Hypertension is a disease that seriously endangers human health and life, and despite the continuous updating of anti-hypertensive drugs and treatments, the incidence of hypertension is increasing year by year, and it has been called the “first killer” of human beings today. At present, there are 1.1 billion hypertensive patients in China, and the number is increasing at the rate of 3.5 million people per year, so we have a long way to go for medical workers. However, there are still some misconceptions in the process of diagnosis and treatment of hypertension that have been confusing some people and hindering the diagnosis and treatment of hypertension. For the middle-aged and elderly, arterial blood pressure increases with age, especially systolic blood pressure, some people think that this is a normal physiological phenomenon and does not require drug intervention, but this view is wrong. Indeed, it is clear in the clinical treatment process that with the increase of age, almost 40% to 50% of middle-aged and elderly people have different degrees of hypertension, and this hypertension is mainly systolic hypertension. This is due to the aortic artery sclerosis in the elderly, the elasticity of the arteries is reduced, and when the left ventricle systolic blood is ejected, the arterial wall is not easily dilated, and the buffering effect on arterial pressure is reduced, so the systolic blood pressure is significantly increased. Recent studies have found that an increase in systolic and/or diastolic blood pressure is harmful to the quality of life and target organ damage. The higher the systolic and/or diastolic blood pressure, the higher the incidence of cardiovascular and cerebrovascular disease and mortality. Studies have also found that elevated systolic blood pressure is more harmful than elevated diastolic blood pressure and more predictive of cardiovascular and cerebrovascular complications, so it is important to pay attention to the diagnosis and treatment of systolic hypertension. It is believed that blood pressure should not be lowered too low, especially diastolic blood pressure, which is closely related to blood supply to the heart, and should not be lowered below 90 mmHg, especially in the elderly. This belief is false. The groundbreaking HOT study solved this long-standing dilemma. This study showed that the most significant reduction in major cardiovascular events (30% reduction) was achieved by lowering blood pressure to 138/83 mmHg. This benefit was maintained if blood pressure continued to fall within the normal range, and there was no worsening of cardiovascular events after the blood pressure was lowered to normal, as previously thought, known as a “J” curve. The reduction in mean diastolic blood pressure from 105 mmHg to 83 mmHg prevented 4 serious cardiovascular events per 1000 patients per year with hypertension, and for those with combined target organ damage, especially diabetes and kidney disease, the reduction in diastolic blood pressure to 80 mmHg or less significantly improved quality of life and reduced the incidence of cardiovascular events. This study also demonstrates that the higher the risk of hypertension, the more important it is to lower the blood pressure to the target level. Because of the close relationship between the risk of cardiovascular events and blood pressure levels, the goal of blood pressure control should be to lower blood pressure to “normal” or even “ideal” levels. According to domestic and international studies, blood pressure should be lowered to normal (<130/85 mmHg) or ideal (120/80 mmHg) levels for young and middle-aged patients with hypertension or diabetes or renal insufficiency, and to <140/90 mmHg for the elderly. The prevalence of diabetes combined with hypertension is high, and the prevalence of both can be as high as 38%. Previously, it was thought that the main focus of treatment for these patients was to lower blood glucose because diabetes mellitus is prone to target organ damage and can also exacerbate the progression of hypertension. Several large-scale pilot studies have disproved this understanding. Studies have shown that intensive glycemic control reduces the risk of diabetes-related endpoints by 12%, while strict blood pressure control further reduces the risk of fatal or nonfatal diabetes-related clinical endpoints by 34%, meaning that the benefits of strict blood pressure control somehow exceed those of intensive glycemic control; strict blood pressure control also further reduces the risk of various diabetes-related deaths by Strict blood pressure control can further reduce the risk of various diabetes-related deaths by 32%, and lowering blood glucose only reduces microvascular complications, while strict blood pressure lowering can reduce macrovascular complications by 34% and further reduce diabetic microvascular complications (such as retinopathy, nephropathy, etc.). The SystChina trial in China also confirmed that satisfactory control of blood pressure can reduce the overall mortality and cardiovascular event rate of diabetic patients by more than 50% to 60%. Therefore, both cardiovascular doctors and endocrinologists should not only control the blood glucose of diabetic patients, but also pay more attention to the strict control of their blood pressure. In the process of hypertension treatment, we only pay attention to lowering blood pressure, but ignore the various risk factors of hypertensive patients and the degree of damage to their target organs In the past, we gave more consideration to how to lower blood pressure in the process of lowering blood pressure, but less consideration to the prognostic factors affecting hypertensive patients, such as risk factors and the degree of damage to target organs and the intervention treatment of clinical diseases related to hypertension, and once erroneously thought that it was enough to lower blood pressure. It was once erroneously believed that it was sufficient to lower blood pressure. Studies have shown that factors such as smoking, obesity, elevated cholesterol, left ventricular hypertrophy, and diabetes mellitus are closely related to the development of hypertension, and that elevated blood pressure can enhance the harmful effects of these risk factors on the body. Therefore, if we do not intervene in the treatment of hypertension, the quality of life and prognosis of patients will not be satisfactory even if the blood pressure is lowered, and the decrease in blood pressure will not last long. For example, if a hypertensive patient has diabetes mellitus or cardiovascular disease or target organ damage such as left ventricular hypertrophy, even if the patient's blood pressure does not reach 140/90 mmHg or higher, but is only at the high limit of normal (130-139/85-89 mmHg), pharmacological intervention should be actively carried out, which can significantly improve the patient's prognosis and quality of life. Therefore, it is necessary to take into account the interventional treatment of factors affecting the prognosis of hypertension in the process of antihypertensive, so as to minimize the risk of cardiovascular and cerebrovascular disease morbidity and mortality. 