Some considerations in the treatment of hypertension

1.Blood pressure control goals for hypertensive patients Individualized antihypertensive programs should be formulated taking into account each hypertensive patient’s age, liver and renal function, co-morbidities, economic status, education level, and family support. The blood pressure should be controlled below 140/90mmHg within 4~12 weeks. Patients with comorbidities of diabetes mellitus, renal disease, previous history of myocardial infarction or stroke should have their blood pressure controlled below 130/80 mmHg if they can tolerate it. Elderly hypertensive patients aged ≥65 years can have their systolic blood pressure reduced to less than 150 mmHg, and further reduced if tolerated. It is important to emphasize that lifestyle interventions are fundamental to the treatment of hypertension, including dietary control, exercise, smoking and alcohol cessation, weight loss, and stress reduction. Effective improvement of lifestyle may result in a 10-20mmHg drop in blood pressure. 2. Selection and use of antihypertensive drugs Currently, there are five major classes of commonly used antihypertensive drugs: diuretics, angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor antagonists (ARBs), calcium channel blockers (CCBs), and beta-blockers (BBs). If the patient has a small increase in blood pressure (<160/100 mmHg), one antihypertensive drug may be used to start treatment. If blood pressure control is unsatisfactory after 2 to 4 weeks of treatment, a combination of drugs may be considered. If the patient's blood pressure is significantly elevated at the time of the visit (more than 20/10 mmHg above the target value), 2 antihypertensive drugs should be chosen for the initial treatment or a new fixed-combination preparation should be used. The recommended combinations of combination drugs are: ACEI and diuretics, ARB and diuretics, ACEI and dihydropyridine CCBs, ARB and dihydropyridine CCBs, and dihydropyridine CCBs and diuretics. 3.Hypertensive crisis or emergency how to do Hypertensive emergency refers to the severe elevation of blood pressure (generally >180/110mmHg) and accompanied by progressive target organ damage performance, such as hypertensive encephalopathy, intracranial hemorrhage, acute myocardial infarction, acute left heart failure, aortic coarctation, etc.; Hypertension sub-emergency refers to the severe elevation of blood pressure but not accompanied by target organ damage. Emergency treatment measures mainly include intravenous application of antihypertensive drugs (such as sodium nitroprusside, nitroglycerin, uradil, etc.), so that the patient’s blood pressure is lowered as soon as possible, but the drop of blood pressure per hour is not more than 25%, and the blood pressure will be reduced to about 160/(100~110) mmHg within the next 2~6h. 4, long-term use of medication needs to be adjusted under the guidance of specialists Many patients with hypertension are in the life style intervention After lifestyle intervention and standardized taking of antihypertensive drugs, the blood pressure is well controlled for a long time, and the dosage and type of antihypertensive drugs can be gradually reduced, and some of them can be discontinued. For these hypertensive patients, it is necessary to continue to closely monitor blood pressure under the guidance of a doctor.