Overview.
Hypertensive disease is one of the most common cardiovascular diseases, and is also closely related to the major diseases of human mortality such as coronary heart disease and cerebrovascular disease, therefore, countries around the world attach great importance to the research of hypertensive disease from pathogenesis to clinical prevention and treatment.
The diagnosis of hypertension should include the following.
1, confirm the diagnosis of hypertension, that is, whether the blood pressure is indeed higher than normal.
2, except for symptomatic hypertension.
3, hypertension staging, grading.
4, estimation of important organ heart, brain and kidney function.
5, the presence of combined conditions that can affect the development and treatment of hypertension, such as coronary heart disease, diabetes, hyperlipidemia, hyperuricemia, chronic respiratory disease, etc.
Due to the volatility of blood pressure, the diagnosis of hypertension should be made at least twice in the resting state on non-same day when the blood pressure is elevated, and the blood pressure value should be the average of three consecutive measurements.
Treatment measures: Once the diagnosis of hypertension is established, treatment should be considered. Hypertension is a chronic disease, so it requires long-term patient and active treatment, the main goal is to reduce arterial blood pressure to normal or as close to normal as possible, in order to control and reduce the target organ damage related to hypertension, such as brain, heart, kidney and peripheral blood vessels. The results of numerous controlled clinical trials in recent years have shown that lowering blood pressure to normal by antihypertensive drugs or nonpharmacological treatment can reduce the incidence of stroke and mortality in hypertensive patients, prevent and correct malignant hypertension, and reduce the morbidity and mortality of aortic coarctation separation.
However, lowering blood pressure has not been shown to significantly reduce the incidence of coronary events to date, possibly because antihypertensive drug therapy was started too late or the treatment period was not long enough to see an effect in this regard; whether this is related to adverse effects of certain antihypertensive drugs is also of some concern.
I. The usual treatment includes.
1. combining work and rest, maintaining adequate and good sleep avoiding and eliminating tension, and using tranquilizers appropriately. Avoid excessive mental and physical load. For patients with mild hypertension, regular physical exercise can help normalize blood pressure, but for patients with moderate to severe hypertension or stage II or III hypertension with manifestations of target organ damage, competitive exercise, especially isometric exercise, should be avoided.
2, reduce sodium intake, maintain adequate dietary intake of potassium, calcium and magnesium.
3, weight control, obese patients with mild hypertension can often reduce blood pressure to normal by reducing weight, for obese patients with moderate to severe hypertension, weight reduction and antihypertensive drug therapy can be carried out at the same time.
4, control other risk factors of atherosclerosis, such as smoking, lipid increase, etc.
Second, antihypertensive drug therapy.
In recent years, the rapid development of anti-hypertensive drug research, especially the introduction of new antihypertensive drugs such as beta-blockers, calcium antagonists and angiotensin-converting enzyme inhibitors, has fundamentally changed the face of hypertension drug therapy. According to the characteristics of different patients individually or in combination with various types of antihypertensive drugs, the blood pressure of most hypertensive patients can be controlled.
Third, the principles of antihypertensive drug selection.
1, a variety of antihypertensive drugs have their own pharmacological characteristics, clinical should be based on the patient’s age, the degree and stage of hypertension, the presence of complications or inclusions (such as diabetes, hyperlipidemia, angina pectoris, heart failure, myocardial infarction, arrhythmia, bronchial and pulmonary lesions, etc.) and the presence or absence of other risk factors for coronary heart disease, as well as the response to the drug selection, in order to get satisfactory results.
2, for patients with slowly progressive hypertension, the first choice of stepwise antihypertensive drug selection principle has been extended from diuretics and beta blockers to include calcium antagonists and angiotensin-converting enzyme inhibitors, according to the characteristics of different patients, the choice of one of these four types of drugs, starting from a small dose gradually increase the dose until the blood pressure is controlled or up to the maximum amount, or adverse reactions. After achieving the purpose of lowering blood pressure, then gradually change to maintenance dose to maintain normal or near normal blood pressure. Maintenance therapy should be simple and at the lowest possible dose to minimize side effects and allow the patient to stay on the medication. Most patients with hypertension need to take maintenance antihypertensive drugs for a long time, and should not suddenly stop or change medication if not necessary. In severe hypertension, a combination of two antihypertensive drugs may be required at the outset. The advantages of combining several antihypertensive drugs are: improving the efficacy through synergistic effects; reducing the dose of each drug to reduce side effects.
