Hypertension can be considered a chronic disease “giant”, but misconceptions about hypertension still abound in our lives, and some are not even clear about the goals of standardized treatment for hypertension. It is not known that the treatment of hypertension also has its own unique criteria.
The principles of hypertension treatment include attainment, stabilization, and comprehensive management, but because hypertension can occur in all types of populations, there are large individual differences in treatment goals.
1.According to the different populations, different treatment goals can be reasonably established
Middle-aged and elderly patients with hypertension
Although the trend of hypertension patients in other age groups is on the rise, the main group of people suffering from hypertension disease is still the middle-aged and elderly. Among them, hypertensive patients aged 65-79 years with blood pressure ≥140/90 mmHg need to be lowered to <140/90 mmHg by initiating antihypertensive drug therapy along with lifestyle interventions.
Hypertensive patients aged 80 years and older with blood pressure ≥150/90 mmHg need to first lower their blood pressure to achieve the target, regardless of the treatment modality, and should lower their blood pressure to below 150/90 mmg. In well-tolerated patients, the blood pressure can be further lowered to <140/90 mmHg.
Children and adolescents with hypertension
Hypertension can also occur in children or adolescents. The goals of treatment for hypertension in these patients, due to their relatively young age, include controlling blood pressure levels, reducing target organ damage, and reducing the risk of hypertension and its associated cardiovascular disease in adulthood. The target value for blood pressure control needs to be closer to the value of normal blood pressure than in middle-aged or older patients with hypertension, and lowering blood pressure to <120/80 mmHg is usually recommended.
Other patients with hypertension
In addition to the two common types of hypertension mentioned above, life also includes other types of hypertensive patients, such as those with hypertension during pregnancy.
For pregnant women, hypertension during pregnancy can easily lead to serious conditions such as cerebrovascular accident, left heart failure, and even systemic multi-organ failure. For the fetus, it may lead to insufficient placental blood supply and placental hypofunction, which may cause abnormalities such as placental abruption or fetal growth retardation, requiring active blood pressure control.
2, some combined with other diseases, such as diabetes and other people’s treatment goals
The difference in treatment goals for hypertensive patients is not only reflected in the age difference, but also the difference in other conditions of patients, which can also affect the treatment goals of patients. For example, if a patient with hypertension has other comorbidities, the goals of treatment may change, which brings us to another “giant” of chronic diseases, diabetes.
It is not uncommon to see patients with hypertension combined with diabetes, which is a disorder of carbohydrate and protein metabolism caused by absolute or relative insufficiency of insulin secretion or impairment of insulin utilization in human body.
For patients with hypertension combined with diabetes mellitus, UNITED recommends a blood pressure target of 130/80 mmHg.
Because hypertension is good at “hiding” in the early stages, and rarely causes patients to have obvious discomfort in the early stages, many patients do not pay enough attention to the scientific treatment of hypertension and the significance of long-term treatment, and always believe that hypertension is not life-threatening. However, this view needs to be corrected in time, and it is necessary for both patients and their families to learn to prevent and treat hypertension scientifically.
References
[1] Expert Committee on Hypertension of the Chinese Association for the Promotion of Chinese and Western Medicine Research and Prevention of Cardiovascular Diseases, Beijing Hypertension Prevention Association, China Hypertension Alliance, et al. Expert recommendations on the key points of clinical diagnosis and treatment of special types of hypertension.2020.
[2]Wu Lin-Lin,Zhou Xin,Niu Jian-Min. Hypertensive disorders in pregnancy: interpretation of the International Society for the Study of Hypertension in Pregnancy Guidelines for Classification, Diagnosis and Management (2018)[J]. Chinese Journal of Practical Gynecology and Obstetrics,2018,34(7):6.
[3]Bureau of Disease Prevention and Control, National Health Care Commission, Editorial Board of Chinese Journal of Cardiovascular Diseases, National Center for Cardiovascular Diseases, et al. Chinese health management norms for hypertension (2019)[J]. Chinese Journal of Cardiovascular Diseases,2020,048(001):10-46.