"Doctor, my dad obviously has high blood pressure, how could he leave because of low blood pressure!" Uncle Wu's son asked sadly!
Uncle Wu, 68 years old this year, has been suffering from hypertension for more than ten years, during which he has been taking medication to control his condition, and his blood pressure is also very stable.
However, one morning, Uncle Wu fainted at home, and his family found him and rushed him to the hospital.
After learning about the past history, it turned out that Uncle Wu felt that the medicine was difficult to swallow, so he crushed nifedipine sustained-release tablets and put them in food to eat, once this blood pressure medicine was crushed, the effect of the drug would be released quickly, resulting in a sudden drop in blood pressure, and Uncle Wu died because of this caused serious low blood pressure side effects.
1. Why do hypertensive patients have low blood pressure?
Many people think that there will be no hypotension after suffering from hypertension, which is actually a misunderstanding, and patients with high blood pressure are actually very prone to low blood pressure in the following 5 situations:
1. Orthostatic hypotension
The higher the basal systolic blood pressure when lying down, the greater the decline after standing up, some elderly patients with hypertension get up suddenly after sitting and lying down for a long time, and are easily dizzy, which is caused by the change of posture and posture that leads to a decrease in blood pressure and affects the blood supply to the brain, which is clinically called orthostatic hypotension.
2. Postprandial hypotension
Postprandial hypotension, as the name suggests, refers to a significant drop in blood pressure after a meal, and the blood pressure measured within 2 hours will generally drop by > 20mmHg compared with before a meal; or systolic blood pressure > 100 mmHg before a meal and drops to <90 mmHg after a meal. Some patients have a small drop in blood pressure after a meal, but they have symptoms of cardio-cerebral ischemia such as fatigue, syncope, and angina, which is also called postprandial hypotension.
It is easy to develop hypotension after eating, which is related to the expansion and congestion of the gastric mucosa by heat stimulation, and may also be related to the decomposition of starch in food into glucose, which leads to an increase in the secretion of active peptides, which dilates the blood vessels of the internal organs and the whole body, and then causes postprandial hypotension.
3. Drug effects
Some elderly patients with hypertension take short-acting antihypertensive drugs during the emergency, which will cause a sudden drop in blood pressure in a short period of time, which in turn will cause hypotension. Some people are more sensitive to medications, which can cause low blood pressure after taking them.
In addition, taking antihypertensive drugs in combination with antidepressants and anxiolytics can also lead to the superposition of antihypertensive effects and induce hypotension.
4. Excessive dosage/irrational drug use
In order to reduce blood pressure faster, many patients increase the dose of medication or increase the type of medication on their own, which will cause the blood pressure to drop too quickly and too low, and induce hypotension symptoms. Some elderly patients may even have cardiovascular and cerebrovascular accidents.
5. Seasonal influences
Blood pressure fluctuations are related to circadian rhythms, seasons and temperature changes, and summer weather is hot, sweating is more, and water loss in the body is greater, which can cause blood pressure to drop.
Older people are less able to regulate blood pressure and are more likely to have orthostatic hypotension when the seasons change. Therefore, when the seasons change, you must pay more attention to your blood pressure, and consult your doctor to adjust your medication in time if you find any abnormalities.
Second, these two time periods are the most likely to have high blood pressure, and they are easy to be ignored
Long-term hypertension can lead to complications of the heart, brain and kidneys, among which the more common ones are myocardial infarction, stroke, etc., which have an acute onset and high risk. To prevent complications, it is important to actively control your blood pressure and take some necessary precautions.
A study by researchers from Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, found that Chinese hypertensive patients had the worst blood pressure control rates at early morning and nighttime hypertension.
- Early morning hypertension
The blood pressure of the human body has circadian rhythmic changes, and the main rule is low at night and high during the day. In general, a person's blood pressure will peak at 6:00-10:00 in the morning, then drop, and then a small peak in blood pressure will occur again between 16:00 and 18:00, and then slowly decline again until 2:00-3:00 in the morning, when the blood pressure will be at its lowest.
Early morning hypertension refers to measuring blood pressure 1 hour after waking up, before taking medication and before breakfast, or measuring blood pressure between 6~10 o'clock after waking up with a dynamic recorder, if the self-test > 135/85mmHg or the office blood pressure > 140/90mmHg, it can be confirmed as early morning hypertension.
Huang Hui, a professor of hypertension in the Department of Cardiovascular Medicine of Sun Yat-sen Memorial Hospital of Sun Yat-sen University, reminded that all hypertensive patients should pay attention to their blood pressure in the early morning hours and control it at <135/85mmHg. The key point of measuring blood pressure in the early morning is to measure it 30~60 minutes after getting up, and it should be measured before taking medicine and after urinating, so that the measured blood pressure value will be more accurate. For patients with poor blood pressure control in the early morning, long-acting antihypertensive drugs are generally recommended to control the condition.
- Nocturnal high blood pressure
Nocturnal hypertension refers to the phenomenon of rising blood pressure during sleep, generally referring to blood pressure ≥ 120/70 mmHg. No matter what type of hypertension patients are and how much blood pressure they have during the day, as long as the blood pressure at night is greater than this value, they can be classified as nocturnal hypertension, which is difficult to detect and can only be diagnosed by 24-hour ambulatory monitoring.
Zhang Zhixuan, a cardiologist at Beijing Temple of Heaven Puhua Hospital, said that high blood pressure at night brings greater damage to the body, and long-term high blood pressure will bring great damage to the target organs, and it is difficult to find in the sleep state, and when the symptoms are obvious, it is often very serious.
Nocturnal hypertension is more likely to occur in people with diabetes, excessive salt intake, chronic kidney disease and snoring.
3. Taking antihypertensive drugs for a long time, 4 mistakes should not be made
During taking blood pressure medication, there are many things that need to be paid attention to, and avoiding these misunderstandings can be used to lower blood pressure more safely.
1. Increase/decrease the dose of drugs at will
All blood pressure medications have a prescribed maximum dose, and overdose is likely to be dangerous. In addition, some components of different drugs may react with each other, and taking drugs together can easily lead to high blood concentrations and induce hypotension.
2. There is no need to take medication after the blood pressure drops to normal
Hypertension is an incurable chronic disease, even after the blood pressure returns to normal, you still need to take medication, otherwise the blood pressure will soon rebound again, bringing great pressure to the blood vessels and organs, and it is easy to induce accidents.
3. The faster the blood pressure drops, the better
The treatment of hypertension needs to follow the principle of slow and steady, and too rapid drop in blood pressure will lead to ischemia due to insufficient perfusion of the heart, brain and kidneys. Most patients with high blood pressure will gradually drop to the target level 3~12 weeks after taking the drug, and the rate will be faster in young people.
4. I only know how to take medicine, but I don't know how to check regularly
Regular follow-up examinations are required while taking the drug, and the purpose of the review is to evaluate the response of antihypertensive drugs and monitor target organ damage. In the early stage of organ damage, there are probably no symptoms, and they can only be found during examination, so we must pay enough attention to this.
Nowadays, there are more and more patients with hypertension in the mainland, which requires sufficient attention from the whole society.
Resources:
[1] "The Voice of Hypertension | You heard it right, people with high blood pressure can also have low blood pressure! 》. Luoyang Dongfang People's Hospital 2019-04-18
[2] National Hypertension Day | Know your blood pressure, starting early in the morning! 》. Health News Doctor Channel 2018-10-08
[3] "Rational Use of Drugs| Top 10 Medication Misunderstandings for High Blood Pressure. China Journal of Food and Drug Administration 2024-02-22
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