Hypertension is one of the most common chronic diseases in clinical practice, which can cause damage to multiple target organs of the body, such as the heart, brain, kidney, and eye, resulting in serious complications such as coronary heart disease, stroke, heart failure, renal damage, and fundus lesions. In order to educate the public about the importance of hypertension and its related diseases, and to provide information on prevention, measurement, and treatment, World Hypertension Day is set on May 17 every year. Today is 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 start with precise strategies and effective control to understand hypertension together.
NO.1
What is high blood pressure?
Blood pressure refers to the pressure of blood on the walls of an artery as the heart pumps blood into an artery. As the name suggests, high blood pressure is when blood pressure is higher than normal. According to the Chinese Guidelines for the Prevention and Treatment of Hypertension, hypertension can be diagnosed when systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg measured three times on the same day without the use of antihypertensive drugs.
NO.2
What are the dangers of high blood pressure?
High blood pressure is potentially harmful and can severely damage vital organs such as the heart, brain, kidneys and eyes.
(1) The effect of high blood pressure on the heart
High blood pressure can damage arteries by reducing their elasticity, which in turn reduces blood and oxygen flow to the heart, leading to heart disease. In addition to this, reduced blood flow to the heart can also lead to the following symptoms/diseases in the patient:
➤ Chest pain, also known as angina;
➤ Heart attack, which occurs when the blood supply to the heart is blocked and the heart muscle dies due to insufficient oxygen supply.
➤ Heart failure, where the heart is unable to carry enough blood and oxygen to other organs.
(2) The effect of high blood pressure on the brain
High blood pressure can cause the arteries that supply blood and oxygen to the brain to rupture or become blocked, leading to a stroke. Because they don't get enough oxygen, brain cells will die during a stroke, leading to severe disability in speech, motor and other essential activities; In severe cases, stroke can also lead to death.
In addition, hypertension, especially in middle age, may be associated with poorer cognitive function and dementia in later life.
(3) High blood pressure on kidney disease
Adults with diabetes and/or hypertension are at increased risk of chronic kidney disease.
NO.3
What are the symptoms of high blood pressure?
High blood pressure has been called the "silent killer," and patients are often asymptomatic. Most people don't realize their blood pressure is elevated until they have a clinical complication, such as a heart attack, stroke or kidney failure, unless they have a blood pressure measurement. Therefore, accurate blood pressure measurement is crucial.
Note: Some patients with high blood pressure may experience symptoms such as severe headache, chest pain, dizziness, difficulty breathing, nausea, vomiting, blurred vision or other vision changes, anxiety, confusion, buzzing in the ears, nosebleeds, and abnormal heart rhythm.
NO.4
How to accurately measure blood pressure?
(1) Selection of blood pressure monitor
Upper arm electronic blood pressure monitors certified to international standards (ESH, BHS or AAMI) are preferred for home measurements, and ESH standards are recommended for mainland China.
The electronic blood pressure monitor should be tested at least once a year, and the accuracy should be checked by a merchant who provides calibration services as much as possible, and the operation steps are as follows: first measure blood pressure with a mercury column blood pressure monitor. After 3 minutes of rest, measure the 2nd time with an electronic sphygmomanometer. Then rest for another 3 minutes and measure the third time with a mercury column sphygmomanometer. The average of the first and third measurements should generally be < 5 mmHg compared to the second measurement with an electronic sphygmomanometer.
(2) How to choose a cuff?
It is currently believed that the cuff should cover at least 4/5 of the circumference of the upper arm. A cuff that is too small or too large can cause deviations in blood pressure measurements.
(3) Measure left or right hand?
When the patient's blood pressure is measured, the blood pressure should be measured on both sides first, and then the upper limb with higher blood pressure should be measured; Or under the influence of excluding other factors (such as injury to one arm of the patient), for the same individual, choose to measure on one arm of the fixed side to achieve the purpose of data comparison before and after.
It is important to note that blood pressure in both arms should be measured when Takayasu's arteritis or coarctation of the aortic arch is suspected, and if the difference in blood pressure (systolic blood pressure) between the arms is > 20 mmHg, blood pressure measurement in the extremities is recommended.
