1, the first thing after the start of medication is to regularly measure blood pressure, according to the blood pressure level to adjust the dosage so that blood pressure gradually return to normal:.
Hypertension patients to the hospital after the first thing you need to pay attention to the first week before the start of the medication is to measure blood pressure regularly every day, so that the target value of blood pressure control is the normal level: 120-130/70-80mmHg between. Some patients only pay attention to taking the medication according to the doctor’s instructions, but ignore the blood pressure measurement, and do not take the medication every day to measure the blood pressure. Based on the feeling alone, one-sidedly think that as long as taking antihypertensive drugs, the original dizziness and headache disappeared after the body does not discomfort is not high blood pressure. When I suddenly felt dizziness and headache one day, my limbs became weak and I did not measure my blood pressure, I thought my blood pressure was high, so I increased the amount of antihypertensive medication at will, and as a result, my dizziness became heavier and heavier, and I had no choice but to come to the doctor. He said, “Doctor, my blood pressure medicine is ineffective, and my blood pressure has risen again, causing headaches and dizziness. The doctor measured the blood pressure, but the blood pressure is too low.
Some patients do not take blood pressure regularly because they have been taking antihypertensive drugs for a long time, and when they feel uncomfortable, they find that their blood pressure is too low, and they feel scared and quickly reduce their antihypertensive drugs, but after a day, they still find that their blood pressure is too low and they do not recover, and then they quickly stop taking their antihypertensive drugs for fear that their blood pressure will be too low. So that after a long time about two or three weeks blood pressure rose again to the original level. This is because the presence of drugs in the human body takes about three weeks to be completely excreted from the body, long-term use of antihypertensive drug overdose is a short time to stop the antihypertensive drug completely in the body also has a buildup will not make the blood pressure rise immediately. Once the drug has been stopped for a certain period of time, 2-3 weeks later, the drug disappears from the body, the antihypertensive effect does not exist, and the blood pressure returns to the original high level state. This causes blood pressure to rise and fall, and it is difficult to know whether to take the drug or not.
So what should I do? Patients with hypertension who have just started taking antihypertensive medication should have their blood pressure measured at least once a day for the first two weeks of taking the medication. Then adjust the dosage according to the fluctuation of blood pressure, roughly after three weeks of time, you can basically control the blood pressure to the normal range, and then basically fixed the dosage of this medication to adhere to take.
Some patients with hypertension are impatient and think that the medication is ineffective when their blood pressure does not drop after three days of use, and want to change the medication. This is not true, a drug should be used for at least three weeks to achieve the best effect, that is to say, just started taking antihypertensive drugs, blood pressure in a short period of time although not back to normal, do not add drugs or change another antihypertensive drugs, but observe three weeks later, blood pressure is not normal high, and then adjust antihypertensive drugs. Unless it is a hypertensive emergency, generally do not switch antihypertensive drugs in a short period of time, and insist on using enough courses of treatment.
The antihypertensive medication prescribed by the cardiologist is based on your current blood pressure level and the blood pressure level after taking antihypertensive medication in the past, which can bring the patient’s blood pressure down to an approximately normal level. It is necessary to further adjust the dosage of antihypertensive medication according to the blood pressure level and gradually return to normal, so there is a time process to adjust the antihypertensive medication from the time you start taking antihypertensive medication to the time your blood pressure returns to normal. Sometimes the prescribed antihypertensive medication may not come down because your blood pressure is too high, and then your dizziness and headache symptoms will not improve. Or it may be lowered too low, both will be detrimental to your body, and you will also feel dizzy and headache uncomfortable.
Especially the elderly, generally accompanied by severe atherosclerosis, the self-regulation ability of the blood vessels in the brain decreases, and it cannot expand well to increase cerebral blood flow in the process of dropping blood pressure. If the blood pressure decreases too fast, or if the blood pressure is too low, cerebral ischemia can easily occur and induce a stroke. Therefore, according to the blood pressure level after taking the medicine, the blood pressure to 110/70mmHg should then reduce the dosage of antihypertensive drugs under the guidance of the doctor. Adjust the dosage of antihypertensive medication in time to control the blood pressure to a normal or higher target level of 120-130/80-70 mmHg.
