In 2002, China’s nutrition and health survey showed that the prevalence of hypertension among residents aged 18 and above was 18.8%, a 31% increase compared to 1991. In contrast to the current situation and development trend of hypertension in China, the awareness rate, treatment rate and control rate of hypertension in China were at a very low level in 1991, only 27%, 12% and 3% respectively, and even in 2002, only 30%, 25% and 6%, with an obvious gap with the level of prevention and treatment of hypertension in advanced foreign countries. To significantly increase the awareness, treatment and control rates of hypertension, it is crucial to educate hypertensive patients on a community basis. In recent years, almost all communities in China have carried out a lot of hypertension education work and achieved certain results, but there are also some problems, not using a graded education approach, many of the contents are still too complicated for non-medical patients, the difficulty is large, the practicality is not good, patients are not good at remembering and understanding, and it is more difficult to apply in practice, and there is a lack of scientific evaluation means of health education effect The lack of scientific means to evaluate the effect of health education. Combined with the actual health education, we put forward several suggestions.
I. Encourage the adoption of population-graded hypertension health education
The community health education population should be divided into two main levels, high-risk groups and diagnosed hypertensive patients. The purpose of education for high-risk groups is to prevent hypertension, and the main content is diet and exercise, in the form of large classes. The main purpose of education for hypertensive patients should be the prevention and reduction of serious events, health education in addition to the above-mentioned content, focusing on the correct use of medication, standardized follow-up, more small classes, easy to interact with the educational situation.
Second, pay attention to the training of medical personnel who implement health education
If the medical personnel who implement health education have wrong or inaccurate concepts, it will have a very negative impact on the educated population. A few primary care doctors measure blood pressure incorrectly and teach patients how to measure their own blood pressure. Therefore it is very important to implement community-based primary care physicians hypertension prevention and control norms and strengthen training.
Third, explore health education norms
Health education is an important work of our medical profession, which is the embodiment of the national policy focusing on prevention. Experts should be organized to develop some systems and requirements, and ensure personnel and funding to facilitate the effective implementation of health education by community-based medical personnel according to the plan.
Fourth, seek a more scientific and easy-to-operate health education effect evaluation system
Most community health education is done, but the effect is not known, so people feel that it can be done or not. Therefore, there should be reasonable evaluation means, and it can be linked to the reward income of educators to promote the development of standardized health education.
Fifth, enhance the practicality of hypertension health education
Many of the participants in health classes are mostly elderly people, so the content of education should be focused, simple and practical, and the duration of each health education should not be too long, we think it is more appropriate to master about 40 minutes. The key contents are suggested as follows.
(A) Introduction of basic knowledge of hypertension
1. What is hypertension?
In the absence of medication, adults (age > 18 years) systolic blood pressure ≥ 140 mmHg, diastolic blood pressure ≥ 90 mmHg.
2, hypertension profile
More than 600 million people worldwide suffer from hypertension, and there are currently 160 million in China. The top three causes of death (heart disease, malignant tumors, cerebrovascular disease), two of the diseases and hypertension are closely related. High prevalence, high disability and high mortality make hypertension the “number one killer” of Chinese people’s health.
3, suffering from hypertension is mainly related to seven factors
Genetics, too much salt, stress, obesity, smoking, alcohol abuse, lack of exercise.
4.Harm of high blood pressure
Brain hemorrhage, cerebral infarction, coronary heart disease, renal insufficiency, arteriosclerosis of the fundus (bleeding).
5, hypertension main symptoms performance
Most hypertension has no obvious symptoms; some patients show: headache, dizziness, insomnia, tinnitus, numbness of the fingers, neck and back muscle pain, tension.
6.Treatment target of hypertension
General hypertensive patients <140/90 mmHg.
<130/80 mmHg in patients with diabetes mellitus or renal disease, or less than 125/75 mmHg for blood pressure control if their urinary protein excretion reaches 1g/24 hours.
SBP <150 mmhg in elderly patients, which can be further reduced if tolerated. < span="">
(II) Reasonable diet and moderate exercise
1.The concept of obesity
The standard of abdominal obesity: Chinese waist circumference ≥ 2125px for men and ≥ 2000px for women.
Chinese normal adult body mass index (BMI, weight/height squared, kg/m2) is 19~24, body mass index ≥24 for overweight, ≥28 for obese.
2.Limit the intake of salt
Diet should be light, eat less salty food, eat too much salt, will make the hardening of blood vessels and blood pressure, salt should be eaten daily to 6 grams or less (2006 World Health Organization regulations: the daily intake of salt per person in 5 grams or less. (Salt tips: put 1/3 to 1/2 less than usual, put salt when you start the pot; buy high potassium and low sodium salt; use a salt spoon).
