Hypertension: a killer of human health, blood pressure is the lateral pressure of blood flowing in human blood vessels against the vessel wall, divided into systolic and diastolic pressure, currently internationally recognized as hypertension when the systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg.
Hypertension is an ancient disease.
At present, one person dies of cardiovascular disease every 15 seconds in China, and the total morbidity and mortality of cardiovascular disease is on the increase and is close to the level of developed countries.
Blood pressure level is continuously and positively correlated with the incidence of cardiovascular diseases, and the higher the blood pressure, the greater the risk. Elevated blood pressure is the most important risk factor for stroke incidence in our population. Studies have shown that blood pressure levels have a log-linear relationship with the risk of stroke incidence, with a 49% increase in the relative risk of stroke occurrence for every 10 mmHg increase in baseline systolic blood pressure and a 46% increase in stroke risk for every 10 mmHg increase in diastolic blood pressure. Active treatment of hypertension can reduce the risk of stroke by 31%. Blood pressure is also a risk factor for the development of coronary heart disease in our population, and a sharp increase in blood pressure can induce acute myocardial infarction, which occurs in 500,000 people each year. In addition, elevated blood pressure also increases the risk of heart failure and kidney disease, diabetes, etc.
Recent studies have found that many hypertension-related diseases occur in people who are usually considered “normotensive,” so the cardiovascular risk in hypertensive patients depends not only on blood pressure levels, but also on the number and degree of other cardiovascular risk factors that are also present, such as age, sex, whether or not they smoke, the presence of dyslipidemia, obesity, diabetes, and the presence of a family with cardiovascular disease. diabetes mellitus and family history of cardiovascular disease.
Who is at risk of developing hypertension?
The internationally recognized risk factors for the development of hypertension are overweight, high-salt diet and moderate alcohol consumption. The normal body mass index of Chinese adults is 19 to 24, with a body mass index of ≥24 being overweight and ≥28 being obese. The difference in population body mass index production has a significant effect on blood pressure levels and the prevalence of hypertension in the population, with each 3 increase in baseline body mass index increasing the risk of hypertension by 57% in women and 50% in men within 4 years. The risk of hypertension over 4 years increased by 40% for those who continued to drink alcohol than for those who did not. Dietary salt intake is significantly correlated with blood pressure levels, with an average increase of 2 g of salt per person per day increasing systolic and diastolic blood pressure by 2 mmHg and 1.2 mmHg, respectively, so special attention should be paid to the prevention of hypertension in these groups.
In 2002, China conducted the third large-scale hypertension population sample survey, the prevalence of hypertension among people aged 18 years and above in China was 18.8%, and the estimated number of people with the disease was 160 million, compared with 1991, the prevalence rate increased by 31%, while the awareness rate of hypertension among the population was 30.2%, the treatment rate was 24.7%, and the control rate was only 6.1%. Therefore, with the rapid development of China’s economy, people’s living standards continue to improve the pace of life, the rising incidence of hypertension has become a serious challenge, our government and every medical workers on the epidemic of hypertension in China and the consequences it will lead to must have a clear understanding, maintain a high degree of vigilance, and take strong preventive and curative measures.
The four major killers of human health at present are hypertension, hyperglycemia, hyperlipidemia and smoking. Among them, high blood sugar is the sweet killer, high blood fat is the quiet killer, smoking is the gentle killer, and high blood pressure is the fear killer. Therefore we should mobilize all people, raise awareness, and start from three aspects: controlling the level of risk factors, early diagnosis and treatment, and standardized management of patients, to construct a comprehensive and three-dimensional prevention and treatment front for hypertension, in order to effectively curb this killer that endangers human health.
Stay away from hypertension: active prevention is an effective measure. Hypertension is a cardiovascular disease that seriously endangers the health and quality of life of our people. The latest epidemiological survey of hypertension in China shows that the prevalence of hypertension among people aged 18 years and above is 18.8%, and the estimated number of people suffering from the disease is 160 million nationwide, which is an obvious rising trend. The awareness rate of hypertension is low, the medication rate is low and the control rate is low. So can hypertension be effectively prevented?
