1.How do I know that I have high blood pressure? What is the standard for hypertension?
Patients with hypertension can have no symptoms in the early stage, and occasionally find elevated blood pressure during physical examination. Some patients with hypertension can have headache, dizziness, palpitations, tinnitus and other symptoms in the early stage, and a few patients are found only after the emergence of heart, brain, kidney and other complications. The diagnostic criteria for hypertension are systolic blood pressure ≥ 140 mmHg or (and) diastolic blood pressure ≥ 90 mmHg.
2.What is ambulatory blood pressure and which patients are suitable for ambulatory blood pressure monitoring?
Ambulatory blood pressure is called non-invasive blood pressure monitoring (ABPM), which is the continuous recording of daytime and nighttime blood pressure according to the design pattern by the examination of the worn blood pressure recorder, thus avoiding the objective difference between single blood pressure measurement and the “white coat phenomenon”, which helps to screen critical and mild hypertension, helps to evaluate the antihypertensive drugs It can help to screen for critical and mild hypertension, evaluate the antihypertensive effect of antihypertensive drugs, explore the extent of target organ damage and estimate the prognosis, etc.
The following conditions are suitable for ABPM monitoring: 1) critical hypertension with target organ damage; 2) recalcitrant hypertension with poor effect of combined antihypertensive therapy; 3) “white coat hypertension”; 4) hypotensive symptoms with antihypertensive therapy; 5) paroxysmal hypertension; 6) differential diagnosis of syncope and pacemaker syndrome; 7) angina pectoris and pulmonary syndrome at night. Those with angina pectoris and pulmonary congestion and pulmonary edema at night; 8, those with autonomic dysfunction.
3.What are the hazards of hypertension?
Cardiovascular disease has become the number one killer of human health, and hypertension is the culprit of cardiovascular disease. The real danger of hypertension lies in the damage to the heart, brain, kidneys and other important organs, causing serious lesions, cerebrovascular accidents (stroke), angina pectoris, myocardial infarction, heart failure, renal insufficiency (serious will lead to uremia) and other fatal and disabling events.
4.What is the appropriate level to lower blood pressure?
For young, mild patients, blood pressure control at 120/80mmHg is appropriate; for elderly hypertensive patients, 140/90mmHg or less is appropriate; for simple systolic hypertension, systolic blood pressure should also be controlled at 140/90mmHg or less; for patients with diabetes and kidney disease, control at 130/85mmHg or less; for patients who have had myocardial infarction and stroke, the optimal blood pressure is 140/ 80mmHg or so.
5.Why should we emphasize steady blood pressure reduction?
Uncontrolled high blood pressure will lead to “stroke”, coronary heart disease, myocardial infarction and renal failure, and other diseases, while poor control, resulting in large fluctuations in blood pressure, will also produce the above-mentioned hazards, just like a rubber band that is taut for a while, and then loosened, will become fragile and easy to break. Studies have shown that due to the abnormal auto-regulation function of hypertensive patients, a significant drop and rise in blood pressure can make the patient unbearable, causing symptoms such as insufficient blood supply to the brain, lack of oxygen and dizziness. In addition, modern medicine also confirmed: early in the morning when waking up is the peak time of various cardiovascular accidents in hypertensive patients, if the blood pressure is not well controlled during this time, resulting in large fluctuations in blood pressure, will greatly increase the risk of “stroke”, and in serious cases, even death. Therefore, it is important to lower blood pressure smoothly and keep it stable throughout the day and 24 hours.
6.How to choose the ideal antihypertensive drug?
The ideal antihypertensive drug: ① good antihypertensive efficacy and stable blood pressure 24 hours a day, so that blood pressure volatility is small; ② small adverse reactions and side effects, easy to take, does not affect the quality of life; does not affect the metabolism of blood lipids and blood sugar; ③ can reverse and reduce the occurrence of complications such as heart, lung, kidney and atherosclerosis; ④ low price.
However, because everyone’s condition is different, so different people need to choose different drugs for treatment, the specialist will choose one or several drugs for you according to your specific situation.
7.Can I stop taking the medication after my blood pressure is lowered?
