Strengthen blood pressure health management and promote a good lifestyle

May 17 this year marks the 20th World Hypertension Day. Hypertension is a risk factor for cardiovascular and cerebrovascular diseases, and it is a common and frequent disease worldwide.

"Early diagnosis and early intervention are effective means to control hypertension." Recently, Hu Chunlian, director of the outpatient department of Yueyang People's Hospital in Hunan Province, told a reporter from Science and Technology Daily that if early intervention can be carried out through drugs and improving living habits to control the trend of blood pressure in the case of level 1 hypertension, the lives of most patients will not be greatly affected.

According to the report "Current Status of Hypertension Epidemic and Prevention in China", many hypertension gradually evolves from high normal blood pressure. If high normal blood pressure is not actively intervened, most people will gradually develop high blood pressure. So, how do you identify people who are at high risk of high blood pressure? What are the current drugs and interventions for the treatment of hypertension? What are the new developments in the prevention, diagnosis and treatment and management of hypertension in mainland China?

Patients tend to be younger

"Hypertension is defined as blood pressure measured three times on the same day, with systolic blood pressure exceeding 140 mm Hg or diastolic blood pressure exceeding 90 mm Hg." Hu Chunlian introduced that hypertension is divided into primary hypertension and secondary hypertension according to the cause. The most common hypertension in life is generally primary hypertension, and the increase in blood pressure caused by some diseases is secondary hypertension. High blood pressure that cannot be controlled with more than three antihypertensive drugs, including diuretics, is called refractory hypertension.

In the "Healthy China Action - Implementation Plan for the Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases (2023-2030)" formulated by the National Health Commission and several departments, there are two hard indicators related to early diagnosis and early intervention: by 2030, the awareness rate of hypertension among residents over 30 years old will not be less than 65%, and the basic standardized management service rate of hypertension patients will reach 70%. According to a nationwide survey, in 2018, the awareness, treatment and control rates of hypertension among adults in mainland China were 41.0%, 34.9% and 11.0%, respectively. There is still a lot of work to be done to make more people aware of their blood pressure and to intervene appropriately.

Due to the fast pace and pressure of modern society, and changes in people's eating habits, hypertensive patients have a trend of getting younger. For example, according to the China Cardiovascular Health and Disease Report 2021, the prevalence of hypertension among young people aged 18-34 exceeds 10% and is on the rise.

The younger age of hypertensive patients has received extensive attention from the medical community. "Young people suffer from high blood pressure mainly because of a less healthy lifestyle or long-term stress, etc." Hu Chunlian said that she had encountered young patients in her teenage years in the clinic. According to the report "Epidemic and Prevention of Hypertension in China", about 4% of children in China have continuously elevated blood pressure levels, hypertension has become a common cardiometabolic disorder in Chinese children, and obesity is the most common risk factor for hypertension in children.

Strengthen the integration of medical treatment and prevention to deal with diseases

Due to the changes in the modern social environment and the aging trend, the age span and proportion of hypertension patients are increasing. In order to realize the transformation from disease treatment as the center to health as the center, the "14th Five-Year Plan" National Health Plan specifically mentions the need to strengthen the integration of medical treatment and prevention. Fu Wei, director of the grassroots department of the National Health Commission, introduced that the National Health Commission relies on basic public health services and takes hypertension and type 2 diabetes as the entry point to implement the integration and improvement project of medical treatment and prevention of chronic diseases in urban and rural communities. Doctors should not only diagnose and treat people, but also provide advice to people with chronic diseases such as hypertension to help them manage risk factors such as obesity through moderate exercise and a healthy diet.

In recent years, the mainland has made a series of achievements in the diagnosis and treatment of hypertension. For example, the team of Li Li, director of the Cardiovascular Center of Guangzhou Red Cross Hospital in Guangdong Province, developed the "CT-guided ozone-mediated lumbar/renal sympathetic surgery", which provides an innovative solution for the treatment of patients with refractory hypertension. This technique uses percutaneous puncture technology, using ozone as the medium, and local injection of medical ozone after determining the surgical target, so as to reduce the renal sympathetic nerve activity of patients. Clinical studies have shown that nearly 50% of patients with refractory hypertension have reached the drug reduction criteria during the 12-week follow-up period after surgery, and the postoperative blood pressure has been further reduced on the basis of a significant reduction in antihypertensive drugs. This technology only needs an ordinary puncture needle, an ordinary CT machine and a medical ozone generator to implement, and the operation process only takes 10-20 minutes. Due to the easy availability of medical equipment, this solution is easy to promote in primary medical institutions, which can help solve the diagnosis and treatment difficulties of hypertension patients in remote and poor areas.

