I. Treatment goals
To achieve this goal, patients need to work closely with their physicians to find a reasonable treatment plan that is suitable for them during repeated visits to the clinic whenever possible.
Second, the four principles of antihypertensive treatment
① Start with small doses Start treatment with small doses of drugs to reduce adverse effects.
② Combination of drugs Reasonable combination of drugs to achieve maximum antihypertensive effect.
③ Adjust the regimen at the right time If the initial treatment regimen is ineffective, or if there are obvious intolerable adverse reactions, change to another treatment regimen.
Use long-acting antihypertensive drugs as much as possible to improve treatment compliance and reduce blood pressure fluctuations.
Types of antihypertensive drugs
①Diuretics (such as dihydrochlorothiazide);
②β-blockers (such as metoprolol);
③Angiotensin-converting enzyme inhibitors (such as captopril);
④Calcium antagonists (e.g. nifedipine);
⑤ α-blockers (e.g. prazosin);
⑥ Angiotensin II receptor antagonists (e.g. Irbesartan).
All of the above drugs are indicated for initial antihypertensive therapy. The benefits of antihypertensive therapy are mainly derived from long-term sustained blood pressure reduction, however, there are a number of factors that can influence the specific choice of antihypertensive agents in practice, such as socioeconomic factors, patient’s cardiovascular risk factors, presence of comorbidities and complications, patient’s antihypertensive efficacy and adverse reactions to various drugs, and interactions with other drugs. For this reason, a reasonable combination of drugs can be used.
IV. Combined antihypertensive treatment plan
①Diuretics + β-blockers.
②Diuretics + angiotensin-converting enzyme inhibitors or angiotensin II receptor antagonists.
③ dihydropyridine calcium orange antagonist + beta-blocker.
④calcium antagonists + converting enzyme inhibitors.
⑤α blocker + β-blocker.
In addition, some fixed-dose compound antihypertensive preparations developed by our country are less expensive, convenient to take and have certain antihypertensive efficacy, which can also be used for low-risk and intermediate-risk hypertensive patients.
Five, once diagnosed, lifelong treatment
After the start of antihypertensive treatment, patients should be followed up regularly within 3-6 months, and the treatment plan should be adjusted according to the blood pressure situation at the right time.
A reasonable treatment plan and good compliance with treatment can keep the patient’s blood pressure under the target value for a long time. If the target value of blood pressure control is not achieved, the following reasons should be considered.
① Poor treatment compliance.
② Failure to improve lifestyle behaviors, such as excessive alcohol consumption, weight gain, and excessive salt intake.
③ Complicated kidney damage.
④ Possible concomitant use of drugs that elevate blood pressure, such as non-steroidal anti-inflammatory drugs.
⑤ There may be secondary etiologies.
⑥ There may be artifacts of the blood pressure measurement itself, such as failure to use a proper cuff in obese individuals, or simple clinic hypertension white coat hypertension.
The main reason for this is poor compliance with medication, which can be corrected by adjusting the treatment plan in addition to the above measures to improve compliance.
It is important not to “fish for three days, but sunbathe for two days” to control blood pressure, or to stop treatment when blood pressure drops after treatment, or to stop treatment. It is important for patients to maintain good and regular communication with their physicians, including family members, to learn as much as possible about the treatment plan and to learn to self-test their blood pressure.