high blood pressure



OVERVIEW

What is hypertension?

Definition

Hypertension is a clinical syndrome in which the systolic and/or diastolic blood pressure in the arteries of the body circulation is abnormally elevated due to various causes or factors.

China’s diagnostic criteria for hypertension in adults are systolic blood pressure ≥140mmHg and/or diastolic blood pressure ≥90mmHg measured three times on non-simultaneous days without the use of antihypertensive medication, which is referred to as hypertension.

Currently, there are also different voices in the academic community, in which the diagnostic criteria recommended by the 2022 Chinese Clinical Practice Guidelines for Hypertension are that, without the use of antihypertensive medication, 3 measurements of blood pressure not on the same day with a systolic blood pressure ≥130 mmHg and/or a diastolic blood pressure ≥80 mmHg is referred to as hypertension [1].

Classification and staging

Grading according to systolic and/or diastolic blood pressure values

It can be categorized as prehypertension, grade 1 hypertension (mild), grade 2 hypertension (moderate), grade 3 hypertension (severe), and simple systolic hypertension. The details are listed in the table below.

Normal high blood pressure

120～139

and/or

80～89

Grade 1 hypertension (mild) 140 to 159 and/or 90 to 99

Grade 1 hypertension (mild)

140～159

and/or

90～99

Grade 2 high blood pressure (moderate) 160～179 and/or 100～109

Grade 2 hypertension (moderate)

160～179

and/or

100～109

Grade 3 hypertension (severe) ≥180 and/or ≥110

Grade 3 hypertension (severe)

≥180

and/or

≥110

Systolic hypertension alone ≥140 and <90

Systolic hypertension alone

≥140

and

<90

Classification by age at presentation

Hypertension in children and adolescents.

Hypertension during pregnancy.

Hypertension in middle-aged and young adults.

Hypertension in the elderly.

Classification according to cause

Primary hypertension: the cause of the disease is unknown, and is related to obesity, less exercise, stress, smoking, dietary patterns, heredity, age and other factors.

Secondary hypertension: often secondary to renal disease, endocrine disease, cardiovascular disease, craniocerebral disease and other diseases, or pregnancy, drugs and other factors.

Morbidity

The China Hypertension Survey (2012~2015) found that the crude prevalence of hypertension among Chinese residents over 18 years of age was 27.9%, and the projected estimated number of adults over 18 years of age with hypertension in China was 245 million.

Data from a national survey in 2018 showed that the proportion of adults aged 18 years and older in China with systolic blood pressure of 130~139 mmHg and/or diastolic blood pressure of 80~89 mmHg amounted to 23.2%, with an estimated total of nearly 243 million people, and that the population in this blood pressure range is mainly young and middle-aged people aged 18~54 years .

Questions you may be concerned about

What medications are used to treat high blood pressure?

These include diuretics such as hydrochlorothiazide, beta-blockers such as metoprolol, calcium channel antagonists (CCBs) such as nifedipine, angiotensin-converting enzyme inhibitors (ACEIs) such as fosinopril, and angiotensin II receptor blockers (ARBs) such as valsartan.

Usually medication is started with a smaller effective dose and gradually increased. Preference is given to long-acting antihypertensive medications, given once a day if possible, and lasting up to 24 hours. When monotherapy is not effective, a combination of drugs or a combination of preparations may be used. Compound preparation refers to the mixed preparation made of two or more drugs, commonly available are compound valsartan amlodipine tablets, compound amlodipine Benadryl tablets, compound timosartan hydrochlorothiazide tablets and so on.

What is better to eat when I have high blood pressure?

Diet is based on fruits, vegetables, low-fat dairy products, whole grains rich in edible fibers, and proteins from plant sources, and reduce the intake of saturated fats and cholesterol.

From the perspective of Traditional Chinese Medicine (TCM), appropriate dietary regimen according to different body types can balance the yin and yang, which is also helpful in the prevention and treatment of hypertension. Therefore, one can consult a Chinese medicine practitioner for individualized dietary guidance through his/her diagnosis.

How can hypertensive patients exercise?

If the physical condition of hypertensive patients allows, in addition to daily life activities, it is recommended that they should exercise at moderate intensity (e.g. walking, jogging, bicycling, swimming, etc.) for a cumulative total of 30-60 minutes per day, four to seven days per week.