5 Blind selection of antihypertensive drugs It is important to pay attention to the selection of antihypertensive drugs, and to consider more drugs that can minimize the risk of cardiovascular morbidity and mortality in the selection of drugs. At present, there are six major categories of antihypertensive drugs: diuretics, beta-blockers, calcium antagonists, angiotensin-converting enzyme inhibitors (ACEI), angiotensin II receptor antagonists (Ang II antagonists) and alpha-blockers. When choosing antihypertensive drugs, it is important to pay attention to the risk factors for hypertension, target organ damage and interventional treatment of concomitant cardiovascular diseases, and to tailor the treatment to the individual. In general, for hypertension without target organ damage and in young patients, β or α-blockers should be preferred because these patients are hyperdynamic, with large blood pressure fluctuations and sympathetic excitability such as tachycardia; in the elderly, ACEI or calcium antagonists or Ang II antagonists should be preferred because of increased peripheral vascular resistance; for patients with combined left ventricular hypertrophy and/or angina pectoris, β-blockers and calcium antagonists should be preferred. For patients with combined left ventricular hypertrophy and/or angina pectoris, β-blockers and calcium antagonists should be preferred; for combined heart failure, ACEI or Ang II antagonists and diuretics should be preferred; for patients with arrhythmias, β-blockers should be preferred. It is worth pointing out that in the application of drugs, the application of long-acting anti-hypertensive drugs should be advocated, the benefits: ① because hypertensive patients need to take medication for life, the use of once-a-day long-acting preparations, which is beneficial to improve patient compliance; ② with long-acting drugs can be 24 hours of smooth antihypertensive, can more fully protect the target organs; ③ because of hypertension patients with blood pressure fluctuations around the clock, most in the early morning blood pressure rises significantly, This is the time when the incidence of myocardial infarction, angina pectoris, sudden cardiac death and stroke is the highest, so the use of long-acting agents can cover this time, which can effectively control the occurrence of cardiovascular events, while short-acting antihypertensive agents cannot cover this dangerous time. Studies have shown that 69% of patients with hypertension need a combination of antihypertensive drugs to bring blood pressure down to the ideal level, especially for patients with moderate to severe hypertension combined with target organ damage and diabetes, the combination of drugs can be as high as 80% to achieve the ideal level of blood pressure reduction. The combination of drugs can not only reduce the side effects of a single drug, but also achieve better antihypertensive control goals. It is believed that blood pressure should be discontinued in time after it has been reduced to normal, otherwise it will drop below normal and aggravate the lack of blood supply to the heart, brain and kidneys. This is incorrect. The correct application of antihypertensive drugs will not lower blood pressure below normal, but will help reduce the occurrence of cardiovascular events and improve the quality of life of patients. It has been proved that once the blood pressure is reduced to normal, an experienced doctor should reduce the dosage or replace it with other more moderate antihypertensive drugs to maintain the treatment, so that the blood pressure can not only be controlled to the target level, but also will not fall below the normal level, and will not cause insufficient blood supply to the heart, brain, kidney and other important organs; on the contrary, if the blood pressure rises after stopping the drug, the blood pressure will fluctuate so much that the damage to the target organs will be greater and more likely to Cardiovascular events are more likely to occur. In recent years, studies have shown that pulse pressure can be an independent predictor of cardiovascular risk, and that there is an independent and significant correlation between pulse pressure and cardiovascular disease, especially for myocardial infarction, heart failure, and stroke. The famous Framingham study showed that increased pulse pressure in middle-aged and elderly people is better than systolic and diastolic pressure in predicting the risk of coronary heart disease, and some scholars found that the level of systolic blood pressure and pulse pressure determine the risk of myocardial infarction and stroke to a greater extent, the relative risk of myocardial infarction and stroke incidence and mortality for patients with pulse pressure ≥ 63 mmHg were 2 6 times and 4 3 times respectively for pulse pressure ≤ 46 mmHg. The relative risk of myocardial infarction and stroke and mortality in patients with pulse pressure ≥63 mmHg were 2 6 and 4 3 times higher than those with pulse pressure ≤46 mmHg. Pulse pressure is a parameter that reflects the change in dilatability of large arteries, and an increase in pulse pressure indicates a decrease in dilatability of large arteries. Therefore, in recent years, more and more attention has been paid to the changes in pulse pressure, and the focus of antihypertensive treatment has shifted from focusing only on diastolic blood pressure to systolic blood pressure and pulse pressure. Long-acting nitrates can selectively act on the large arteries to improve their compliance and lower pulse pressure without lowering diastolic pressure, and are suitable for the adjunctive treatment of systolic hypertension in the elderly. Calcium antagonists and ACEI or Ang II antagonists can act on large vessels such as the aorta to reduce its pressure, so patients with systolic hypertension should choose calcium antagonists, ACEI agents or Ang II antagonists.