Antihypertensive treatment with complications and comorbidities

  I. Cerebrovascular disease: In patients who have had a stroke, the purpose of antihypertensive treatment is to reduce the occurrence of another stroke. Patients with hypertension combined with cerebrovascular disease cannot tolerate too fast or too large a drop in blood pressure, the pressure receptor sensitivity is reduced, and postural hypotension is likely to occur, so the process of lowering blood pressure should be slow and steady, preferably without reducing cerebral blood flow, and ARB, long-acting calcium antagonists, ACEI or diuretics can be chosen ARB, long-acting calcium antagonist, ACEI or diuretic can be chosen. Note that starting with a small dose of a single drug, and then slowly increasing the dose or combination therapy.  Second, coronary heart disease: hypertension combined with stable angina pectoris antihypertensive treatment, should choose beta-blockers and long-acting calcium antagonists; patients who have had myocardial infarction should choose ACEI and beta-blockers to prevent ventricular remodeling. Long-acting agents should be used whenever possible to reduce blood pressure fluctuations and control 24-hour blood pressure, especially early morning blood pressure.  Third, heart failure: hypertension combined with asymptomatic left ventricular insufficiency of antihypertensive treatment, should choose ACEI and β-blockers, pay attention to start with small doses, in patients with symptoms of heart failure, should use ACEI or ARB, diuretics and β-blockers combined treatment.  IV. Chronic renal failure: ACEI or ARB can delay the deterioration of renal function in the early and middle stages.  Diabetes: Diabetes and hypertension are often combined, and the prevalence of hypertension reaches 70%-80% when the kidney is damaged. type 2 diabetes often coexists with hypertension early. Most patients with diabetes combined with hypertension often have obesity, lipid metabolism disorders and more serious target organ damage, belonging to a high-risk group of cardiovascular risk, about 80% of patients die from cardiovascular and cerebrovascular disease. In order to achieve the target level, a combination of 2 or more antihypertensive drugs, ARB or ACEI, long-acting calcium antagonists and low-dose diuretics is a reasonable choice. ACEI or ARB can effectively reduce and delay the progression of diabetic nephropathy and improve glycemic control.