(4) Do I need to take off my clothes?
Clothing can affect the results of blood pressure measurements, so the upper arm clothing that requires blood pressure measurement should be removed as much as possible (be careful not to pull it up and tighten the upper arm). When the clothing is too thick, the blood pressure measured through the clothing is higher than that of the bare upper arms.
(5) What is the correct measured posture?
Blood pressure should be measured at the same level as the upper arm at the same level as the heart. When generally sitting, the upper arm is placed on the table in a relaxed position, and the upper arm is basically level with this, and the specific position is located in the middle of the sternum, flat at the level of the fourth rib; In the recumbent position, a small pillow support should be used to keep the upper arm at the same height as the midaxillary line.
In addition, when the cuff is tied, the lower edge is 2~3 cm above the elbow fossa, so that it can be tucked into 2 fingers. Tightening the cuff too tightly or too loosely can make the blood pressure measurement inaccurate.
Figure Blood pressure measurement posture chart
(6) How often is blood pressure monitoring?
For patients with hypertension who are newly diagnosed with hypertension or unstable blood pressure, it is recommended to monitor once a day in the morning and evening, and the specific monitoring method is: every morning, after urination, before taking medicine, take a sitting position, measure blood pressure continuously with arm blood pressure for 3 times, and the average value of blood pressure and heart rate after 2 times is the morning blood pressure value. Before bedtime or 1 hour after dinner, the blood pressure is measured in the same way, which is the blood pressure value at night.
Those whose blood pressure control is stable and up to the standard can self-measure their blood pressure 1~2 days a week, once in the morning and once in the evening.
(7) How to measure special patients?
In patients with severe bradycardia (heart rate < 40 beats per minute), if a mercury sphygmomanometer is used, blood pressure is measured at a slower rate than at normal heart rate, and an electronic sphygmomanometer can measure it multiple times. Similarly, for arrhythmias, especially in patients with atrial fibrillation, repeated measurements are needed to reduce errors.
NO.6
How to prevent the onset/development of high blood pressure?
The Guidelines for the Prevention and Treatment of Hypertension in China (2023) recommend an "eight-step lifestyle" to prevent the occurrence/development of hypertension.
(1) Reduce sodium intake and increase potassium intake
➤ Salt reduction measures are clearer and more precise: the sodium limit has been reduced from the original <6g of salt to <5g;
➤ Assess salt intake using a simple urine dotting formula;
➤ It is not recommended to take potassium supplements (including medications) to lower blood pressure;
➤ Renal function should be assessed prior to the administration of low-sodium potassium-rich salts. Patients with good renal function are recommended to choose low-sodium potassium-rich salt instead; Patients with renal insufficiency should consult a physician before taking potassium supplementation.
(2) Reasonable diet
The new guidelines recommend that patients follow the DASH diet, CHH diet, and spicy dietary pattern to lower blood pressure.
(3) Limit alcohol consumption
➤ Any type of alcohol is not beneficial to the human body, and it is recommended that people with high blood pressure do not drink alcohol to minimize the loss of health;
➤ If you drink alcohol, the daily alcohol intake of adults should not exceed 15g;
➤ Assess alcohol use and develop an individualized intervention plan based on the results.
(4) Control your weight
➤ Normal high blood pressure and all patients with high blood pressure should actively control their weight;
➤ All overweight and obese patients lose weight;
➤ Aim for weight loss of 5%-15% or more; 5% to 10% of initial body weight loss within 1 year;
➤ First, weight control was carried out through comprehensive lifestyle interventions, including self-monitoring of weight, reasonable diet, increased physical activity/exercise, and behavioral interventions.
➤ For patients with unsatisfactory weight loss results of comprehensive lifestyle intervention, drug therapy or surgical treatment is recommended;
➤ For special populations, such as lactating women and the elderly, individualized weight loss measures should be used on a case-by-case basis;
➤ The weight loss plan should be adhered to for a long time, the speed varies from person to person, and it should not be rushed.
