Hypertension is the most common cardiovascular disease in China and one of the largest epidemics, often causing complications in the heart, brain, kidneys and other organs, seriously endangering human health. For a long time, because many patients have some misunderstandings about hypertension disease, which affects the treatment and recovery of this disease.
Be alert to your blood pressure
Check your blood pressure frequently, and if you find an increase you should first ask your doctor for a comprehensive analysis and assessment of your condition, and determine whether risk factors are present through blood glucose, lipids, kidney function, ECG and other tests. If other risk factors are also present in mild hypertension, you should undergo blood pressure reduction treatment as soon as possible under the guidance of your doctor. If other risk factors are not present, they should be observed for 6 to 12 months while non-pharmacological treatment is administered.
Elevated blood pressure is influenced by a variety of factors that may persist over time, and if observed for 6 to 12 months, a more average objective level can be obtained. During this period, it is best to measure blood pressure at the same time every 1 to 2 weeks and keep a record. If the blood pressure remains elevated after 6 to 12 months of non-pharmacological treatment, long-term antihypertensive therapy under medical supervision is required.
The age of first onset of hypertension is early. Currently, the age of first onset of hypertension tends to be early, and the proportion of adolescents with hypertension is increasing, with the number of primary hypertension being higher than the number of secondary hypertension. Primary hypertension in adolescents is associated with genetics and obesity, and children are more likely to suffer from hypertension and have an earlier age of onset if their parents suffer from hypertension. Obesity is also another important cause of primary hypertension.
The main cause of secondary hypertensive disease is kidney disease, such as chronic nephritis, congenital malformations of the kidney, and renal artery stenosis. Since the treatment of the two types of hypertensive disorders is different, once elevated blood pressure is detected in adolescents, a distinction should be made as to whether it is primary or secondary. The most important thing is to check urine routine and blood potassium. If the kidney function or blood potassium is abnormal, most of them belong to secondary hypertension disease and should be further examined and treated for the cause. If there is no cure, secondary hypertension should be treated with the same antihypertensive therapy as primary hypertension.
Be alert to adolescent hypertension
Diagnostic criteria for adolescent hypertension: the same as adults for those over 12 years of age, varying by age and gender for those under 12 years of age, and lower than adult standards. For blood pressure measurement in adolescents, the standard for judging diastolic blood pressure is not the disappearance of the bass tone, but the gradual tone prevails. Therefore, parents should learn to measure their children’s blood pressure correctly under the guidance of a doctor.
Hypertension is a syndrome Hypertension is not only an abnormal hemodynamic disease, but also a metabolic disorder syndrome. The rise in blood pressure is accompanied by many other metabolic changes, such as elevated blood sugar, obesity, increased lipids, etc. The combination of multiple risk factors can cause serious cardiovascular and cerebrovascular diseases. Therefore, patients with hypertension must pay attention to other metabolic changes along with antihypertensive treatment, and if other metabolic problems occur, treatment should be carried out simultaneously with antihypertensive.
Management of hypertension
By carrying out non-pharmacological treatments, such as eating lighter, losing weight appropriately, adhering to a scientific lifestyle, and drinking less alcohol and quitting smoking, most low-risk mild hypertension can return to normal. Low-risk mild hypertension is likely to return to normal The so-called mild hypertension is a systolic blood pressure of 140 to 159 mmHg or diastolic blood pressure of 90 to 99 mmHg, which belongs to the category of grade 1 hypertension.
The so-called low-risk is the absence of other risk factors for cardiovascular disease and the absence of target organ damage such as heart, brain and kidney. Over a period of time, there are three trends in mild hypertension: 1/3 of people have a rise in blood pressure, 1/3 of people maintain their original blood pressure level, and 1/3 of people fall to normal levels. 1/3 of people have blood pressure that can return to normal naturally, and they obviously do not need to be treated with medication.
Myths of hypertension treatment
The so-called pulse pressure difference is the difference between the systolic pressure minus the diastolic pressure. As we get older and the duration of the disease increases, the pulse pressure difference will increase. In the past, people have always thought that this is a physiological phenomenon, many elderly patients with hypertension often feel relieved that they “although high blood high, but the low pressure is normal” situation. In fact, this perception is wrong. The pulse pressure difference is an important indicator of the degree of arterial damage, the real cause of which is atherosclerosis, not just atherosclerosis, but also fibrosis. An increase in pulse pressure difference indicates poor vascular elasticity.
Hypertension, diabetes, and aging can change the structure and function of the arterial wall, causing the wall to harden, become less elastic, and the artery to dilate, leading to an increase in pulse pressure. Generally, the pulse pressure difference begins to increase after the age of 50. As with increased systolic and diastolic blood pressure, increased pulse pressure difference is an independent risk factor for cardiovascular disease.