The available clinical evidence suggests that people over 70 years of age may benefit from maintaining systolic blood pressure at a level no higher than 160 mmHg. If there is concomitant diabetes or renal failure, lower the blood pressure to below 150 mmHg. Older adults often have what is known as “pseudohypertension,” which refers to a falsely reported high blood pressure index due to vascular sclerosis in the elderly, where the brachial artery vasculature is not easily compressed by the sphygmomanometer cuff. If this is recognized, over-treatment of such patients can be avoided. If a patient’s blood pressure is found to remain “high” on physical examination and cannot be brought down to normal with multiple medications; if there are no signs of organ damage (including cardiac thickening and enlargement, renal insufficiency, proteinuria, retinal hemorrhage, etc.) on instrumentation; and if the sphygmomanometer is inflated at the time of measurement, the mercury column reaches about 200/100 mmHg and then The radial artery can also touch the pulse fluctuation. And even side effects from too much medication. Once these signs are present, the possibility of “pseudohypertension” should be considered. “White coat” hypertension is also common in the elderly. Based on this, if blood pressure levels are not completely certain or if the patient faints or becomes hypotensive after taking the medication, then 24-hour out-of-office blood pressure monitoring is needed to assess the patient’s true blood pressure.
In elderly people over 65 years of age, blood pressure can be around 150/90 mmHg and can be further lower if tolerated. In the event of cerebral ischemia symptoms such as dizziness and lightheadedness, unresponsiveness, hearing loss, and limb weakness, blood pressure lowering should be stopped immediately and treated with medications that improve cerebral blood supply.
In this way, after about three weeks of several adjustments of the amount of antihypertensive drugs, the blood pressure is basically normal, and the amount of drugs is basically fixed and not easily changed. At this time with the Chinese medicine soup can promote blood pressure decline and is conducive to blood pressure stability, adhere to long-term use of Chinese medicine can also make the Western medicine antihypertensive drugs gradually reduce the amount.
Normal people will also have blood pressure fluctuations in postural changes, generally 10mmHg difference between lying, sitting and standing, more than 20mmHg is abnormal, this situation is mostly seen in the elderly postural hypotension.
2.Take long-acting antihypertensive drugs once a day on time for blood pressure to be stable.
After seeing hypertension, you should follow the doctor’s advice and take antihypertensive drugs on time and in quantity. But some people take antihypertensive drugs is very arbitrary, is when you want to take when you want to take, no rule, think that as long as the antihypertensive drugs according to the dose ordered by the doctor to take on it. This is not true.
The human body’s blood pressure level not only needs to be reduced to normal, but also to maintain a normal rhythm. Normal human blood pressure is high during the day and low at night. The approximate rhythm is as follows: it is generally higher in the morning when you wake up, and gradually rises to a peak of about 10 am. Then it drops, and around 4:00 to 6:00 p.m., there is another small increase in blood pressure, but it usually does not exceed the morning blood pressure level. It then gradually decreases until it is at its lowest at midnight. This rhythm is normal and is called a “spoon” rhythm.
Therefore, it is necessary to take antihypertensive medication in front of the daily high peak of blood pressure. It is best to take a once-daily long-acting antihypertensive drug between 6:00 and 7:00 am. If a twice-daily antihypertensive medication is used due to economic conditions, the second dose is usually taken around 3:00 pm. If you do not take antihypertensive drugs regularly, not in a more reasonable time with antihypertensive drugs, it is not in line with the body’s biological rhythm, will lead to the body’s own blood pressure fluctuations rhythm disorder, which is not conducive to the stability of human blood pressure.
3, the blood pressure drop is not a bad change of drugs, is to add another drug:.
Just started taking antihypertensive drugs for hypertension patients friends, if the effect of lowering blood pressure after using an antihypertensive drug is not ideal, or is not down, be anxious, some friends taking antihypertensive drugs for a few days, a measure of blood pressure is not normal thought antihypertensive drugs are not effective, frequent drug changes, in fact, this is not right. Because the maximum effect of antihypertensive drugs need time, generally need three weeks, some long-acting drugs need a month to play the maximum effect. Therefore, you should take antihypertensive drugs after three weeks or four weeks after the blood pressure is not normal before you consider adding antihypertensive drugs. At this time, if the antihypertensive drug has reached the normal dose, has been used for three weeks or four weeks enough time, do not increase the dose of the drug. At this time is not to stop using the drug and replace the original antihypertensive drug with another antihypertensive drug, should be in the original antihypertensive drug based on the addition of a second antihypertensive drug, the effect is not good and then add a third drug.
