Hypertension exists universally and increases with age and is a serious health hazard to human beings. The classification and treatment of hypertension are discussed as follows.
1.Diagnostic criteria and classification of hypertensive disorders
The World Health Organization/International Society of Hypertension (WHO/ish), the authoritative organization for international hypertension, formulated the WHO/ish 1999 hypertension guidelines (fourth revised edition) based on the latest large-scale clinical trials and epidemiological research data on the diagnosis and treatment of hypertension internationally, which clearly define the diagnostic criteria for hypertension: (1) adults (>18 years old) with systolic blood pressure greater than or equal to 140 mmhg and/or diastolic blood pressure greater than or equal to 90 mmhg as hypertension, 130 to 139/85 to 89 mmhg as normal high limit, less than 130/85 mmhg as normal blood pressure, and less than 120/80 mmhg as ideal blood pressure.
The new classification criteria for hypertension disease specified in the guidelines no longer use the original,, period or mild, moderate or severe classification method. The new classification criteria are: Grade 1 hypertension 140 to 159/90 to 99 mmhg, Grade 2 hypertension 160 to 179/100 to 109 mmhg, and Grade 3 hypertension greater than or equal to 180 to 110 mmhg. classified by the highest level of systolic or diastolic blood pressure, such as a hypertensive patient with blood pressure of 161/99 mmhg, which belongs to Grade 2 hypertension. Systolic hypertension alone is systolic blood pressure greater than or equal to 140mmhg and diastolic blood pressure less than 90mmhg. The increased systolic and diastolic blood pressure is more dangerous.
Since hypertension, if not treated in time, can induce a variety of pathologies, such as cardiovascular, brain, kidney and other pathologies, and some even cause life-threatening. The Ministry of Health and the Chinese Hypertension Alliance have developed guidelines for the prevention and treatment of hypertension in China. According to the blood pressure level is divided into ideal, normal, normal high blood pressure and 1, 2, 3 levels of hypertension, while according to the combination of cardiovascular risk factors, damage to target organs and suffering from other diseases combined with blood pressure level and hypertensive disease is divided into 4 categories, namely p 140 ~ 159mmhg or dbp 90 ~ 99mmhg for the level 1 hypertensive patients, no other risk factors for low-risk, with 1 to 2 risk factors as medium-risk, those with more than 3 risk factors as high-risk, and those with target organ damage or diabetes as very high-risk.
2. Principles of treatment of hypertension [1]
2.1 Treatment of hypertension aims to minimize the overall risk of death and disability from cardiovascular disease. Physicians are required to intervene in all reversible risk factors detected in patients while treating hypertension, and to manage the patient’s various concurrent clinical conditions in a timely and appropriate manner. The goal of blood pressure reduction in the elderly should be 140/90 mmhg or less, while patients in the high-risk and very high-risk group with combined diabetes should have their blood pressure reduced to 135/85 mmhg or less.
2.2 Treatment strategy High-risk and very high-risk patients should start treatment immediately; medium-risk patients should be followed up and tested for 3-6 months; low-risk patients should be followed up and monitored for 6-12 months, and if blood pressure is still high, pharmacological treatment should be started; all patients should take pharmacological measures.
2.3 Blood pressure reduction target Young, middle-aged or diabetic patients: 130/85mmhg; elderly: 140/90mmhg.
2.4 Medication principles From low dose to gradually increase the dose; long-acting preparations, once a day (t/p>50%). 24h stable antihypertensive, improve compliance; small dose combination (70% must be combined with drugs); once started drug therapy, need to take drugs for life, can be adjusted as appropriate, the selection of drugs should take into account the drug for the treatment of comorbidities.
3, hypertension drug therapy in the rational use of drugs [2]
3.1 The choice of antihypertensive drugs depends mainly on the antihypertensive effect and adverse effects of the drugs on the patients. It is the most ideal and reasonable choice for patients who can effectively control blood pressure and suitable for long-term treatment. In the selection should also consider the drug on the patient’s target organ damage and the presence of diabetes, lipids, uric acid and other metabolic abnormalities, as well as the interaction between antihypertensive drugs and other drugs used. Another influence on the availability of antihypertensive drugs, in terms of the current state of our medical economy and the relatively low treatment rate, should be to first increase the treatment rate and then gradually increase the control rate, in addition to recommending the use of inexpensive antihypertensive drugs in general hypertensive patients whenever possible.
