. This leads to excessive excitation of the sympathetic nervous system, causing small blood vessels throughout the body, especially arterioles, to remain in a state of constriction or spasm for an extended period, resulting in elevated blood pressure. Some people are particularly sensitive to this reaction, thus developing orthostatic hypertension. Orthostatic hypertension is generally not treated with antihypertensive drugs. Using antihypertensive drugs, such as diuretics, will not only fail to lower blood pressure but may also trigger a further increase. Therefore, the main treatment method is to strengthen physical exercise and improve muscle mass. For individuals with significant symptoms, appropriate supplementation with neuromodulation drugs such as Cerebrolysin, inosine, B vitamins, and oryzanol may be taken to regulate the nervous system.

Orthostatic hypertension generally has a good prognosis with no long-term adverse consequences. However, it is crucial to confirm orthostatic hypertension during diagnosis to avoid unnecessary or incorrect treatment measures that could negatively impact the patient's physical and mental health.

Sleep-related hypertension: Among hypertension types, there is a special one called sleep-related hypertension. This type of hypertension often occurs during sleep or upon waking. Its causes may be related to increased sympathetic activity due to shallow, slow, and paused breathing, fluctuating heart rate, decreased blood oxygen saturation, and increased carbon dioxide concentration during sleep.

It is commonly seen in patients with obstructive sleep apnea syndrome and those with snoring accompanied by sleep apnea. Increased secretions in the upper respiratory tract during sleep cause obstruction, leading to decreased blood oxygen saturation and increased carbon dioxide concentration, thus increasing sympathetic activity. This increased sympathetic activity can cause compensatory changes in peripheral resistance arterioles, resulting in thickening of the vessel walls, narrowing of the lumen, and increased responsiveness to vasoconstrictive substances, leading to elevated blood pressure. It often causes various arrhythmias and other cardiovascular diseases due to changes in blood gas patterns. Treatment for sleep-related hypertension primarily involves correcting the apnea caused by airway obstruction. Generally, after the airway obstruction is relieved, the blood pressure of most patients will significantly decrease, even returning to normal. When sleeping, one should lie on their right side and try to avoid or reduce snoring and breath-holding to prevent sleep apnea and subsequent high blood pressure. It's also important to avoid smoking, drinking alcohol, taking sleeping pills before bed, keeping the nasal passages clear, and not breathing through the mouth.

If sleep-related hypertension occurs, seek medical attention promptly. Surgical removal of enlarged tonsils, excess pharyngeal wall fat, or uvulopalatopharyngoplasty can widen the pharyngeal airway and improve airflow.