Because an antihypertensive drug if the antihypertensive drug has been used in full, the effect is still not good, do not increase the drug dose. Because simply on the basis of the original increase, the antihypertensive effect not only does not increase, and side effects increase a lot; this time to change another antihypertensive drugs, the application of a single antihypertensive drug effect is still not much different from the original antihypertensive drug effect of the beginning. Therefore, some patients have changed all the antihypertensive drugs one by one, but the blood pressure still can not be lowered for this reason. Now clinical observation shows that antihypertensive drugs, the beginning should be a variety of antihypertensive drugs a small number of combined application, so that fewer side effects, good results. And two types of drugs together with the effect than but a drug doubled the effect of much larger, and side effects are very small. Now the study found that the treatment of hypertension is a variety of antihypertensive drugs in small doses in combination with a good antihypertensive effect, while the side effects are small, and not easy to produce drug resistance. So don’t mind the doctor prescribing a lot of drugs.
It is important to note that patients who start taking antihypertensive drugs, because the maximum effect of antihypertensive drugs is generally after three weeks, so do not just use antihypertensive drugs for a few days blood pressure does not drop to change the drug. The second is to wait for three weeks after the application of antihypertensive drugs according to the blood pressure situation is not satisfactory before looking for a doctor to add another antihypertensive drugs.
And also need to remind patients that if a kind of antihypertensive drugs used very well, blood pressure is stable in the normal range, and no side effects are found, do not hearsay, others take what is good, then change the original antihypertensive drugs, which will lead to unstable blood pressure, some people originally took antihypertensive drugs after the blood pressure is normal, once the change, halfway through the change of several antihypertensive drugs are not good, and re-use the original The blood pressure can only be stabilized after the antihypertensive drugs.
4, read the instructions carefully, and regular annual physical examination.
Many antihypertensive drugs have varying degrees of side effects, these side effects only occur in a small percentage of patients, not necessarily everyone has. But the patient used antihypertensive drugs, pay attention to what side effects this drug have. Pay attention to whether they happen to you. There are some side effects of antihypertensive drugs that do not have serious consequences. For example, the headache caused by nifedipine disappears after stopping the drug. The bradycardia caused by betalactone disappears after the dose is reduced. There are side effects of antihypertensive drugs that cannot be detected in time and can lead to serious consequences, such as a decrease in white blood cells due to captopril. But do not be afraid of drugs, as long as under the guidance of doctors, long-term antihypertensive drugs patients, regular annual checkups, review liver function, kidney function and blood lipids, blood sugar, blood, urine routine, etc. to see what changes in the body, timely adjustment of drugs, is not a serious consequence.
5, low blood pressure can reduce the amount of medication, but can not just stop.
Hypertension patients taking long-term antihypertensive drugs, if you pay attention to adjust with life, blood pressure will gradually reduce, (because the beginning of the antihypertensive drugs for hypertensive patients, when after two to three weeks of antihypertensive drug dose adjustment, blood pressure is basically normal, the dose is generally fixed.) Therefore, long-term application of antihypertensive drugs should also measure blood pressure at least three times a month. Once the blood pressure is found to be abnormal, the blood pressure should be reduced if it is low to 110/70mmHg in a quiet state most of the day, and the specific how to do it should be promptly checked by the doctor where the doctor adjusts the drug dose. Do not think that your blood pressure is normal to stop the medication, hypertension is difficult to cure, most of the patients are almost lifelong medication. Otherwise, blood pressure will rebound to the original level of hypertension, some patients will even appear higher than the original blood pressure after discontinuing antihypertensive drugs, which can easily lead to cardiovascular and cerebrovascular disease accidents. There is the restoration of the original dose of drugs that can control blood pressure normal blood pressure can not return to normal, you must use a greater amount of antihypertensive drugs than before in order to make the blood pressure back to normal.
6, blood pressure fluctuations, should exclude the life of the factors affecting the stability of blood pressure, and do not frequently adjust the dose of antihypertensive drugs.
I often encounter such patients with hypertension in the clinic, can not see a little fluctuation in blood pressure. As soon as they see their blood pressure rise, they are afraid and immediately increase their antihypertensive medication frequently (in fact, their blood pressure is slightly higher than usual and not life-threatening). Because the amount of antihypertensive drugs added for a short period of time is too large, and after the addition of drugs and blood pressure is too low and uncomfortable and do not dare to take drugs on time, due to intermittent taking antihypertensive drugs, and blood pressure is too high, so repeatedly high and low blood pressure fluctuations are too large, resulting in high and low blood pressure, nothing is from. In the absence of external stimuli (e.g., strenuous exercise, overly rapid emotional response, alcohol consumption, and high levels of mental stress) normal people’s blood pressure fluctuates between 20-30 mmHg throughout the day, and the fluctuations are greater in the elderly.
