Hypertension is a common condition among middle-aged and elderly people. Once established, hypertension is a chronic disease that is difficult to cure and can lead to secondary changes in many organs, particularly the heart, brain, and kidneys.
I. Definition of Hypertension
Hypertension refers to clinically elevated systolic or diastolic blood pressure. Mainland China adopts the blood pressure classification criteria recommended by the World Health Organization in 1978:
1. Normal blood pressure in adults is a systolic pressure ≤140 mmHg and a diastolic pressure ≤90 mmHg.
2. Adults with a systolic pressure ≥160 mmHg or a diastolic pressure ≥95 mmHg are considered to have hypertension.
According to the Cardiovascular Conference of Medical Professionals in Mainland China, based on the physical constitution of the Chinese population, it has been determined that any adult with a diastolic blood pressure consistently exceeding 90 mmHg, regardless of their systolic blood pressure, can be diagnosed with hypertension.
II. Hypertension and Hypertensive Disease
Hypertension and hypertensive disease should not be conflated in medical terms. Hypertension is not a distinct disease; it is merely a symptom. In certain diseases, hypertension is just one of the clinical symptoms; this type of hypertension is referred to as **symptomatic hypertension or secondary hypertension**. When hypertension is the primary clinical manifestation and the cause is unknown, it is referred to as **primary hypertension or hypertensive disease**. The vast majority of clinically observed hypertension cases fall under the category of primary hypertension.
III. Staging of Hypertensive Disease
Stage I: Blood pressure reaches the level diagnostic of hypertension, with no clinical manifestations involving the heart, brain, or kidneys.
Stage II: Blood pressure reaches the level diagnostic of hypertension, accompanied by one of the following: ① left ventricular hypertrophy; ② generalized or focal narrowing of the retinal arteries; ③ proteinuria or a mild increase in plasma creatinine concentration.
Stage III: Blood pressure reaches the level diagnostic of hypertension, accompanied by one of the following: ① cerebral hemorrhage or hypertensive encephalopathy; ② heart failure; ③ renal failure; ④ retinal hemorrhage or exudates, with or without papilledema.
Traditionally, Traditional Chinese Medicine (TCM) did not have a specific term for “hypertension.” In the past, TCM attributed the symptoms of hypertension to conditions such as dizziness, headache, liver yang hyperactivity, yin deficiency with yang hyperactivity, and stroke.
IV. Etiology and Pathogenesis
Traditional Chinese Medicine attributes the causes of hypertension to emotional disturbances, irregular dietary habits, and internal injuries leading to deficiency. The pathological changes primarily involve the liver, kidneys, and heart, with the imbalance of yin and yang in the liver and kidneys being particularly significant.
Prolonged mental tension, worry, depression, or anger leads to stagnation of liver qi; when this stagnation persists, it transforms into fire, resulting in excessive liver yang and symptoms such as dizziness, headache, restlessness, and facial flushing. Excessive physical exertion, age-related kidney deficiency, or prolonged liver fire that depletes kidney yin can lead to liver-kidney yin deficiency. Yin deficiency causes yang hyperactivity, manifesting as headache, dizziness, heat in the palms and soles, and tinnitus. Deficiency of kidney yin prevents it from nourishing heart yin; when the heart and kidneys fail to communicate, symptoms such as palpitations, forgetfulness, and insomnia may occur; A preference for rich and sweet foods, excessive alcohol consumption, or worry and overthinking that injure the spleen can all damage the spleen and stomach. When the spleen fails to transport and transform, phlegm and turbidity are generated internally, obstructing the meridians and causing stasis of heart blood, resulting in chest tightness and chest pain; When Yang becomes excessive and transforms into wind, and Liver wind enters the collaterals, symptoms such as numbness in the limbs, or even facial paralysis and drooping of the mouth and eyes, may occur, leading to stroke or syncope.
V. Differential Diagnosis and Treatment of Hypertension
1. Excessive Liver Yang Rising: Manifested as dizziness, headache, flushed face and red eyes, a bitter taste in the mouth and restlessness, a red tongue with a yellow coating, and a taut, forceful pulse. Treatment should focus on calming the Liver and subduing Yang; the Gastrodia elata Gou Teng Decoction with appropriate modifications may be used.
