What if I really have high blood pressure? After several blood pressure monitoring sessions or ambulatory blood pressure checks, what if I really have hypertension? First, you should further improve several tests, which include: Basic: blood biochemistry (potassium, fasting glucose, total serum cholesterol, triglycerides, HDL cholesterol, LDL cholesterol and uric acid, creatinine); routine blood count; urinalysis (urine protein, sugar and urine sediment microscopy); electrocardiogram. Recommended items: 24-hour ambulatory blood pressure monitoring (ABPM), echocardiography, carotid ultrasound, postprandial glucose (measured when fasting glucose ≥6.1 mmol), homocysteine, urine albumin quantification (mandatory for diabetic patients), urine protein quantification (for those with positive protein in routine urine examination), fundus, chest radiograph, pulse wave velocity (PWV), and ankle-arm blood pressure index ( ABI), etc. Selective tests: For patients with suspected secondary hypertension, the following tests can be selected as needed: plasma renin activity, blood and urine aldosterone, blood and urine cortisol, blood free methoxyprenaline (MN) and methoxynorepinephrine (NMN), blood and urine catecholamines, arteriography, renal and adrenal ultrasound, CT or MRI, sleep apnea monitoring, etc. For hypertensive patients with comorbidities, appropriate brain function, cardiac function and renal function tests are performed. Many people will ask, “With so many items, do I have to check them all? No. The basic items should be checked for all hypertensive patients. The recommended items can be selected according to your own economic conditions and local medical conditions, or according to the results of the basic items. The optional tests are mainly for patients suspected of having secondary hypertension or complications of hypertension. Why should these tests be done? On the one hand, these tests can help determine the overall condition of a patient with hypertension, such as blood glucose, lipids, and kidney function. On the other hand, these tests can help doctors rule out some of the secondary causes of hypertension, such as kidney disease, adrenal gland disease, and vascular lesions, so if you clearly have hypertension, then check it out carefully!!! It doesn’t really cost much, especially for the basic items, which can be done for about $200. Secondly, you should improve your lifestyle, which is a long and difficult task. Take a look at the table below, which gives us a list of the effects of lifestyle improvements on blood pressure. I think, but from the text you may not have much intuition, so let me give you an example: it should be 5 or 6 years ago, when I was still new to the hospital, one day I met a young man in the clinic, because of severe chest pain to the hospital, I received him, at that time measured blood pressure 210/115mmHg, ECG normal, encountered this situation, I think as long as the doctor can think A disease – aortic coarctation (this is an extremely serious complication of hypertension, simply put, the inner layer of the artery is torn, but not the whole layer torn, if the whole layer torn, people will soon die. The patient was discharged from the hospital with four antihypertensive medications (the blood pressure was barely controlled with four antihypertensive medications). (The blood pressure was barely controlled with four antihypertensive drugs). The patient’s basic situation: male, 37 years old, programmer, often stay up late, life is not regular, no family history of hypertension, height 169cm, weight 84kg. what to do? The blood pressure medicine is definitely necessary because the blood pressure is too high, but at the same time the improvement of lifestyle is also necessary. The patient was discharged from the hospital and was never seen. Six months later, one day when I was still in the clinic, someone greeted me with “Dr. Tang, do you remember me? (In fact, it is estimated that doctors are a bit face blind, mainly because they are too busy and receive too many patients, can not remember ah, I usually do not recognize people, but a look at the case or discharge summary can be recognized: Oh. You are the patient who got 。。。。 (The patient:)). Then that patient …………. I finally remembered, is the patient with high blood pressure, the results really can not recognize, people are thin, dark. He told me that he is now living a very regular life, low salt, low fat diet, and also insists on exercising every day, and now he is no longer taking medication, and his blood pressure is very well controlled, so this patient made a particularly deep impression on me, and every time I talk about the impact of lifestyle on blood pressure I will take him as an example:)