I. Physiological activity of cardiovascular
Hypertension is a result of arterial blood vessel damage that no one can get rid of. Zhou Menghan, Department of Orthopedics, Fifth Affiliated Hospital of Xinjiang Medical University
First of all, we have to know blood pressure first. Blood pressure is the result of the subtraction of the impact of the heart on the walls of blood vessels and the elastic buffering force of blood vessels.
Each contraction of the heart squeezes a certain volume of blood into the arterial vessels. The sudden entry of blood into the arterial vessels causes dilation of the arterial vessels. The degree of expansion of the blood vessels is determined by the elasticity of the arterial blood vessels, which is good for great expansion, poor for little expansion, and inelastic for no expansion. The pressure of blood against the vessel wall when the vessel is dilated to its maximum is the arterial blood pressure. Arterial blood vessels leave the heart in the form of dendrites, and the further away from the heart, the thinner the diameter of the arteries. Arteries of different diameters are subjected to different pressures of blood. Regardless of the different arterial diameters, all arterial walls are stressed and dilated at the same time.
With each diastole of the heart, a certain volume of blood is collected from the veins in preparation for the output of the next contraction. Because venous blood flows extremely slowly, the heart takes a little longer to diastole than to contract in order to output roughly equal volumes of blood each time.
The sudden entry of blood from the heart into the arteries produces a strong impact on the walls of the arterial blood vessels. The vessel walls use their own elasticity (retraction force) to gradually relieve this shock until they no longer do so – dilating to their (maximum) limit. As the heart expands (collects venous blood), the arterial wall uses its own elasticity to retract its diameter to a minimum. The degree of retraction of the arterial wall is determined by the elasticity of the vessel wall and the amount of blood in the vessel; with less blood and better elasticity, the degree of retraction is greater, otherwise, the degree of retraction is less. The duration of retraction is the same as the duration of cardiac dilation. How long the heart dilates, how long the arteries retract (rest).
The arterial vessels use elasticity to relieve the impact of blood on the vessel walls, and when they expand to their maximum (this moment), the pressure of blood on the vessel walls is what we often call blood pressure (arterial blood pressure).
Therefore, the blood vessels dilate when the pressure of the blood against the arterial vessel wall is greater than the elasticity (retraction force) of the vessels. The combined force is zero when the pressure of blood against the arterial wall gradually equals the elasticity of the vessel (maximum retraction force). When the pressure of blood on the arterial wall is less than the elasticity of the vessel, the arterial vessel retracts. This is a cyclic, non-stop activity. Once it stops, life stops with it.
Understanding the normal cardiovascular process described above, the cause of hypertension is simple.
Two causes of hypertension (mechanism of hypertension formation)
The arterial blood vessel wall is roughly divided into three layers. The inner layer is the smooth endothelium and subcutaneous lax tissue, this layer of lax tissue can generate new endothelium. In the middle is the muscular layer of the vessel, which contains smooth muscle and elastic fibers, with the smooth muscle gradually decreasing as the arterial branches become thinner in caliber and the terminal artery has only elastic fibers. The outer layer is lax vascular nutrient tissue. Together, the three layers of the artery form the elasticity of the vessel. The most variable forces are applied to the inner and middle layers.
The inner and middle layers are the most damaged by the repeated passive extreme expansion of the arterial vessel wall over a long period of time driven by the heart. Based on 60-80 beats per minute, there should be as many as 80,000 to 110,000 beats a day for 24 hours. With so many beats, it is strange that the vascular muscle is not tired. The damaged muscle fibers break and are repaired by denaturation and infiltration of the outer layer of tissue to form a scar. This is the process of arteriosclerosis. As the scar expands, cholesterol calcification occurs.
