Diagnosis of hypertension.
How to know that you have hypertension
1. Understand the predisposing factors for hypertension
That is, whether there is a family history of hypertension, whether there is a family history of diabetes, whether there are dyslipidemia, and a family history of coronary heart disease, stroke, kidney disease. Lifestyle habits, fat intake, salt intake, and alcohol, whether it is drinking, whether it is heavy taste, and smoking, smoking time and number of cigarettes, and physical activity, etc., these and blood pressure are related. In addition, is not at the same time taking drugs that cause blood pressure, such as birth control pills, and some drugs containing licorice, ephedra and so on, steroid drugs, etc., erythropoietin, cyclosporine. There are also psychosocial factors, that is, family situation, work environment, education.
2, the correct measurement of blood pressure
Blood pressure should be measured quietly, and the subject should rest quietly for 5 minutes after measurement. In addition this sphygmomanometer should be calibrated, preferably with a mercury column sphygmomanometer, electronic sphygmomanometer should be calibrated.
Criterion I: In-office hypertension standard requires blood pressure > 140/90 mmHg.
Criterion two: ambulatory blood pressure monitoring that is, 24-hour blood pressure: the criteria for diagnosing hypertension when the 24-hour average blood pressure ≥ 130/80 mmHg, or the average daytime blood pressure ≥ 135/85 mmHg or the average nighttime blood pressure ≥ 120/70 mmHg.
Criterion 3: The criteria for diagnosing hypertension with home self-measured blood pressure is greater than or equal to 135/85 mmHg. because it is 5 mmHg lower than the office blood pressure, for example, both systolic and diastolic blood pressure are 5 mmHg lower. generally measured every morning and evening, 2-3 times each time, and taken as an average. Blood pressure is more stable can be self-measured once a week for one day.
The basic principles of hypertension treatment
The basic principles of hypertension treatment are: long-term, comprehensive, individualized treatment, and stable attainment. Long-term is to adhere to long-term treatment. Because to control blood pressure for a short period of time, patients will not benefit much, so long-term, or even lifelong adherence to treatment to reduce the incidence of cardiovascular and cerebrovascular mortality. Comprehensive is a combination of interventions. In addition to blood pressure attainment, there is a risk factor intervention and a comprehensive treatment of clinical disease. The individualized treatment and smooth achievement of the standard is to choose different drugs according to the type, level and cause of blood pressure, to measure blood pressure regularly, to standardize treatment, to improve the compliance of treatment, to achieve the standard of blood pressure reduction as much as possible, to insist on long-term smooth and effective control of blood pressure, and to lower blood pressure must achieve the standard.
Keep in mind the 4 goals of hypertension treatment
1.Stable blood pressure level to achieve the standard.
2, efficient protection of the heart, brain and kidney important target organs.
3.The highest goal is to prevent the occurrence or development of cardiovascular and cerebrovascular diseases more quickly and efficiently, and to prolong life.
4.Reducing adverse reactions and improving quality of life.
Rational Compounding
The role of rational combination is to complement each other’s strengths and weaknesses, with positive effects synergistically added and side effects offsetting each other.
It is very important to comprehensively control the multiple risk factors of cardiovascular disease, because the goal of blood pressure lowering is to control the risk factors and reduce the morbidity and mortality of cardiovascular and cerebrovascular disease.
The idea of how to choose the right kind and variety of drugs
1. It is on accurate diagnosis
Based on the full assessment of the condition and its risk, we have to grasp the efficacy of the drug based on the evidence, pharmacogenetics, pharmacodynamics and safety characteristics.
Even some instructions to read carefully, often need ≥ 2 appropriate drugs together.
2.Compounding principles
Therapeutic effects superimposed, synergistic or complementary; adverse reactions offset each other; prevention and treatment combined, lipid and blood glucose comprehensive comprehensive standards, quit smoking and alcohol, reduce weight; less money to do more, improve the effectiveness ratio; less risk to gain more benefits, the ideal effectiveness of the risk ratio. First to cure the disease, and then comprehensive, high level, high efficiency to meet the standard.
3.Objective evaluation of high, medium and low risk
Objective evaluation of the patient’s risk, the intensity of treatment must match the degree of the disease, to avoid the error of “left and right”, to avoid over-treatment of low-risk patients and under-medication of high-risk patients.
4.Understand the drug-based symptoms and select drugs according to the latest guidelines
To understand the characteristics of drugs, each type of drug has different characteristics, commonality and characteristics, when available, the use of new drugs with better efficacy than the old formula, but can not exclude the combination of old drugs with symptoms. To new and old drugs with, interactive prevention and treatment.
5, personalized medicine, targeted should be strong
The principle of personalized medication is mainly to target should be strong. For example, hypertensive left ventricular hypertrophy, combined with old myocardial infarction and positive proteinuria, the choice of a number of indications.
ACEI/ARB class of drugs, not only lowering blood pressure, and a multi-benefit, not only lowering blood pressure, and medicine multi-effect, improve left ventricular hypertrophy, secondary prevention of coronary artery disease, not only can lower blood pressure but also comprehensive protection of target organs, the principle of treatment is that the efficiency of treatment should be maximized.
6, RAS antagonist ACEII/ARB alone is not as effective as the compound lowering tablets
For example, the RAS antagonist ACEII/ARB alone is not as effective as the compound lowering tablets, because it is not compatible with diuretics and other causes. In fact, one antihypertensive drug is definitely not as good as more than one drug, because the old use of compounded antihypertensive drugs, as many as 7 drugs, or as few as 4 drugs, so he is a compounded preparation, we should also be based on the latest medical knowledge, dispensing a reasonable prescription. For example, RAS antagonists with diuretics work best, and it is best to formulate your own reasonable new ACEI/ARB-based compound that is most suitable for your specific condition.