Hypertension is divided into two categories: primary hypertension and secondary hypertension. Primary hypertension accounts for more than ninety-five percent of hypertension, and what we often call hypertension refers to primary hypertension.
Hypertension is painless and asymptomatic, and is known as the “invisible killer”. Patients with unstable blood pressure control can suffer strokes, myocardial ischemia, myocardial infarction, sudden cardiac death and other cardiovascular accidents.
First, the drug treatment of hypertension
It is generally recommended that a reasonable combination of several antihypertensive drugs to achieve the standard blood pressure, the standard blood pressure value is 130/80mmHg, commonly used antihypertensive drugs include the following, it is generally believed that the strongest antihypertensive effect of Loxodren drug, Bison drug is the second.
1.Diuretics
Hydrochlorothiazide (25-100 mg daily, divided into 1-2 doses), furosemide (usually the daily dose does not exceed 100 mg, divided into 2-3 times), amiloride (1 tablet, 1/day), indapamide (1 tablet, 1 day), and indapamide.
day), and indapamide (2.5 mg, 1/day) are the diuretic drugs commonly used in clinical practice today.
The use of diuretics in elderly hypertensive patients should start with small doses and monitor for adverse effects, such as hypokalemia, hyperuricemia, and abnormal glucose metabolism.
2.Calcium antagonists (CCB)
Dihydropyridine CCB has a vasodilatory effect, adverse effects include peripheral edema, flushing, constipation, increased sympathetic excitability, etc., long-acting CCB
Long-acting CCBs have fewer adverse effects, and the representative drugs are nifedipine controlled-release tablets (30-60 mg, 1/day), felodipine extended-release tablets (5-10 mg, 1/day), amlodipine (5-10 mg, 1/day), etc.
(5-10 mg, 1/day), amlodipine (5-10 mg, 1/day), etc.
The non-dihydropyridine CCBs verapamil (80-120 mg 3/day) and diltiazem (90-360 mg/day in 3-4 divided doses) are contraindicated in the second to fourth doses.
The CCB verapamil (80-120 mg 3/day) and diltiazem (90-360 mg/day in 3-4 doses) are contraindicated in patients with second- to third-degree AV block and are relatively contraindicated in patients with heart failure.
3. ACEI (angiotensin-converting enzyme inhibitor)/ARB (angiotensin II receptor antagonist)
Especially suitable for patients with heart failure or impaired renal function, such as Benazepril (ACEI) (10-20 mg 1/day), Crosartan (ARB) (50-100 mg 1/day), and Valsartan (ARB) (50-100 mg 1/day).
day), valsartan (ARB) (80-160 mg 1/day).
4.β-Blocker
Commonly used are metoprolol succinate (47.5-95 mg, 1/day), bisoprolol fumarate (5-10 mg 1/day), etc.
day), etc. The drug is prohibited in patients with second degree or higher atrioventricular block, bronchial asthma, long-term use of large amounts may cause disorders of glucose and lipid metabolism.
5. alpha-blockers
The elderly patients with hypertension combined with prostate enlargement can be preferred. It should be taken at bedtime in small doses to avoid the occurrence of postural hypotension, such as terazosin (starting dose 1 mg, maintenance dose 2-10 mg, taken at bedtime).
mg, taken at bedtime).
6.Sympathetic nerve inhibitors
Central antihypertensive drugs colistin (starting dose 0.1 mg, 2/day, maintenance dose 0.3-0.9 mg/day, divided into 2-4 doses) and methyldopa (starting dose 250 mg, 2/day, maintenance dose)
(starting dose 250 mg, 2/day, maintenance dose 0.5-2 g/day, divided into 2-4 doses), which activate the central α2 receptors in the brain and inhibit the release of sympathetic impulses in the central nervous system to lower blood pressure.
Sympathetic nerve terminal inhibitor lispro (starting dose 0.1-0.25 mg 1/day, extreme dose not exceeding 0.5 mg/day) blocks norepinephrine.
day) blocks the transport of norepinephrine to its storage vesicles, reduces sympathetic impulse transmission, decreases peripheral vascular resistance, and depletes catecholamines in the brain.