3, it is advisable to eat more food containing potassium
Soybeans, pinto beans, tomatoes, zucchini, celery, fresh mushrooms and various green leafy vegetables; fruits such as oranges, apples, bananas, pears, kiwis, persimmons, pineapples, walnuts and watermelons.
4.Learn to apply the “Chinese Residents’ Balanced Diet Pagoda (2007)
The first layer: 250-400g of cereals, potatoes and beans (50-60% of total calories), 1200ml of water; the second layer: 300-500g of vegetables, 200-400g of fruits; the third layer: 50-75g of animal and poultry meat The fourth layer: 300g of milk and milk products, 30-50g of soybeans and nuts; the fifth layer: 25-30g of oil, 6g of salt.
Hypertensive patients are basically suitable for the above food low limit.
5, appropriate exercise, aerobic exercise
To do aerobic exercise, should not be strenuous exercise, pay attention not to do too violent action of low bending, excessive amplitude of change of body position and forceful breath-holding action. The most suitable aerobic exercise is walking, jogging, taijiquan, taiji sword, cycling, swimming, etc., the best is “walking”. A moderate amount of exercise can reduce the risk of hypertension by 30%. 20-60 minutes a day, 3-5 days a week (preferably every day). Self-judgment of the intensity of moderate exercise: heart rate control at “170-age”. Light sweating, relaxation, good appetite and sleep; slight fatigue, which disappears after rest. Indicators of diurnal blood rheology of human body, especially the blood attack degree, tend to rise in different degrees from 20:00 pm to 6:00 am, with the most obvious rise from zero to 6:00 am. To avoid cardiovascular accidents, early morning exercise is not recommended. Scientific fitness, especially for cardiovascular patients, is best chosen at 9-10 am, or 4-6 pm or 30 minutes after dinner.
(C) Teach patients to self-monitor blood pressure
1, the choice of sphygmomanometer
As there are more factors influencing human operation in the process of applying mercury column sphygmomanometer, it is recommended to purchase electronic sphygmomanometer that meets international standards.
2, blood pressure fluctuation pattern
Under normal circumstances, blood pressure in the day and night 24 hours in a cycle of rhythmic changes. Early in the morning, a wake-up call, blood pressure shows a continuous upward trend, reaching a peak at 9-11 a.m.; then gradually declining, rising again at 3-6 p.m. As night falls, blood pressure decreases again, and after going to sleep, a continuous downward trend, the lowest at midnight. This “two highs and one low” time is the risk period for hypertension. It is important to note that the time of peak blood pressure is not the same for every patient, and it is important to find out the summation through self-monitoring in practice.
3, blood pressure measurement precautions
(1) The person to be measured should rest quietly for at least 5 minutes, refrain from smoking, drinking tea, coffee and alcohol, and emptying the bladder within 30 minutes before the measurement.
(2) Stay relaxed before the blood pressure measurement.
(3) The patient is seated, removes the upper arm clothing, places the upper arm on a cushion and the table, and measures the blood pressure of the right arm with the arm band of the electronic sphygmomanometer and the heart placed at the same level.
(4) No talking during the blood pressure measurement.
(5) Repeat measurements should be taken 2 minutes apart, and the average of the two readings should be recorded. If the difference between the SB and DB readings of the two remeasurements is >5 mmHg, take another measurement 2 minutes apart and then take the average of the three readings.
(6) It is best to measure blood pressure at a fixed time every day and register it well.
(4) Make the patient aware of the treatment strategies for hypertension
(1) Most patients with hypertension (but not all) should gradually lower their blood pressure to the target level within a few weeks.
(2) To achieve these goals, most patients will need to take more than one antihypertensive medication.
(3) Depending on the baseline blood pressure level and the presence of comorbidities, low-dose monotherapy or low-dose combination of two drugs should be used at the start of therapy.
(4) Recommend the use of long-acting agents, which can act for up to 24 hours and be taken once daily, which can reduce fluctuations in blood pressure, reduce the risk of major cardiovascular events and prevent target organ damage, and improve medication adherence. Emphasis is placed on long-term, regular antihypertensive therapy to achieve effective, smooth, long-term control.
(5) Hypertension is a lifelong disease, and once diagnosed, lifelong treatment should be adhered to. This is especially true when applying antihypertensive drug therapy.
(6) Patients are advised to follow up regularly at the hospital (1-3 months) and to have a comprehensive physical examination at least once a year.