Because the cause of primary hypertension is unknown, you can only take medication to lower your blood pressure for life. When the blood pressure drops to a normal level after taking antihypertensive medication, it means that the antihypertensive medication chosen at this time is basically appropriate. However, it does not mean that the hypertension has been “cured”, therefore, treatment should be adhered to. If you blindly stop or intermittent medication, blood pressure often fluctuates greatly, but aggravates the damage to the heart, brain, kidneys and blood vessels. For patients with mild hypertension (diastolic blood pressure of 95-100 mmHg), when the weather turns warm, especially in the summer, blood pressure can be reduced or discontinued for a short period of time without treatment to normal, but it is necessary to repeatedly measure the pressure and adjust the medication in a timely manner. Certain antihypertensive drugs, such as colistin, can cause a sudden rise (“rebound”) if taken in large quantities for a long time and then suddenly stopped, resulting in serious consequences. Long-term large amounts of beta-blockers such as betalactam, sudden discontinuation of the drug may have the risk of myocardial infarction. Therefore, the dosage should be gradually reduced and finally stopped or changed to other drugs. If there are changes in the condition should be timely consultation with the doctor.
8.What is the primary prevention of hypertension?
Primary prevention of hypertension refers to the prevention or reduction of hypertensive factors to prevent the onset of hypertension. It is achieved not by drugs, but by changing lifestyle. It includes the following aspects: reasonable diet, smoking and alcohol cessation, moderate exercise, and maintaining psychological balance.
A reasonable diet can be summarized in two sentences: one, two, three, four and five; red, yellow, green, white and black, as recommended by the Chinese Nutrition Society.
(1) One, two, three, four, five
① One refers to one bag of milk per day. Milk is rich in high-quality protein, and can supplement the body’s calcium needs of about 300mg, while our dietary common calcium deficiency, generally at about 500mg. Milk is advisable to start from one year old and insist on lifelong consumption.
② Two is about 250g of carbohydrates per day, equivalent to 6 taels of staple food, and this amount varies from person to person. It can be as little as 3 taels or as much as 1 pound. By regulating staple foods, blood sugar, blood lipids and body weight can be regulated.
③ Three refers to three servings of high-protein foods daily. This is an important material basis for health and should not be neglected, but can also be increased to four servings. Equivalent to 1 to 1.5 g of protein per kilogram of body weight. each portion of high protein is equivalent to one or two lean meats, two or two tofu, one large egg, half a dozen soybeans, two or two fish and shrimp, or two chicken and duck.
④four refers to four phrases: coarse and fine; not sweet and not salty; three, four, five meals; seven or eight servings full.
⑤ Five refers to 500g of vegetables and fruits per day. The Chinese Nutrition Society recommends eating 400g of vegetables and 100g of fruits per day.
(2) Red, yellow, green, white and black
①Red refers to red wine drinking 50-100ml daily, which can raise HDL cholesterol and reduce atherosclerosis in middle and old age. The World Health Organization has changed the view that a small amount of alcohol is good for health to the less alcohol the better.
②Yellow refers to yellow vegetables such as carrots, sweet potatoes, pumpkins, corn, tomatoes.
Green refers to green tea, green tea has the most tea polyphenols, has a strong anti-oxidant free radicals, anti-atherosclerosis and anti-cancer effects.
④White refers to white oat flour and oatmeal, it has the effect of lowering triglycerides.
⑤ Black refers to black fungus, which has anti-platelet aggregation, anticoagulation and cholesterol-lowering effects.
Moderate exercise exercise to adhere to three principles: constant, orderly, moderate. This refers to the long-term regular, gradual, persistent, according to the specific circumstances of each person moderate exercise in order to receive the maximum effect. Usually should adhere to the “three, five, seven” principle. “Three” refers to the daily walk three kilometers, more than 30 minutes; “five” refers to more than five times a week to exercise, only regular exercise to have an effect. “Seven” refers to the heart rate after exercise plus age of about 170, so the exercise is moderate. In this way, both for health and not due to excessive exercise to produce anaerobic metabolism, resulting in adverse effects or accidents.
Quit smoking and limit alcohol smoking is considered to be an independent risk factor for cardiovascular disease.
Maintain mental balance Research shows that of all health measures, maintaining mental balance is one of the most critical. Maintaining a good and happy state of mind can antagonize almost all other internal and external adverse factors.