Second, the surgical treatment of refractory hypertension
According to statistics, about 5-10% of patients with hypertension, i.e., with regular oral administration of three or more antihypertensive drugs (including diuretics), their blood pressure is still not controlled at normal levels, which we call Resistant
hypertension).
Resistant hypertension has always been a difficult area in the treatment of hypertension, and this type of hypertension often requires surgery to treat it before it can be lowered. The following 2 types of surgery are commonly used.
Hypertension surgery (1) Renal artery denervation radiofrequency ablation
Patients with renal artery anatomy suitable for denervation (including those without multiple renal arteries, with a renal artery trunk length of not less than 20 mm and a diameter of not less than 4
mm, no renal artery stenosis, no previous renal artery intervention, etc.), the blood pressure is lowered by releasing energy through a radiofrequency catheter inserted into the renal artery to selectively destroy the renal sympathetic nerves and cut off sympathetic innervation in both kidneys.
In 2009, a study led by Prof. Murray
In 2009, Professor Murray Esler led the first successful human case of renal artery desympathetic ablation (catheter-based renal sympathetic ablation, RDN) using a minimally invasive percutaneous catheter intervention.
denervation (RDN), and has completed two consecutive clinical trials in Europe and Australia, namely Simplicity
The results of these trials confirmed that patients with recalcitrant hypertension who underwent this minimally invasive procedure experienced a reduction in mean systolic and diastolic blood pressure of 30 mmHg and 12 mmHg, respectively.
mmHg without significant adverse effects or complications. More importantly, these patients showed no signs of significant rebound in blood pressure after about 3 years of follow-up. Because this was the first minimally invasive surgical technique in history to be proven to definitively lower a patient’s blood pressure, it quickly spread in developed countries such as Europe and Australia, and it is estimated that more than 10,000 patients have successfully undergone this procedure worldwide.
However, just when almost everyone thought this revolutionary technology would rapidly spread worldwide, a clinical study led by the U.S. Food and Drug Administration (FDA) in the U.S., Simplicity
Simplicity
HTN-3 was conducted within the United States and enrolled 535 patients with intractable hypertension, 2/3 of whom underwent radiofrequency ablation of the renal arteries and 1/3 of whom were enrolled in a sham-operation group (Sham-operation) that underwent renal arteriography only. The researchers compared the blood pressure of the two groups after 6 months of follow-up and found that patients in the renal artery ablation group had a decrease in systolic blood pressure of about 14
There was no significant difference between the two groups, as patients in the sham-operation group had a systolic blood pressure drop of about 12 mmHg. The results of this trial, while reaffirming the safety of this procedure, negate its efficacy in reducing blood pressure in patients with intractable hypertension.
Hypertension surgery (2) Median neuromodulation
Median nerve modulation : Anovel approach to resistant
hypertension) is a procedure invented by a New Zealand doctor named Mark Webster.
The procedure involves the subcutaneous implantation of a coin-sized nerve stimulation device in both forearms, which stimulates the median nerve for 30 minutes a week. After 6 months of treatment, the patient was able to achieve a significant reduction in hypertension, but its efficacy remains to be further confirmed.
Finally, it should be emphasized that for all hypertensive patients, the following two considerations should be taken into account.
1. Etiological treatment
In the face of refractory hypertension,
The common causes include renal hypertension, obstructive sleep apnea syndrome, primary aldosteronism, pheochromocytoma, Cushing’s syndrome, hyperthyroidism, Hashimoto’s thyroiditis, etc., which should be treated for their causes.
2.Strengthen health education and lifestyle intervention
Improve patient compliance Strengthen health education, raise patients’ awareness of hypertension and its long-term risks, establish follow-up mechanisms, supervise patients’ adherence to treatment, and adjust the antihypertensive regimen when appropriate. Patients are advised to perform low to moderate intensity exercise daily, reduce body weight, stop smoking and limit alcohol, reduce intake of fat, cholesterol, sodium and salt, consume more vitamin-rich protein and vegetables and other foods, combine work and rest, and maintain a happy mood.