In addition to the continuous improvement of treatment technology, the mainland's hypertension screening, prevention and control, and monitoring systems are also gradually improving. Liu Xiaoqing, chief physician of the Guangdong Provincial Institute of Cardiovascular Diseases, told reporters that in recent years, many places have strengthened the construction of chronic disease prevention and control systems, including hypertension, from the community level, and community prevention and control plays an increasingly important role in the management of hypertension. At the previous regular press conference of the National Health Commission, relevant persons in charge of many regions introduced the efforts of the grassroots in the prevention and treatment of hypertension. For example, relying on the application of the grassroots smart medical system, Jiangxi Province has established a pre-diagnosis screening, in-diagnosis follow-up, and post-diagnosis management service process and a working mechanism of "two-way referral for two chronic diseases" to guide patients with hypertension and diabetes to be diagnosed for the first time and referred at the grassroots level to achieve full-cycle health management. Yunnan Province has fully implemented the first diagnosis blood pressure measurement for people over 18 years old and blood sugar measurement for people over 35 years old, and guided the masses to carry out health self-monitoring.

In terms of medical insurance, the National Health Insurance Administration has set up a special guarantee for the "two diseases" of hypertension and diabetes in the residents' medical insurance, which is used to pay for the "two diseases" drugs incurred in primary medical institutions at the secondary level and below.

Be alert to common misunderstandings in the prevention and treatment of hypertension

"Treatment of essential hypertension is mainly based on medications, and lifestyle changes are also very important." Hu Chunlian said that if we can reasonably arrange our lives and adhere to a healthy lifestyle while controlling blood pressure with drugs, the adverse effects of high blood pressure on our lives and the possibility of cardiovascular and cerebrovascular diseases will be greatly reduced.

However, there are often some misunderstandings in the prevention and treatment of hypertension in clinical patients. Some patients feel that they have no symptoms and their blood pressure is well controlled for a period of time, so they stop taking the drug or reduce the amount of medication. Liu Xiaoqing said: "Stopping the drug increases the risk of cardiovascular and cerebrovascular events. The repeated blood pressure caused by drug withdrawal often shows a trend of "steep rise and steep decrease", and the impact of repeated blood pressure fluctuations on cardiovascular and cerebrovascular vessels is very unfavorable, and it is easy to induce cardiovascular and cerebrovascular events.

"There are also some patients who have been taking a certain antihypertensive drug for a long time, and often question whether the long-term medication will have great side effects, or they want to try another drug when they hear that there is a new drug." Hu Chunlian said that the causes of hypertension are complex, and there are individual differences in drug treatment. In the process of diagnosis and treatment of hypertension, the doctor will select antihypertensive drugs according to the patient's condition, observe and adjust them, and form an appropriate treatment plan. If the treatment regimen is good and stable in controlling the patient's blood pressure, then this treatment regimen is suitable. In the absence of special circumstances, patients should not change dressings on their own.

There are also various theories circulating on the Internet about what and how people with high blood pressure should eat. In response to the confusion of patients, the National Health Commission previously issued the "Dietary Guidelines for Adults with Hypertension (2023 Edition)". The guide lists in detail the recipes suitable for people with high blood pressure in different regions of the east, west, south, north and central, and in different seasons of spring, summer, autumn and winter, as well as common food exchange tables and commonly used dietary recipes for different diseases. Zhang Qian, a researcher at the Institute of Nutrition and Health of the Chinese Center for Disease Control and Prevention, said that patients and young patients in the early stage of hypertension can refer to the dietary guidelines to maintain a healthy posture and prevent and improve hypertension by adjusting their diet and exercising actively.

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