Post-stenting blood pressure management should not be underestimated!

  It is well known that hypertension is an important risk factor for the development of coronary heart disease, and stenting is only an option for patients with coronary heart disease who have more severe vascular lesions. Normal blood vessels can gradually form plaque and stenosis, and diseased blood vessels are more susceptible. In other words, blood vessels that have been stented are prone to form stenoses again if blood pressure is not controlled. The main goal of blood pressure control after stenting is to minimize the overall risk of cardiovascular complications in occurrence.  The target value of blood pressure lowering varies from near to far and from high to low.  The target level of blood pressure lowering should be achieved has been modified several times over the years by the relevant academic groups. After years of clinical practice and evidence-based research, a basic consensus has been reached. This year, the American Heart Association, the American College of Cardiology and the American Society of Hypertension jointly issued an updated scientific statement on the treatment of hypertension in patients with existing coronary artery disease, the key point of which is to emphasize that for patients with general hypertension, blood pressure should be lowered to less than 140/90 mmHg; for those who have had a prior cardiovascular event For patients with prior cardiovascular events, a lower goal of less than 130/80 mm Hg may be more appropriate.  How is blood pressure monitored after stenting?  It is impossible for everyone to go to the hospital every day to have their blood pressure measured, so home monitoring of blood pressure is very important.  2, the blood pressure measured in the hospital may not be accurate (such as the “white coat phenomenon” – pseudo-hypertension), if such patients take their own blood pressure at home, the mood is more relaxed, the measured blood pressure is often more real.  3, early in the morning after waking up blood pressure must be measured, other times can be randomly measured. If the blood pressure is basically normal, the number of times a day can be reduced accordingly.  4.Some people’s blood pressure in the morning and afternoon is obviously different, and in the afternoon and evening is also obviously different, this kind of patients should be measured more times, so as to really grasp the process of their blood pressure changes.  How to choose drugs for post-stenting patients?  Calcium antagonists, angiotensin-converting enzyme inhibitors, angiotensin receptor antagonists, beta-blockers and nitrates are all commonly used after stenting for patients with coronary artery disease. However, in comparison, the most classical drug of choice is – beta-blockers (such as the common atenolol, metoprolol, etc.).  This drug mainly relieves myocardial ischemia and angina by reducing myocardial contractility, slowing down the heart rate and reducing myocardial oxygen consumption, and is often used as an initial treatment for patients with stable angina to relieve symptoms. It is worth mentioning that long-term use of beta-blockers has a certain effect on protecting the heart, preventing sudden death and reducing the mortality rate of coronary heart disease.  Of course, it is also necessary to consider long-term treatment with beta-blockers in all patients with coronary or other vascular disease. Recent ACCF/AHA guidelines recommend treatment with beta-blockers in patients with normal left ventricular function after myocardial infarction or acute coronary syndrome, especially in all patients with left ventricular insufficiency (EF ≤ 40%) or with heart failure or previous myocardial infarction, with carvedilol, metoprolol succinate or bisoprolol, unless contraindicated.  Regardless of the type of antihypertensive drug chosen, it should be used appropriately based on the patient’s risk factors, subclinical target organ damage, and comorbid clinical disorders. In addition, many patients may think that they can stop taking medication once their blood pressure reaches the standard, but in fact, interruption of medication can raise blood pressure again, which can lead to serious heart attacks and strokes. In order to avoid these malignant events, regular use of antihypertensive medication should be adhered to. The previous article “How to take antihypertensive drugs? Can I stop taking them? You can check the history for more information.  Finally, we must mention “lifestyle interventions”: first, you should completely stop smoking and limit alcohol; second, eat low-salt foods. It is best not to exceed 6 grams of salt per person per day. Here is a tip that does not need to be measured – just put 1/3 less salt than usual each time, and then drop 1/3 after you get into the habit, so you will basically meet the standard. Potassium can counteract the adverse effects of sodium. It is recommended to eat more foods with high potassium content, such as green beans, seaweed, spinach, watermelon and lemon, etc. Finally, patients should also do physical activities and stay away from obesity.  This is the peaceful world that everyone is looking forward to. The advancement of medical technology has given everyone the greatest guarantee to continue their life and health, and we have to thank this era. The purpose of stenting is to repair diseased blood vessels, but stenting is not the same as healing, and the various risk factors mentioned above should be strictly controlled. As the saying goes, it is never too late to mend, as long as you follow the doctor’s advice and adhere to the medication, you can continue to enjoy a good life.