Chapter 1: High-risk groups of hypertension
Those whose parents have high blood pressure; 2. Those who consume more salt; 3. Those who consume more animal fat; 4. Those who drink alcohol for a long time; 5. Those who are mentally stressed; 6. Those who smoke and are obese.
Chapter 2 How to measure blood pressure
First sit in a quiet environment and start measuring after 5 minutes. Make the upper arm, sphygmomanometer and heart in the same plane, put the cuff on the upper arm, the lower edge of the cuff should be on the arm bend 2.5 cm, put the stethoscope probe at the brachial artery pulsation, inflate quickly, make the balloon pressure reach the brachial artery pulsation sound disappears and then rise 30 mmHg, then deflate slowly at a constant rate, listen carefully during deflation: the first sound and the disappearing sound corresponding to the mercury column reading are Systolic and diastolic blood pressure. For special diseases such as severe anemia, hyperthyroidism, and pregnancy, the mercury column reading corresponding to the tone that does not disappear will be set as the diastolic pressure. Measure at least twice and take the average. If the difference between the two times is large, measure again and take the average of the three times. Blood pressure greater than 135/85mmHg in home self-measurement and 140/90mmHg in clinic is considered hypertension. Zhao Lixin, Department of Cardiovascular Medicine, Second Hospital of Chifeng City
Chapter 3 Definition of hypertension
Hypertension: systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg without anti-hypertensive drugs.
Simple systolic hypertension: systolic blood pressure ≥ 140 mmHg and diastolic blood pressure < 90 mmHg.
Chapter 4: Myths about the treatment of hypertensive patients
1. Take medication when blood pressure is high, but not when it is not.
This makes the blood pressure high and low, which can easily cause damage to important organs such as the heart, brain, kidney and fundus. Such as heart failure, cerebrovascular disease (cerebral hemorrhage, cerebral thrombosis), kidney failure, fundus bleeding, etc.. Blood pressure can be gradually reduced by maintaining normal blood pressure for more than six months, but the drug should not be stopped. If you stop the drug on your own, your blood pressure will eventually return to the pre-treatment level sooner or later.
2. Although the blood pressure is high but no conscious symptoms, no medication is needed
Although there are no conscious symptoms, organs in the body such as the heart, brain and kidneys are always at high blood pressure levels and are prone to danger.
3. Taking antihypertensive drugs every day will make your blood pressure drop too low
Taking antihypertensive drugs every day to maintain normal blood pressure is like eating every day to maintain life, and drugs are metabolized as well as food.
4. Western medicine has side effects on the human body, long-term medication will damage liver and kidney function
Now advocate the joint application of antihypertensive drugs, the combination of each drug dose is small, and some side effects can offset each other, the body will not have a major impact; hypertension requires long-term drug control, so it is more convenient to take Western medicine, Chinese medicine to lower blood pressure slowly and weak, and Chinese medicine also has side effects, but Chinese medicine clinical trials are less. Certain Chinese medicines can cause hypertension, such as ginseng, American ginseng, licorice, ephedra, etc.
Nowadays, false advertisements mislead the majority of hypertension patients, such as the package to cure hypertension, ancestral secret recipes, etc. Some patients do not know the name of the medicine nor the dosage of antihypertensive drugs, patients do not know whether there are side effects.
Drug treatment
1. commonly used antihypertensive drugs in a total of five categories.
(1) Nifedipine class: including cardiac pain, niskundipine, nicardipine, nimodipine, felodipine, amlodipine, etc. The side effects are mainly headache, heartbeat, red face, etc. Long-term use of some people can appear ankle edema, gum thickening.
(2) Captopril: including enalapril, benazepril, ramipril, etc. Side effects mainly include cough, increased blood potassium, angioedema, etc.
(3) Betaxolol (metoprolol) class: including atenolol, bisoprolol, propranolol (insulin), etc. The side effects mainly include slow heart rate, bronchospasm.
(4) diuretics: including dihydrochlorothiazide (double gram), indapamide, etc.; side effects are mainly reduced blood potassium and increased blood uric acid.
5) Sartans: including temisartan, cloxacin, valsartan, irbesartan, etc.; side effects are mainly elevated blood potassium and angioedema (rare).
※※ Less commonly used antihypertensive drugs.
1) Terazosin Mostly used for prostate enlargement; side effects are mainly postural hypotension.
2) Lipiodol Side effects are mainly nasal congestion, depression, bradycardia, and peptic ulcer.
※※※ Principles of antihypertensive treatment.
(1) Use a smaller effective dose to obtain the possible efficacy with minimal adverse effects, if effective and unsatisfactory, gradually increase the dose to obtain the best efficacy.
(2) The requirement for a stable blood pressure within the target range for 24 hours per day can prevent sudden death, stroke or heart attack from a lower blood pressure at night to a sudden rise in blood pressure in the early morning. To achieve this, it is best to use a drug that is administered once a day and continues to act for 24 hours.
(3) In order to increase the antihypertensive effect without increasing the adverse effects, the combination of two or more antihypertensive drugs can be used if the treatment with low-dose monotherapy is unsatisfactory.