The answer is yes. It has been shown that primary prevention, which focuses on healthy lifestyles, can reduce the incidence of hypertension by 55%, followed by a significant reduction in prevalence, complication rates, and medical costs. Thus, the direct and indirect benefits of successful prevention are enormous. So we should pay attention and take active action to prevent hypertension effectively!
How can we achieve proper prevention?
The main method of hypertension prevention is the “four cornerstones of health” as pointed out in the “Victoria Declaration” of the 1992 American Heart Health Conference, namely “proper diet, moderate exercise, smoking cessation and alcohol restriction, and psychological balance. “It has become a preventive measure advocated by various countries. Specifically, they include the following.
I. Reasonable diet.
It can be summarized as two simple words: one, two, three, four, five and red, yellow, green, white and black. One refers to 1 bag of milk per day. It is recommended to start from the hour, 1 bag of milk per day and insist on drinking it for life. Two refers to about 250g of carbohydrates per day. The third refers to 3 servings of high-protein foods per day. Each serving of high-protein food is equivalent to any of the following: 50g of lean meat, 100g of tofu, a large egg, 25g of soybeans, 100g of fish, shrimp or chicken and duck. Four refers to four phrases: coarse and fine, not sweet and not salty, three, four, five meals, seven or eight portions full. Five refers to 500g of vegetables and fruits per day. Red refers to red wine, 50-100ml of red wine per day can raise HDL cholesterol and reduce atherosclerosis in middle-aged and elderly people. Yellow refers to yellow vegetables such as carrots, sweet potatoes, pumpkins, corn, tomatoes. Green refers to green tea. White refers to oats. 50g of oatmeal cooked in porridge daily can bring down blood lipids. Black refers to black fungus, the significant anticoagulant effect of black fungus, its anti-platelet aggregation effect is comparable to a small amount of aspirin.
Second, moderate exercise. The best exercise is walking, should master the “three, five, seven” and “constant, orderly, moderate” exercise principles: three refers to the daily walking 3 kilometers, more than 30 minutes; five refers to exercise more than 5 times a week, only regular exercise to have an effect. “Seven” refers to the exercise heart rate plus age of about 170, so the amount of exercise is medium, such as 50-year-old people, after exercise heart rate of 120 times / min, 60-year-old people, after exercise heart rate of 110 times / min, so as to maintain aerobic metabolism.
Third, quit smoking and limit alcohol.
Fourth, mental balance. Have a “happy heart” and “normal heart” is very important to prevent hypertension.
In addition to the above four items, we should also pay attention to the “3 half minutes” and “3 half hours”. The “3 and a half minutes” means that when you wake up in the morning, you should lie still for half a minute, then sit up for half a minute, then hang down the edge of the bed with both lower limbs for half a minute, and then move down to the floor. The “3 half hours” refers to a half-hour walk in the morning, a half-hour walk after dinner, and a half-hour nap at noon. Studies have shown that the human body 24-hour blood pressure is a double peak a valley, noon nap can make the blood pressure valley deeper and wider, helping to relieve heart and blood vessel pressure. There are more than 30 minutes nap habit, coronary heart disease mortality rate reduced by 30%.
In short, hypertension can be prevented, but prevention is a complex system engineering, the interaction between the factors and influence, should be flexible according to the specific circumstances of each person, the integrated application to achieve good results.
Effective control of hypertension requires a combination of drug therapy, the pathogenesis of hypertension is more complex, how to effectively control hypertension is a major problem for doctors and patients, but also a huge challenge. Traditional monotherapy for hypertension is often ineffective and difficult to achieve ideal blood pressure control. Therefore, after years of clinical practice, medical experts believe that a reasonable combination of antihypertensive drugs and combination therapy can truly achieve the goal of lowering blood pressure.