(5) Exercise intervention
Exercise interventions such as aerobic exercise, resistance exercise, meditation and breathing exercises, flexibility training, and stretching training may be used.
For hypertensive patients with well-controlled blood pressure, mixed training with aerobic exercise (moderate-intensity, 30 minutes per day, 5-7 days a week) supplemented by resistance exercise (2-3 times a week) is recommended; It is also recommended to combine breathing exercises with flexibility and stretching exercises.
For people with uncontrolled blood pressure (SBP > 160 mmHg), high-intensity exercise is not recommended until blood pressure is controlled.
(6) Non-smoking
➤ Hypertensive smokers should be strongly advised and urged to quit smoking; ➤ If necessary, use smoking cessation medications to combat withdrawal; ➤ Try to avoid the use of e-cigarette substitution therapy; ➤ When quitting smoking, supplemented by physical exercise; ➤ combined smoking cessation interventions;
➤ Individualized smoking cessation interventions.
(7) Maintain mental balance
➤ Self-adjustment to avoid psychological imbalance;
➤ Build defensive barriers to maintain mental balance, such as physical defense, emotional defense, and mental defense.
(8) Manage sleep
Increasing effective sleep duration and/or improving sleep quality can significantly increase the efficacy of antihypertensive drugs and reduce the morbidity and mortality of hypertension.
The main measures to manage sleep include sleep assessment, sleep cognitive behavioral therapy, and medication if necessary.
NO.7
How is high blood pressure treated after it's diagnosed?
Patients with hypertension whose blood pressure is uncontrolled despite lifestyle therapy should be treated with hypertension medications. According to the Chinese Guidelines for the Prevention and Treatment of Hypertension (2023), patients with hypertension can use calcium channel antagonists (CCBs), angiotensin-converting enzyme inhibitors (ACE inhibitors), angiotensin II receptor antagonists (ARBs), thiazide diuretics, β blockers, and angiotensin receptor neprilysin inhibitors (ARNIs), as well as single-tablet combination preparations (SPCs) composed of the above drugs as commonly used drugs for initial and maintenance therapy. Spironolactone is given as a combination drug in addition to the three-drug combination base, and eplerenone can be selected for those who cannot tolerate it.
In addition to drug therapy, patients with hypertension may be treated with instrumentation. At present, the efficacy and safety of transrenal artery renal sympathetic nerve (RDN) in the treatment of hypertension have been widely confirmed. RDN therapy may be considered in patients with high cardiovascular risk who are refractory to medication control and who have poor medication adherence to exclude secondary causes.
Bibliography:
[1] Guidelines for the Prevention and Treatment of Hypertension in China
[2]https://www.cdc.gov/high-blood-pressure/about/?CDC_AAref_Val=https://www.cdc.gov/bloodpressure/about.htm
[3]https://www.who.int/zh/news-room/fact-sheets/detail/hypertension
[4] Cheung AK, Whelton PK, Muntner P, et al. International Consensus on Standardized Clinic Blood Pressure Measurement - A Call to Action. Am J Med. 2023 May; 136(5):438-445.e1. doi: 10.1016/j.amjmed.2022.12.015. Epub 2023 Jan 6. PMID: 36621637; PMCID: PMC10159895.
[5] Accurate measurement, effective control, blood pressure management is right! World Hypertension Day. Peking University People's Hospital.2024-05-16.
[6] Charchar FJ, Prestes PR, Mills C, et al. Lifestyle management of hypertension: International Society of Hypertension position paper endorsed by the World Hypertension League and European Society of Hypertension. J Hypertens. 2023 Sep 13.
Yimaitong is a professional online doctor platform, and the mission of the platform is to "sense the pulse of the world's medicine and help China's clinical decision-making". Yimaitong has a series of products such as "Clinical Guidelines", "Medication Reference", "Medical Literature King", "Yizhiyuan", "eYantong" and "ePulse", which fully meet the needs of medical workers in clinical decision-making, obtaining new knowledge and improving scientific research efficiency.