Exercise intensity should be judged according to the patient’s specific condition. Patients with high risk factors such as myocardial infarction and cerebral hemorrhage need to consult a doctor before exercising and exercise after careful evaluation.

Moderate exercise intensity refers to exercise with a maximum heart rate of (220-age)*60% to 70%.

Is there a certain food that is the nemesis of high blood pressure?

There is no food that can cure high blood pressure, so there is no such thing as a high blood pressure nemesis.

Hypertensive patients need to improve their living habits according to their blood pressure, appropriate exercise, low-salt and low-oil diet, and patients with grade 2 or above hypertension need to cooperate with relevant medication, which should be prescribed by doctors and should not be self-medicated.

Is Danshen Tablet effective in treating hypertension?

Danshen tablets are not generally used in the treatment of hypertension, but patients with hypertension combined with coronary heart disease, angina pectoris, belonging to the type of blood stasis and obstruction, can be taken under the guidance of a doctor, can improve chest tightness, chest pain and other discomforts.

Danshen Tablet is a kind of Chinese patent medicine, the main effect is to activate blood circulation and eliminate blood stasis, used for the treatment of chest paralysis caused by blood stasis obstruction, manifested as chest pain, fixed pain, purple and dark tongue, and angina pectoris in coronary heart disease, see the above symptoms, but there is no blood pressure lowering effect, and it can’t be used as the main medication for high blood pressure. Also note that pregnant women and allergies should be used with caution.

Causes

Causes

Primary hypertension

The cause of essential hypertension is not clear. The following factors may increase the risk of developing the disease.

Body weight

Obesity or overweight: BMI (body mass index) greater than or equal to 24 kg/m2 (kilograms per square meter), or waist circumference greater than or equal to 90 centimeters for men and 85 centimeters for women.

Less active lifestyle

Sedentary, cerebral work, less or almost no exercise.

Stress

Chronic mental state of stress, anxiety, anger, panic, depression, high stress, or irregular work and rest.

Smoking

Chronic active or passive smoking.

Diet

Chronic high sodium, low potassium diet: excessive salt intake in the diet.

Alcoholism: chronic heavy drinking.

Genetic factors

Relatives with primary hypertension.

Age factor

The older the person is, the higher the risk of developing the disease.

Other chronic diseases or abnormal states

Diseases such as diabetes mellitus, hyperlipidemia, and chronic hyperglycemia and/or hyperlipidemia increase the risk of developing the disease.

Poor blood pressure control

Individuals with chronic systolic blood pressure of 120 to 139 mmHg and/or chronic diastolic blood pressure of 80 to 89 mmHg are at higher risk of developing the disease.

Secondary hypertension

Secondary hypertension often has a well-defined primary disease or factor.

Primary Diseases

Renal disease: e.g. glomerulonephritis, renal artery stenosis, etc.

Endocrine diseases: Cushing’s syndrome, pheochromocytoma, primary aldosteronism, hyperthyroidism, menopausal syndrome, etc.

Cardiovascular diseases: such as aortic insufficiency, etc.

Craniocerebral diseases: such as brain tumor, traumatic brain injury, etc.

Other diseases: such as sleep apnea syndrome, erythrocytosis, etc.

Drug factors

Such as glucocorticoids, sympathomimetic drugs, Chinese medicines containing licorice, etc.

Other factors

Such as pregnancy [2].

Symptoms

In most cases there are no obvious symptoms or only high blood pressure.

In some cases, the elevated blood pressure is only noticed after the development of complications, or the symptoms are only apparent.

Main Symptoms

Elevated blood pressure.

Headache, head swelling, hooded feeling: may return after blood pressure returns to normal.

Vertigo: feeling of spinning oneself, rotation of objects around one’s body, and unsteadiness in standing.

Nosebleed: sudden nosebleed in the absence of trauma.

Facial flushing.

Neck Tightness: stiffness and tightness at the back of the neck.

Weakness.

Palpitations: manifested by feeling a rapid heartbeat, etc.

Tinnitus: Abnormal sounds such as buzzing and cicadas can be heard, but such sounds are not present in the environment.

Blurred vision: a sudden feeling of not being able to see.

The above symptoms may be triggered or aggravated by factors such as emotional stress, insomnia, and fatigue.

Other symptoms

In secondary hypertension, the corresponding symptoms of the primary disease may be present at the same time.

If suffering from renal disease, oliguria, lumbago, hematuria, facial edema and other symptoms may also appear.

