May 17, 2024 is the 20th World Hypertension Day, with the theme of "Accurate Measurement, Effective Control, Healthy and Longevity".
Uncle Li is over 70 years old, and he has always been dizzy and headache recently, so he went to the hospital for examination, hung up the number of the neurology department, and took blood tests, head CT, and head magnetic resonance are normal, that is, when he first visited the doctor, his blood pressure was measured at 180/100mmHg. The neurologist told Uncle Li that his current symptoms ruled out the disease of the head, which should be caused by high blood pressure, and prescribed antihypertensive drugs and asked Uncle Li to go to the cardiology department again. Uncle Li was confused, obviously his head was uncomfortable, why did he still go to the cardiology department, Uncle Li went to the cardiology department, and he was ready to ask the doctor.
Q: Hello doctor, I have been dizzy and headache recently, I went to the neurology department, the laboratory tests are normal, the doctor asked me to come to you to see a doctor, my head is much better today, why do I still have heart disease because of the headache?
Doctor: It's not that you have heart disease, you have high blood pressure. I read the medical records in the neurology department, your blood pressure was 180/100mmHg when you first went to the doctor, and your blood pressure was 183/95mmHg when you came to the follow-up visit the next day after the examination, and your blood pressure was high at 165/90mmHg when you visited our hospital 1 year ago. Hypertension is diagnosed when systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg measured three times on the same day in the absence of antihypertensive drugs. Your head examination done in the neurology department is normal, and your blood pressure is 140/76mmHg today, and your blood pressure has dropped and you have no dizziness or headache, so your discomfort is caused by high blood pressure.
Q: Huh? I remember that the doctor told me that I had high blood pressure, but my blood pressure was not always high, sometimes high, sometimes low, and I didn't care about it at that time.
Doctor: Hypertension in the elderly is characterized by fluctuations in blood pressure. There are 4 characteristics of hypertension in the elderly:
1. Systolic blood pressure is mainly elevated, and elderly patients with hypertension often have increased systolic blood pressure and increased pulse pressure.
2. Large fluctuations in blood pressure, due to the decline in blood pressure regulation ability, the blood pressure level of the elderly is easily affected by various factors and fluctuations, such as position, meals, mood, season or temperature, etc., which is called abnormal blood pressure fluctuations. The most common are abnormal circadian rhythm of blood pressure, orthostatic blood pressure fluctuations, and postprandial hypotension.
3. Polypharmacy, elderly patients with hypertension are often accompanied by a variety of risk factors and related diseases, including diabetes, hyperlipidemia, coronary atherosclerotic heart disease (coronary heart disease), renal insufficiency and cerebrovascular disease. Due to the comorbidity of multiple chronic diseases, polypharmacy is a common phenomenon in the elderly.
4. Pseudohypertension, when elderly hypertensive patients are accompanied by severe arteriosclerosis, it is difficult to compress the brachial artery when the cuff is compressed, and the measured blood pressure value is higher than the intra-arterial pressure measurement value, which is called pseudohypertension.
Q: What are the symptoms of high blood pressure?
Doctor: The symptoms of hypertension are: dizziness, headache, neck tightness, fatigue, palpitations, etc., and can also appear more severe symptoms such as blurred vision and nosebleeds, and the typical hypertension headache can disappear after the blood pressure drops.
Q: Why do I have high blood pressure?
Doctor: Common causes of high blood pressure are as follows:
1. Genetic factors: About 60% of patients with hypertension have a family history. It is thought to be due to polygenic inheritance.
2. Mental and environmental factors: long-term mental tension, excitement, anxiety, noise or adverse visual stimulation and other factors can also cause the occurrence of hypertension.
3. Age factor: The incidence rate has a tendency to increase with age, and the incidence rate is high in people over 40 years old.
4. Lifestyle factors: unreasonable dietary structure, such as too much sodium salt, low potassium diet, heavy drinking, and excessive intake of saturated fatty acids can increase blood pressure. Smoking accelerates the process of atherosclerosis and is a risk factor for high blood pressure.
5. Effect of drugs: Contraceptives, hormones, anti-inflammatory painkillers, etc. can affect blood pressure.
6. Influence of other diseases: obesity, diabetes, sleep apnea-hypopnea syndrome, thyroid disease, renal artery stenosis, renal parenchymal damage, adrenal space-occupying lesions, pheochromocytoma, other neuroendocrine tumors, etc.
Q: What are the dangers of high blood pressure for me?
Doctor: The five major harms of high blood pressure are mainly reflected in the following aspects:
1. Heart damage: High blood pressure will increase the burden on the heart, and long-term hypertension may lead to heart hypertrophy, heart failure, and even serious consequences such as myocardial infarction. In addition, high blood pressure increases the incidence of coronary atherosclerotic heart disease, further threatening heart health.
2. Cerebrovascular accident: hypertension is one of the main risk factors for cerebrovascular disease. During strenuous exercise or mood swings, a sharp increase in blood pressure may lead to serious events such as cerebral infarction and cerebral vascular rupture, resulting in sequelae such as hemiplegia and aphasia.
3. Kidney damage: High blood pressure can damage the blood vessels of the kidneys, leading to a decline in kidney function and even uremia. Long-term hypertension can also cause glomerulosclerosis, tubular atrophy and other pathologies, which may eventually lead to kidney failure.
4. Retinopathy: High blood pressure can lead to fundus vascular lesions, causing symptoms such as retinal hemorrhage and edema. In severe cases, these lesions can even lead to blindness, seriously affecting the patient's quality of life.
