Traditional medicine in China has known hypertension for more than 200 years, and modern medicine has been studying hypertension for more than 100 years. After the reform and opening up, people’s living standards have improved, but hypertension patients are also increasing day by day. The prevalence and mortality rates remain high, and the age of onset is getting younger and younger, the form is severe, and the road is long. 1, a very special disease – ordinary name, outstanding personality Hypertension, a common name for the disease, but as long as the fossil. The ancients did not have a blood pressure meter, but the ancient “pulse cutting”, but found the “string pulse” – that is, increased arterial blood pressure. The Yellow Emperor’s Classic of Internal Medicine records “Therefore, the salty person, the pulse is also string”, just six words, not only recorded hypertension, but also know that it is due to salt addiction, like to eat salty. The second characteristic of hypertension is that it is the most widespread. Countries around the world, regardless of north and south, race, gender, old and young, almost all suffer from it, the global patients amount to 1.2 billion, China has up to 200 million patients. The third characteristic is that it is the most harmful, the most hidden, often asymptomatic, once the attack, causing death. 2, a form of low-profile, vicious disease hypertension symptoms are few, so not only patients, even doctors often ignore, do not think. Therefore, its awareness rate, medication rate and control rate are very low, but its comorbidity is very serious, accounting for the first death composition of the population. Although diabetes is terrible, 75％ of its causes of death are not diabetes itself, but are caused by the accompanying hypertension and cardiothoracic vascular accidents. 3, despite the global outcry, it is all the way high Many diseases, with the progress of medical science, either eradicated or reduced, but hypertension, on the contrary, has been increasing for more than a hundred years. It increases by about 10 million people every year. How many hospitals and how many doctors are needed to accomplish the task of treating 200 million patients? Assuming that each doctor can be responsible for managing the treatment of 1,000 patients, that would require 200,000 doctors, and the cost of drugs? Can the country afford it? Can the country afford it? Can the individual afford it? 4. What to do The goal of hypertension treatment is to achieve the blood pressure standard to minimize the total risk of cardiovascular and cerebrovascular disease and death. The target blood pressure for antihypertensive treatment is clearly defined, and the systolic blood pressure target for antihypertensive treatment of elderly hypertension is <150 mm Hg. The blood pressure target for antihypertensive treatment of general hypertension is blood pressure <140 mm Hg and/or <90 mm Hg. Patients with diabetes, cerebrovascular disease, stable coronary artery disease, and chronic kidney disease (all at high risk) have their blood pressure reduced to below 130/80 mm Hg. In general, grade 1 to 2 hypertension aims to achieve blood pressure gradually within 4 to 12 weeks and to adhere to the long-term standard; however, the time to achieve blood pressure in patients with poor tolerance or in the elderly can be extended appropriately. The early achievement of blood pressure standard is conducive to reducing cardiovascular and cerebrovascular events. Timing of hypertension drug treatment: After follow-up observation, the blood pressure level of general hypertension ≥ 140/90 mm Hg, and the blood pressure level of high-risk patients ≥ 130/85 mm Hg will start drug treatment. Self-measurement of blood pressure: Patients with hypertension are advocated to self-measure their blood pressure at home, using an upper-arm electronic blood pressure monitor certified by international standardization. (1) Non-pharmacological therapy for hypertension Non-pharmacological therapy is an important part of hypertension treatment and should be adhered to for a long time. Reduce sodium intake to 6 g/d. The main sources of salt in daily life are cooking salt and preserved, brined, and soaked foods, which should be used sparingly. Use alternative products, such as salt substitutes and vinegar, etc. Eat a rational diet, reduce dietary fat, and eat less sugar and sweets. Regular exercise, moderate intensity, 3 to 5 times/week duration: lasting about 30 min/time. The form of exercise can be walking, brisk walking, jogging, swimming, qigong, taijiquan and other items are available, the upper limit of exercise up to heart rate = 170 - age. Weight control, BMI <24 kg/m2, waist circumference: <90 cm (men), <85 cm (women). Resolve to give up smoking and promote scientific cessation. Avoid secondhand smoke. Limit alcohol consumption. Psychological balance, reduce mental stress, maintain balanced psychology, maintain optimism, reduce psychological burden, overcome paranoia, correct bad character, resist