In general, the higher the value, the greater the risk, both for systolic and diastolic blood pressure. However, when the systolic blood pressure is higher than 130 mmHg, the higher the systolic blood pressure and the lower the diastolic blood pressure, the higher the risk. For example, at a systolic pressure level of 160 mmHg, a diastolic pressure of 75 mmHg increases the risk of cardiovascular disease by 12% compared to a diastolic pressure of 95 mmHg, and this is where the pulse pressure difference comes into play.
Systolic blood pressure decreases more indicative of the actual antihypertensive effect in the past, people pay more attention to diastolic blood pressure than systolic blood pressure, mainly for two reasons: hypertension first manifested in increased diastolic blood pressure. For example, in a 40-year-old patient with hypertension, the systolic blood pressure does not exceed 140 mmHg, while the diastolic blood pressure has exceeded 90 mmHg, and the diagnosis is based on the diastolic blood pressure, thus easily attracting attention.
It has long been thought that as we age, increased systolic blood pressure is a physiological phenomenon, while increased diastolic blood pressure is abnormal, so we care more about increased diastolic blood pressure. In fact, systolic blood pressure has a more important impact on health. For every 20 mmHg increase in systolic blood pressure, the risk of cardiovascular disease is doubled. The control of systolic blood pressure is relatively difficult at present.
Data show that diastolic blood pressure can be controlled by up to 90%, while systolic blood pressure is controlled by only 60%. In the past, the treatment of hypertension was aimed at controlling diastolic blood pressure, but now it seems to be biased, and blood pressure control must be balanced at both ends. Because systolic blood pressure is more difficult to control, a decrease in systolic blood pressure is a better indicator of actual blood pressure reduction than a decrease in diastolic blood pressure.
Narrowing the pulse pressure difference with non-antihypertensive drugs In elderly patients with hypertension with increased pulse pressure difference, traditional antihypertensive treatment has been to narrow the pulse pressure difference by reducing total peripheral vascular resistance, but with limited effect. It is now believed that hypertension, dyslipidemia, increased blood glucose, and smoking can affect arterial endothelial function, resulting in increased systolic blood pressure, decreased diastolic blood pressure, and increased pulse pressure differential; therefore, improving arterial elastic function is a new therapeutic avenue. In this regard, the application of non-antihypertensive drugs will play an important role. Such drugs are nitrates, statins, folic acid, vitamin B6, insulin sensitizers, etc.
Long-term treatment problems of hypertension
Long-term antihypertensive treatment has many benefits The biggest problem in the treatment of patients with hypertension is the irregularity of medication, including intermittent medication, or stopping medication after the blood pressure has dropped, which is very harmful. Patients with hypertension who are ineffective after 6 to 12 months of non-pharmacological treatment, or who originally had other risk factors, need to implement long-term effective treatment with antihypertensive drugs.
First, blood pressure returns to normal after antihypertensive treatment, which is the result of antihypertensive treatment, but on average, after 6 to 8 months of discontinuation, the majority of patients’ blood pressure will still return to its original level. If the medication is discontinued, during this time the important target organs related to blood pressure will be in a state of unprotection because it is not known when the blood pressure rises.
Second, the return to normal blood pressure is not the same as the return to normal cardiovascular and cerebrovascular lesions caused by hypertension, which usually take at least two years of treatment to improve.
Thirdly, there are many patients who are worried about the side effects of the drugs and stop taking them. In fact, the side effects of these drugs are most likely to occur in the 2 to 4 weeks after initiating treatment, and after long-term treatment, the side effects instead become less and less frequent. If the medication is frequently discontinued, patients have to keep unnecessarily accepting the side effects during the initiation of treatment. Fourth, some patients are concerned that continuing treatment after normal blood pressure will cause their blood pressure to drop lower and lower, so they will stop taking their medication during the summer months when their blood pressure is low. In fact, the main effect of antihypertensive drugs is to dilate the peripheral blood vessels and lower the peripheral resistance, and when the resistance is normalized, the blood pressure will not be lowered again.
The principle of choosing antihypertensive drugs
Try to use long-acting drugs from the duration of antihypertensive effect, antihypertensive drugs are divided into two categories: long-acting drugs and short-acting drugs. However, from the perspective of drug efficiency ratio, patients who have the conditions should try to use long-acting drugs.
One reason is that long-acting drugs are taken less often and are less likely to be forgotten, so patients will receive long-term standardized treatment. Short-acting drugs are taken more often, patients, especially elderly patients, are prone to forget, and the lack of time for protection will put the body in a dangerous state.
Second, the long-acting drugs to lower blood pressure smoothly, the fluctuation of blood pressure is smaller. Short-acting drugs to lower blood pressure so that blood pressure fluctuations, easily caused by left ventricular hypertrophy, increased myocardial oxygen consumption, to bring some damage to the cardiovascular system. If you need to use short-acting drugs, pay attention not to use a single short-acting drugs, should be combined under the guidance of a doctor, that is, several short-acting drugs organic combination together, or directly with the compound short-acting drugs, in order to reduce blood pressure fluctuations caused by antihypertensive and reduce the number of doses.