9.What is an ambulatory electrocardiogram and which patients are suitable for ambulatory electrocardiogram?
The ECG, also known as Holter, is a continuous recording of 24-48 hours of body surface ECG by an ECG recorder worn by the patient, and then processed and analyzed by an electronic computer, which can display the total number of heartbeats, the fastest and slowest heart rate, the average heart rate, the hourly heart rate during the monitoring period, and can automatically analyze premature beats, atrial fibrillation, pre-excitation syndrome, paroxysmal tachycardia, cardiac arrest, atrioventricular block and myocardial infarction. It can also automatically analyze premature beats, atrial fibrillation, pre-excitation syndrome, paroxysmal tachycardia, cardiac arrest, atrioventricular block and myocardial ischemia to provide clinical information.
The following patients are suitable for ambulatory ECG examination: 1) patients with coronary heart disease; 2) patients with arrhythmia; 3) patients with recurrent syncope; 4) patients with unexplained panic, chest tightness, dizziness, etc. who have no abnormalities in general ECG examination, etc.
10.What are the symptoms of angina pectoris?
Typical angina pectoris symptoms have four basic features: pain site, pain-exercise relationship, pain characteristics and pain duration.
Pain site: typical angina is located behind the sternum and can radiate to both sides of the chest, both upper arms (common on the left side) as far as the wrist, and the neck and palate. It can also radiate to the back, but is uncommon.
Relationship between pain and exercise: In most cases, myocardial oxygen consumption increases during exercise (or other stressful situations), with the result that angina is triggered and rapidly resolves after rest. Angina can also be triggered by emotional excitement, full meals, etc. In some patients, angina occurs even in a quiet state, suggesting severe coronary artery disease.
Pain characteristics: The severity of this symptom varies greatly and can be mildly limited discomfort or very severe pain. Many patients have no significant pain, but only chest tightness, chest pressure or cramping sensation.
Duration of pain: Angina induced by physical activity usually resolves on its own within 1-3 minutes after interruption of activity, but can last more than 10 minutes after very strenuous activity. The relief of angina induced by emotional excitement is slower than that induced by physical activity.
11.What first aid measures should be taken at home for patients with angina pectoris?
①Rest in place, quickly inhale oxygen if possible.
②Take nitroglycerin or cardiac pain quickly, if it cannot be relieved, repeat it again after 10 minutes.
③Take sedative drugs, such as Valium and Luminal, at the same time.
④People in the family should not panic, resuscitate lightly and quickly, minimize the number of unrelated people around, keep the environment quiet, pay attention to warmth, and persuade the patient not to be impatient.
⑤ Wait for the condition to stabilize before moving the patient or sending him to hospital for treatment.
⑥If the condition cannot be controlled by the above methods, one should be alert to the occurrence of unstable angina pectoris, which is very likely to develop into acute myocardial infarction, and should contact the hospital immediately for the time of rescue.
12.What are the precursors of myocardial infarction?
Clinically, about 1/2-2/3 of patients have some precursors 1-2 days or 1-2 weeks or even longer before the onset of myocardial infarction.
(1) Sudden recurrent attacks of angina pectoris, which are more severe and longer in duration, in a normally healthy patient.
(ii) The symptoms of angina pectoris are frequent, severe and prolonged, and cannot be relieved by rest or nitroglycerin.
(③The angina was easy to attack during activity in the past, but later became angina at rest or at night.
(4) Angina attack with arrhythmia and profuse sweating, nausea, vomiting, etc.
⑤ Angina attack combined with obvious symptoms of cardiac insufficiency such as dyspnea, inability to lie down and coughing.
⑥The original myocardial infarction has long been healed, and then sudden onset of severe angina pectoris.
(7) There are obvious changes in myocardial ischemia on the ECG compared to a few weeks ago, especially the presence of transient ST-segment elevation and depression and T-wave elevation or inversion, which should be especially alarming.
If you encounter one of the above conditions, you should immediately go to the hospital for examination and timely hospitalization.
13. Precautions for activities in patients with coronary artery disease.
① Avoid emotional excitement and mental tension before and after exercise. Because it can increase the level of catecholamines, inducing arrhythmia and myocardial ischemia.