Chapter 5: Hazards of hypertension and auxiliary tests to be done
Hypertension can cause damage to the heart, brain, kidney and fundus, and if not treated can cause cerebral hemorrhage and cerebral thrombosis; heart failure, easily combined with coronary heart disease, leading to myocardial ischemia or even myocardial infarction; kidney failure; and fundus atherosclerosis. In severe cases, it can cause bleeding in the fundus of the eye and lead to vision loss or even blindness. Therefore, the following auxiliary examinations are required after the detection of increased blood pressure.
Routine examination
Blood glucose, blood lipids, serum potassium, kidney function (including urea nitrogen, uric acid, creatinine), electrocardiogram, blood and urine routine, etc.
Recommended tests
Echocardiography, carotid ultrasound, chest X-ray, fundoscopy, etc.
Chapter 6: Other risk factors for cardiovascular and cerebrovascular diseases
Hypertension is the main risk factor for cardiovascular disease. Other risk factors leading to cardiovascular disease include: diabetes, hyperlipidemia, obesity or abdominal obesity, smoking, men older than 55 years old, women older than 65 years old, and those with familial cardiovascular disease.
Obesity: Body mass index (weight “kg” divided by height “m” squared, i.e. kg/m2) equal to or greater than 24 is overweight, equal to or greater than 28 is obese.
※ Abdominal obesity: waist circumference ≥ 85cm for men and ≥ 80cm for women.
Chapter 7 Treatment of hypertensive patients
Non-pharmacological treatment
1) Weight reduction It is recommended that the body mass index should be controlled below 24. Weight reduction methods: on the one hand, reduce eating fatty and sugary food, on the other hand, need to increase physical exercise, such as running (jogging), tai chi, aerobics, etc., but should pay attention to moderate activity.
2）Reasonable diet
★ Limit salt Northerners must reduce the amount of salt consumed per person per day to less than 8 grams, and later to less than 6 grams, and southerners can be controlled to less than 6 grams.
★ Reduce the amount of fat intake Do not eat animal offal, chicken skin, fish roe, squid, crab yolk, eel, etc.; eat less eggs, fatty meat, western food and fried food. It is advisable to eat white meat (poultry meat, meat of domestic animals) and less red meat (pork, beef and mutton). It is advisable to eat vegetable oil, not animal oil. Increase fresh vegetables to 400-500 grams, 100 grams of fruit, 50-100 grams of meat, 50 grams of fish and shrimp, 250 grams of milk, 20-25 grams of cooking oil, and 3-4 eggs per week.
3) Increase and maintain appropriate physical activity Generally, exercise 3-5 times a week, lasting 20-60 minutes each time. If you feel good about yourself after exercise and maintain a good weight, it indicates that the amount of exercise and the way of exercise are suitable.
4) Maintain an optimistic attitude and improve emergency response ability
5) Do not smoke (smoking for 15 minutes can raise blood pressure by 20 mmHg) and do not advocate drinking alcohol; if drinking alcohol, men should drink no more than 25 grams of alcohol per day, i.e. less than 100-150 ml (2-3 taels) of wine, less than 250-500 ml (half a pound-1 pound) of beer, or less than 25-50 ml (0.5-1 tael) of white wine. For women, the amount is reduced by half, and pregnant women do not drink alcohol. Not advocated due to highly potent alcohol. Patients with a definite diagnosis of hypertension should abstain from alcohol.
Chapter 8: Drugs contraindicated in patients with hypertension
1. antipyretic and analgesic drugs: including anti-inflammatory pain, ibuprofen, ubiquin, neproxen, etc., usually used for acute and chronic rheumatoid arthritis, hypertensive patients should be particularly cautious when using these drugs.
2. certain drugs for the treatment of depression: such as morclobemide, toloxadone, etc.
3. estrogen
4. oral contraceptives
5. Adrenaline: certain nasal drops, nasal drops and other drugs used for the treatment of acute and chronic rhinitis and conjunctival congestion.
6. Corticosteroids: including cortisone, hydrocortisone, prednisone, dexamethasone, etc.
7. certain drugs used for the treatment of bronchial asthma: including ephedrine, isoprenaline, salbutamol, terbutaline, clenbuterol, etc.
8. Chinese herbal medicines: such as ephedra, ginseng, American ginseng, etc.
Chapter 9 Blood pressure compliance
Blood pressure should be strictly controlled below 140/90 mmHg in general patients; in patients with diabetes and renal disease, it should be reduced to below 130/80 mmHg; in elderly people (>60 years old), systolic blood pressure should be reduced to below 150 mmHg, and further reduced if tolerated. If the diastolic blood pressure has been reduced to 70 mmHg, it is not advisable to continue lowering the blood pressure even if the systolic blood pressure is high. Most hypertensive patients should gradually lower their blood pressure to target levels over several weeks.
Chapter 10: Usual precautions for patients with hypertension.
1. do not participate in activities that tend to cause high mental excitement.
2. keep warm in winter, as cold can cause vasoconstriction.
3. keep the bowels open.
4. abstain from sexual intercourse.
5. prevent postural hypotension: avoid standing still for a long time, sudden squatting or head-down action, change the posture when the action should be slow, the shower water temperature should not be too high. If once hypotension occurs should immediately lie down, elevate the feet, you can get relief.
6. Do not take antihypertensive medication according to their own feelings to increase or decrease the drug in the process, take the medication on time, can not be suddenly withdrawn from the drug.