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Table of Contents
Year : 2017  |  Volume : 2  |  Issue : 2  |  Page : 1-3

C-type hypertension: An ignored new killer?

1 Department of Cardiovascular Medicine, Nanchang University, Nanchang 330006, China
2 Boston TransTec, Boston, MA 02459, USA
3 Department of Cardiology, The Second Affiliated Hospital, Nanchang University, Nanchang 330006, China
4 Department of Cardiovascular Medicine, Nanchang University, Nanchang 330006; Department of Cardiology, People's Hospital of Peking University, Beijing 100044, China

Date of Web Publication26-Dec-2018

Correspondence Address:
Prof. Da-Yi Hu
Department of Cardiology, People's Hospital of Peking University, Beijing 100044
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2470-7511.248465

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In this paper, the authors introduced a kind of hypertension called “C-type Hypertension (CtH)” which is related to “a new type of stress” caused by unhealthy lifestyles. Unlike H-type hypertension caused by an elevated serum level of Hcy, the clinical feature was found to cause a temporary remarkable increase or continually slow increase in the level of human cortisol, the standard biomarker of CtH. This kind of hypertension often appears among young- or middle-age people and may present as a new killer which may result in acute myocardial infarction, acute or chronic heart failure, stroke, or sudden cardiac death.

Keywords: Biomarker, clinical feature, cortisol, hypertension, lifestyle

How to cite this article:
Hu CS, Tkebuchava T, Wu QH, Hu DY. C-type hypertension: An ignored new killer?. Cardiol Plus 2017;2:1-3

How to cite this URL:
Hu CS, Tkebuchava T, Wu QH, Hu DY. C-type hypertension: An ignored new killer?. Cardiol Plus [serial online] 2017 [cited 2019 Oct 13];2:1-3. Available from: http://www.cardiologyplus.org/text.asp?2017/2/2/1/248465

For most countries, noncommunicable disease (NCD) remains the leading cause of death according to the Global Burden of Disease Study 2013.[1] Hypertension has already been recognized as one of the most widespread chronic NCD, not only in China,[2] but also globally. Hypertension is harmful to health and places a heavy burden on public health worldwide. Moreover, a significant proportion of hypertension goes undiagnosed, and its high prevalence leads to severe consequences or complications like stroke due to the clustering of lifestyle-related risk factors and comorbidities.

Hypertension is known to be classified basically as 95% essential and 5% secondary.

Excluding the results of chronic kidney diseases, endocrine, vascular, and metabolic causes, secondary hypertension is primarily attributed to unhealthy modern lifestyles. “C-type Hypertension (CtH)” is closely related to “new type of stress” which results from unhealthy lifestyles. We found its main clinical features are as follows: (1) it often appears among young or middle-aged people and easily develops from prehypertension to stage 1, 2, or 3 hypertension; (2) it easily leads to acute or chronic cardiovascular events (CVEs), such as acute myocardial infarction (AMI), acute or chronic heart failure, stroke, or even sudden cardiac death (SCD) if the patients do not alter their unhealthy lifestyle, seek treatment or control their blood pressure; (3) CtH is linked closely to an unhealthy lifestyles and gradually develops in daily life. It is often ignored because it is either asymptomatic or presents mild symptoms, and is discovered only during a physical examination; and (4) the effect of anti-hypertensive treatment is ineffective for some patients while other patients showed symptoms of resistant hypertension due to unhealthy lifestyles and related risk factors. Although hypertension is a common killer, CtH is easily ignored and should be considered as a new killer resulting from unhealthy lifestyles. Once CtH is diagnosed, patients need to proactively eliminate risk factors by changing their unhealthy lifestyles before target organ damage and/or CVEs occur. There are many reports in China of cases with unexpected CVEs, such as AMI, stroke, and even SCD in men and young women with hypertension.[3],[4] Although there were some attention and studies between cortisol and hypertension in 1990s, no related concept on unhealthy lifestyles induced hypertension marked by the change of human cortisol level, and as a secondary hypertension, it is now defined as CtH.

The “new type of stress” is pertains to five health elements: environment, sleep, emotion, exercise, and diet. These core elements are described herein as “E(e)SEED” and other related strategies, including a good environment, getting away from pollution; sensible sleep and a nap at noon; stable emotion and a peaceful attitude; exercise with enough oxygen; and scientific diet and constant balanced nutrition. The “new type of stress” is not only emotional or psychological but is also caused by abnormal external and internal environments. External environments include water-air-radiation-sound pollution, while internal environments refer to chronic inflammation, vascular injury, abnormal sleep (obstructive sleep apnea [OSA], staying up late, work shift, and insomnia), chronic anxiety, depression, lack of physical activity (including sitting too much), excessive physical activity, or from abnormal diets, including an excessive intake of salt and oil, smoking, alcohol, and insufficient hydration. We found these “new types of stress” may lead to a biomarker change - human cortisol level - and ultimately induce hypertension [Table 1]. Thus, we named this kind of hypertension as CtH.
Table 1: Preliminary data on a group of patients with C-type hypertension

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Normal ranges of Cortisol levels: F8Am 66–286 ng/ml and F4Pm 22–154 ng/ml. About 60% of patients have a family history, most of their mothers with hypertension. A typical case, female, 25 years, her F8Am was 320 ng/ml, and F4Pm 632 ng/ml due to staying up later to over 24:00 for half a year and even 2:00–3:00 for 1.5 months, no family history of hypertension or other cardiovascular diseases.