In fact, normal people’s blood pressure fluctuates every day, blood pressure is a dynamic balance, like the tide every day, there is a rise and fall, not a fixed value, but within a certain range of up and down, we measure the blood pressure is calm, quiet rest half an hour after the blood pressure value. Therefore, the drinking of alcohol in life (a short period of time after drinking alcohol blushing and expanding blood vessels is a temporary reduction in blood pressure, the total long-term impact on the human body is to raise blood pressure.) The blood pressure can be increased by mood swings, mental tension, and exertion. If you take antihypertensive drugs for a long time blood pressure control is normal, accidentally found that there are temporary factors leading to increased blood pressure, if it is not too serious, you can not add drugs, first observe two or three weeks, if it is persistently elevated, we must analyze the causes of elevated blood pressure, to eliminate it can make the blood pressure back to normal; if not back to normal, this time is not the first to add antihypertensive drugs, but should check the body, to see if there is a new body If the blood pressure does not return to normal, then instead of adding antihypertensive medication, we should check the body to see if there are new lesions in the body that affect the blood pressure, such as blood lipids, elevated blood sugar, poor kidney function, etc. If your blood pressure is too high and you feel uncomfortable, it is best to go to the hospital to find a doctor to adjust the medication, with herbal treatment can improve the symptoms, but will not lead to excessive fluctuations in blood pressure.
Sometimes the blood pressure you measure is not too accurate, so if you want to change the dosage of antihypertensive drugs, you should find a doctor to determine. High blood pressure damage to the human body is a chronic process of decades, unless the blood pressure is suddenly too high, or there is a heart disease or a hemangioma in the body, high blood pressure will cause accidents to the human body. General blood pressure even if there are fluctuations, a little higher will not lead to serious damage to the human body, so do not be too afraid.
7, pay attention to seasonal changes: and the impact of life factors on blood pressure.
Generally speaking, the hot weather in summer, the human body vasodilation, blood pressure will be reduced, plus, summer sweating, the body more salt excretion, water reduction, will also lead to lower blood pressure. Long-term antihypertensive drugs for hypertensive patients have this experience, after the spring, into the summer will find blood pressure gradually reduced, if less than 110/70mHg can be under the guidance of doctors to reduce the amount of antihypertensive drugs; and into the winter, due to the cold weather sympathetic excitation of the human body, resulting in skin vasoconstriction, will lead to an increase in blood pressure. If blood pressure in the season appears too much change should find the doctor to adjust the amount of antihypertensive drugs, the appropriate increase or decrease the amount of antihypertensive drugs to maintain blood pressure in the normal range. Smoking, drinking, exertion, emotional stress, nervousness, insomnia, and lack of exercise are all factors that cause blood pressure to fluctuate in the short term. After analyzing the causes of high blood pressure in life and eliminating them, blood pressure can return to normal. However, the factors that lead to high blood pressure in life such as smoking, drinking alcohol, long-term mental stress, overwork, emotional excitement, mood is difficult to stabilize, insomnia, lack of exercise, etc. long-term failure to improve and control, will affect the effect of antihypertensive drugs, thus making it difficult to restore blood pressure to the normal range.
8, pay attention to the application of drugs with other prevention of cardiovascular and cerebrovascular disease risk factors.
The purpose of treating hypertension is to prevent the occurrence of cardiovascular disease (such as hemiplegia, angina pectoris, etc.), however, there are various causes of cardiovascular disease, hypertension is only one of them. Smoking, obesity, especially abdominal obesity, diabetes, high blood lipids, atherosclerotic plaques, and elevated homocysteic acid are all risk factors for cardiovascular disease, and are often associated with hypertension. Under such circumstances, some patients still think that hypertension can be treated by taking antihypertensive drugs, and they will not get hemiplegia or coronary heart disease. In fact, this is not possible. Even if the blood pressure is well controlled, if the above factors are not treated, there is still a risk of hemiplegia, coronary artery disease and other cardiovascular diseases, so it is necessary to treat all these risk factors with medication under the guidance of the doctor and to carry out comprehensive prevention in order to achieve good results. For example, if severe atherosclerosis is detected by carotid ultrasound or fundus radiograph, we should combine with lipid-lowering drugs, as well as herbal medicines to activate blood circulation and remove blood stasis and phlegm. In addition, Chinese and Western medicines should be used to dilate blood vessels and improve blood supply to the heart and brain. Pay attention to the comprehensive use of drugs, in order to well prevent the occurrence of cardiovascular and cerebrovascular disease.