If you suffer from endocrine disease, you may also have symptoms such as agitation, anterior calf edema, palpitations, emaciation, and fatigue.

If suffering from cardiovascular disease, palpitation, chest tightness and other symptoms may also occur.

If suffering from craniocerebral disease, headache, projectile vomiting and other symptoms may also occur.

If suffering from sleep apnea syndrome, symptoms such as sudden pauses in breathing during sleep at night, dizziness, weakness and drowsiness after waking up in the morning can also occur [3].

Complications

Primary hypertension can cause vascular lesions throughout the body, resulting in complications such as cerebrovascular disease, coronary artery disease, heart failure, hypertensive nephropathy, hypertensive retinopathy, and aortic coarctation.

Cerebrovascular disease

Cerebrovascular disease includes cerebral hemorrhage, cerebral infarction, cavernous cerebral infarction, transient ischemic attack and so on. The following symptoms may occur.

Severe headache.

Severe vomiting.

Slurred speech.

Hemiplegia: loss of muscle strength in one limb.

Facial paralysis: decrease in muscle strength of one or both sides of the face, with crooked corners of the mouth, puffed cheeks and leakage of air.

Impaired consciousness: manifested by unresponsiveness, drowsiness (not easy to wake up after falling asleep), coma (loss of consciousness).

Coronary heart disease and heart failure

Long-term chronic hypertension leads to abnormal function of coronary arteries and heart, causing coronary heart disease and heart failure, etc. The following symptoms may appear.

Chest pain: It may manifest as crushing pain, i.e. the feeling of a heavy object pressing on the chest. It can be accompanied by pain in the back, upper abdomen, left upper arm, teeth, and numbness in the left arm.

Chest tightness.

Edema: Most often appears first in the lower limb areas such as feet and calves, and depressions may appear after pressing. In severe cases, generalized edema may appear.

Dyspnea: may be manifested as shortness of breath; or dyspnea when lying down and relieved when sitting up.

Hypertensive nephropathy

Long-term hypertension leads to decreased renal function and chronic renal failure, which can present the following symptoms.

Increased urine output: under the condition that the amount of drinking water and sweating remain unchanged, the daily urine output is significantly higher than before. Some of them may show increased urine volume at night.

Proteinuria: foam in the urine.

Oedema: mostly on the face and other parts of the body first, and in severe cases, generalized oedema may appear.

Decreased urine output: under the condition that the amount of drinking water and sweating remain unchanged, the amount of urine per day is significantly reduced or almost absent than before. Most often appear in renal failure is severe.

Hypertensive retinopathy

Chronic high blood pressure causes retinopathy, which can present with the following symptoms.

Blurred vision.

Hemorrhages in the fundus of the eye.

Aortic dissection

Aortic dissection is a serious vascular disease, which is often urgent and critical, and may present with the following symptoms.

Severe chest pain: this is often sudden and may occur in the front and/or back of the chest. The pain is tearing, cutting and unbearable.

Large difference in blood pressure: there is a significant difference between the blood pressure of the upper and lower extremities bilaterally, with a large difference in the values.

Consultation

Department of Medicine

Cardiovascular Medicine

The presence of elevated blood pressure, dizziness, headache, palpitations, hemiparesis, edema, blurred vision, increased or decreased urine output, urinary protein, facial edema, etc., prompt consultation is recommended.

Emergency Department

For symptoms such as severe headache, severe vomiting (especially projectile), slurred speech, hemiparesis, impaired consciousness, severe chest pain, crushing or tearing pain in the chest and/or chest tightness, and difficulty in breathing, it is recommended to go to the Emergency Department or call 120 emergency immediately.

Preparation for medical treatment

Preparation for medical consultation: registration, preparation of documents, frequently asked questions

Tips for seeking medical treatment

Do not abuse drugs without doctor’s permission, so that the drugs will not affect the relevant examinations and interfere with the diagnosis and treatment of the disease.

Preparation List

Symptom list

Pay particular attention to the time of onset of symptoms, special manifestations, etc.

What is the discomfort? How long has the discomfort lasted?

Are there any symptoms such as headache, dizziness, hooded feeling, blurred vision, etc.?

Are there any symptoms such as fatigue, palpitations, etc.?

Is there any noticeable change in urine output?

When did these symptoms become more noticeable?

When did the symptoms start to appear?

