This morning, a 58-year-old woman came to my clinic. She reported that she has been using a certain antihypertensive drug for 3 years for hypertension and came here today specifically to change her medication. I looked at her previous examination and found that there were no complications and her blood pressure was maintained reasonably well. I asked her, “Your blood pressure is basically under control, why do you want to change your medication? She said, “I was told that one antihypertensive drug must be changed after 3 years at most, and if it is not changed, it will become resistant. They also said that you can’t start with a good drug, otherwise there will be no more drugs available if your blood pressure gets higher. I immediately told her that she should not listen to what she was told when she came to the doctor, and that what you were told was all wrong.
There are many patients who hold such misconceptions in the clinic like this sister, and there are more than just these misconceptions.
Myths
If you don’t feel bad, you don’t need antihypertensive medication;
The antihypertensive drugs can not be used casually, once used, can not be stopped (fear of drug dependence);
Stop taking antihypertensive drugs when blood pressure is normal and take them again when blood pressure is high (use drugs as needed).
Long-term use of antihypertensive drugs has side effects (choking);
Antihypertensive drugs damage the kidneys (fear of damaging the kidneys as well as sexual function).
……
Many people are misled by these misconceptions, blood pressure is not controlled and complications cannot be avoided. When hypertension is not controlled for a long time (usually 5 to 10 years), complications such as heart attack, brain infarction, brain hemorrhage, and kidney failure will occur, which not only shorten a person’s life span, but also reduce the quality of life. It can be said that hypertension is not terrible, what is terrible is its complications. Therefore, there are three key words for treating hypertension: know, treat, and meet the standard.
Know
Know if you have hypertension, systolic blood pressure ≥ 140mmHg and/or diastolic blood pressure ≥ 90mmHg is hypertension;
Treatment
Treatment is necessary when hypertension is present, so when to start treatment? For people aged <60 years, pharmacological antihypertensive treatment should be initiated whenever hypertension is present; for people aged ≥60 years, pharmacological antihypertensive treatment should be initiated for systolic blood pressure ≥150 mmHg and/or diastolic blood pressure ≥90 mmHg.
Achieving the standard
Not only to treat, but also to achieve the treatment goal. In hypertensive patients <60 years of age, a systolic blood pressure <140 mmHg and diastolic blood pressure <90 mmHg is considered to be attainment; in hypertensive patients ≥60 years of age, a systolic blood pressure <150 mmHg and diastolic blood pressure <90 mmHg is considered to be attainment.
I have always told patients that treating hypertension is like treating myopia. If your eyes are nearsighted, just get a pair of glasses to correct them normally, which does not affect your work or your life. If you don’t wear glasses when your eyes are nearsighted, you can only live a semi-blind life.
The first-line antihypertensive drugs recommended by the current hypertension treatment guidelines include four categories: diphenhydramine (CCB), sartan (ARB), priligy (ACEI), and diuretics. Generally speaking, the principles of antihypertensive medication say: individualized medication, using long-acting drugs, combined medication, on-time medication, lifelong medication, etc.
To summarize.
1, not uncomfortable also need to use drugs: hypertension is a gradual occurrence, the symptoms of hypertension is like a frog boiled in warm water, the beginning may be a little uncomfortable, but no feeling after a long time. However, no feeling is not the same as no harm, and so on the occurrence of heart attack, brain infarction, brain hemorrhage felt when it may be too late. Therefore, hypertension guidelines summarize a large number of cases to develop the value of the beginning of the lowering of blood pressure, regardless of whether there is no feeling should be used drugs.
2, hypertension requires lifelong treatment: the formation of hypertension is the result of a combination of genetic and environmental factors, and is irreversible, lifelong disease, so antihypertensive drugs should be used for life. Not antihypertensive drugs have dependence, but a lifelong disease requires lifelong drug treatment.
3, the highest level of antihypertensive treatment is a stable antihypertensive: high blood pressure medication, blood pressure normal stop medication, this practice of using drugs on demand is very wrong, often leading to blood pressure fluctuations, and heart attacks, brain attacks and other complications often occur when the blood pressure is unstable. Normal blood pressure is the result of medication, and when you stop the medication your blood pressure of course bounces back. Taking the medication on time can maintain a constant concentration of the drug in the blood to maintain a relatively constant blood pressure, and it is generally recommended to take it orally in the morning on an empty stomach. Amlodipine (representative drug Loxodil), sartan, and priligy are all long-acting drugs, which can be taken once a day. In order to enhance the antihypertensive effect and reduce side effects, often need to combine drugs, commonly known as “add variety not quantity”.
4, undeniably, no drug can avoid side effects. However, these types of first-line drugs do have the side effects controlled very little. Furthermore, the side effects of antihypertensive drugs are minimal compared to the dangers of hypertension, worrying about side effects and not using drugs to control blood pressure, is not choking on food?
5, the folk on the antihypertensive drugs damage the kidneys of a long time and very stubborn, where the “kidneys” also implies the meaning of male sexual function. First of all, hypertension can cause kidney damage and accelerate the deterioration of kidney function, which is already common medical knowledge, control blood pressure is the most important measure to protect kidney function (kidney protection), sartan, Pulley class, diphenhydramine class by controlling blood pressure have the role of kidney protection, especially the first two are the first choice of drugs for chronic kidney disease; secondly, hypertension leads to atherosclerosis is one of the main causes of organic erectile dysfunction, lowering blood pressure, treatment Arteriosclerosis is also the main measure to treat male sexual dysfunction. In short, “kidney” is high blood pressure injury, not antihypertensive drugs.
6, finally, the sister’s misconceptions. In general, the control of infection can not be the first to use high-level antimicrobial agents, because once drug resistance occurs, there will be no drugs available. The antibiotic is not an antimicrobial, the object of the antimicrobial is the living bacteria, bacteria through mutation and their own transformation to escape the antimicrobial kill. But antihypertensive drugs work on the receptor, which does not mutate and does not transform itself, so there is no situation like antimicrobial resistance. The so-called good drugs are not only effective in lowering blood pressure with few side effects, but also have a strong protective effect on the heart, brain, kidneys and other organs, so choose the antihypertensive drug, which is good, which one to choose. In addition, if the blood pressure is well controlled, stick with it for a long time, there is no justification for changing a drug in three years.