Between 1990 and 2019, although the overall global prevalence of hypertension did not change significantly, there was a significant geographical shift in the distribution of the disease burden.

In the past, hypertension appeared to affect more wealthy countries, but in recent years this trend has shifted, with the prevalence of hypertension increasing in low- and middle-income countries.

This shift reflects rising global health inequalities, as well as the health impacts of lifestyle changes and urbanization.

Global trends in hypertension

In this context, the situation of hypertension in China is of particular concern. According to the 2017 Guidelines for the Prevention and Treatment of Hypertension in China, it is estimated that there are more than 270 million people with hypertension in China.

Worryingly, more than 10 million people are newly diagnosed with hypertension each year. This not only shows the widespread prevalence of hypertension in China, but also highlights the huge demand and economic burden on medical resources.

As a major risk factor for cardiovascular disease, the impact of hypertension on individuals and society is multifaceted.

On an individual level, high blood pressure can lead to serious health problems such as heart disease, stroke, kidney disease, significantly reducing quality of life, and increasing the risk of premature death.

At the socio-economic level, the health problems caused by hypertension lead to an increase in the consumption of medical resources, an increase in medical costs, and an impact on economic productivity due to the reduction of the labor force due to diseases.

The "red line" of high blood pressure

The 2023 Chinese guidelines for the prevention and treatment of hypertension provide clear guidance on the grading of hypertension, aiming to help people better understand and manage their blood pressure in order to prevent related complications and improve quality of life.

Normal blood pressure is defined as a systolic blood pressure of less than 120 millimeters of mercury (mmHg) and a diastolic blood pressure of less than 80 mmHg. For this group, it is advisable to maintain a healthy lifestyle and monitor blood pressure regularly to ensure that it remains within the normal range.

High normal blood pressure, systolic blood pressure between 120 and 139 mmHg, diastolic blood pressure between 80 and 89 mmHg, this stage requires people to start paying attention to lifestyle improvement and regular blood pressure monitoring.

Grade 1 hypertension, which is a systolic blood pressure between 140 and 159 mmHg and a diastolic blood pressure between 90 and 99 mmHg. Individuals at this stage may need medications to control their blood pressure in addition to lifestyle modifications.

It is important to check blood pressure regularly to assess the effectiveness of treatment and to be aware of potential complications. Second-degree hypertension is defined as a systolic blood pressure of 160 to 179 mmHg and a diastolic blood pressure of 100 to 109 mmHg.

In this case, lifestyle modifications are often required in conjunction with medication, and close monitoring of blood pressure and potential target organ damage is required.

Grade 3 hypertension is the most severe condition, with systolic blood pressure greater than or equal to 180 mmHg and diastolic blood pressure greater than or equal to 110 mmHg.

At this stage, it is necessary not only to optimize the lifestyle, but also to carry out aggressive medical therapy, and closely monitor blood pressure, target organ damage and complications, and adjust the treatment regimen at any time to control blood pressure.

It is important that blood pressure management is not implemented mechanically based on grading criteria alone, and that the actual treatment plan is tailored to the patient's specific situation, including age, gender, and the presence of comorbidities.

The advice of a professional physician plays a decisive role in this process.

Individuals with blood pressure over 180/110 mmHg, i.e., at high risk, young or old, require immediate action to lower blood pressure.

Blood pressure levels that reach extremely high levels, such as 250/140mmHg, are already in a very dangerous state and can quickly lead to serious complications that require immediate medical attention for emergency treatment to avoid fatal risks.

Onset of high blood pressure

Lifestyle factors have a direct impact on the occurrence and progression of hypertension. A high sodium and low potassium ratio in your diet is a common cause of high blood pressure.

Excessive sodium intake, especially when consumed in processed foods and fast foods, can lead to an increase in blood pressure. On the contrary, potassium intake has a positive effect on blood pressure control, and potassium can help balance sodium levels in the body, which can help lower blood pressure.

Therefore, adjusting your diet to reduce sodium intake and increase your intake of potassium-rich foods, such as fresh vegetables and fruits, is essential to prevent and control high blood pressure.

Being overweight and obese is another important risk factor for high blood pressure. Weight gain increases the burden on the heart, leading to an increase in blood pressure. Therefore, maintaining a healthy weight through a balanced diet and regular physical activity is an effective way to control blood pressure.

Smoking and excessive alcohol consumption can also have adverse effects on blood pressure. Smoking can cause vasoconstriction, which increases blood pressure, while excessive alcohol consumption can interfere with the normal regulation of blood pressure.