Medical History Checklist

Has blood pressure been measured in the past? Is the blood pressure higher than normal?

What previous illnesses have you had?

Any kidney disease, endocrine disease, cardiovascular disease, etc.?

Any relatives with primary hypertension?

What medications have you taken recently?

Are there any allergic foods or medications?

Have you had any previous checkups? What are the results?

Have you had any treatment? What kind of treatment? What is the effect of the treatment?

Checklist

Results of the last six months, which you can bring with you to the doctor’s office

Blood biochemistry

Routine blood test

Urine routine

24-hour urine protein quantification

Echocardiogram

Head CT and/or head magnetic resonance imaging (MRI)

Adrenal gland and renal artery ultrasound

Ambulatory blood pressure monitoring

Electrocardiogram

List of medications used

Medication use in the last 3 months, if available in boxes or packages, carry to doctor’s appointment

Diuretics: hydrochlorothiazide, furosemide, spironolactone

Beta-blockers: metoprolol, bisoprolol, carvedilol, propranolol

Calcium channel antagonists (CCB): nifedipine, verapamil, diltiazem

Angiotensin II receptor antagonists (ARBs): chlosartan, valsartan, irbesartan

Lipid regulating drugs: simvastatin, atorvastatin

Diagnosis

Diagnosis is based on

Medical history

Chronic high sodium and low potassium diet.

Alcoholism.

Obesity or overweight.

Chronic stress and poor psychological state.

Elderly.

Relatives who have primary hypertension.

Less physical activity.

Smoking or frequent exposure to “second-hand smoke”.

Have sleep diabetes, hyperlipidemia, kidney disease, endocrine disease, cardiovascular disease, apnea syndrome and other diseases.

Previously had a blood pressure of 120-139 mmHg systolic and/or 80-89 mmHg diastolic for a long period of time.

Women in pregnancy.

Use of drugs such as glucocorticoid glucocorticosteroids, sympathomimetic drugs, and herbal medicines containing licorice components.

Clinical manifestations

There is elevated blood pressure measured at home by self-measurement or in the office, with dizziness, headache, and blurred vision.

There may be limb weakness, lower extremity edema, and abnormal sounds on cardiac auscultation.

Laboratory Tests

Routine blood tests

Check white blood cell count, neutrophil count, red blood cell count, platelet count, and hemoglobin concentration.

Other diseases can be excluded.

Blood biochemistry

Test liver function, kidney function, fasting blood glucose, blood sodium ions, potassium ions, total cholesterol, triglycerides, HDL cholesterol, LDL cholesterol, cardiac enzymes, homocysteine and so on.

It can clarify the cause of the disease, the severity of the disease, prepare for treatment, or exclude other diseases.

Precautions: Fasting is required before the test, i.e., 6 hours of fasting and 4 hours of water fasting; no fasting is required for emergency tests.

Urine Analysis

Detect protein, glucose, sediment, etc. in urine.

It can clarify the cause of the disease, the severity of the disease or exclude other diseases.

Precautions: The test should be retained in the middle part of the urine, i.e., a part of the urine should be discharged first, and then the urine after that should be left in the urine cup, stop urinating when it is not completely discharged, and drain the remaining urine in the body after removing the urine cup.

24-hour urine protein quantification

It can test kidney function and clarify the cause and severity of the disease.

Precautions: Use a clean container to retain the urine for 24 hours and measure the volume of urine; use a clean container such as a urinary catheter provided by the hospital for extraction.

Hormone Levels

Test specimens include urine and blood for thyroxine, renin, angiotensin, aldosterone, adrenocorticotropic hormone, and catecholamines.

The cause can be clarified or secondary hypertension caused by other factors can be ruled out.

Imaging

Echocardiography

Detect the structure and function of the heart, with or without hypertrophy and enlargement of the left ventricle.

It can clarify the severity of the disease, etc.

Precautions:

Expose your chest as requested by your doctor before the examination.

A gel will be applied to the skin at the examination site. Generally, the gel does not damage the skin.

Keep in a fixed position and avoid moving around during the examination as requested by the doctor.

The gel may be removed with a tissue after the examination.

Head CT and/or Head Magnetic Resonance Imaging (MRI)

Check for the presence of cerebrovascular and brain lesions, which can clarify the presence of complications.

Precautions:

Remove jewelry or metal objects, such as necklaces, from the exam area before the CT exam, and remove clothing with metallic materials.