It should be specifically noted here that the steroids that harden the vascular muscle do not originate from the blood inside the blood vessels. Rather, it originates from the cholesterol contained in the muscle itself. Most of the cholesterol in our body (about 80 to 90 percent) is made by the liver. It is not ingested. The products made by the liver are transported throughout the body, via the bloodstream. If it is not used, it is returned. Mixed in with the newly made cholesterol, it is then sent elsewhere. The increase in blood cholesterol levels only indicates that less cholesterol is being utilized and has nothing to do with hardening of the blood vessels. Cholesterol is only being transported within the bloodstream, it is passing through. If (hypothetically) cholesterol in the blood vessels could harden the walls, atherosclerosis would begin in the endothelium and would accumulate into clots forming blockages. In fact, all atherosclerosis begins in the muscular layer and gradually invades the subendothelium. Only ruptured damage to the endothelium results in the formation of clot blockage – secondary to thrombosis. Damage to the myofibers of the blood vessels, denaturing them, allows the cholesterol contained in itself to participate in scar composition in small amounts that are not visible. Large amounts can form clots. This is the material basis of vascular sclerosis. This view of mine is different from the textbook because the one who compiled the textbook is copying the book, while I am thinking about it. This is the fundamental reason why internal medicine doctors have no success in treating atherosclerosis. As we all know, life that has died cannot come back to life. Then, of course, the same is true for dead muscle cells.
Repeated damage and scar repair, the subendothelial loose tissue of the arterial vessels and the inelastic fibrous scar of the middle layer of the arterial vessels increase, the walls of the vessels gradually become harder and less elastic, the toughness of the impact resistance increases, and the resistance to the sudden increase of blood increases, which is the reason why hypertension arises. Arterial blood vessel walls become less elastic (sclerosis), the resistance of the heart to discharge the normal amount of blood increases, instead, the heart contraction at a time to squeeze out the amount of blood to reduce, which is why hypertension instead appears to be a shortage of blood supply to the body.
Vascular sclerosis also makes the heart muscle to use greater force to discharge arterial blood, the heart muscle gradually thickens, consuming more oxygen and energy, the number of blood vessels in the adult heart remains unchanged (will not increase), the blood vessels supplying the heart muscle are squeezed by the heart muscle, the heart nutrient blood volume is relatively insufficient, causing myocardial injury. After myocardial damage, fibrous scar is formed, elasticity and strength are reduced, the amount of blood drainage decreases, and the volume becomes larger. This is the principle of the formation of hypertensive heart disease.
Arterial vasoconstriction, in addition to the elasticity of the blood vessel walls themselves, is also regulated by mental factors.
The human brain, when stressed (frightened), prompts the glands to secrete various hormones. These hormones act on the nerves, heart and blood vessels, and the nerve conduction is enhanced and accelerated, which can lead to increased strength of the heart muscle and vascular muscles (increased blood pressure) and increased blood supply, providing more energy to the body’s brain and motor system. This is why people feel orthopedic when they are stressed. This is the stressful state of the body. If the brain is in a state of stress for a long time, the heart and arterial vessels are under high load for a long time, and damage to the heart muscle and blood vessels also occurs, and scar repair of the damage can likewise cause myocardial weakness and atherosclerosis.
In summary, there are two causes of hypertension formation: first, organic changes that develop with age; second, prolonged brain stress that controls vasoconstriction through hormones and nerves (functional changes). Of these two factors, only the mental factor (functional changes) is variable and can be reduced by medication to weaken the nerve conduction velocity and reduce the tension in the heart muscle and vascular muscles. Organic changes are unchangeable, which is why no one can get rid of hypertension, but those with greater mental relaxation (often called “no heart, no lungs”) suffer from hypertension later, and those with less mental relaxation suffer from hypertension earlier.
Many families with hypertension say it is genetic. I think it is due to the way of thinking of the family. The family mindset subconsciously causes family members to unconsciously think and react in the same way to what is happening around their bodies. This is why people in the same family do not have the same age and degree of hypertension. If family genetics were at work, people in the family should develop hypertension at the same age, but this is not the case.
Self-determination of hypertension
Regarding the diagnostic criteria for hypertension, I quote the following passage from Baidu’s encyclopedia.
“The current diagnosis of hypertension in China uses the criteria recommended in the 2000 Chinese guidelines for the treatment of hypertension:.
Category
Systolic blood pressure (mmHg)
Diastolic blood pressure (mmHg)
Normal blood pressure
<120
<80
Normal high value
120～139
80～89
High blood pressure
≥140
≥90
Grade 1 hypertension (mild)
140～159
90～99
Grade 2 hypertension (moderate)
160～179
100～109
Grade 3 hypertension (severe)
≥180
≥110
Simple systolic hypertension
≥140
<90
“
Quoting it does not mean I agree with the criteria. I think it’s the work of a bunch of brain-dead doctors. Even if the people who set the standard are experts they are brain-dead or cerebral palsy experts.
