Adults with blood pressure ≥140 mmHg and/or 90 mmHg are considered hypertension, regardless of age. The prevalence of hypertension among adults in China is 25.2%, with 270 million people suffering from hypertension nationwide, making it the most prevalent chronic disease.
A. General knowledge of Hypertension
Adults with blood pressure ≥140 mmHg and/or 90 mmHg are considered hypertensive, regardless of age. The prevalence of hypertension in adults is 25.2%, making it the most prevalent chronic disease.
Hypertension is the most important risk factor for heart attack, brain attack and kidney failure. According to statistics, 2 million people die each year from diseases related to hypertension nationwide. Moreover, more than 60% of coronary heart patients, more than 80% of brain infarction patients, and 90% of brain hemorrhage patients have a history of hypertension. It can be said that hypertension is the most important “killer” of human health. Therefore, it is very important to understand hypertension correctly and control it strictly.
So, when to start blood pressure lowering treatment? What is the goal of blood pressure reduction?
The JNC8 (U.S. Hypertension Guidelines 8) released in early 2014 clearly states.
1. When to initiate antihypertensive therapy?
① Patients ≥ 60 years of age with hypertension, systolic blood pressure ≥ 150 mmHg and/or diastolic blood pressure ≥ 90 mmHg can initiate pharmacological antihypertensive therapy.
② Patients with hypertension < 60 years of age, as long as the systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg can start drug antihypertensive treatment.
2. What is the target for blood pressure reduction?
① For hypertensive patients ≥60 years old, the target values for blood pressure lowering are systolic blood pressure <150mmHg and diastolic blood pressure <90mmHg.
② For hypertensive patients < 60 years old, the target values for blood pressure lowering are systolic blood pressure < 140 mmHg and diastolic blood pressure < 90 mmHg.
Of course, there are still different opinions on the target values for lowering blood pressure in patients with diabetes and renal disease, and the general trend is that the target values for lowering blood pressure in these two groups of patients should be more stringent.
The occurrence of hypertension is related to genetics and unhealthy lifestyle. To control hypertension, in addition to medication, lifestyle should be improved, but medication is undoubtedly the main measure.
The starting medications for hypertension include ACEI class (Prilosec) drugs, ARB class (Satan class) drugs, CCB class (Diphenhydramine class), thiazide diuretics, beta-blockers, etc.
B. Hypertension medication, 10 mistakes
Myth 1: No feeling, there is no problem
Elevated blood pressure will feel headache, dizziness, ringing in the ears, insomnia, etc.. But some people feel nothing, which is like boiling a frog in warm water, slowly rising instead of uncomfortable.
No feeling is not the same as no harm, and when you feel it after a heart attack, brain attack or brain hemorrhage, it may be too late. Therefore, elevated blood pressure, whether or not the feeling should be used drugs.
Myth 2: Antihypertensive drugs can not be taken casually, once eaten, can not be broken
Antihypertensive drugs are not addictive drugs, there is no dependence, and can be stopped at any time. The problem is that you can’t stop, once you stop, your blood pressure will rise again.
Hypertension is a lifelong disease and needs to be controlled with medication for life. In this way, it is not the drug that is dependent, but the hypertension that is “dependent”.
Of course, in the early stage of hypertension without family history, blood pressure can be normalized by improving lifestyle and can be treated without medication. Otherwise, medication should be used.
Myth 3: You can’t start with good drugs
High-grade antimicrobials should not be preferred for treating infections because once they are resistant, there is no medicine available. This is due to the ability of bacteria to fight against the drug.
The antihypertensive drugs act not on the bacteria but on the receptor, and there will be no situation similar to antimicrobial resistance.
The so-called good drugs not only have good antihypertensive effect with few side effects, but also have protective effect on heart, brain, kidney and other organs. So choose antihypertensive drugs, which is good, choose which, and start with a good drug.
Myth 4: high blood pressure to take drugs, blood pressure is normal to stop the drug
normal blood pressure after medication, is the result of the action of the drug, is the balance under the control of the drug, stop the drug after the balance is broken, blood pressure will rise again.
High with medication, normal with discontinuation. This pattern of medication on demand will lead to blood pressure is always in fluctuation, and heart attack, brain infarction and other complications occur when blood pressure fluctuations.
Myth 5: The lower the blood pressure, the better
Systolic blood pressure is best maintained between 110-140 mmHg; too high or too low and complications and mortality will increase, which is the well-known J curve of antihypertensive therapy.
By the same token, diastolic blood pressure should ideally be maintained between 70-90mmHg.
Myth 6: When blood pressure is found to be elevated, it should be quickly lowered to normal
Blood pressure rises gradually, and blood pressure lowering should also be done gradually. Except for emergency situations such as hypertensive crisis, rapid and substantial lowering of blood pressure is not recommended, otherwise it may cause unexpected situations such as cerebral underperfusion.
For hypertensive emergencies, a slow reduction of blood pressure to 160/100mmHg within 24-48 hours is sufficient, and intravenous medication is generally not required.
The common clinical use of sublingual cardiac painkillers (nifedipine) for emergency blood pressure lowering is currently considered inappropriate. In addition to lowering blood pressure too quickly, it can also cause sympathetic excitation and induce cardiovascular disease.
Myth 7: Antihypertensive drugs should be replaced every few years
If the correct choice of antihypertensive drugs, blood pressure control is very good, and there are no side effects, should continue to use, it is not recommended to change the drug regularly.
Unless a new variety is listed, and the new drug has great advantages in terms of efficacy and side effects, you can consider changing the drug.
Myth 8: Antihypertensive drugs have side effects
Any drug has side effects, including antihypertensive drugs. However, FDA-approved original drugs (imported drugs) are relatively safe. If the drug is used as directed, the side effects will be mild.
Don’t choke on it. The side effects of antihypertensive drugs are minimal compared to the dangers of high blood pressure.
Myth 9: Antihypertensive drugs hurt the kidneys
This is a long-standing and very persistent argument, where the word “kidney” also implies male sexual function.
The first two drugs in particular are the first choice for chronic kidney disease, and have the effect of improving sexual function.
Arteriosclerosis caused by hypertension is the main cause of erectile dysfunction in men, lowering blood pressure, treatment of arteriosclerosis is also the main measure to treat male sexual dysfunction.
In short, it is high blood pressure that hurts the kidneys, not antihypertensive drugs.
Myth 10: Health products can also lower blood pressure
In recent years, there are more and more antihypertensive health products, such as antihypertensive pillows, antihypertensive watches, antihypertensive caps, antihypertensive insoles, etc. These health products claim to have a good antihypertensive effect, but the results are not so.
The antihypertensive efficacy of health care products is simply not clinically certified by science, and the use of such health care products to lower blood pressure can delay the treatment of hypertension, even if the health care products are not harmful.