Before MRI examination, items containing metal materials should be removed, as well as electronic products, magnetic cards, etc.; if there are metal dentures, steel plates in the body, implantable pacemakers and other medical devices, the doctor should be informed in advance.

Ultrasound of adrenal glands and renal arteries

The structure and function of the kidneys and adrenal glands, and the renal arteries can be examined.

Secondary hypertension can be clarified or excluded.

Precautions:

Expose the lower back as requested by the doctor before the examination.

A gel will be applied to the skin at the examination site. Generally, the gel is not damaging to the skin.

Keep in a fixed position and avoid moving around during the examination as requested by the doctor.

The gel can be removed with a tissue after the examination.

Ambulatory Blood Pressure Monitoring

Measurement of blood pressure for 24 hours. It can clarify the changes in blood pressure and the relationship with time and daily behavior.

It can provide a basis for diagnosis and development of treatment programs.

Precautions:

Tie the cuff and carry the instrument according to the doctor’s requirements during the examination.

If the cuff falls off during the examination, it should be tied in time according to the doctor’s requirements, and avoid damaging the instrument by bumping it when moving around. If the instrument malfunctions, you should go to the hospital in time to be adjusted by the doctor.

During the examination, it is enough to carry out the necessary activities of daily life, avoid deliberately increasing the time of exercise or inactivity, and avoid taking a bath.

Go to the hospital at the time specified by the doctor to terminate the examination.

Electrocardiogram

It is possible to check the electrical signals of the heart.

Electrocardiogram can detect myocardial hypertrophy.

Precautions:

Avoid strenuous exercise and emotional excitement before the examination, remove electronic devices and bracelets from your body.

Expose the skin of the forehead, bilateral wrists and ankles during the examination, position yourself according to the doctor’s requirements, maintain even breathing and avoid movement.

Fundus examination

By checking the condition of blood vessels and retina in the fundus.

The damage to the fundus caused by high blood pressure can be clarified.

Sleep monitoring

Measure the respiratory rate, heart rate, blood pressure and peripheral oxygen saturation during sleep.

It can determine whether sleep apnea syndrome exists and provide information for clarifying the etiology [3].

Diagnostic criteria

Hypertension can be diagnosed by meeting any of the following.

Three blood pressure measurements on non-same day in the clinic with systolic blood pressure greater than or equal to 140 mmHg and/or diastolic blood pressure greater than or equal to 90 mmHg.

Previous hypertension controlled with antihypertensive medication although the blood pressure is within the normal range [1].

Differential diagnosis

Hypertension must first be identified as primary or secondary hypertension, and secondary hypertension must have a clear etiology.

Primary hypertension: most of the patients have no obvious medical history or medication history, and hypertension caused by other diseases must be ruled out by laboratory tests, imaging tests, and so on.

Hypertension secondary to renal disease: patients usually have a history of renal disease, such as glomerulonephritis, renal artery stenosis, etc. It can be identified by history, clinical manifestations, renal function tests, hormone tests, abdominal ultrasound, renal angiography and other tests.

Hypertension secondary to endocrine disease: patients often have a history of endocrine disease, which can be identified through medical history, clinical manifestations, hormone testing and other examinations.

Hypertension secondary to cardiovascular disease: patients often have a history of aortic insufficiency, which can be identified by history, clinical manifestations, echocardiography and other tests.

Hypertension secondary to craniocerebral disease: patients usually have a history of brain tumor, traumatic brain injury, etc., which can be identified by medical history, clinical manifestations, head CT, head MRI and other examinations.

Hypertension secondary to medication: most patients have a history of taking glucocorticoids, sympathomimetic drugs, Chinese medicines containing licorice, etc., which can be identified through medical history.

Stress-induced elevation of blood pressure: Physiological stress related to exercise, emotional excitement, diet, etc., can cause elevation of blood pressure, and after removing these factors and measuring again, the blood pressure value can be within the normal range.

Treatment

Aims of treatment: control blood pressure, delay the time of complications, weaken the degree of complications, reduce symptoms, improve quality of life and prolong life.

General treatment

Improve diet

Low-salt, low-fat diet, avoid pickled foods and fried foods.

Avoid stimulating foods or drinks.

Abstain from alcohol.

Improve life habits

Avoid exertion.

Regular work and rest, ensure enough sleep, avoid staying up late.