Hypertension combination therapy, the narrow concept refers to the combination of various antihypertensive drugs, the existing antihypertensive drugs include diuretics, beta-blockers, calcium antagonists (CCB), angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor antagonists (ARB), alpha-blockers and other six categories of more than 100 kinds, doctors can use these six categories of antihypertensive drugs in combination according to the needs of patients with different conditions, so that Blood pressure can be lowered to the ideal level; and the broad sense of combination therapy also includes the combination of non-pharmacological treatment.
I. Emphasis on non-pharmacological treatment, especially lifestyle improvement
The new hypertension treatment guidelines emphasize the improvement of lifestyle as the first choice for the prevention and treatment of hypertension and throughout the process of measures, including improving dietary structure and increasing physical activity, all patients, including those who need drug treatment should improve their lifestyle, mobilize patients’ motivation, promote a healthy lifestyle, eliminate behaviors and habits that are not conducive to mental and physical health, to achieve the reduction of hypertension as well as other The risk of developing hypertension and other cardiovascular diseases should be reduced.
Second, lowering blood pressure to achieve the standard and the joint application of antihypertensive drugs
The majority of patients need to lower their blood pressure to ≤140/90mmHg, and the benefits of antihypertensive treatment mainly come from the reduction of blood pressure itself, so it is very important to achieve the standard of blood pressure reduction. The original use of a single drug treatment efficiency is low, even for mild hypertension is only 40% to 50%, satisfactory antihypertensive more need to combine drugs, the lower the target blood pressure, the greater the proportion of patients need to combine drugs, in order to achieve the target blood pressure, the blood pressure to 140/90mmHg or less, especially in patients with diabetes or chronic kidney disease should be reduced to 130/80mmHg or less, most hypertensive patients need a combination of 2 or more antihypertensive drugs. The new view of hypertension drug therapy is to advocate the use of two or even three antihypertensive drugs in combination, and this view has been clearly written in the latest guidelines for the treatment of hypertension.
If the blood pressure does not reach the standard, the dose of one of the drugs can be increased to the full dose or a third drug can be added at a low dose, and if the blood pressure still does not reach the standard, the dose of the third drug can be adjusted to the effective dose. The advantage of combining drugs is that the dose of drugs is small while the antihypertensive effect is added, the adverse effects are reduced, and the patient’s compliance with treatment can be improved. The number of drug combinations should not be excessive to avoid complex drug interactions. A reasonable combination should also take into account the consistency of the time of action of each drug, i.e., chronotherapeutics. Therefore, the combination of drugs should have its pharmacological basis. At present, the following categories of antihypertensive drug combinations are considered more reasonable: diuretics + β-blockers, diuretics + ACEI or ARB, CCB + β-blockers; CCB + ACEI or ARB; CCB + diuretics; α-blockers + β-blockers, etc. The combination therapy of hypertension in China can be traced back to the compound antihypertensive tablets in the 1960s and 1970s until the present day Beijing Antihypertensive 0. However, it has been reported that compound antihypertensive tablets may cause depression or even dementia, especially in elderly patients, so their use in the elderly population should be closely observed. What kind of combination is used should be under the guidance of a cardiovascular specialist for good.
Third, the treatment of hypertension should pay attention to the comprehensive control of risk factors
Hypertension is not only a hemodynamic abnormal disease, but also a metabolic abnormal disease. More than 80% of hypertensive patients have one or several risk factors combined, mainly including diabetes, dyslipidemia, obesity, etc. In addition, there are gender, age, family history, etc. In the antihypertensive treatment, attention should be paid to the comprehensive control of risk factors, such as weight control, treatment of blood sugar and dyslipidemia, and for high-risk patients, it may also Intensive lipid-lowering therapy is needed, and small doses of aspirin (75 mg) are also needed to prevent ischemic cardiovascular disease under the premise of good blood pressure control.
Get out of the misunderstanding of hypertension treatment
Myth 1: I don’t have headache and dizziness, so I can’t have hypertension. In fact, there are many patients who have no abnormal sensation of elevated blood pressure until the emergence of cardiovascular disease, when they are found to have elevated blood pressure, at which time a better time to intervene in hypertension has been lost. Therefore, blood pressure should be measured at least once or twice a year for young and middle-aged people, and for people with a family history of hypertension, the number of blood pressure monitoring should be increased.
