Hypertension is a clinical syndrome characterized by sustained elevation of arterial blood pressure, accompanied by pathological damage to target organs such as the heart, brain, kidneys, and surrounding blood vessels. In recent years, the number of hypertensive patients in China has been on the rise. Among these patients, H-type hypertension accounts for about three-quarters. What is H-type hypertension and how should I scientifically use medication for it? Let's take you through it below.
H-type hypertension refers to hypertension accompanied by elevated homocysteine (HCY) levels. HCY is produced during the metabolism of proteins in the human body and can be metabolized under normal circumstances. If there is a deficiency of key enzymes (methylenetetrahydrofolate reductase) or cofactors (such as folate, vitamin B6, vitamin B12) during the metabolism process, homocysteine cannot be metabolized normally and accumulates in the body. Excessive concentration of HCY in the blood can cause serious damage to blood vessels. If it exceeds 10 μ mol/L, there is a high risk of stroke, which is very dangerous.
So, what are the other reasons for the high HCY?
Diet
Lack of folate, vitamin B6 and vitamin B12
Genetic abnormalities
Methylenetetrahydrofolate reductase gene (MTHFR) mutation and
Cysteathione beta synthase gene (CBS) mutation
Diseases
Obesity, hypertension, diabetes, hypercholesterolemia, renal failure, hypothyroidism
Drugs
Atorvastatin, fenofibrate, methotrexate and niacin
Bad lifestyle
Smoking, lack of exercise
How to make clinical diagnosis of type H hypertension?
1. Diagnostic criteria for hypertension: Three measurements of blood pressure exceeding 140/90mmHg at different times. The "Chinese Clinical Practice Guidelines for Hypertension (2022)" recommend lowering the diagnostic threshold for adult hypertension in China from systolic blood pressure ≥ 140mmHg and/or diastolic blood pressure ≥ 90mmHg to systolic blood pressure ≥ 130mmHg and/or diastolic blood pressure ≥ 80mmHg (1B).
2. Diagnostic criteria for hyperhomocysteinemia: serum homocysteine>10 μ mol/L.
In addition, abnormal serum folate levels and MTHFR677TT genotype can further increase the risk of stroke. It is recommended to perform genotype testing and risk stratification.
Finally, how should H-type hypertension be scientifically treated?
1. Drug therapy: The "Expert Consensus on Diagnosis and Treatment of H-type Hypertension" recommends the combination of antihypertensive drugs and folic acid supplementation. For hypertensive patients who can tolerate it, fixed compound preparations containing folic acid are recommended as antihypertensive drugs; If the blood pressure cannot meet the standard after using fixed compound preparations, other types of antihypertensive drugs can be used in combination. At present, it is recommended to take 0.8mg folic acid daily. After taking folic acid continuously for three to six months, a follow-up examination should be conducted to adjust the treatment plan based on the results.
2. Lifestyle intervention: quit smoking and limit alcohol consumption, exercise appropriately, eat a salt limited diet, and consume foods with high folate content such as green leafy vegetables, fresh fruits, animal liver, egg yolks, nuts, and grains. Folic acid is unstable to light and heat, and can easily be destroyed and lose its activity. When cooking, pay attention to cooking time and methods, and avoid frying and prolonged cooking.