This is a common cause of high blood pressure, and young and middle-aged people should pay special attention!

Author: Cai Jun, Chief Physician, Fuwai Hospital, Chinese Academy of Medical Sciences

Reviewer: Wang Fang, Chief Physician, Beijing Hospital

Hypertension can be divided into two categories: primary hypertension with unknown cause and secondary hypertension with clear cause.

For secondary hypertension, after finding the cause, targeted treatment can be given through special surgery, drugs, etc., which can fundamentally treat hypertension and is very beneficial to patients.

1. What are the causes of secondary hypertension?

There are many common causes of secondary hypertension, including renal hypertension, that is, hypertension caused by kidney disease, such as acute or chronic glomerulonephritis, chronic pyelonephritis, kidney stones, bladder stones, as well as reninoma, renal artery stenosis, etc., can all cause hypertension.

When the kidneys are damaged, many toxic small molecules metabolized by the body cannot be excreted, which will damage the vascular endothelium and harm our entire body, including causing an increase in the secretion of renin and aldosterone, leading to subsequent high blood pressure.

In addition to renal hypertension, there is also renal vascular hypertension, such as ischemic nephropathy caused by renal artery stenosis, which causes hypertension.

There is also endocrine hypertension, which includes primary aldosteronism, pheochromocytoma, hypercortisolism, etc. Because the increase of aldosterone, catecholamines, dopamine, and cortisol can all cause high blood pressure.

There are also some problems with large blood vessels, such as aortic stenosis, aortic valve regurgitation, etc., which can also cause high blood pressure. For example, aortic stenosis is more common in young children, because the aorta is the entire blood circulation channel. If this channel is blocked, it will of course cause subsequent blood pressure to increase, because only with higher blood pressure can blood pass through this blocked area.

Others are respiratory problems, such as obstructive sleep apnea syndrome.

There are others, such as polycystic ovary syndrome, which is more common in women, which can also cause high blood pressure.

Among them, the most common cause is sleep apnea syndrome, the second is primary aldosteronism, and the third is renal hypertension.

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2. Why does sleep apnea syndrome cause high blood pressure? How to treat it?

Sleep apnea syndrome is common among young and middle-aged people, especially obese men.

Because when he sleeps, the body relaxes and the muscles of the posterior pharyngeal wall are also relaxed, which will block the airway during sleep, causing difficulty breathing or even respiratory arrest.

In this case, the body will be lacking in oxygen and the carbon dioxide level will increase, and our body will naturally experience some subsequent sympathetic nerve activation. The secretion of renin, aldosterone, and catecholamines will increase, leading to high blood pressure.

Therefore, sleep apnea syndrome and primary aldosteronism often co-exist.

If a patient has primary aldosteronism, about 20 to 30 percent of them have sleep apnea syndrome. Patients with sleep apnea syndrome are an important clue and reminder for us to screen for endocrine hypertension and primary aldosteronism.

For sleep apnea syndrome, we usually have two treatment methods for moderate and severe patients:

First, if the patient is obese, he or she should lose weight and choose to sleep on the side, and try to avoid sleeping on your back, because lying on your back is more likely to cause airway obstruction.

Second, a very important treatment is to use a small ventilator, which can monitor apnea and then actively pump air into the respiratory tract to avoid severe apnea. Severe apnea may last for one or two minutes, which is very bad for the body. Therefore, ventilator treatment is very useful for relieving high blood pressure.

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Some refractory hypertension is actually caused by sleep apnea syndrome due to obesity. However, if we perform some posterior pharyngeal wall surgery through the otolaryngology department, the probability of recurrence of these patients is about 60%-70%, which is still relatively high.

Therefore, we first use this non-invasive ventilator treatment, which can help patients improve their level of hypoxia, improve blood pressure, and make hypertension easier to control.