Back in 1733, the first human blood pressure measurement
In 1733, Stephen Hales, an English priest, used a glass tube with a metal tube at the end, 270 cm long, to insert into the carotid artery of a horse.
The blood entering the glass tube was 270 cm high, which means that the blood pressure in the horse’s carotid artery could maintain a column height of 270 cm.
The height would rise or fall slightly depending on the horse’s heartbeat, with the blood pressure rising when the heart is contracted (systolic pressure) and falling when the heart is relaxed (diastolic pressure)
Shuttling back to 1937, hypertension was still considered untreatable
Paul DudleyWhite, the world’s leading cardiologist of the modern era, said that hypertension was probably an important compensatory mechanism that did not require intervention (even if we could control it).
It wasn’t until President Roosevelt died of a cerebral hemorrhage in 1945, when his blood pressure was as high as 300/190 mmHg, that hypertension was taken seriously!
In 1977, the world’s first U.S. hypertension guidelines were issued to begin exploring disease management of hypertension, and by 2017, disease management of hypertension in China was increasingly improved!
Today, how should blood pressure be managed?
What are today’s blood pressure measurement methods?
Currently, there are 3 commonly used methods of blood pressure measurement: office blood pressure, home blood pressure measurement and ambulatory blood pressure monitoring
What is the basis for the diagnosis of hypertension?
In-office blood pressure is the primary basis for assessing blood pressure levels and clinically diagnosing and grading hypertension.
Ambulatory blood pressure monitoring, which avoids the white coat effect and measures blood pressure during sleep, and is therefore more effective in assessing short term variability in blood pressure as well as circadian rhythms.
home blood pressure monitoring, which not only avoids the white coat effect but also allows assessment of long-term blood pressure variability and blood pressure treatment effects and helps to increase patient awareness of participation and improve treatment adherence
Threshold for hypertension diagnosis?
Office blood pressure ≥ 140/90 mmHg
Ambulatory blood pressure daytime mean ≥ 135/85 mmHg; 24h mean ≥ 130/80 mmHg
Home blood pressure ≥ 135/85mmHg
What are the principles of treatment for hypertension?
Early reduction of blood pressure to achieve the standard: regardless of the treatment, the early control of blood pressure below the target value is fundamental
Comprehensive intervention management: The selection of antihypertensive drugs should take into account the concomitant comorbidities; in addition, for patients with existing cardiovascular disease and patients with certain risk factors, antiplatelet and lipid-regulating therapy should be considered to reduce the risk of recurrence of cardiovascular disease and death
Lifestyle interventions: Patients are advised to adhere to long-term lifestyle interventions to remove behaviors and habits that are detrimental to physical and mental health.
What are the treatment goals for hypertension?
The basic goal of hypertension treatment is to achieve blood pressure targets.
The ultimate goal is to minimize the overall risk of cardiovascular and cerebrovascular disease morbidity and mortality
What are the treatment options for hypertension?
What are the non-pharmacological treatment measures? —— “Six Steps to a Healthy Lifestyle”
Limit salt, reduce weight, exercise more, stop smoking and limit alcohol, and have a calm mind
When to take medication?
Once diagnosed, all patients with hypertension are recommended to start medication immediately along with lifestyle interventions
For hypertensive patients with systolic blood pressure <160 mmHg and diastolic blood pressure <100 mmHg who do not have combined coronary artery disease, heart failure, stroke, peripheral atherosclerosis, kidney disease or diabetes mellitus, physicians may also withhold medication according to the patient's condition and wishes, and use lifestyle intervention alone for a maximum of 3 months, and then initiate medication if the target is not met.
When should combination therapy be used?
Combination therapy should be used when the target is not reached after 2-4 weeks of monotherapy
Combination therapy is indicated for the following conditions at initial treatment
Grade 2 or higher hypertension
Above target 20/10 mmHg
High-risk individuals with multiple risk factors, target organ damage or clinical disorders
What should I look for in hypertension treatment?
Adherence to long-term treatment and regular follow-up
There is no fundamental treatment for the cause of hypertension, and most patients require long-term, or even lifelong, antihypertensive therapy.