bad social factors, conduct psychological counseling, music therapy and self-discipline training or qigong, etc. Non-pharmacological treatment has a clear effect on lowering blood pressure, such as obese people can reduce body mass by 10 kg systolic blood pressure can be reduced by 5-20 mm Hg, dietary salt restriction (salt <6 g), systolic blood pressure can be reduced by 2-8 mm Hg. Regular exercise and limit alcohol consumption can make blood pressure drop. For patients with hypertension and susceptible people, non-pharmacological treatment is required, regardless of whether they have received medication or not, and should be continued. (2) Pharmacological treatment of hypertension In the treatment of hypertension, we should pay attention to the principle of individualized treatment, as patients have different combined cardiovascular risk factors, different target organ damage and other cardiovascular diseases, and naturally different therapeutic drugs, so we advocate the principle of individualized treatment. The principle of treatment is to use a smaller effective dose to obtain efficacy with minimal adverse effects, gradually increase the dose or combination of drugs, and strive to achieve the blood pressure standard within 3 months. In order to effectively prevent target organ damage, blood pressure should be stabilized within the target range within 24 hours, and long-acting drugs that can be administered once/day with a 24-hour duration of effect are actively recommended. If medium- or short-acting drugs are used, they must be administered 2 to 3 times/day. In order to increase the antihypertensive effect without increasing the adverse effects, a combination of 2 or more antihypertensive drugs with different mechanisms of action can be used. The actual treatment process of grade 2 or higher hypertension or high-risk patients to achieve the target blood pressure, often need antihypertensive drug combination therapy. There are five main classes of drugs, namely: calcium antagonists, angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor antagonists (ARB), diuretics (thiazides), and β-blockers (βB). All of the above five classes of antihypertensive drugs and fixed low-dose combinations can be used as the drugs of choice for the initial or maintenance treatment of hypertension. There are also α-blockers and other antihypertensive drugs. When choosing antihypertensive drugs, we should first consider the contraindications and indications for drug treatment, and choose the drugs suitable for the patient according to the condition and the patient's will; patients should regularly visit the hospital for follow-up visits during treatment to understand the antihypertensive effect and adverse reactions. Calcium antagonists are suitable for most types of hypertension, especially for elderly patients with hypertension, ISH, stable angina, coronary or carotid atherosclerosis, and peripheral vascular disease. It can be used alone or in combination with other 4 classes of drugs. A few patients may have adverse effects such as headache, ankle edema, and gingival hyperplasia. Angiotensin-converting enzyme inhibitor (ACEI) has clear antihypertensive effects, more evidence of target organ protection, and no adverse effects on glucolipid metabolism; it is suitable for grade 1 to 2 hypertension, especially beneficial for patients with hypertension combined with chronic heart failure, post-myocardial infarction, cardiac insufficiency, diabetic nephropathy, non-diabetic nephropathy, metabolic syndrome, proteinuria/microalbuminuria. May be used in combination with low-dose thiazide diuretics or dihydropyridine calcium antagonists. Contraindicated in bilateral renal artery stenosis, pregnancy, hyperkalemia; note adverse effects such as cough and occasionally angioneurotic edema. Angiotensin receptor antagonist (ARB): clear antihypertensive effect, precise effect on target organ protection, no adverse effect on glucose and lipid metabolism; suitable for grade 1 to 2 hypertension, especially beneficial for patients with hypertension combined with left ventricular hypertrophy, heart failure, prevention of atrial fibrillation, diabetic nephropathy, metabolic syndrome, microalbuminuria, proteinuria, also suitable for ACEI-induced cough. It can be used in combination with low-dose thiazide diuretics or dihydropyridine calcium antagonists. Contraindicated in patients with bilateral renal artery stenosis and hyperkalemia; occasional adverse effects such as angioneurotic edema. Diuretics: The antihypertensive effect is clear, and small doses of thiazide diuretics are suitable for grade 1 to 2 hypertension or secondary prevention of stroke, and are also one of the basic drugs for refractory hypertension. Diuretics are especially beneficial for elderly patients with hypertension and heart failure. Can be combined with ACEI/ARB and calcium antagonists, but pay attention to the effect on glycolipid metabolism when combined with βB. Use with caution in patients with abnormal