Hypertension has always been one of the important fatal culprits in the elderly. In recent years, due to long-term work pressure and mental overstrain, hypertension is becoming younger, and office workers have become a high incidence group of this disease.
Primary hypertension is a chronic disease, which often comes unnoticed, and once it is developed, there will be a long or even lifelong treatment process. In most cases, this long treatment process is carried out by the hypertensive patient in his or her own home. Although it has always been said that “a long illness becomes a good doctor”, patients often go into misconceptions due to the lack of guidance from doctors. For example.
When blood pressure is high, use medication immediately
Once some people find their blood pressure is high, they can’t wait to start taking antihypertensive drugs. In fact, take antihypertensive drugs should be careful. The first thing you need to find out is: are you really suffering from high blood pressure?
Currently, the criteria for determining hypertension are: normal adult arterial systolic pressure greater than (equal to) 18.6 kPa 140 mmHg and diastolic pressure greater than (equal to) 12 kPa 90 mmHg. However, high blood pressure needs to be measured three times at different times of the day, in a quiet state, before hypertension can be determined.
Second, after determining hypertension, the most important clinical examination step is to find the cause of hypertension. In the vast majority of patients, the cause of hypertension is unknown and is called primary hypertension, or hypertensive disorder. In about 5% of patients, the elevated blood pressure is a manifestation of some disease, called secondary hypertension. It is more important to treat these patients for the associated primary disease rather than just for the symptom of high blood pressure.
Finally, even if a diagnosis of hypertension does occur, not all cases require immediate antihypertensive medication. This should be done on a case-by-case basis: if the blood pressure is already higher than 24/13 kPa (180/100 mmHg) when hypertension is detected and confirmed by multiple measurements, antihypertensive medication should be used immediately; if it is at a critical hypertension of about 20/12 kPa (150/90 mmHg), and sometimes high and sometimes low, “non-pharmacological treatment” can be carried out first If the blood pressure is around 20/12 kPa (150/90/mmHg), and it is high and low, you can first carry out “non-pharmacological treatment”, such as exercise, weight loss, sodium restriction, potassium supplementation, calcium supplementation, sedation, and exclusion of psychological factors. Treatment for 3-6 months, if the blood pressure does not come down, then consider the use of antihypertensive drugs, and also pay attention to the use of small doses to start.
Stop the medication as soon as the blood pressure drops
Patients in the application of antihypertensive drug treatment for a period of time, blood pressure dropped, the symptoms improved. At this point, some people often think that blood pressure has been reduced to normal, they immediately stop the drug, resulting in blood pressure rebound, and then use the drug to make blood pressure down, and then stop the drug. This repeatedly, not only can not achieve the therapeutic effect, but also the blood pressure fluctuation range is large, easy to cause heart, brain, kidney and other organ complications.
The purpose of hypertension treatment is to bring blood pressure down to normal or near normal range on the one hand, and to prevent or reduce the rate of death and disability due to cardiovascular and cerebrovascular complications on the other. Therefore, long-term or even lifelong treatment is generally required. Once the medication is taken, it cannot be stopped. Even if the blood pressure is reduced to normal, the maintenance dose should be taken, otherwise the discontinuation syndrome will occur, i.e., the rapid rebound of blood pressure and sympathetic excitement, such as palpitations, irritability, excessive sweating, headache, tachycardia and so on.
The correct approach is to gradually reduce the dose of antihypertensive drugs under the guidance of the doctor after the blood pressure is satisfactorily controlled, and take maintenance doses until you can really consider stopping the drug.
Take your medication regularly, three times a day
The blood pressure of each person, whether normal or hypertensive, is not constant throughout the 24 hours of the day, and the data measured at a certain time is only “instantaneous blood pressure”, which does not reflect the actual situation of the patient. If you take a measurement every hour (or 2 to 4 hours) and draw the data from each measurement on a coordinate, you will find that the “coordinate line” is a curve with “double peaks and valleys”. That is, blood pressure starts to rise in the early morning, the first peak appears at 8-9 a.m., drops at noon, the second peak appears at 16-18 p.m., and starts to fall again in the evening, and drops to a nadir at 2-3 p.m.
To treat hypertension, it is important to grasp the peak of blood pressure during the day and to time the medication. Generally, medication should be taken 1 to 2 hours before the peak of blood pressure. When the concentration of the drug in the blood reaches its highest value, which is also the time when the blood pressure peaks, the effect of lowering blood pressure is the best.
In the past, the traditional “three times a day” dosing method did not take into account this pattern of blood pressure changes in a comprehensive manner. As a result, there is often a situation where the blood pressure is not well controlled when it is at its peak, and when the patient’s blood pressure is already falling at night, resulting in even lower blood pressure (with the exception of those with very high blood pressure). This can easily cause cerebral ischemia and cerebral thrombosis on the one hand, and on the other hand can cause blood pressure to “rebound”, as shown by a rise in blood pressure the next day.
Many elderly people with hypertension in China take medication every night before bed in order to “spend the night safely” is incorrect, and many people take medication for a long time for ineffective reasons here.
In fact, patients should learn to self-test blood pressure, measured 4 to 6 times a day for several days, you can find out their blood pressure fluctuations, and according to this law under the guidance of the doctor to determine the time to take medication, so that blood pressure in the whole day 24 hours to get stable control, which is the key to take the correct antihypertensive drugs.
Take medication to lower blood pressure, seeking fast and low
Some patients with hypertension hope that by taking medication can bring down their blood pressure quickly, and the faster the better, the lower the better. In fact, this idea is not right.
Generally speaking, most elderly people over 60 years old have different degrees of arteriosclerosis combined. When arteriosclerosis, the blood vessel wall thickens, elasticity decreases, and the lumen of the blood vessel narrows, making the local blood supply decrease. In this case, a slightly higher blood pressure is beneficial to the blood supply of the heart, brain, kidneys and other important organs. If the patient’s blood pressure is lowered to a normal or even low level blindly without regard to the patient’s age and other specific conditions, it will often outweigh the losses. On the one hand, it will affect the function of the above organs; on the other hand, the blood pressure is lowered too fast and too low, which will easily induce the formation of cerebral thrombosis.
Therefore, when hypertensive disease, except for some special cases, such as hypertensive crisis, need to quickly bring down the blood pressure, in general, the principle of lowering blood pressure is slow, smooth, lasting and moderate.
Rely on drugs alone, regardless of other
Hypertension is considered to be high blood pressure, and everything will be fine if the blood pressure is lowered with antihypertensive drugs. This is also a lot of hypertension patients are prone to enter a misunderstanding. It is important to know that the occurrence of hypertension is related to a variety of factors, including genetics, diet, obesity, tobacco and alcohol, psychosomatic factors. Therefore, the treatment of hypertension also requires comprehensive measures, including non-pharmacological treatment and drug therapy. Only when the two are well coordinated can the ideal treatment effect be achieved.
Non-pharmacological treatment is suitable for patients with all types of hypertension. Especially for milder patients, non-pharmacological measures alone can lead to a certain degree of blood pressure reduction. The main measures include: limiting sodium intake (5-6 grams per day); reducing body weight; appropriate physical activity; quitting smoking and limiting alcohol; avoiding emotional stress and ensuring adequate sleep. It is important to know that good lifestyle and habits are directly related to the effectiveness of treatment and prognosis of hypertensive patients. If you think that drugs alone can solve the problem, then you are very wrong.