The human body is different and each person has their own normal blood pressure. How can you set one standard to frame everyone. According to this standard, people with blood pressure at 90/60mmHg are not hypotensive or half dead (in shock)? But people live a normal life, without any discomfort. There are young people with blood pressure of 140/100mmHg who are also living very comfortably.
Usually statistical values are only valid for a general description of a certain type of organism, but not for each individual. Each individual has its own physiological normal. Normal values should not be boxed and should vary from individual to individual. Only if the normal value of an individual is not available, the normal value of the group can be referred to, but it should not be the only basis.
I believe that whether or not one has hypertension should be judged based on one’s own feelings, the results of the examination when one is just an adult, and the results of the examination when one is actually normal for one’s age.
Daily self-judgment is mainly based on one’s own feelings.
The most important thing to determine if you have hypertension is how you feel. If you have dizziness or headache, you should consider having elevated blood pressure. Dizziness indicates brain tissue ischemia, and headache indicates brain tissue damage. Hypertension can be determined after other definite causes (trauma, drugs, infection, etc.) have been ruled out.
IV Regarding the interpretation of systolic and diastolic blood pressure.
Anyone who has used a mercury sphygmomanometer knows that when the balloon cuff is inflated to a certain mercury column height, the sound of pulsating blood vessels cannot be heard, and then the sound of pulsating arteries can be heard when the air is slowly deflated. The systolic pressure is usually taken as the position where the mercury drops when the first arterial beat is heard. Continuing to deflate, the column of mercury continues to fall to the point where it is no longer heard as a diastolic pressure.
The terms “systolic” and “diastolic” arterial pressure are used in all textbooks. At this point, all the textbooks are wrong. Common sense tells us that what everyone says is not always right and is often a fallacy that is passed on. The arterial blood pressure usually measured at the elbow, whether systolic or diastolic, is the diastolic pressure of the elbow artery. Both are the pressure of the artery when it is dilated to its maximum. They are the same. The different sound heard is just a change in the force of compression of the artery by the airbag, which causes a change in sound transmission. This is common sense physics. All Western medical textbooks are actually wrong, and they have been wrong for a hundred years. This shows that Western doctors have learned physics lessons very poorly.
Therefore, according to the above, blood pressure can be detected by just one value. It can be the first sound (high value) heard after the artery is completely occluded and then opened, or it can be the last sound when the artery is completely released. Use this value to compare with the previously measured value. The difference between the high value and the low value is called pulse pressure in textbooks. In fact, there should not be a difference in pulse pressure at a point in the artery at the same time. A high difference means that the pressure of the air sac blocking the arterial blood is high, which indirectly means that the artery is stiff.
Five treatment of hypertension
The first thing to cure the disease is to clarify the cause of the disease, and only when the cause is removed is it possible to cure the disease (many of the clarified causes cannot be cured). Physicians have listed many causes of hypertension, but in fact there are only two categories. One category is mental-fluid causes (functional damage) and the other is structural causes (organic damage). Since the structural causes cannot be changed, the treatment of hypertension should not be based on the delusion of “removing the root cause”. Hypertension cannot be completely cured, but only mental and neurological factors can be adjusted through environment and medication. As structural factors become more dominant with age, the ability of drugs to adjust mental factors becomes less and less effective.
Overall, the treatment of hypertension is about controlling both the mental and cardiovascular aspects. The cardiovascular aspect is medicated in terms of reducing blood volume and arterial vascular tension.
Since blood pressure can only be adjusted by psychotropic and neurologic drugs. Psychotropic drugs should then be the basis of hypertension treatment. Since the human mind is most relaxed during deep sleep. Therefore, I believe that sleep medication should be the first choice for treating hypertension from the mental aspect factor and should be used as the basic medication.
Therefore, when hypertension is found to be present, sedative sleep-aiding drugs can be used first. With a good sleep, one can feel comfortable. Blood pressure can basically return to normal (comfort blood pressure). Therefore, the goal of treatment for hypertension should not be to restore the blood pressure of youth, but to achieve a comfortable blood pressure.
If sedative drugs are not effective, it is recommended that antihypertensive drugs be used in addition to sedative drugs.
The following classes of antihypertensive drugs are currently in common use.
