Hypertension nursing goals and nursing measures

The core goals of hypertension care can be summarized as two points. First, to stabilize blood pressure within an individually adapted target range for a long time, to minimize the risk of damage to target organs such as the heart, brain, kidneys, and blood vessels, and to reduce the incidence and mortality of complications such as myocardial infarction, cerebral infarction, and renal failure.； The second is to help patients establish healthy behavior patterns that can be adhered to for a long time and minimize the impact of the disease on normal life. There is no unified template for nursing measures. The core principle is "individualized adaptation", which needs to be flexibly adjusted based on the patient's age, underlying diseases, living habits and even economic conditions. There is no "standard answer" that suits everyone.

When it comes to goals, many family members and even patients themselves have a misunderstanding, thinking that the lower the blood pressure, the better. In fact, this is actually a controversial point in the industry. Regarding the blood pressure target value, there are currently two mainstream views in the academic community: one is the idea of ​​"loose blood pressure control" that has been followed for many years. It is believed that patients over 65 years old and with a history of cerebrovascular disease should control their systolic blood pressure at 140-150mmHg to avoid low blood pressure leading to insufficient cerebral perfusion and inducing dizziness, falls and even cerebral infarction. ； The other is the "strengthened blood pressure control" idea based on the conclusions of the recent SPRINT study. It is believed that as long as the patient can tolerate it, lowering the systolic blood pressure to less than 120mmHg can further reduce the risk of cardiovascular events by about 30%. There is no right or wrong in these two views. In the end, goals must be determined based on the individual situation of the patient.

Don’t think this is an exception. I have seen too many patients suffer from problems because of their blind pursuit of “lower is better”. Last year, I met a 74-year-old retired teacher who had suffered from lacunar cerebral infarction and orthostatic hypotension. He had listened to a health lecture and said he wanted to lower his blood pressure to 120, so he secretly added half a pill. As a result, he fell and knocked his head as soon as he stood up in the morning. When he was sent to the hospital, his systolic blood pressure was only over 90. Later, we adjusted his target to 140-150/80-90mmHg and reduced the dosage. However, he never had dizziness again, and his daily walks and taking care of his grandchildren were not affected.

Once the goal of adaptation is clear, the next nursing measures will not go astray. Many people think that high blood pressure care is as simple as taking antihypertensive drugs. In fact, it is like balancing the scales, with drugs on one side and lifestyle habits on the other. It won’t work if either side is off.

The easiest pitfall for many patients is to "stop as soon as they feel better". They stop taking the medicine when their blood pressure is normal, and then take it again when they feel uncomfortable. Not long ago, there was a 40-year-old business executive who had high blood pressure of 150/100 during a physical examination. He was prescribed medicine. After taking it for two months, his blood pressure stabilized at 130/80. He felt that he was better, so he stopped taking the medicine without taking another test. Half a year later, the physical examination revealed that the urine protein had increased by two points, indicating that he had early kidney damage. Fortunately, it was discovered early, and the medication was slowly reversed after adjusting the medication. In fact, for the vast majority of patients with essential hypertension, antihypertensive drugs do not "treat" the disease, but "control the disease". Just like wearing myopia glasses, you can see clearly if you wear them, but you will still be myopic without wearing them. The same goes for antihypertensive drugs. Your blood pressure will be stable after taking it, but it will still rise if you stop it. Don't stop blindly. Of course, there are also studies saying that a small number of low-risk hypertensive patients, whose blood pressure has been stabilized within the normal range for a long time through lifestyle adjustments, can gradually reduce or even stop taking their medications under the guidance of a doctor. However, this must be strictly evaluated and they must not stop on their own.

After talking about taking medicine, let’s talk about the life adjustments that are most easily overlooked by everyone. Don’t think of them as “auxiliary means.” Sometimes adjusting your living habits is as effective as taking medicine. Many people say, "I eat very light meals, but my blood pressure is still high." In fact, have you considered invisible salt? As for common breakfast items, a bag of pickled mustard contains 3g of salt, a bowl of instant noodles seasoning packet contains 5g of salt, and even the bread, biscuits, and processed meat products you eat contain salt. Many people consume more than the 5g of salt per day recommended by the WHO in one breakfast. I used to give dietary guidance to an aunt, and she always said she didn’t eat salty food. When I asked her carefully, I found out that she put a spoonful of sauce in her cooking every day, and just this spoonful of sauce contained 2g of salt. Later, I taught her to use natural ingredients such as lemons, onions, ginger, garlic, and mushrooms to enhance the flavor. She replaced it with low-sodium soy sauce. After half a month without adjusting the medicine, her systolic blood pressure dropped by 6mmHg, which is more effective than adding half a pill.

There is also exercise, and don’t follow the trend of counting steps. Some elderly people have bad joints and have to walk 10,000 steps. Not only will their knees hurt, but their blood pressure will also rise due to pain and stress. It is better to walk slowly for 20 minutes a day, or do Tai Chi or swim.

There is also blood pressure monitoring, which is also very particular. Don’t think that everything is fine just because one test is normal when you get up in the morning. Everyone's blood pressure rhythm is different. Some people have "spoon blood pressure", which is high during the day and low at night. Some people have "reverse spoon blood pressure". The blood pressure soars at two or three in the morning. If you get up in the morning and measure it, it has already dropped, and you can't find it at all. There was a patient who always complained that he had headaches, especially when he woke up in the morning. His blood pressure during the day was normal. Later, he was put on a 24-hour ambulatory blood pressure monitor and found that his systolic blood pressure was above 170 from 2 to 4 in the morning. Later, he changed his antihypertensive medication from taking it in the morning to taking it before going to bed, and the headache was quickly cured. Don't measure your blood pressure more than a dozen times a day. If it's slightly higher, you'll be nervous. The more nervous you are, the higher it will be, forming a vicious cycle. Generally speaking, if your blood pressure is stable, measure it 2-3 days a week. One measurement each morning and evening is enough. Sit down for 5 minutes before taking the measurement. Don't smoke or drink coffee. Only then will the measured value be accurate.

After nearly 8 years of chronic disease care, my deepest feeling is that there is never a "perfect answer" in high blood pressure care. You don't have to compare yourself with others. It doesn't matter what medicine others take or how much their blood pressure should be controlled. The most important thing is to find a rhythm that suits you. To put it bluntly, this is a chronic disease that needs to be with you for a lifetime. If you understand its temper, know what to eat to get high, not sleeping well will get high, and anger will get high. If you try to avoid it, take medicine on time and monitor it regularly, it will not cause you any big trouble, and your quality of life will be the same as that of a normal person.