High blood pressure care methods

The core logic of hypertension care is to "stabilize blood pressure fluctuations + reduce the risk of target organ damage." There is no unified plan that applies to all patients. It needs to be combined with age, blood pressure classification, and underlying diseases to make personalized adjustments in three dimensions: standardized medication, lifestyle adjustments, and dynamic blood pressure monitoring. There is no so-called "radical cure" and long-term control is the ultimate goal.

Last week, I met 52-year-old Uncle Zhang at a community free clinic. He had been diagnosed with high blood pressure for 3 years. He stopped taking medication when he felt that he did not feel dizzy or headache. Recently, he had been suffering from insomnia for a week and came to take a test. His systolic blood pressure soared to 165mmHg and his diastolic blood pressure also reached 102mmHg. He is a typical patient who has no idea about nursing principles and relies entirely on his feelings. In fact, more than half of cases like him can be found in clinical practice.

When it comes to medication, the biggest concern for many people is "should I not stop taking it once I take it?" There are currently two mainstream views in the academic community: one is represented by the latest European and American guidelines, which believe that as long as hypertension is diagnosed, it is recommended to start drug intervention as soon as possible regardless of grade, which can minimize the probability of later cardiovascular and cerebrovascular complications.； The other group prefers personalized stratification and believes that low-risk patients with grade 1 hypertension (systolic blood pressure 140-159mmHg/diastolic blood pressure 90-99mmHg) and no underlying diseases such as diabetes, hyperlipidemia, abnormal renal function, etc. can first be given a 3-month window period to adjust their lifestyle. If their blood pressure can be reduced to below 130/80mmHg, they can temporarily stop taking medicine. Xiao Zhou, a 28-year-old programmer I have contacted personally, had just found out that his blood pressure was 148/96mmHg. He had no other problems except that his BMI was 28. He stopped eating takeout and milk tea in the middle of the night and rode a bicycle for 40 minutes home from get off work every day. His blood pressure was stable at 129/79mmHg when he was retested three months later. After a year of follow-up, it has not gone up. He really does not need to take medicine. ； But the 67-year-old Aunt Li who was also newly diagnosed had a 20-year history of diabetes. The doctor prescribed antihypertensive drugs to her on the same day, requiring her to keep her blood pressure below 130/80mmHg to avoid damage to her kidneys and fundus.

Many people think that lifestyle adjustment means "cutting out salt, fat, and exercising more." It really doesn't need to be so extreme. I met a 78-year-old man who had eaten pickled radishes all his life. His children had previously insisted that he give up salty food. As a result, he couldn't even eat. He lost 8 pounds in two months and his blood pressure fluctuated. Later, we adjusted him and the pickled radish increased the amount of salt. Soaked in water for 2 hours before cutting and frying, the total amount of salt per day was reduced from 12 grams to 6 grams. Now the old man eats delicious food, and his blood pressure is stable at around 140/90mmHg, which is completely within the standard for his age. I would also like to mention a different research conclusion here: most current guidelines recommend that healthy adults consume no more than 5 grams of salt per day, but some epidemiological studies on the elderly have shown that excessive sodium restriction may increase the risk of hyponatremia and falls. Therefore, elderly people over 75 years old do not have to stick to the 5-gram line. They can eat comfortably and have stable blood pressure.

The same goes for exercise. You don't have to force yourself to walk 10,000 steps a day. If you have bad knees, you can do Tai Chi or Ba Duan Jin. Young people like swimming or playing ball. As long as it can raise the heart rate slightly and last for more than 20 minutes, it will be useful. Two months ago, there was a 40-year-old brother who heard someone say that he ran at night to lower his blood pressure. He drank a bottle of iced Coke immediately after running 5 kilometers every time. As a result, he had a severe headache after a certain run. When he came to the hospital, his blood pressure was directly measured at 180/110mmHg. This was caused by the sudden contraction of blood vessels stimulated by iced drinks. Fortunately, he was delivered in time and no major problems occurred. So after exercise, don’t be greedy for cold drinks. Rest for 10 minutes before drinking warm drinks slowly. Many people don’t notice this little thing.

Oh, by the way, I have to mention a few details about blood pressure measurement. Many people are obsessed with "the measurement is only accurate when they get up in the morning." In fact, this is not always the case. About 15% of patients with high blood pressure belong to "non-dipper hypertension". Their blood pressure is normal during the day, but it only rises in the middle of the night or in the afternoon. If you only measure the blood pressure in the morning, it is easy to miss the diagnosis. There are also people whose blood pressure is high as soon as they go to the hospital, but normal when they go home. There is no need to be overly anxious about this kind of "white coat hypertension". Just use the average of three consecutive days of self-measurement at home as the standard. There is no need to increase the dosage of medicine randomly for the hospital's values. I generally advise patients to record the blood pressure value measured each time in a memo on their mobile phone, and show it to the doctor when they go for a follow-up visit. It is much more useful than saying "I feel my blood pressure is normal."

After nearly 10 years of chronic disease management, the most common thing I say to patients is, don’t compare yourself to others. For others, one tablet of nifedipine is enough for you, but half a tablet may be enough for you. For others, it can be reduced by exercise without taking medicine. If you have coronary heart disease, you must take medicine obediently. No one's plan is better, and the one that suits you is the right one. In addition, don’t believe that anti-hypertensive pillows and anti-hypertensive tea can cure high blood pressure. There is currently no evidence-based medical evidence to prove that these things can replace drugs, so don’t waste your money.

To put it bluntly, high blood pressure care is like having a long-term relationship with the body. The more you understand its temper, don’t fight against it, eat comfortably, move happily, and take medicines on time and monitor them, then it won’t cause you too much trouble.