1 Diuretics: there are thiazides, tab diuretics and potassium-protective diuretics.
The blood vessel is equivalent to a closed tank of water. We know that when the tank is filled with water, the tank bears the pressure of water is high. The same is true for the blood vessels. The principle of diuretic treatment is to reduce this pressure by accelerating the removal of water from the blood by the kidneys. This presupposes that the kidneys must be healthy. The result is accelerated damage to the kidneys.
The kidneys are actually equivalent to the grate (filter) at the outlet of the sewer. The blood vessels have their own blood volume adjustment function. One is to retain water through osmotic pressure (the absorption of organic and inorganic components of blood), and the other is to discharge water that cannot be retained by osmotic pressure. The water that cannot be retained flows through the kidneys and will leak out naturally. As long as the kidneys can retain the organic and inorganic active ingredients, they can maintain an adequate amount of blood. Diuretics are used to speed up drainage by excreting inorganic salts of sodium. It is tantamount to widening the gap in the normal water grate and leaking more. Wouldn’t this achieve drainage by destroying the water grate? The grate will not repair itself, the kidney can (note that the ability of the repaired kidney is only close to the “original” kidney). Therefore, this method can be used only for a while, not for a long time.
In addition, this method can be used for young people but not for the elderly. In the elderly, the bladder muscle is weak, there is a lot of residual urine, and the bladder’s urinary storage function is weakened. The use of diuretics increases nocturia and is more detrimental to sleep.
2 Beta-blockers: commonly used are metoprolol, atenolol, bisoprolol, carveolol, labetalol. These drugs are used to reduce blood pressure by weakening the conduction of the myocardial and vascular myocardial nerves, reducing the number of contractions and the force of contraction, so that the blood vessel filling volume is reduced. The main thing is the reduction of the heart beat out volume. This reduces the burden on the heart and blood vessels, and also relatively will appear to be insufficient blood supply to the body.
3 calcium channel blockers (also known as calcium antagonists): the main nifedipine, verapamil and diltiazem, etc. According to the duration of drug action, calcium channel blockers can be divided into short-acting and long-acting.
We know that muscle contraction (whether transverse or smooth muscle) has calcium involvement. This drug affects the contractility of the muscle mainly by reducing the entry of calcium into the myocyte. However, the amount of blood discharged from the heart is usually the same as the body’s needs. As muscle strength decreases, the number of contractions per minute of the heart has to increase in order to keep the blood supply up. This is not good for people with poor heart function. It should not be used by people with cardiac insufficiency. Lest it aggravate heart failure.
4 Angiotensin converting enzyme inhibitors: commonly used are captopril, enalapril, benazepril, and cilazepril.
These drugs are mainly used to lower blood pressure by relaxing the blood vessel muscles. When the blood vessel muscle relaxes, it is easy to dilate and the burden on the heart is relatively reduced. You can use this type of antihypertensive drugs if you have poor heart function. However, the relaxation of blood vessel muscles reduces the elasticity. The force of blood vessel retraction is reduced, and the flow rate slows down, which inevitably affects the quality and quantity of blood supply. And it also often causes irritating dry cough. I consider that this is mainly due to the relaxation of vascular smooth muscle while also weakening organ smooth muscle activity, and a small amount of mucus accumulation leads to a dry cough. It is really a case of losing one thing and losing the other, and the fire at the city gate affects the fish in the pond.
5 angiotensin II receptor inhibitors: commonly used are cloxacin, the antihypertensive effect is slow to take effect, but lasting and stable. The most important feature is that there are few adverse reactions directly related to the drug and does not cause irritating dry cough.
Hypertension treatment drugs, only different types and prices, no different purposes. The purpose is one – to lower blood pressure. Therefore, as long as they are used correctly, they can all lower blood pressure.
As for the method of hypertension medication, the usual requirement of internal medicine doctors is that once the medication is used, it cannot be interrupted. This is actually not true. At the beginning of hypertension, medication can be intermittent. When you feel slightly uncomfortable, you have to take the medicine. If you take it three or two times in a row and feel comfortable, you can stop taking it. To keep a good sleep as the next. As the course of the disease lengthens, the duration of taking the medication gradually lengthens (stopping the medication to the extent that the discomfort disappears), and the interval will naturally shorten gradually. Until continuous.
Six prevention of hypertension
Hypertension is bound to occur in a person’s life. Therefore it is impossible to prevent hypertension. However, it is possible to delay its appearance by changing bad lifestyle habits.