At the same time, psychosocial factors such as stress and mood swings can also affect blood pressure. Therefore, quitting smoking, limiting alcohol, and managing stress and mood are very important to maintain normal blood pressure levels.

Increasing age is a natural factor in the development of hypertension. As we age, blood vessels may become more stiff, increasing the risk of high blood pressure.

Although this is an unavoidable natural process, blood pressure can be effectively managed through a healthy lifestyle and the risk of elevated blood pressure associated with advanced age can be reduced.

In the diagnosis and management of hypertension, accurate measurement and evaluation of blood pressure is very important. Clinical blood pressure measurement is the most common method, and hypertension is usually diagnosed when blood pressure is greater than or equal to 140/90 mmHg measured three times on the same day.

However, fluctuations in blood pressure and day-to-day variations mean that office measurements alone may not be sufficient to fully paint a picture of an individual's blood pressure status.

Therefore, 24-hour ambulatory blood pressure monitoring and home blood pressure measurement, especially early morning blood pressure, are important additions to assess patient prognosis.

These methods can provide more comprehensive blood pressure data, which can help doctors evaluate the effectiveness of treatment, monitor patients' blood pressure control, and adjust treatment regimens in a timely manner.

Risk of intracerebral hemorrhage

Intracerebral hemorrhage is closely linked to high blood pressure. If high blood pressure is not effectively controlled for a long time, it will increase the risk of rupture of blood vessels in the brain, leading to the occurrence of cerebral hemorrhage.

It accounts for about 20% to 30% of all stroke types, and the case fatality rate in the acute phase is as high as 30% to 40%.

Therefore, it is crucial for patients with hypertension to understand the risk factors for intracerebral hemorrhage and take effective preventive measures.

Controlling blood pressure is the primary strategy to prevent intracerebral hemorrhage. The risk of intracerebral hemorrhage can be significantly reduced by regularly monitoring blood pressure and ensuring that it remains within the normal range.

This is usually achieved in combination with a healthy lifestyle and necessary medications. A healthy diet, moderate physical activity, adequate rest and sleep, and avoiding excessive mental stress can all contribute to the stabilization of blood pressure.

In addition to controlling blood pressure, aggressive treatment of primary disorders that may lead to intracerebral hemorrhage is important. For example, diabetes and hyperlipidemia may increase the risk of intracerebral hemorrhage.

Therefore, effective management of these diseases can not only improve the general health of patients, but also reduce the probability of intracerebral hemorrhage.

Environmental factors, such as weather changes, are also a risk factor for people with high blood pressure that should not be ignored. Sharp temperature changes may cause fluctuations in blood pressure, increasing the risk of intracerebral hemorrhage.

Patients with high blood pressure should pay attention to the weather forecast and take appropriate precautions under extreme weather conditions, such as keeping the indoor temperature stable and avoiding prolonged stay in cold or hot environments.

In addition, overexertion is also one of the factors that increase the risk of intracerebral hemorrhage. Prolonged work and mental stress can lead to increased blood pressure, which increases the risk of bleeding in the brain.

Patients with high blood pressure should pay attention to the combination of work and rest, avoid overwork, and ensure sufficient rest time.

Heart disease

The impact of high blood pressure on heart health cannot be ignored. It can lead to a variety of health problems, including arterial damage, heart disease, brain damage, kidney damage, retinal damage, and sexual dysfunction.

High blood pressure increases the pressure of blood in the arteries, leading to hardening, narrowing, and possibly even aneurysms. These changes increase the risk of heart attack and heart failure.

Long-term hypertension puts an extra burden on the heart and can lead to heart problems such as coronary artery disease, heart failure and left ventricular hypertrophy.

High blood pressure has an equally serious effect on the brain. It increases the risk of transient ischemic attack (TIA) and stroke, and long-term high blood pressure may also lead to cognitive decline and dementia.

This is because high blood pressure can damage the blood vessels in the brain, affecting the blood supply to the brain.

For the kidneys, high blood pressure can lead to impaired kidney function, and long-term uncontrolled high blood pressure increases the risk of kidney failure. The kidneys are important organs for blood pressure regulation, and if damaged, it can lead to a vicious cycle that further exacerbates high blood pressure.

Retinal blood vessels can also be affected by high blood pressure, leading to vision problems and even blindness. High blood pressure can damage the tiny blood vessels in the fundus, causing retinopathy.

