A year ago, I received two patients with hypertension, both about 70 years old, and when I found high blood pressure, my blood pressure was around 160-180/70mmHg.
All belong to the typical senile hypertension, followed by routine examination, basically no major problems, that is, simple hypertension. In the results of the blood test, there is one indicator that is also super high, that is, homocysteine.
Uncle Wang's homocysteine is 125umol/L, and Uncle Sun's homocysteine is 110umol/L. According to the blood pressure of the two elderly people, as well as the level of homocysteine. It is recommended that the elderly take antihypertensive drugs on the one hand, and supplement folic acid on the other hand.
Subsequently, antihypertensive drugs were prescribed to the elderly, but the hospital did not have folic acid tablets, so it was recommended that the elderly buy them.
At the 3rd week of the review, Uncle Wang's blood pressure dropped to 130/60mmHg, and Uncle Sun's blood pressure dropped to 132/68mmHg; that is to say, the blood pressure of the two elderly people was basically controlled well.
At that time, when Uncle Wang came, he took out a box of medicines from his pocket and showed it to me and said: Dr. Wang, I can't eat this, my daughter bought it.
As soon as I looked at the pill box, it turned out to be folic acid. Tell the uncle that of course you can eat, supplement folic acid, reduce the level of homocysteine, the purpose is to prevent cerebral infarction. Long-term eating antihypertensive drugs and folic acid tablets, usually at home to monitor blood pressure, after a while to review the homocysteine level.
When Uncle Sun reviewed the day, he said that his blood pressure control was good, and he didn't want to take other medicines. I said that other drugs can not be taken, but folic acid tablets are still recommended for you to eat, because your homocysteine is too high, so the risk of cerebral infarction will increase, even if the blood pressure is well controlled, there is also a risk of cerebral infarction.
In the following days, Uncle Wang also reviewed several times, Uncle Wang's blood pressure was stable, and homocysteine had dropped to 8umol/L, that is, it had returned to normal.
But I have never seen Uncle Sun again, maybe he found another doctor to follow up, or he went to another hospital for a follow-up consultation, it is possible.
This is just after the end of the year, Uncle Wang came to the follow-up clinic again, all the indicators are more ideal, it is recommended to continue to follow the plan of treatment.
Coincidentally, that night, during the emergency consultation, I met Uncle Sun. Uncle Sun was lying on the bed, one finger was pointing at me, and his mouth was crooked and he couldn't speak anymore. The son explained next to him: The old man had a stroke and recognized that you had seen him sick.
I asked: Blood pressure control is not good, how did you have a stroke?
Uncle Sun's son, while taking out antihypertensive drugs to show me, said: I have been eating this antihypertensive drug, usually also measured, blood pressure is OK.
I said: Did you still recommend folic acid tablets at that time?
Uncle Sun couldn't tell, his son said, he took antihypertensive drugs, did not take other drugs.
Subsequently, Uncle Sun was admitted to the hospital. (After Uncle Sun was hospitalized, the re-examination of homocysteine was 134umol/L.) ）
The same is hypertension, the same blood pressure control can also be, the age is also similar, why uncle Sun suddenly cerebral infarction, Uncle Wang all indicators are normal?
One of the main reasons is that Uncle Wang controlled homocysteine, while Uncle Sun did not control it.
Homocysteine is a very important blood indicator, especially for the elderly or people with high blood pressure. In addition to paying attention to blood pressure, blood sugar, and blood lipids, we must also pay attention to homocysteine levels.
Our healthy homocysteine is 0-10umol/L; when we draw blood tests, homocysteine is 10-15umol/L, it is a critical increase. When homocysteine is higher than 15umol/L, it is called hyperhomocysteinemia.
If a person's blood pressure is high, and the homocysteine is also high, it is called H hypertension, and 75% of the friends with hypertension in our country are H hypertension!
The Chinese Hypertension Guidelines state that hyperhomocysteinemia increases the risk of stroke. People with H-type hypertension have a 30-fold increased risk of developing stroke than healthy people!
At the beginning, we also said that uncle Wang and uncle Sun have high blood pressure, and homocysteine is also high, so both elderly people belong to H-type hypertension and have a high risk of stroke.
Homocysteine levels can be lowered by folic acid supplementation, thereby reducing the risk of stroke in people with H-type hypertension. Uncle Wang not only took antihypertensive drugs, but also supplemented folic acid, the homocysteine was lowered to a normal level, and Uncle Sun was only a simple blood pressure booster, did not supplement folic acid, did not reduce the level of homocysteine, this admission to the hospital when the review of homocysteine is 134umol / L, or very high, so Uncle Sun cerebral infarction and no supplementation of folic acid, there is no control of homocysteine has a direct relationship.
Originally it was to lower blood pressure, supplement folic acid, and now engage in stroke hemiplegia aphasia, but also admitted to the hospital, more than worth the loss!
The "Multidisciplinary Expert Consensus on Rational Clinical Supplementation of Folic Acid in China" recommends that for patients with hyperhomocysteinemia with hypertension, in order to reduce the risk of first stroke, folic acid monotherapy or fixed compound preparations containing folic acid can be used.
Friends who need to supplement folic acid tablets, it is currently recommended to take 0.8mg of folic acid tablets every day to reduce the level of homocysteine, which in turn plays a role in reducing the risk of cardiovascular and cerebrovascular diseases.