1 Starting from youth, do not stay up late. Have regular work and rest.
As we said earlier, hypertension is caused by damage to blood vessels. As we know, there are minor and major damage according to the degree. Minor damage recovery is fast, serious damage recovery is slow, and even affect the future function. The repair of damage in our body is mainly in sleep, especially in the evening. Although the heart and blood vessels work the night shift all year round, their burden is relatively reduced because the body is mostly at rest. Our body secretes growth hormone to repair all the damage (including blood vessels) that can be repaired during this time. If you stay up late, the body does not have time to repair the damage, it will cause the damage to expand and not heal over time, and even if it does, the scar formed will be large. Affects future function.
Someone once said, “People who can’t rest can’t work.” People who can relate to this statement often already suffer from hypertension. There are often biographies of great people who say that a certain person does not like to be disturbed when they sleep, and I want to laugh when I see this content. Because I know that person must suffer from high blood pressure, good sleep, being disturbed must be very annoying.
2 ban smoking, alcohol, tea, coffee and other hobbies
Prohibit the use of all excitatory substances that can help refresh the mind. For example, tea, coffee, tobacco, alcohol and so on.
Smoke has nicotine base, its ph value is higher than the blood, absorption into the blood, the endothelial cells is chemical damage. The accumulation in the peripheral blood vessels is also an irritant damage to the nerves of the brain, is stimulated to increase the excitability of the brain.
The same is true of coffee.
Alcohol, regardless of the type and degree, the effect of alcohol is the same. Alcohol has a certain permeability, and when alcohol enters the blood, it is an irritation to the walls of blood vessels. Alcohol decomposes into acetaldehyde in the body, stimulating blood vessels, which can cause circumferential vascular avoidance of dilation, deep blood vessels invisible to the naked eye, superficial visible (circumferential skin reddening). Stimulates the nerves in the brain and creates excitement. Acetaldehyde decomposes into acetic acid, which then participates in the glucose metabolism process in the body and decomposes into carbon dioxide and water. A large amount of carbon dioxide accumulates in the blood and flows through the brain, causing an anesthetic effect. This is why the process of drunkenness is all about making a scene (excitement) and then falling asleep (inhibition). At the same time, a large amount of carbon dioxide flows through the lungs causing hyperventilation, taking away water and causing dry mouth. Causes a lot of water drinking. Blood volume increases. This is the reason why blood pressure first falls and then rises after drinking alcohol.
What a small amount of alcohol is good for the body, according to the above process, proved to be nonsense.
The functions that tea, coffee, cigarettes and alcohol can mobilize are the same as exercise, which is the body’s reserve function to deal with emergencies and diseases. It is the exchange of future pain for immediate enjoyment. Occasionally, a short time will not see the effect of damage.
3 not full of food
Eating allows us to take in a variety of nutrients. But various nutrients into the blood, the blood vessel wall is also chemical damage. Sugar, for example, can stimulate the walls of blood vessels. Blood is not a single water. The various nutrients ingested gather in the blood and the blood is equivalent to mud. High-speed flowing mud can destroy the riverbed, and high-speed flowing blood naturally destroys the blood vessel walls. So the endothelial cells of the blood vessel wall are shedding and growing frequently. If they do not grow enough, they are the vessel wall scar.
But without eating, we die faster. So eat, but not full, not over intake of various substances to reduce the viscosity of the blood.
4 Try not to use intravenous drip or push treatment
Intravenous injection of drugs is a kind of irritating damage to blood vessels. For example, infusion of glucose. 5% glucose is consistent with the osmotic pressure of the blood. People use it a lot. But no one thinks about the damage to the blood vessels at this concentration of glucose. 5% glucose is 278 mmol/L, almost 50 times the normal blood sugar. The damage to blood vessels can be imagined from a sugar level that rises instantly and lasts for hours. This is in addition to the damage caused by other fine particles in the fluid. Not to mention the addition of other drugs. That’s why I don’t use IVs if I can.
Friends often ask me how I get hypertension, how to treat it and how to prevent it. Today, with the prevalence of specialties, it is a bit of a dog’s game to talk about hypertension as an orthopedic surgeon. But as a friend, and can not not solve such a friendly disease. Do more, and have their own insights. Write here in the hope that it will help people who do not suffer from hypertension and those who already suffer from hypertension.