Exercise moderately and avoid sitting for a long time.

Quit smoking and avoid second-hand smoke.

Weight control

If you are obese or overweight, it is recommended to lose weight.

If your weight is within the normal range, it is recommended to maintain it.

Maintain a good mood

Avoid bad moods such as tension, anxiety, anger and depression.

Pay attention to mood regulation on a daily basis.

Monitor blood pressure

Measure your blood pressure at home with an electronic sphygmomanometer to keep abreast of the effects of treatment and changes in blood pressure.

For details, please refer to the relevant content in the “Daily Life” section.

First aid treatment

In emergencies such as severe chest pain, severe headache, drowsiness, slurred speech, hemiplegia, etc., stop activities immediately and sit or lie down to rest.

Ask your family members or others to call “120” or take you to the emergency room of a hospital.

If unconsciousness occurs, family members can let them lie on their side to avoid choking on oral secretions.

Stay warm in winter and away from high temperatures in summer.

Medication

Blood pressure control

Medications to control blood pressure are the main treatment. Medications to control blood pressure are also known as “antihypertensive drugs”.

Applicable conditions

Patients with grade 2 hypertension.

People with diabetes or who have suffered damage to organs such as the heart, brain, or kidneys.

People with persistently elevated blood pressure that cannot be controlled by improving diet and lifestyle.

Blood Pressure Control Targets

In general, the target value is less than 140/90mmHg.

In combination with diabetes mellitus, chronic kidney disease, heart failure or stabilized coronary heart disease, the blood pressure control target is less than 130/80mmHg.

In elderly systolic hypertension, systolic blood pressure should be controlled to less than 150 mmHg or, if tolerated, less than 140 mmHg.

The blood pressure control target value is affected by a variety of clinical factors, and the specific lowering target value needs to be judged by the clinician according to the patient’s individual situation.

Commonly used drugs

These include diuretics, beta-blockers, calcium channel antagonists (CCBs), angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs).

Diuretics

By promoting the discharge of sodium ions with urine, reducing the volume of extracellular fluid and lowering peripheral vascular resistance, thus achieving the purpose of lowering blood pressure.

They are suitable for mild, moderate and severe hypertension, especially salt-sensitive hypertension, combined with obesity or diabetes, menopausal women and elderly hypertension.

The antihypertensive effect is smooth, slow onset and long lasting.

Commonly used thiazide diuretics (hydrochlorothiazide), labeled diuretics (furosemide), potassium-preserving diuretics (spironolactone) and so on.

Adverse reactions include affecting the metabolism of blood lipids, blood glucose, blood uric acid, causing electrolyte disorders such as hypokalemia and hyponatremia.

Potassium-preserving diuretics can cause hyperkalemia, try to avoid combining with ACEI or ARB, and are contraindicated in renal insufficiency.

β-blocker

They play antihypertensive effect by reducing myocardial contractility, slowing down heart rate and other mechanisms.

It is suitable for mild, moderate and severe hypertension, and has better effect on middle and young people with fast heart rate (more than 80 times/minute) in quiet time, or those who are combined with angina pectoris, after myocardial infarction and chronic heart failure.

The antihypertensive effect is weaker and lasts longer (1 to 2 weeks).

Metoprolol, atenolol, bisoprolol, carvedilol, propranolol, etc. are commonly used.

Adverse effects include bradycardia, weakness, and chills in the extremities.

Contraindicated: severe bradycardia, heart block, asthma, chronic obstructive pulmonary disease, peripheral vascular disease.

Use with caution: insulin-dependent diabetes mellitus and hyperlipidemia.

Calcium channel antagonists (CCB)

By blocking the entry of extracellular calcium ions into vascular smooth muscle cells, they reduce vasoconstriction and exert antihypertensive effects.

Compared with other kinds of drugs, this class of drugs is more effective in lowering blood pressure in the elderly and alcoholics, and is less affected by high sodium diets and non-steroidal anti-inflammatory drugs.

They can be used in combination with diabetes, coronary artery disease or peripheral vascular disease.

Commonly used dihydropyridines (amlodipine, nifedipine, felodipine, lacidipine), non-dihydropyridines (verapamil, diltiazem) and so on.

Adverse reactions include increased heart rate, facial flushing, headache, and lower extremity edema.

Avoid non-dihydropyridine CCBs in heart failure and heart block.

