About 3.5 million people die from cardiovascular and cerebrovascular diseases every year in mainland China, accounting for the first cause of death, and hypertension is the most important risk factor for cardiovascular and cerebrovascular diseases. According to the latest epidemiological survey, the adult prevalence of hypertension in mainland China is 27.9%, and there are more than 245 million hypertension patients in the country, with an average of 1 hypertension patient in every 5 adults.
May 17 this year marks the 20th World Hypertension Day, with the theme of "Accurate Measurement, Effective Control, Healthy and Longevity". On the occasion of World Hypertension Day, let's talk about the prevention and treatment of hypertension.
Author: Wang Jianhua, Director of Diabetes Diagnosis and Treatment Center, Jinan Hospital, Shandong Province
This article is authorized by the author to be published by Yimaitong, please do not reprint without authorization.
1. How high is blood pressure?
Blood pressure refers to the lateral pressure of the blood flowing in the blood vessels on the blood vessel wall, it is not high, it is not low, too high blood pressure will damage the blood vessels, causing damage to the heart, brain, kidneys, eyes and other target organs; If the blood pressure is too low, it will cause insufficient blood supply to important organs such as the heart, brain and kidney, and even lead to syncope and shock.
So, how are the diagnostic criteria for hypertension defined?
Hypertension is diagnosed when systolic blood pressure > 140 mmHg and/or diastolic blood pressure > 90 mmHg are measured at rest on three different days of the same day. Hypertension can also be diagnosed by continuous standard measurement of blood pressure at home for 5~7 days, and the average blood pressure > 135/85mmHg. Pulse pressure is the difference between systolic blood pressure and diastolic blood pressure, and the normal is 30~40 mmHg. Increased pulse pressure is an indicator of arteriosclerosis.
Note: Hypertension should be diagnosed if the patient has a history of hypertension, is currently using antihypertensive medications, and has a blood pressure of less than 140/90 mmHg.
2. Why should we pay attention to high blood pressure?
Clinically, most patients with hypertension have no obvious discomfort, and only a few patients will have dizziness, swelling, headache and other uncomfortable symptoms, however, no symptoms does not mean that there is no danger, and the harm of hypertension to the body is often silent. I believe many people have heard of cerebral hemorrhage, cerebral infarction, coronary heart disease, myocardial infarction, heart failure, kidney failure, fundus hemorrhage, aortic dissection, these diseases, but did you know that one of the main causes of these diseases is high blood pressure!
It is important to note that hypertension is often co-existent with diabetes. Compared with patients with diabetes alone, the risk of cardiovascular events in patients with diabetes and hypertension increases by 2~3 times, therefore, diabetic patients should pay special attention to hypertension and actively control hypertension, in order to prevent and reduce cardiovascular complications such as heart, brain, kidney, and eye!
3. How to choose antihypertensive drugs for hypertensive patients?
When choosing antihypertensive drugs, multiple factors such as antihypertensive efficacy, protective effect on the heart, brain and kidney, safety and compliance, and impact on metabolism should be comprehensively considered.
In addition to the six categories of antihypertensive drugs currently used in clinical practice, namely calcium ion antagonists (CCBs), angiotensin-converting enzyme inhibitors (ACE inhibitors), angiotensin II receptor antagonists (ARBs), thiazide diuretics, β blockers, and α blockers, the upcoming "Guidelines for the Prevention and Treatment of Hypertension in China" also recommend angiotensin receptor neprilysin inhibitors (ARNI) as a new class of commonly used antihypertensive drugs. The above six classes of antihypertensive drugs and single-tablet fixed combination preparations (SPCs) can be commonly used as initial and maintenance treatments. Spironolactone can be treated as an agent in addition to the three-drug base, and eplerenone can be used as an option for those who cannot tolerate it.
Fig.1 Flow chart for selecting monotherapy or combination therapy
Fourth, can blood pressure reduction follow the feeling?
Many friends know that they have high blood pressure, but they refuse to take it because they have no symptoms and are worried about the side effects of the drug. There are also some patients who take the drug based on their feelings, using it when they have symptoms and stopping it when they have no symptoms. As everyone knows, hypertension is a silent killer, as long as the blood pressure exceeds the normal range, regardless of whether there are symptoms or not, its damage to the heart, brain, kidneys and other target organs has begun, therefore, blood pressure can not follow the feeling, asymptomatic hypertension also needs to be treated.
In fact, the safety of antihypertensive drugs currently used in clinical practice is guaranteed as long as they are used rationally under the guidance of doctors. Compared with the side effects of antihypertensive drugs, the harm of long-term hypertension is much more serious.
5. Is antihypertensive drug resistance?
Some patients with high blood pressure feel that the effect is not as good as before after taking antihypertensive drugs for a period of time, and they are considered to be drug resistance. We say that antihypertensive drugs generally do not develop drug resistance, and the reason for the decrease in drug efficacy is often due to changes in one's own condition (such as weight gain, mood swings, increasing age, etc.), or the weather has become colder, or the drug is used inappropriately and the dosage is inappropriate, rather than drug resistance. In this case, it is necessary to adjust the dosage or change the medication under the guidance of a medical professional.