3.2 Overview of antihypertensive drugs According to domestic and foreign clinical trials and relevant studies, the main drugs with good antihypertensive efficacy in clinical practice are diuretics, β-blockers, calcium antagonists, angiotensin-converting enzyme inhibitors or angiotensin receptor (at) antagonists or fixed-dose combination antihypertensive preparations composed of the above drugs.
3.2.1 Diuretics Diuretics are used primarily for mild to moderate hypertension, especially in the elderly with hypertension or secondary heart failure. They are contraindicated in patients with gout and used with caution in patients with diabetes mellitus and hyperlipidemia. Small doses may avoid adverse effects such as hypokalemia, decreased sugar dose and cardiac arrhythmias. Dihydrochlorothiazide 12.5mg once or twice daily and indapamide 1.25-2.5mg once daily can be used. Furosemide is used in case of concomitant renal failure.
3.2.2 β-blockers Mainly used for mild to moderate hypertension, especially in young and middle-aged patients with rapid heart rate (>80 beats/min) at rest or in combination with angina pectoris. Contraindicated in patients with heart block, asthma, chronic obstructive pulmonary disease and peripheral vascular disease. Use with caution in patients with insulin-dependent diabetes mellitus. Options: metoprolol 50 mg once or twice daily; atenolol 25 mg once or twice daily; bisoprolol 2.5-5 mg once daily; betaxolol 5-10 mg once daily. β-blockers can be used in heart failure, but usage is completely different from antihypertensive drugs and should be noted.
3.2.3 Calcium antagonists Calcium antagonists can be used in all degrees of hypertension, especially in elderly people with hypertension or in combination with stable angina pectoris. Non-dihydropyridine calcium antagonists are contraindicated in patients with heart block and heart failure. Rapid-acting dihydropyridine calcium antagonists are contraindicated in unstable angina pectoris and acute myocardial infarction. Long-acting agents such as felodipine extended-release tablets 5-10 mg once daily, nifedipine controlled-release tablets 30 mg once daily, amlodipine 5-10 mg once daily, and lacidipine 4-6 mg once daily are preferred. Generic nifedipine 10mg 2-3 times daily can also be used in general. Use nifedipine fast-acting capsules with caution.
3.2.4 Angiotensin-converting enzyme inhibitors These drugs are mainly used in patients with hypertension combined with diabetes mellitus, or concomitant cardiac insufficiency or renal damage with proteinuria. They are contraindicated in pregnancy and in patients with renal artery stenosis and renal failure (blood creatinine >2655 μmol/l or 3 mg/dl). Options: captopril 12.5-2.5 mg twice to three times daily; enalapril 10-20 mg once to twice daily; perindopril 4-8 mg once daily; benazepril 10-20 mg once daily; lenopril 20-40 mg once daily.
3.2.5 Angiotensin receptor antagonist Cloxacin 50-100mg once daily; Valsartan 80-100mg once daily, applicable and prohibited objects are the same as ace-1, currently mainly used for dry cough occurring after ace-1 treatment.
3.3 Combination medication for hypertension A patient with essential hypertension, the cause of increased blood pressure is the coexistence of multiple factors and pathological diversity, giving a theoretical basis for combination medication. Single drug therapy can bring blood pressure under control in 50% of primary patients, while two drugs can increase the above figure to 80%. Effective drug combinations use drugs with different antihypertensive mechanisms to limit the fall in blood pressure by reducing the effect of post-hypertensive compensatory mechanisms. The combination of drugs with the same mechanism of action produces limited value, so the antihypertensive effect fails to add up, or increases the risk of side effects due to similar side effects.
In conclusion, the treatment of hypertension is a systemic project, and individual treatment plans should be formulated according to the clinical conditions of patients, treating them according to their diseases and insisting on reasonable use of drugs in order to receive good results and maintain health.