In addition, high blood pressure can also lead to sexual dysfunction, such as erectile dysfunction, which is due to the negative effects of high blood pressure on the health of blood vessels, including restricted blood flow to the reproductive organs.

Target organ damage

High blood pressure has potentially serious effects on multiple target organs in the body.

High blood pressure has a significant impact on the heart. It can lead to left ventricular hypertrophy, which is caused by the heart working more to overcome high blood pressure, which thickens and stiffens the heart muscle.

This change can reduce the efficiency of the heart, leading to cardiac insufficiency. In more severe cases, high blood pressure can also cause myocardial infarction, in which part of the heart's blood flow is suddenly blocked, resulting in damage to heart muscle tissue or death.

The harm of high blood pressure to the brain cannot be ignored. It is a major risk factor for stroke, including cerebral hemorrhage and ischemic stroke.

Intracerebral hemorrhage is bleeding caused by the rupture of blood vessels in the brain, while ischemic stroke is caused by a blockage or narrowing of blood vessels that reduce blood flow to the brain. All of these conditions can lead to brain tissue damage and, in severe cases, permanent neurological impairment.

The kidneys are also an important target organ for hypertension. High blood pressure can cause narrowing or occlusion of the lumen of the renal arteries, reducing blood flow to the kidneys and causing renal parenchymal ischemia.

In the long term, this condition can lead to a gradual decline in kidney function that can eventually progress to kidney failure, a serious health condition that may require dialysis or a kidney transplant.

The effects on the eyes are also a major hazard of high blood pressure, especially the damage to the retina. High blood pressure can lead to lesions of retinal blood vessels, such as hemorrhage, exudation, and papilledema.

These changes not only affect vision, but can also lead to long-term visual impairment and even blindness.

Treatment strategies for hypertension

Treatment of hypertension requires not only medical intervention, but also long-term lifestyle adjustment and management by the patient.

Effective control of hypertension often requires a combination of medication, lifestyle modification, and, in some cases, surgical intervention. These treatment strategies are described in detail below.

Lifestyle changes are the cornerstone of hypertension treatment. For many people with high blood pressure, lifestyle changes can effectively control blood pressure and even reduce drug dependence. Lifestyle adjustments mainly include the following aspects:

Lose weight and manage it: Being overweight and obese are major risk factors for high blood pressure, and it can be effective in lowering blood pressure by losing weight and maintaining a healthy weight.

Limit sodium intake: Too much sodium intake can lead to an increase in blood pressure, and reducing salt intake has a positive effect on blood pressure control.

Calcium and potassium supplementation: Potassium and calcium play an important role in maintaining normal blood pressure, and increasing your intake of these minerals can help control blood pressure.

Reduce fat intake: A high-fat diet increases the risk of heart disease, and controlling fat intake, especially saturated and trans fats, is beneficial for cardiovascular health.

Increase exercise: Regular physical activity can help lower blood pressure and improve cardiovascular health.

Quit smoking and limit alcohol consumption: Both smoking and excessive alcohol consumption increase the risk of high blood pressure, so quitting smoking and drinking alcohol in moderation is essential to control blood pressure.

Medication becomes a necessary option when lifestyle modifications do not allow complete control of blood pressure. Choosing the right antihypertensive medication is key to treating high blood pressure.

Typically, doctors develop a personalized medication plan based on the patient's specific situation, such as age, medical history, complications, and response to medications.

For some patients, a combination of multiple antihypertensive drugs may be needed to achieve optimal blood pressure control.

Surgical intervention may be necessary in patients with refractory hypertension who do not respond well to medications and lifestyle modifications.

Renal artery balloon dilation and radiofrequency ablation of renal sympathetic ganglion are common surgical methods for the treatment of refractory hypertension. These surgeries help control blood pressure by improving the blood supply to the kidneys or by interfering with nerve signals that affect blood pressure.

Patients should work closely with their doctor to develop a treatment plan that works for them, monitor their blood pressure regularly, and adjust their treatment plan if necessary. With this comprehensive treatment, blood pressure can be effectively controlled and the health risks caused by high blood pressure can be reduced.

References are as follows:

[1] More than 700 million people with hypertension worldwide are untreated – World Health Organization

[2] Guidelines for the prevention and treatment of hypertension in China (2018 revised edition)

【3】高血压性视网膜病变——Sonia Mehta

[4] China Cardiovascular Health and Disease Report 2021 on the prevalence and prevention of hypertension in China

[5] The 2020 ISH International Guidelines for Hypertension were launched in the world: a full summary of the key points of the guidelines