3, should pay close attention to the antihypertensive drug treatment produced by a variety of adverse reactions, timely correction or adjustment of medication. In principle, the ideal antihypertensive drugs should be able to correct the hemodynamic abnormalities caused by hypertension 9 increased peripheral resistance and reduced cardiac output) without affecting the patient’s pressure receptor reflex mechanism. Before using antihypertensive drugs that can cause significant postural hypotension, it is advisable to explain to the patient that the movement should be as slow as possible when rising from a sitting or lying position, especially at night when getting up to urinate, so as to avoid accidents caused by fainting due to sudden drop in blood pressure. In recent years, it has been found that thiazide diuretics can increase plasma cholesterol and triglyceride levels, and beta blockers can increase plasma triglyceride and lower HDL cholesterol levels, so they should be used with caution for people with dyslipidemia. Calcium antagonists and angiotensin-converting enzyme inhibitors have no effect on blood lipids, while alpha blockers and central sympathetic stimulants can mildly lower total serum cholesterol, so they are suitable for hypertensive patients with dyslipidemia.
4, recent studies have found that target organ damage in hypertensive patients is more closely related to circadian 24-hour blood pressure than it is to one-time follow-up blood pressure measurements. Therefore, when available, long duration of action antihypertensive drugs or slow (controlled) release preparations should be used according to the results of 24-hour ambulatory blood pressure measurement in order to achieve 24-hour blood pressure control and reduce target organ damage.
5, in patients with severe increase in blood pressure for many years, because the peripheral small arteries have produced organic changes, or because the patient can not tolerate the drop in blood pressure, even if the combined use of several antihypertensive drugs, it is not easy to make the systolic or diastolic blood pressure drop to normal levels. At this time should not be overly forced to lower the blood pressure, otherwise the patient can often feel discomfort, and may lead to brain, heart, kidney blood supply is further inadequate and cause cerebrovascular accidents, coronary artery thrombosis, renal insufficiency, etc..
6, the simple systolic hypertension of the elderly, should start from a small dose of cautious use of antihypertensive drugs, calcium antagonists or converting enzyme inhibitors can be used, if necessary, add a small amount of thiazide diuretics. Elderly people with insensitive pressure receptors should avoid the use of guanethidine, alpha blockers and labetalol to avoid postural hypotension.
7. The treatment measures for acute hypertension are similar to those for slow-onset severe hypertension. If the blood pressure does not drop continuously, hibernation therapy can be considered; if renal failure occurs, antihypertensive drugs such as methyldopa, hydrazidiazine, minoxidil, colistin, etc. should be used, and the blood pressure should not drop too much, so as not to reduce renal blood flow and aggravate renal failure.
Fourth, Chinese medicine treatment.
1, dialectical treatment: according to the Chinese medicine dialectical typing “liver” Yang type treatment to pacify the “liver” submerged Yang, with Tianma hook vine drink plus reduction. “The treatment is to nourish Yin and Yang and nourish Liver and Kidney, using Liu Wei Di Huang Tang plus or minus. The treatment is to warm yang and blind yin, using Dihuang Drink plus or minus.
2. Single herbs: According to domestic literature, single herbs with certain antihypertensive effect include: wild chrysanthemum, scutellaria, eucommia, dandruff, Huanglian and Chuanxiong, which can lower blood pressure by dilating peripheral blood vessels. The dosage is 15~30g and 10~15g respectively. rooibos and xiaquan have diuretic effect, the dosage is 3~6g and 10~15g respectively. green mullein lowers blood pressure through sympathetic ganglion blocking effect, the dosage is 10g.
3, acupuncture therapy including plum blossom needle and ear acupuncture therapy have certain effect.