6. Once you take blood pressure medicine, you can't stop?
This is not a one-size-fits-all question. Hypertension is divided into two categories: primary and secondary, essential hypertension accounts for 95%, the cause is unknown, there is no cure at present, such patients often need to take medication for life, of course, this is not absolute, some patients with mild essential hypertension can also make blood pressure well controlled by improving their lifestyle; Secondary hypertension accounts for 5%, the cause is clear, often caused by some specific diseases (such as pheochromocytoma, hyperthyroidism, etc.), through the treatment of the underlying disease, hypertension is expected to be completely cured and discontinued.
7. How much is the right blood pressure to drop?
Is the goal of blood pressure control "one size fits all", and it is enough to control blood pressure at 140/90mmHg? The answer is no. According to the Chinese Guidelines for the Prevention and Treatment of Hypertension, the goal of blood glucose control should vary from person to person, and the specific requirements are as follows:
1) In general, for patients with high blood pressure, the blood pressure drops below 140/90mmHg;
2) Patients with diabetes, coronary heart disease, heart failure, and chronic kidney disease with proteinuria should be reduced to below 130/80mmHg;
3) The blood pressure of hypertensive patients aged 65~79 years old drops below 150/90mmHg, and can be further reduced to below 140/90mmHg if tolerated;
4) Blood pressure in hypertensive patients aged 80 years and above is reduced to below 150/90mmHg.
Of course, blood pressure is not always lowered, especially diastolic blood pressure should not be lowered too low, preferably not lower than 60mmHg. Because diastolic blood pressure is too low, it will lead to cardiovascular and cerebrovascular hypoperfusion, resulting in myocardial ischemia, myocardial infarction, and ischemic stroke.
8. What are the four basic principles that must be adhered to in the use of antihypertensive drugs?
1) Individualized medication: antihypertensive drugs are divided into seven categories: calcium channel blockers (CCBs), angiotensin-converting enzyme inhibitors (ACE inhibitors), angiotensin II receptor antagonists (ARBs), diuretics, β receptor blockers, α receptor blockers, and angiotensin receptor neprilysin inhibitors (ARNI).
2) Start with a small dose: The use of antihypertensive drugs should be started with a small dose. The dose is then gradually increased according to blood pressure until the desired blood pressure lowering goal is achieved, and maintenance therapy is continued.
3) Early combination of drugs: if the efficacy of monotherapy is not satisfactory, two or more low-dose antihypertensive drugs should be used as soon as possible to increase the antihypertensive effect, and clinically, for patients with secondary and tertiary hypertension (blood pressure ≥ 160/100mmHg), it is generally advocated to take combination therapy at the beginning. Single-tablet combinations (eg, olmesartan hydrochlorothiazide, perindopril amlodipine) can help improve patient adherence, especially in older patients with hypertension.
4) Preferential selection of long-acting preparations: long-acting antihypertensive drugs have long-lasting efficacy, stable antihypertensive effect, only need to be taken once a day, are not prone to missed doses, and patients have high treatment compliance.
9. How should patients with hypertension adjust their lifestyle?
Among the many risk factors that lead to hypertension, in addition to uncontrollable factors such as age, gender, and genetics, there are more controllable factors such as unhealthy lifestyle, and hypertension can be effectively prevented and controlled by improving lifestyle. The specific requirements are as follows:
1. Low-salt diet: Excessive sodium intake increases the risk of high blood pressure. The World Health Organization recommends that the daily salt intake per person should be less than 5 grams.
2. Reasonable diet: limit fat intake, eat less fatty meat, animal offal, fried food, pastries and sweets, and eat more fresh fruits and vegetables, fish, poultry, mushrooms, low-fat dairy products, etc.
3. Quit smoking and limit alcohol: Tobacco contains a lot of nicotine, which can stimulate the sympathetic nerves, make the heart beat faster, blood vessels constrict, and lead to increased blood pressure. Heavy alcohol consumption, especially strong alcohol, can also increase the heartbeat and increase blood pressure.
4. Moderate activity: low- to medium-intensity aerobic exercise (such as brisk walking, jogging, tai chi, etc.) can help lower blood pressure, and each activity is generally suitable for 30~60 minutes. Note: Patients with severe hypertension (BP≥180/110mmHg) who have not yet been controlled or hypertensive patients with unstable angina, heart failure, and severe arrhythmia should not exercise temporarily.
5. Weight control: Overweight and obesity (especially abdominal obesity) can lead to increased blood pressure. The most effective way to control your weight is to eat less and move more, keep your mouth shut and open your legs. Aim to make the body mass index (BMI) < 24kg/m2, waist circumference < 90cm (men) and <85cm (women).
6. Psychological balance: Long-term mental tension, anxiety, and insomnia can lead to increased blood pressure, so learn to decompress yourself, maintain an optimistic attitude, and avoid staying up late for insomnia.
In addition to circadian rhythm changes, blood pressure is also related to seasonal changes, usually "low in spring and summer, high in autumn and winter". At present, it is mid-autumn, the weather is getting cooler, and the blood pressure of many patients around us (especially the elderly) has begun to rise, so we must be extra vigilant, do a good job in daily health care, strengthen blood pressure monitoring, adjust medication in time, and keep blood pressure stable.
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