Analysis of White Coat Hypertension, Primary and Secondary Hypertension, and Refractory Hypertension

**25. What is white coat hypertension?**

Many patients have normal blood pressure readings when they measure them at home, but when they go to the hospital, they become nervous when they see medical staff in white coats, and their blood pressure readings are higher than usual. This type of blood pressure increase is called "white coat hypertension," also known as clinic hypertension.

"White coat hypertension" is not true hypertension, but a temporary increase in blood pressure. If you can calm down, it will return to normal within 10 minutes.

Therefore, doctors should rule out the possibility of "white coat hypertension" during the diagnosis process.

**26. What is primary hypertension?**

Based on the causes of hypertension, it can be divided into two categories: primary hypertension and secondary hypertension.

Primary hypertension is the most common type, accounting for about 95% of all hypertension cases.

The causes of essential hypertension are still unclear, but it may be related to a variety of factors and is the result of the interaction between genetic and environmental factors.

It is generally believed that genetic factors account for about 40%, while environmental factors account for 60%.

**27** **.** **What is secondary hypertension?**

Secondary hypertension refers to hypertension with a clear underlying cause, where elevated blood pressure is merely a symptom of a certain disease.

The common primary diseases causing secondary hypertension are as follows:

Kidney diseases, such as glomerulonephritis, pyelonephritis, and renal artery stenosis.

Endocrine disorders: such as hyperthyroidism, pheochromocytoma, primary aldosteronism, etc.

Sleep apnea syndrome.

Pregnancy-induced hypertension (PEH): mostly occurs in late pregnancy.

In addition, long-term use of oral contraceptives and certain hormones can also lead to high blood pressure.

**28. What is refractory hypertension?**

Refractory hypertension refers to a condition in which blood pressure remains above 140/90 mmHg despite the use of three or more adequate doses of antihypertensive drugs, including diuretics.

The following are some of the causes of refractory hypertension:

*Secondary hypertension not ruled out: 20% of refractory hypertension cases are complicated by hyperaldosteronism; approximately 80% have sleep apnea syndrome; renal artery stenosis is also one of the causes of refractory hypertension.

*Improper use of antihypertensive drugs: Insufficient drug dosage; unreasonable drug combinations; failure to adjust the medication regimen in a timely manner according to the doctor's orders.

Other drug interferences: Long-term use of painkillers, corticosteroids, oral contraceptives, etc. while taking antihypertensive drugs.

Incorrect blood pressure measurement: ill-fitting cuff; cuff placed outside thick clothing; excessively rapid deflation; stethoscope placed inside the cuff; white coat hypertension, etc.

**29. How should we deal with high-normal blood pressure?**

Essentially, hypertension is a vascular damage disease, and all complications are related to vascular damage.

Therefore, the earlier hypertension is treated, the better. Effective control of hypertension can prevent vascular damage.

Once the function and structure of blood vessels have undergone serious changes, treatment becomes more difficult and less beneficial.

So, is treatment also necessary for high-normal blood pressure?

Blood pressure between (120-139)/(80-89) mmHg is defined as high-normal blood pressure, or prehypertension.

Studies show that people with high-normal blood pressure have twice the cardiovascular risk of those with blood pressure less than 120/80 mmHg.

If you are not a person with high blood pressure, but your blood pressure is already at the high end of the normal range, you should also pay attention to it.

Whether people with high-normal blood pressure need treatment remains controversial.

Most experts advocate that cardiovascular risk should be assessed first.

No treatment is needed for individuals with low cardiovascular risk; for those at medium risk, lifestyle modifications should be actively implemented, such as reducing food intake, limiting salt intake, increasing exercise, controlling weight, quitting smoking, and limiting alcohol consumption; for those at high risk, low-dose antihypertensive medications may be considered.

**30. What are the principles of medication for patients with hypertension?**

The following four principles should be followed when taking antihypertensive drugs:

Start with a small dose and gradually increase the dose as needed.

Use long-acting antihypertensive drugs as much as possible to lower blood pressure steadily.

Combination therapy can increase the antihypertensive effect and reduce the occurrence of adverse reactions.

Personalized treatment. For example, blood pressure targets, medication types, and dosages should all be individualized.