9, the correct measurement of blood pressure, in order to ensure that the blood pressure is stable.
A good number of patients at home to measure blood pressure incorrect method, the measured blood pressure value will be inaccurate, based on this adjustment of antihypertensive drugs will lead to abnormal blood pressure. How to correctly measure blood pressure? The hospital commonly uses mercury tabletop sphygmomanometer (generally do not use electronic sphygmomanometer). The patient should rest quietly for at least 15 minutes, with the right arm fully exposed and the sphygmomanometer placed at the level of the heart. The cuff is tied around the elbow at two horizontal fingers and is tightened to fit one finger. The brachial artery pulsation can be felt by touching the inside of the elbow with the fingers, and the stethoscope is placed at the pulsation (do not tuck it into the cuff, and do not press the cuff). Open the valve of the sphygmomanometer with the mercury column at 0. Close the valve of the balloon and pressurize the balloon. Listen for a thumping sound on the stethoscope while pressurizing. When the sound disappears, pressurize 20 mm Hg. Slowly release the valve of the balloon, the mercury column will fall, and listen to the thumping sound at a rate of 2 mm Hg per second. The value of the mercury column at the first sound is the systolic pressure, and the value at the last sound disappears is the diastolic pressure. The blood pressure should be measured again as described above, and the average of the two values is the blood pressure value for this time.
Hospital sphygmomanometer is generally a technical supervision bureau calibration once a year, if you are using electronic sphygmomanometer measured at home, you can compare with the doctor’s sphygmomanometer to see if there is no error.
1, will turn on the switch of the mercury column, so that the sphygmomanometer’s mercury column deflated after the liquid level back to 0 position.
2, the preparation of the patient before the measurement of blood pressure. The patient should be in a quiet state to measure the patient’s blood pressure, keep the spirit relaxed, calm and emotionally stable. If the patient has just ridden a bicycle or just walked up the stairs, etc., the blood pressure will be measured immediately, and the blood pressure reading will be elevated. In this case, the patient should rest for 10-15 minutes before taking the blood pressure, and it should be noted that the patient should not change position five minutes before taking the blood pressure. At the same time, do not smoke or eat half an hour before the blood pressure measurement, do not hold urine, and also note that tension, anxiety, pain, fatigue, excessive cold, excessive heat and other conditions can affect the blood pressure and should be avoided.
3, the cuff should be wrapped loosely and tightly to be able to put a finger as the standard, the lower edge of the cuff should be in the elbow bend two horizontal fingers, the stethoscope’s listening head should be placed in the right place, should be placed on the elbow bend of the upper arm on the lower edge of the medial cuff, do not press in the cuff. The limb being measured, the heart and the sphygmomanometer should be at the same level. Then inflate, and after the sound of a thumping heartbeat is not heard, then inflate so that the mercury level of the sphygmomanometer rises by 20 mmHg, then deflate, dropping 2 mmHg each time. When the pressure inside the air cuff is equal to or slightly lower than the systolic pressure, the sphygmomanometer reading corresponding to the first sound heard is the systolic pressure (commonly known as high pressure), and during the period when the pressure inside the air cuff is lower than the systolic pressure and higher than the diastolic pressure The blocked blood flow in the brachial artery of the upper arm begins to be restored, and deflation continues. During the period when the pressure in the air cuff is lower than the systolic pressure and higher than the diastolic pressure, an arterial beat sound can be heard for each contraction of the heart. When the pressure inside the cuff is equal to or slightly lower than the diastolic pressure, the blood flow is smooth again and the vortex disappears, then the sound suddenly decreases and disappears soon, and the sphygmomanometer reading corresponding to the last arterial beat sound before the sound disappears is the diastolic pressure. When the sound is not heard, it is the diastolic pressure (low pressure).
4, the blood pressure of the two upper arms is not the same, the blood pressure of the right upper wall should prevail.
5, each time the blood pressure should be measured 2-3 times, 1-2 minutes between each time, each time after the measurement to put the mercury column of the mercury to the scale zero and then re-test, take the average as the current blood pressure level.