Since we think that CtH results from single or “multi-risk” factors which are closely related to an unhealthy lifestyle, the common and core risk factors include obesity and OSA (related OOH syndrome), staying up late, excessive intake of salt, and smoking all of which suggest that CtH is a preventable NCD. CtH can be easily diagnosed through a review of a patient's history and lifestyles. Differences between CtH and other kinds of hypertension are much clearer, such as essential and secondary hypertension. Unlike H-type hypertension caused by an elevation in the serum level of Hcy, CtH features mainly at the change of human cortisol level in the center (blood and saliva) or the periphery (urinary and hairs) and is caused primarily by unhealthy lifestyles. Hence, CtH requires the early prevention and intervention of a E(e)SEED-based healthy lifestyle, which has been summarized and referenced as Hu's healthy lifestyle (HHL). A related interventional strategy is HHLi, which is developed from SEEDi or E(e)SEEDi, also known as a Chinese “dual-effects vaccine” for the treatment and prevention of hypertension. Lifestyle intervention in children and young adults in a developing country is a potentially feasible strategy for significantly ameliorating hypertension and stroke risk,[5],[6] especially for the new type of stress-related CtH.

The RT-ABCDEF strategy consists of (1) follow-up for long-term; (2) examining or evaluating regularly; (3) disease and risk factors control; (4) changing unhealthy lifestyles; (5) biohazard and bio-index control; and (6) antagonistic treatment and intervention. As to changing unhealthy lifestyle, people should follow SEEDi, E(e)SEEDi, or HHLi strategies. When combined with the RT-ABCDEF strategy, they are suitable for managing and preventing NCDs, especially for CtH and atherosclerotic cardiovascular disease.[7] As we know, a drug-based strategy, for example, “polypill,” may decrease cardiovascular events by more than 80%, and we think that “cocktail strategies” or “poly-strategies” from HHL which include a rational selection of drugs, can particularly benefit CtH patients who are living unhealthy lifestyles. Although long-term survival increases after evidence-based medical treatment of AMI and revascularization, more attention should be given to these simple and cost-effective methods of health care and prevention, which include rational selection of medicines for prehypertension and hypertension (e.g., by angiotensin-converting enzyme inhibitor and angiotensin receptor blocker),[8] and the use of Traditional Chinese Medication, such as Danshen Dripping pills, Shexiang Baoxin pills, Tongxinluo, Wenxin Keli, and Xuezhikang.

With evidence that modern lifestyles are increasingly playing an important role on human blood pressure, CtH is a viable new concept that has the potential for acceptance and use in medical practice. The significance of CtH is obvious because current unhealthy lifestyles are common in both advanced and developing countries, not just in China. Fortunately, this discovery and our previous work can help people enhance the management of CtH by a novel program, which adopts the RT-ABCDEF strategy and the seven core principals.[9] At the same time, we need to continue practicing the new strategies for CtH, such as SEEDi, E(e)SEEDi, HHLi, and even the general formula.[10] With the RNA-guided human genome editing technology,[11],[12],[13] there may be a new alternative for the prevention of cardiovascular disease. However, as an emerging field in applying genome editing technologies to therapeutics and its potential prevention, current applications of gene editing are still in vitro or in vivo studies, related technology is still in its infancy, and there are no clinical studies available as of this writing. Technological advances may 1 day allow the prevention of CtH by these methods, not just Duchenne muscular dystrophy.[14]

Indeed, CtH is a new concept we propose based on our clinical observation; it improved diagnosis, therapeutic efficacy, and prognosis of this group of patients with hypertension. Lifestyles affect human blood pressure level. Major depression is associated with an increased risk of cardiovascular disease including prehypertension and hypertension. The latter can be lowered by lifestyle intervention, such as controlled salt intake. Although lifestyle intervention has a long tradition in the treatment of hypertension, and the value of lifestyle intervention combined with medication is well-documented in medical publications, there are no data on the use of our SEEDi, E(e)SEEDi, or HHLi for hypertension, especially CtH. Just like the BRIGHT and CSPPT randomized clinical trials (RCTs) in China,[15],[16] as an important and potential risk factor of CDC strips,[17] CtH needs to be carried out in large-scale clinical studies in the future to determine its prevalence, incidence rate, life expectancy, and long-term survival or mortality. Moreover, we need RCTs to confirm the effects of a novel program or new strategies on CtH,[9],[10] which include biological structure editing as well as policy prevention or Grade-zero Prevention.[18],[19]


As a part of Dr. Chun-Song Hu's doctoral thesis, this manuscript was finished first in 2013. The authors gratefully acknowledge editors and experts for their critical review.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

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