②It is not advisable to have a full meal before exercise. After a full meal, the heart load increases, the human blood supply redistribution, so that the visceral blood flow increases, while the heart blood supply is relatively reduced, thus causing insufficient coronary blood supply.
③ Exercise should be carried out gradually, persistently and in a systematic manner.
④Sports activities should pay attention to the season, climate and temperature changes. Because winter and spring is the peak incidence of coronary heart disease and myocardial infarction.
⑤ Physical activity should be carried out after ten o’clock in the morning, especially in the cold season, avoiding too cold and too hot environment.
⑥Do not take a cold bath or sauna after sports activities, especially for patients with myocardial infarction.
(7) Patients at high risk of coronary heart disease and myocardial infarction should not engage in sports activities.
14.What is atrial fibrillation?
Atrial fibrillation, referred to as atrial fibrillation, is one of the most common clinical arrhythmias. The total prevalence of AF in the general population is 0.4%, and the prevalence in adults ranges from 0.5% to 0.95%, with a prevalence of 1% in those under 60 years of age.
In atrial fibrillation, the direction of excitation conduction in the atria is inconsistent, and the frequency is fast and irregular, which causes the atria to lose their effective contraction function. In atrial fibrillation, the frequency of atrial excitation is as high as 300 to 600 beats/min. Although the protective effect of the atrioventricular node prevents all these excitations from reaching the ventricles, the ventricular rate (heart rate) can still reach 100 to 160 beats/min, which is not only much faster than normal sinus rhythm, but also absolutely irregular.
15.What are the hazards of atrial fibrillation?
(1) Thrombosis and embolism: When atrial fibrillation loses its contraction function, blood is easily stagnated in the atria and forms thrombus, which can be dislodged with the blood to all parts of the body, leading to cerebral embolism (stroke, hemiplegia), limb artery embolism (serious cases even require amputation) and so on. The annual incidence of stroke is about 1% in patients with atrial fibrillation who are younger than 60 years old without other diseases, and 2% in patients who are 60 to 75 years old or older. In the presence of other embolic risk factors, the annual incidence of stroke can be as high as 4%. Risk factors for stroke in patients with atrial fibrillation include a history of previous embolism, hypertension, diabetes, coronary artery disease, heart failure, left atrial enlargement, and age over 65 years.
(ii) Rapid heart rate and irregular rhythm may cause palpitations in patients.
③Loss of atrial systolic function and prolonged increase in heart rate can lead to heart failure.
④Increase the mortality rate (twice as high as normal).
16.Non-pharmacological treatment for patients with heart failure includes those?
① Physical activity should be limited in mild cases, bed rest in severe cases, and appropriate bed activity after improvement of cardiac function, but all activities should be done in such a way that they do not cause symptoms.
②Eat fewer and more frequent meals, a low-salt diet is advisable, and eat less or no salt-pickled foods and salt-containing fried foods.
③Do not smoke, drink alcohol, strong tea, coffee and other stimulants.
④Those taking diuretics should eat more fruits.
Patients with heart failure should seek early medical consultation once they have a cold, diarrhea, fever or change in condition
17.What is dyslipidemia?
Dyslipidemia is the abbreviation of abnormal lipid metabolism. It mainly refers to ① high serum total cholesterol (TC) or serum low-density lipoprotein cholesterol (LDL-C) level; ② high serum triglyceride (TG) level; ③ low serum high-density lipoprotein cholesterol (HDL-C) level.
18.How should I prepare before the lipid test?
① Maintain the usual diet within 2 weeks before the blood test, and do not have any recent acute illness, trauma, surgery, etc.; ② It is best to stop using drugs that affect blood lipids (such as lipid regulating drugs, contraceptives, certain antihypertensive drugs, hormones, etc.) for several days or weeks, otherwise the medication should be recorded; ③ Fasting within 12 hours (a small amount of water is allowed), and the last meal before the blood test should be fasted from a high-fat diet; ④ Do not drink alcohol, do not do ④No alcohol, no strenuous exercise, except for bedridden patients, all sit still for 5 minutes. If abnormal lipids are found in the first test, the test should be repeated within 2-3 weeks afterwards.