Myth 2: Not to go to the hospital after finding elevated blood pressure. Current research has found that 15-25% of hypertensive patients are secondary hypertension, 75%-85% are primary, for secondary hypertension, if the diagnosis is accurate, timely treatment, it is possible to completely cure, while for primary hypertension, it is necessary to take lifelong antihypertensive drug treatment. Therefore, after the discovery of hypertension, you should promptly go to a specialist hospital and queue secondary hypertension, so as not to lose the opportunity for correct diagnosis and treatment.
Misconception 3: When elevated blood pressure is found, it should be brought down immediately. Unless it is hypertensive crisis or acute hypertension in, lowering the blood pressure should not be too fast, some people once found hypertension, hate to immediately bring down the blood pressure, and even arbitrarily increase the dose of medication, which is very easy to accident, especially the high blood pressure level of middle-aged and elderly patients with severe hypertension, is very likely to cause serious cardiovascular and cerebrovascular lesions.
Misconception four, blood pressure is normal, you can stop the drug. Some patients with antihypertensive drugs when serving when stopping, a high blood pressure to eat a few tablets, blood pressure a drop, immediately stop the drug. Suddenly stop the drug, it is very easy to make the blood pressure rebound. Blood pressure is sometimes high and sometimes low, just like the climate is sometimes cold and sometimes hot, more harmful to health. Therefore, drug treatment should be persistent, when taking and stopping is not only an important reason for treatment failure, but also easy to cause accidents. In more severe cases of hypertension, which can be considered a lifelong disease, long-term treatment should be adhered to. When the treatment has achieved satisfactory results, the dosage can be gradually reduced so that the amount of treatment is maintained at a lower and stable level of blood pressure control, but this process must be carried out slowly.
Myth 5: Without a doctor’s prescription or advice, buy antihypertensive medication from a pharmacy on your own. There are more than 100 varieties of antihypertensive drugs in six categories, and their effects and antihypertensive mechanisms are not exactly the same. Some antihypertensive drugs may be effective for this type of hypertension, some antihypertensive drugs may be effective for another type of hypertension. If the type of antihypertensive is not right, the antihypertensive effect will not be fully developed, and sometimes it is mistaken that antihypertensive drugs do not work. Therefore, the drug treatment of hypertensive patients should be carried out under the guidance of a specialist.
Myth six, the treatment process does not monitor blood pressure. Some patients do not monitor their blood pressure during the treatment process, and only take medication based on their own feelings. When they feel better, they take less, and when they feel dizzy, they increase the dose. In fact, most of the time, self-perception is not consistent with the severity of the disease, such as blood pressure is too low, insufficient blood supply to the brain will also appear dizziness, so continue to high doses of drugs is very dangerous. Therefore, blood pressure should be measured regularly, and the dose should be adjusted in time to consolidate and maintain the efficacy of treatment.
Myth 7: Change the treatment plan at will. A considerable number of patients are prone to trust the advice of non-professionals or other patients and casually change their treatment plan. The treatment of hypertensive patients is individualized, each person’s situation is different, and the drugs that work for others may not be suitable for you. If you need to change the drug, or should be under the guidance of a specialist, and some drugs are best not to suddenly stop, especially the beta-blockers such as Jinan, Melotol, more slowly stop the drug to avoid blood pressure rebound.
Myth eight, gullible advertising. For example, “a certain antihypertensive capsule is the only pure Chinese medicine approved by the Hypertension League and the U.S. Food and Drug Administration to treat hypertension” “a certain antihypertensive drug can completely get rid of the problems of Western medicine, without the need to take medication for life” “a certain Hypertension treatment device, a significant effect on hypertension” and so on, has not found a treatment can completely cure hypertension disease, hypertension Alliance has not recommended any treatment of hypertension Chinese medicine, the treatment of hypertension has never heard of gene therapy. It is also important to emphasize that most people with hypertension need to take medication for life and that people with hypertension must have their blood pressure measured regularly during treatment.