2. Yin Deficiency with Excess Yang: Manifestations include headache, dizziness, dry mouth, restlessness, heat in the palms and soles, palpitations, tinnitus, forgetfulness, and insomnia, with a string-like, thin, and rapid pulse. Treatment should focus on nourishing yin and subduing yang; modified Qi Ju Di Huang Wan may be used.
3. Liver-Kidney Yin Deficiency: Manifestations include dizziness, dry and sore eyes, soreness in the lower back and weakness in the knees, tinnitus, heat in the palms and soles, and insomnia; the tongue is dry and red with little or no coating. Treatment should focus on nourishing the Kidney and the Liver; the Shou Wu Yan Shou Dan formula with appropriate modifications may be used.
4. Deficiency of Both Yin and Yang: Manifestations include dizziness, headache, palpitations, tinnitus, fatigue and weakness, soreness in the lower back and weakness in the knees, a pale tongue with a white coating, and a string-like, thin pulse. Treatment should focus on nourishing Yin and assisting Yang, using Er Xian Decoction with modifications. For women experiencing hypertension caused by irregular menstruation during menopause, taking Er Xian Decoction can also yield good results.
5. Internal Liver Wind: Patients with this pattern present with dizziness, a sensation of heaviness in the head and lightness in the feet, numbness in the limbs, and in severe cases, convulsions; the tongue is crimson with a sparse coating, and the pulse is taut. Treatment should focus on calming the liver and subduing wind. The Zhen Gan Xi Feng Decoction with appropriate modifications may be used.
VI. Prevention of Hypertension
Preventing hypertension is of utmost importance, as it can be caused by numerous factors, and once established, it is difficult to cure immediately.
1. Emotional Factors Have the Greatest Impact on Blood Pressure: Traditional Chinese Medicine strongly emphasizes the role of psychological factors, holding that hypertension often results from extreme emotional states (the “Five Emotions”) transforming into “fire.” Modern medicine also holds that this condition is often caused by dysfunction of the cerebral cortex. A long-term lifestyle characterized by excessive busyness and tension, as well as prolonged mental stress, stimulation, and emotional fluctuations, can all lead to cerebral cortical dysfunction. When this occurs, the mutual regulatory and balancing functions between the cerebral cortex and subcortical centers are disrupted, causing dysfunction in the subcortical vasodilation center. This results in the constriction of small arteries throughout the body and an increase in blood pressure. Over time, certain angiotensins are sequentially produced and take effect, leading to the development of hypertension. Statistics show that urban dwellers and those engaged in mentally demanding work are more prone to hypertension.
2. The Impact of Obesity and Diet on Blood Pressure: Most research reports indicate that the incidence of hypertension among obese individuals is 3 to 4 times higher than among those of normal weight. Therefore, as people reach middle age, moderating their diet and maintaining regular, moderate exercise are among the most important ways to prevent obesity and hypertension.
The dietary factor most closely linked to hypertension is salt. While salt is essential, excessive intake is detrimental to those with hypertension, as salt is sodium chloride, and sodium ions cause blood vessels to constrict, thereby raising blood pressure. Therefore, maintaining a low-sodium diet is crucial for preventing hypertension; Preferences for salty or bland flavors are often cultivated in housewives from childhood. We remind every housewife to reduce the amount of salt as much as possible when cooking. It is advisable for families to eat less meat and more varieties of vegetables, as vegetables contain vitamin C, which helps lower blood cholesterol and reduce atherosclerosis. However, vegetables should not be cooked for too long, as prolonged cooking destroys vitamin C and renders it ineffective.
It has been established that smoking raises blood pressure. The nicotine in tobacco stimulates the central nervous system and the sympathetic nervous system, which control blood vessel constriction, causing small arteries to constrict and leading to hypertension. Long-term smoking can cause small arteries to constrict; over time, the muscle tissue in the walls of these small arteries degenerates, leading to small-artery atherosclerosis and resulting in difficult-to-treat hypertension. Therefore, it is extremely important to advocate for not smoking, smoking less, or quitting smoking.
Coffee is detrimental to patients with hypertension and coronary heart disease because it stimulates increases in blood lipid and blood sugar levels; therefore, it should be consumed in moderation. Instead, drinking plenty of weak tea is recommended. According to research, tea contains polyphenols that enhance the flexibility, elasticity, and permeability of blood vessels, thereby helping to prevent vascular hardening.