Expert consensus on the management of hypertension in the young and middle-aged Chinese population

Background and purpose The increased prevalence of hypertension, along with obesity, dyslipidemia, and type 2 diabetes in the young and middle-aged population has become a major global public health issue. Although more attention has been paid to the management of hypertension and cardiovascular disease (CVD) risks in elderly patients nationally and internationally, there is currently no consensus worldwide on appropriate evaluation and treatment of hypertension in younger subjects. We developed the consensus and aimed to provide a comprehensive strategy for the management of hypertension in young and middle-aged population. Methods The authors and experts of the Hypertension Group of the 10th committee of Chinese Society of Cardiology reviewed the available literature and evidence on the pathophysiological characteristics of hypertension, CVD risk assessments and antihypertensive therapies, discussed and reached an agreement on recommendations. Disccussions and recommendations The pathophysiological and clinical characteristics of hypertension in young and middle-aged patients are vastly different from those observed in the elderly. In particular, the sympathetic nervous system (SNS) and the renin-angiotensin system (RAS) are significantly activated in this population. Global CVD risk assessment should be performed as determinants of initiating anti-hypertensive therapy. A blood pressure (BP) target of <140/90 mm Hg should be achieved first on BP-lowering therapies, with an ultimate BP <130/80 mm Hg for most patients, if tolerated. Initiating BP-lowering therapies with a beta-blocker or RAS inhibitor (angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker), or in combination with calcium channel blocker or diuretic in high CVD risk patients, along with active lifestyle changes, are preferred. Conclusions An aggressive and comprehensive BP and CVD risk management strategy should be implemented in the young and middle-aged hypertensive population. What's known The pathophysiology of hypertension in young and middle-aged adults differs from that in elderly subjects, and tends to be associated with metabolic disorders. Hypertension in young and middle-aged adults is usually mild and has no typical symptom in comparison with hypertension in elderly subjects. CVD risk is increased in young and middle-aged prehypertensive and hypertensive adults, but hypertension awareness, treatment and control rates are low. For young and middle-aged adults, this consensus recommends: accurate diagnosis of hypertension using BP measurements (including the use of ABPM and HBPM); a long-term CVD risk assessment prior to initiating treatment; and a BP target of <140/90 mm Hg (<130/80 mm Hg if tolerable, or in patients with relevant comorbidities). Lifestyle interventions are key and should be started early. Pharmacologic antihypertensive strategies should be tailored to the individual, and take into account the management of CVD risk factors such as smoking, overweight/obesity, dyslipidemia, diabetes and metabolic syndrome. Patients should be monitored and encouraged to share data with doctors for medication adjustment and to improve compliance.