The concept of primary hypertension and the preventive care aspects have been introduced in our previous programs and will not be repeated today. Today, we will focus on a brief introduction to the therapeutic aspects (mainly for the following aspects of western drug application).
The main treatments are the following.
I. Physical therapy.
1.Manipulation therapy.
(1) foot therapy: by stimulating the reflex zones on the bottom of the foot, to play a role in lowering pressure.
(2) massage: rubbing Fengchi, Sun and ear points, wiping the forehead and pinching Nei Guan, Shen Men, Hegu, Foot San Li, can help lower pressure and eliminate symptoms.
2.Apparatus treatment.
(1) Acupuncture: commonly used points are mainly Fengchi, Baihui, Neiguan, Taichong, Sanyinjiao, etc.
(2) Ear acupuncture pressure bean: can use the adrenal gland, subcortical, Shen Men, the back of the ear buck ditch, liver, brain and other points.
(3) Therapeutic instrument: ion introduction of certain drugs, pulsed ultrashort wave or short wave therapy and magnetic therapy can be used as an adjunct to sedation and antihypertensive treatment.
Most of these therapies need to be carried out by specialized doctors, and individual methods can be tried on their own.
Second, drug therapy.
1, topical drugs
(1) foot bath: (Previously introduced in the program, not repeated here.)
(2) drug paste.
Chinese medicine to make ointment, in accordance with the acupuncture points, paste. On the one hand, there is the effect of drugs, through transdermal absorption to play a therapeutic role, on the other hand, the drug as a stimulus to stimulate the acupuncture points, play a therapeutic role. Commonly used acupuncture points include Neiguan, Shenqu, Sanyinjiao, etc.
Introduce a simple drug patch formula:
Composition: Cornu Cervi Pantotrichum and Rhizoma Chuanxiong, each in equal parts, pressed together with fine powder and stored in a dense store for use.
The method: the umbilicus with alcohol cotton ball wipe clean, take the powder 5-10 grams into the umbilicus, outside the musk strong bone paste fixed closed. 3 days to change the medicine once, 1 month for a course of treatment.
2.Internal medicine
(1) Chinese medicine treatment
It needs to be treated according to the dialectical evidence of Chinese medicine, which is difficult for patients to master by themselves, so it is not introduced here.
(2) Western medicine treatment
(Treatment principles)
In principle, a single drug is used first, which is required to have good antihypertensive effect and not to increase cardiovascular complications. Usually calcium antagonists or converting enzyme inhibitors are used. Such as nifedipine, amlodipine, captopril, enalapril, etc.
②Application of antihypertensive drugs should be taken from a small dose, and the dosage should be adjusted in a timely manner according to the antihypertensive effect. Generally speaking, oral antihypertensive drugs can not be lowered to a satisfactory level in a few days, and blood pressure is usually gradually brought under control in 2 weeks or more.
③ Combined application of several antihypertensive drug therapy, ABCD principle can be used to guide the effective combination of drugs. The steps of combination drug administration are approximately.
Step 1: Prefer a single drug; if it is not effective, proceed to Step 2: A or B+C or D or A+D; if it is still not well controlled, proceed to Step 3: Add or switch to an alpha-blocker, and finally proceed to Step 4: Re-evaluate the secondary blood pressure lowering level or expert guidance.
④ 24-hour blood pressure control, with extended-release agents as the preferred option. There is evidence that 24-hour blood pressure control is effective in reducing left ventricular hypertrophy. In this way, all patients should achieve this goal, avoiding short-acting drugs by controlling them as much as possible in a single dose as their financial situation allows.
Precautions for the treatment of hypertension
1, rational use of drugs, which is mainly controlled by doctors with professional knowledge.
2.Measure blood pressure frequently, at least once in 1-2 weeks.
3, timely adjustment of drugs, if the application of a certain antihypertensive drug is not effective, should promptly contact the doctor, adjust the medication.
4, do not arbitrarily reduce and stop drugs, blood pressure is satisfactorily controlled, stable for a period of time, before gradually reducing the variety of drugs, reduce the dose, and then long-term medication to maintain blood pressure at the desired level.
5, the use of ganglion blockers (piperidine, pentamidine tartrate) or vasodilators (hydrazinepyridazine, long pressure, prazosin, pipercytidine, etc.) can cause obvious upright position hypotension, pay attention not to sudden position changes.
6, long-term patients with severe hypertension, should not require the blood pressure to be completely reduced to normal levels. In particular, most elderly people over 65 years old have varying degrees of atherosclerosis, and a moderate blood pressure level can ensure the blood supply to important organs.
Drug selection for hypertension combined with important organ lesions
For hypertension has caused damage to various organs of the body or combined with other diseases (such as diabetes, renal insufficiency, etc.), it is necessary to consider selective use of drugs with certain protective effects or special effects. renin angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor antagonists (ARBI) have unique advantages in the protection of target organs in hypertension.
Angiotensin-converting enzyme inhibitors are the most effective vasodilators, mainly: captopril, enalapril, and siropril. These drugs act locally on the kidney and play a more important role in renal protection; do not affect the heart rate; have a protective effect on the endothelium of the heart and brain vessels; reduce the mortality rate of patients with heart failure, treat coronary heart disease, reduce the recurrence rate of patients with cerebral junior high school, and do not reduce blood flow to the brain while lowering blood pressure; their effects are related to zinc; most of them are long-acting drugs, except captopril. Therefore, these drugs are currently widely used.
Angiotensin receptor antagonists have been widely used in patients with dry cough and diabetes taking the previous class of drugs, mainly: Crosartan, Eprosartan, Valsartan, etc. These drugs can not only effectively lower blood pressure and have the effect of protecting heart, brain and kidney blood vessels, so they are mainly used clinically for mild to moderate hypertension, with left ventricular hypertrophy, heart failure, coronary artery disease, hypertension combined with renal pathology, atherosclerosis, and cerebrovascular protection.