5.Drug to lower blood pressure When I recommend patients to start taking antihypertensive drugs, many patients are reluctant to accept them, usually for the following reasons: 1) Do I need to take medication right now. 2) Do I need to take medication for life after taking medication. 3) I don’t have any symptoms, why should I take medication. 4) Will I be resistant to medication after taking medication too early, which will lead to worse and worse results in the future. 5) Cost factor, can I use ordinary antihypertensive drugs. (6) Will taking a good antihypertensive drug at the beginning lead to no drug being available in the future. I will answer each of these questions below. 1) Do I need medication right away? For most hypertensive patients, once hypertension is diagnosed (i.e., blood pressure ≥ 140/90 mmHg on 3 non-same days), antihypertensive treatment should be started and blood pressure should be controlled below this value, as recommended by many foreign guidelines for the prevention and treatment of hypertension. And the aforementioned lifestyle improvement should be carried out throughout the prevention and treatment of hypertension. For the elderly, it may be appropriate to relax the antihypertensive guideline to ≥150/90 mmHg to consider initiating drug therapy and lowering blood pressure below this value. (But what patients belong to the elderly patients, the definition given by each country varies, our country defines it as >65 years old, the United States defines it as >60 years old, but in general, the elderly can be appropriately relaxed to lower the BP target, but if tolerated can also be further reduced below 140/90 mmHg) In addition, for a part of low-risk hypertensive patients, this mainly refers to mildly elevated blood pressure (140-159/ 90-99), age (55 years for men; 65 years for women), absence of smoking, absence of glucose abnormalities (fasting or postprandial), absence of dyslipidemia, absence of family history of premature cardiovascular disease, absence of obesity, and absence of hyperhomocysteinemia. For these patients, blood pressure can be monitored closely along with lifestyle improvement and observed for 3 months, and if blood pressure still cannot be reduced to normal, antihypertensive therapy needs to be started. 2) Whether lifelong medication is needed after taking the medication Treatment of hypertension usually requires long-term, or even lifelong, adherence to treatment. It is for this reason that many patients are reluctant to start antihypertensive treatment. In fact, this statement is correct, but not absolute. The use of our antihypertensive drugs depends mainly on the specific situation of blood pressure, such as the patient mentioned in my last Weibo post, who was first diagnosed with hypertension, took medication to control blood pressure and then improved it through active lifestyle, thus stabilizing it, and then gradually reduced the dosage until it was discontinued (during this process, blood pressure did not increase, so the patient stopped the medication successfully, but if blood pressure increased again during the reduction process, the reduction was not recommended). In addition, for some elderly patients, blood pressure can also be reduced in summer when the temperature rises and blood vessels dilate and sweat more, which leads to lower blood pressure. In conclusion, we should face hypertension properly and accept treatment actively. We should always know that hypertension does not automatically disappear just because we do not do anything about it, and if we do not give enough attention to it, it will only bring bigger problems. At the same time, we emphasize the importance of lifestyle improvement. 3) I don’t have any symptoms, so why should I take medication. In fact, most people with hypertension do not have any symptoms, and some patients may have symptoms such as headache, dizziness, blurred vision, insomnia, etc. But the absence of symptoms does not mean the absence of harm. The harm of hypertension is not in the high or low blood pressure you have in the short term, but in the damage to the heart, brain, kidneys and other target organs brought about by long-term hypertension. Therefore, it is not the case that no symptoms do not require antihypertensive treatment. Once a patient with hypertension develops symptoms, it is usually a sign of target organ damage, which is actually a complication of hypertension, and these damages are usually irreversible. The same with an example, I should say a painful lesson: more than 3 years ago, our own hospital nurse relative, a young man in his 20s, chef, physical examination found high blood pressure admitted to the hospital, the highest blood pressure 240/130mmHg, the patient does not have any symptoms, a comprehensive examination to exclude the possibility of secondary hypertension, recommended drug treatment. Later the patient left the country for work. A few months ago, our colleague told me that he did not pay any attention to his condition after he left the country and stopped taking the medication on his own after about one month. This is a painful example, but is it still useful to regret it now? (4) Will the premature use of drugs lead to drug resistance, which will lead to the deterioration of the effect of future medication or the good antihypertensive drugs at the beginning will lead to no drugs available in the future. In fact, there is no such thing as drug resistance to antihypertensive drugs. Some patients find that they are taking more and more drugs because many patients do not pay sufficient attention to lifestyle improvement after taking the drugs, which aggravates hypertension, not because of drug resistance. Similarly, I am often asked by patients why I use 3 drugs while others can control it with 1 drug. Of course, hypertension drugs do have good and bad points, which are mainly reflected in several aspects: 1, the difference in antihypertensive efficacy. 2, whether the target organs such as the heart, brain and kidney have a protective effect. 3, the difference between long-acting and short-acting drugs: long-acting drugs are usually taken as long as one meal a day, which can guarantee a smooth price a day. Short-acting drugs usually require multiple doses in a day. The current recommendation is mainly to try to apply long-acting agents: as far as possible to use a day once a dose and have a continuous 24-hour antihypertensive effect of long-acting drugs, why? 1, long-acting drugs to lower blood pressure more smoothly. 2, long-acting drugs are easy to take, once at a time, can reduce the rate of missed doses. 3, long-acting drugs usually have more protective effect on target organs. Of course, long-acting drugs also have disadvantages, that is, they are relatively expensive: (. 5) Cost factor, can you use common antihypertensive drugs. Yes, if you really because of economic problems, can not buy long-acting drugs, the application of ordinary antihypertensive drugs is also possible, we have a lot of choices, such as Beijing 0, compound antihypertensive tablets, nifedipine tablets, nifedipine tablets, etc., although these drugs have such and such shortcomings, but the application of so many years down, the effect of lowering blood pressure can still be, no matter what, first to lower blood pressure, lowering blood pressure is (6) the choice of antihypertensive drugs with a chart to summarize it. 7) About self-measurement of blood pressure We recommend self-measurement of blood pressure, because the value of blood pressure measured occasionally at the clinic does not reflect the normal state of blood pressure in the patient’s daily life, so self-measurement of blood pressure at home is a very critical step. Many people think that blood pressure measurement in hospitals is more accurate than at home, but this is not true. In many cases, blood pressure measurement in hospitals is not necessarily more accurate than at home. Take our own hospital, our outpatient clinic is on the 3rd floor, every time patients are rushing up, still breathing heavily, they ask for blood pressure measurement, I said can you measure this accurately? But it is different when people are at home, where the environment is close to the real life environment, so they are more relaxed and avoid the nervousness that comes with seeing a doctor, which can make the blood pressure results more accurate. In addition, the blood pressure value will fluctuate with the person’s emotional state, seasonal changes and other factors, at home to measure blood pressure, and then let the doctor according to your measurement results to adjust the antihypertensive program can often play a half-hearted role. Electronic sphygmomanometer accurate: I would like to say, as long as you apply properly, electronic sphygmomanometer is still reliable, the specific measurement method referred to in my previous microblogging blood pressure measurement, in fact, mercury sphygmomanometer and electronic sphygmomanometer use is basically similar. Besides, in a few years, the mercury sphygmomanometer will not be produced (mercury contamination), do we not measure blood pressure? However, I must emphasize here that we do not recommend wrist-type electronic blood pressure monitor, we recommend the application of upper-arm electronic blood pressure monitor, which is also recommended by the WHO!