Angiotensin converting enzyme inhibitors (ACEI)

By inhibiting angiotensin-converting enzyme, reduce the production of angiotensin II, to achieve the purpose of lowering blood pressure.

The onset of antihypertensive effect is slow, and the maximum effect is reached in 3 to 4 weeks.

It has better effect on hypertension accompanied by obesity, heart failure, myocardial infarction, atrial fibrillation, proteinuria, impaired glucose tolerance, diabetes mellitus, diabetic nephropathy.

Commonly used captopril, enalapril, benazepril, fosinopril, perindopril, lynopril and so on.

Adverse reactions include pharyngeal itching, irritating dry cough, dysgeusia, and edema.

Monitor blood creatinine and potassium levels regularly.

Contraindicated in hyperkalemia, pregnant women, bilateral renal artery stenosis.

Angiotensin II receptor antagonist (ARB)

By blocking the angiotensin II receptor subtype, inhibit the corresponding vasoconstriction, so as to achieve the effect of lowering blood pressure.

The antihypertensive effect is slow, but long-lasting and smooth, and the antihypertensive effect is dose-dependent.

Applicable people are the same as the above ACEI drugs.

Chlorosartan, valsartan, irbesartan, timosartan, candesartan, etc. are commonly used.

Adverse effects are rare and may include headache, dizziness, cough, diarrhea, and fatigue.

Monitor blood creatinine and potassium levels regularly.

Also contraindicated in hyperkalemia, pregnant women, and those with bilateral renal artery stenosis.

Other drugs

Sympathetic inhibitors

They can lower blood pressure by inhibiting myocardial contraction and vasoconstriction.

Commonly used sympathetic nerve terminal blockers (rifampicin), central sympathoinhibitors (colistin).

Direct vasodilators

By directly relaxing the smooth muscle and dilating the peripheral blood vessels, the effect of lowering blood pressure can be achieved.

Commonly used drugs include hydralazine and sodium nitroprusside.

α1 receptor blocking drugs

By relaxing blood vessels and lowering peripheral vascular pressure, to achieve the effect of lowering blood pressure.

Commonly used drugs include prazosin, terazosin, doxazosin and so on.

Indapamide

Has diuretic and calcium channel blocking effects.

It can be used alone or in combination with other antihypertensive drugs.

Renin inhibitors

Can exert antihypertensive effects by regulating the renin-angiotensin system.

Such as Aliskiren, etc.

Angiotensin receptor-enkephalinase inhibitors

The representative drug is sacubitril valsartan.

Sacubitril valsartan is the antihypertensive drug of choice for patients with hypertension combined with heart failure, and can replace ACEI and ARB drugs to control blood pressure.

Treatment of hypertensive emergencies and sub-emergencies

Hypertensive emergency: blood pressure suddenly or obviously rises to a certain value, usually 180/120mmHg, and is accompanied by heart, brain, kidney and other lesions.

Hypertension sub-acute: a situation in which blood pressure is significantly elevated without serious symptoms or lesions in the heart, brain, kidneys and other organs.

Treatment principle

Timely lowering of blood pressure, controlling the rate of blood pressure decline, rational selection of antihypertensive drugs, while taking into account the blood supply to vital organs.

Drugs that may be used

Including uradil, sodium nitroprusside, nitroglycerin, nicardipine, labetalol, etc.

Lipid regulating therapy

If the combination of total cholesterol, triglycerides, LDL cholesterol, HDL cholesterol is abnormal, it is necessary to regulate blood lipids based on the improvement of living and dietary habits.

Commonly used drugs include simvastatin and atorvastatin.

Adverse reactions are rare, and rhabdomyolysis (muscle pain, weakness, etc.), liver function abnormalities, etc. occur in a few cases.

Antiplatelet therapy

Used in hypertension combined with ischemic disease of the heart and brain to reduce the risk of serious conditions such as heart and brain.

Commonly used drugs include aspirin, clopidogrel, and tegretol.

Adverse reactions include gastrointestinal discomfort, gastrointestinal bleeding, intracranial hemorrhage, and allergic reactions.

It needs to be started after the blood pressure is stabilized (less than 150/90 mmHg), otherwise it increases the risk of cerebral hemorrhage.

Anticoagulation

Oral warfarin may be given to high-risk patients with hypertension combined with atrial fibrillation.