glucose and lipid metabolism. High-dose diuretics have certain effects on blood potassium, uric acid and sugar metabolism, so pay attention to checking blood potassium, blood sugar and uric acid. Beta receptor antagonist (βB): The hypotensive effect is clear, and small doses are suitable for grade 1 to 2 hypertension with post-myocardial infarction, coronary angina or rapid heart rate. It has a preventive effect on sudden death in patients at high cardiovascular risk. Can be used in combination with dihydropyridine calcium antagonists. Contraindicated in patients with asthma, chronic obstructive pulmonary emphysema, severe sinus bradycardia and atrioventricular block; use with caution in patients with abnormal glucose tolerance or athletes. Note adverse reactions such as bronchospasm and bradycardia; note the effect on glucose and lipid metabolism with long-term use. Alpha-blockers: For patients with hypertension with prostatic hyperplasia, but contraindicated in patients with postural hypotension and used with caution in heart failure. The medication should be started before going to sleep to prevent the occurrence of postural hypotension. Take care to measure blood pressure in sitting and standing position during use. Fixed compound: It is a commonly used class of hypertensive drugs, which has the advantage of being easy to use and can improve the compliance of treatment. Regardless of the type of antihypertensive drug used, monotherapy is only able to achieve target blood pressure levels in a minority of patients. Most patients must be treated with two or more drugs to achieve target blood pressure levels. A variety of effective and well-tolerated combination therapy options are available. Initial therapy may be monotherapy or a combination of 2 drugs (both at low doses), followed by an increase in drug dose or drug class if necessary. For patients with mildly elevated blood pressure and low or moderate overall cardiovascular risk, starting therapy may be monotherapy. For patients with an initial blood pressure of grade 2 or 3, or high or very high overall cardiovascular risk, a low-dose combination of 2 drugs is preferred as starting therapy. Lipid-lowering therapy: All patients with hypertension diagnosed with cardiovascular disease or type 2 diabetes should be considered for statin therapy aimed at achieving total serum cholesterol; 4.5 mmol/L (175 mg/dL) and LDL cholesterol; 2.5 mmol/L (100 mg/dL), or even lower if possible. Patients with hypertension without significant cardiovascular disease but with a high cardiovascular risk (10-year event risk ≥20%) should be considered for statin therapy even if baseline total and LDL cholesterol levels are not elevated. Antiplatelet therapy: Antiplatelet therapy (especially low-dose aspirin therapy) should be administered to hypertensive patients with a history of cardiovascular events without an excess risk of bleeding. low-dose aspirin therapy should also be considered in hypertensive patients over 50 years of age without a history of cardiovascular disease, with moderately elevated serum creatinine, or with a high cardiovascular risk. This intervention has been studied and confirmed to have a good benefit/risk ratio (reduction in the incidence of heart attack greater than the risk of bleeding) in all of the above conditions. To minimize the risk of hemorrhagic stroke, antiplatelet therapy should be initiated after good blood pressure control. Can hypertension be prevented other than by treatment? In the 1970s, J. Stamler, a leading American epidemiologist of cardiovascular disease, demonstrated through controlled studies that salt restriction, exercise, smoking cessation, and weight loss can reduce the incidence of hypertension by 55%. In 1996, the U.S. Centers for Disease Control and Prevention reported: If medical treatment is used, it will take tens of billions to hundreds of billions of dollars to extend the life expectancy of the United States by one year, but if a healthy lifestyle is adopted, it will not cost much to extend the life expectancy of the United States by 10 years, and the quality of life and happiness index will be greatly improved. A 24-year prospective study of 80,000 women aged 35-59 years from 1980 to 2004 showed that a healthy lifestyle can reduce the mortality rate of middle-aged women by 55%, which is a significant effect. Therefore, hypertension is preventable and controllable. However, hypertension in China is generally characterized by the "three highs" of high prevalence, high mortality rate and high disability rate, and the "three lows" of low awareness, low treatment and low control rate. The goal of hypertension prevention and treatment is to prevent hypertension and reduce the occurrence of hypertension-related diseases and deaths. The main goal is to prevent hypertension and reduce the occurrence of hypertension-related diseases and deaths through health education programs and the production and dissemination of health education materials based on scientific research evidence.