5. Peripheral vascular damage: High blood pressure can also affect the health of peripheral blood vessels, which may lead to lesions such as aortic aneurysm, aortic dissection, and artery stenosis or occlusion of the lower limbs. These lesions not only affect the patient's ability to move normally, but can also be life-threatening.
Q: There are so many dangers of high blood pressure, please prescribe some medicine for me.
Doctor: In addition to taking medicine, a healthy lifestyle is also important:
1. Healthy diet: Reducing sodium intake and increasing potassium-rich foods can help lower blood pressure.
2. Quit smoking and limit alcohol: Quitting smoking can reduce the risk of cardiovascular disease, lung disease and death.
3. Maintain ideal body weight: Elderly hypertensive patients who are overweight or obese can properly control energy intake and increase physical activity to reduce blood pressure by reducing body weight.
4. Reasonable exercise: Reasonable aerobic exercise in elderly patients with hypertension and prehypertension can effectively lower blood pressure, such as walking, jogging, swimming, etc.
5. Improve sleep: Sleep duration and quality are associated with increased blood pressure and the risk of cardiovascular disease. Ensuring 6-8 hours of sleep at night and improving sleep quality are of great significance for improving quality of life, controlling blood pressure and reducing complications of cardiovascular and cerebrovascular diseases.
6. Pay attention to keeping warm: keep the room warm and ventilate frequently; Reduce going out when it is cold and windy; Add appropriate clothing and keep warm to avoid large fluctuations in blood pressure.
7. Psychological balance: Maintain a healthy psychological state, maintain a state of mind that is not alarmed and panicked, and avoid emotional ups and downs in the environment and events.
Q: What are the main types of antihypertensive drugs?
Doctor: On the basis of lifestyle adjustment, if the blood pressure is not controlled or the blood pressure has increased significantly when hypertension is found, or even if there are cardio-cerebral and renal complications, it is necessary to take antihypertensive drugs under the guidance of a doctor. Antihypertensive drugs are mainly divided into the following six categories:
1. Diuretics: This class of drugs is generally suitable for patients with mild hypertension.
2. Calcium channel blockers: common drugs are nifedipine, amlodipine, verapamil, and felodipine.
3. β receptor blockers: commonly used drugs are metoprolol tartrate, bisoprolol, betarol, etc.
4. Angiotensin-converting enzyme inhibitors: common drugs include enalapril maleate, benazepril hydrochloride, lisinopril, etc.
5. Angiotensin II receptor antagonists: common drugs include irbesartan tablets, telmisartan tablets, valsartan, etc.
6. Angiotensin receptor neprilysin inhibitors: This is a new class of antihypertensive drugs, which combines the effects of angiotensin receptor antagonists and neprilysin inhibitors to have a more comprehensive antihypertensive effect.
These drugs should be applied under the guidance of a doctor, and they can't listen to their neighbors and old comrades eat whatever they eat, and some elderly people have a heartbeat of only 60 beats per minute, and it is good to listen to their old neighbors take metoprolol, and they also take two tablets a day, and the result is severe bradycardia.
Q: What are the requirements or principles for taking high blood pressure medications?
Doctors: Drug therapy for older patients with hypertension should follow the following four principles:
1. Small dose: Hypertension patients who are elderly, frail, or have cognitive impairment are usually treated with a smaller effective therapeutic dose and gradually increase the dose as needed.
2. Long-acting: Use long-acting drugs with 1 time/day and 24-hour continuous antihypertensive effect as much as possible to effectively control nocturnal blood pressure, morning peak blood pressure and cardiovascular and cerebrovascular complications.
3. Combination: If the effect of monotherapy is not satisfactory, two or more low-dose antihypertensive drugs can be used to increase the antihypertensive effect.
4. Individualization: According to the specific situation of the patient (especially the frail elderly and the elderly ≥80 years old), tolerance, personal willingness and long-term tolerance, the antihypertensive drugs suitable for the patient are selected.
Your blood pressure is relatively high, you need to combine two antihypertensive drugs, I prescribed you telmisartan and nifedipine controlled-release tablets, you have to take medicine every day, and you have to check your blood pressure by yourself, and your blood pressure is best controlled below 130/80mmHg.
Q: That's great, I took my medicine and I didn't feel any discomfort, so I didn't always come to the hospital.
Doctor: You still need to go to the hospital for regular check-ups. Patients with blood pressure should be followed up at least once every 3 months; For patients whose blood pressure does not meet the target, follow-up is conducted once every 2-4 weeks. Necessary ancillary examinations are required on a regular basis, including blood routine, urine routine, biochemistry, electrocardiogram, etc. According to the situation, some patients need to undergo ambulatory blood pressure monitoring, echocardiography, carotid artery ultrasound, fundus examination, etc., and the significance of regular review is to determine whether the blood pressure is safe and effective to meet the standard, timely find out whether there are complications of the heart, brain, kidney, and fundus, and at the same time monitor and control the risk factors that may also cause the development of arteriosclerosis with hypertension, such as hyperglycemia, hyperlipidemia, hyperuricemia, etc.
"Thank you, doctor, through your explanation, my understanding of hypertension has deepened a lot, I will definitely take medicine on time according to your doctor's instructions, change my lifestyle, and have regular check-ups." Uncle Li listened carefully and said gratefully.
Author: Zhang Yanhong
Source: The Second Affiliated Hospital of Shenyang Medical College
Editor: Wu Guiping
Proofreading: Chi Qian, Chen Zeming
Preliminary review: Liu Yang
Review: Xu Jiang