Glucose control

Control goals: glycated hemoglobin (HbA1c) less than 7%, fasting blood glucose of 4.4-7.0 mmol/L, and 2-hour postprandial blood glucose <10.0 mmol/L.

Metformin, empagliflozin, cargliflozin, liraglutide, dagliflozin, and liraglutide are available.

Management of hypertension with multiple risk factors

Hypertension with elevated homocysteine is treated with folic acid supplementation, if necessary, to reduce the risk of stroke while improving lifestyle and dietary habits [4].

Other treatments

If caused by renal artery stenosis, pheochromocytoma, aortic valve closure insufficiency, brain tumor, or traumatic brain injury, it can be treated by surgery.

If caused by sleep apnea syndrome, it can be treated by non-invasive ventilator.

If caused by medication, it can be treated by stopping or changing medication.

For obese hypertensive patients, if the effect of weight control through diet and exercise intervention is unsatisfactory, they can go to the weight loss clinic and follow the doctor’s instructions to use relevant drugs and surgical treatment.

Prognosis

Cure

Long-term medication will slow down the progression of the disease, delay the onset of complications, improve the quality of life and prolong life expectancy.

In the case of normal high blood pressure, i.e., systolic blood pressure of 120 to 139 mmHg and/or diastolic blood pressure of 80 to 89 mmHg, the progression of the disease can be slowed down by improving dietary and living habits, and by improving the mood in the absence of other diseases.

Harmfulness

It can cause complications such as cerebral hemorrhage, cerebral infarction, heart failure, angina pectoris, myocardial infarction, chronic renal insufficiency, retinopathy, and aortic coarctation, resulting in blurred vision, hemiparesis, and coma, which can be life-threatening.

Daily

Daily Management

Dietary management

Low salt diet

Daily salt intake should be less than 5 grams (equivalent to about 25 ml of soy sauce). A dosing spoon can be used to control salt intake when cooking, and low-sodium salt can be used instead of common salt when conditions permit.

Avoid pickled foods, such as pickles, fermented bean curd, dashi, bacon, preserved meat and red sausage.

Reduce the intake of fast food, such as instant noodles and instant rice.

Ensure balanced nutrition

Limit total calories and diet should be eight-minute full.

Ensure adequate protein, unsaturated fat, vitamins, minerals and dietary fiber.

Meat is preferred to poultry and fish, about the size of a poker box per day.

Skimmed milk 300 ml per day.

Nuts 1 palmful daily.

Fresh low-sugar fruits, such as kiwi, strawberries, pears, grapefruit, etc., 1~2 per day.

Fresh vegetables 400 to 500 grams (raw weight) daily.

Reduce the intake of carbohydrates appropriately by choosing cereals and potatoes instead of refined rice and noodles.

Control the amount of cooking oil, which should be less than 25 grams per day (about the amount of 2.5 white porcelain soup spoons)

If there is no heart failure, chronic renal insufficiency or other diseases, the daily water intake should be more than 1,500 milliliters, or follow the doctor’s instruction to ensure water intake.

Avoid other inappropriate diets

Avoid stimulating beverages such as strong tea and coffee.

Avoid foods high in saturated fat such as fatty meats and fried foods.

Abstain from alcohol.

Lifestyle Management

Work and rest management

Ensure adequate sleep.

Try to avoid heavy physical labor such as lifting heavy objects, long or prolonged riding or driving. Or choose the intensity of labor according to your doctor’s requirements.

Exercise Management

Exercise for at least 150 minutes a week, at least 30 minutes each time; choose activities such as brisk walking, cycling, jogging, tai chi and swimming. Or follow the doctor’s instruction to plan the time of exercise and choose the program of exercise.

Exercise should be gradual and avoid excessive exercise.

If you feel uncomfortable during exercise, you should stop exercising immediately.

Quit bad habits

Quit smoking and stay away from second-hand smoke.

Avoid staying up late.

Emotion management

Avoid stress, anxiety, anger, depression and other negative emotions.

Relieve them by chatting with friends and relatives, listening to soft music, reading books and watching soothing TV programs.

In serious cases, you can go to a formal psychological counseling agency for psychological counseling and treatment.

Avoid environmental stimuli

Avoid cold and heat.

Keep warm when going out in winter.

In summer, pay attention to prevent heatstroke, and the temperature of indoor air-conditioning should not be too low.

Avoid prolonged exposure to excessive cold or heat.

Weight and Waistline Management