High blood pressure prevention and treatment knowledge lecture

There is no universal solution for the prevention and treatment of hypertension. The core logic is Early screening, control of controllable risk factors, and individualized intervention strategies ——Don’t believe in the false popular science that “hypertension can be cured by eating certain foods”, and don’t fall into the panic that “once you take antihypertensive drugs, you won’t be able to quit them for the rest of your life.” If you take either extreme, you will suffer.

I spent an afternoon at a community free clinic last week and came across two particularly typical examples. A 31-year-old programmer worked on the Double 11 project for nine consecutive days. He woke up in the morning with a terrible headache. He stopped by to take a blood pressure test. His systolic blood pressure soared to 154. His face turned pale when he took the report. He opened his mouth and asked, "Am I going to have to take medicine for the rest of my life?" ”There is also a 64-year-old Aunt Wang who has been taking valsartan for 4 years. When she was dancing in the square, she heard from her elder sisters that the antihypertensive medicine hurt her kidneys. She secretly stopped taking it for half a month. She fainted at the market while shopping for groceries that day and was sent to the emergency room for a blood pressure test of 187. Fortunately, she was sent to the hospital early and no serious accident occurred.

You see, in fact, most people’s misunderstandings about high blood pressure are extreme. Let’s talk about prevention first. Many people ask, “Should we avoid eating salt at all?” Do I have to run 5 kilometers every day? ”There is really no need to be so stuck. The previous guidelines uniformly required adults to consume no more than 5 grams of salt per day. In the past two years, there have been different opinions in the academic community: last year, a study conducted by the American Heart Association with a 10-year follow-up stated that people with no family history of hypertension and normal blood sugar and blood lipid metabolism will not significantly increase the risk of hypertension as long as they do not eat pickled products, pickles, processed meats and other hidden heavy salt foods, and occasionally indulge in hot pot and braised food. Even if the daily salt intake reaches 7 or 8 grams, the risk of hypertension will not be significantly increased. ； However, if you have an immediate relative who was diagnosed with high blood pressure before the age of 50, and you are already hyperlipidemia or obese, you still have to strictly control the amount of salt to less than 5 grams, or even lower.

The same goes for exercise. Don’t be deterred by the requirement of “30 minutes of moderate-intensity exercise every day.” I’ve seen many people apply for a gym membership and go there twice before giving up. Instead, they don’t do any exercise. There is now a lot of evidence-based evidence to support the effect of fragmented exercise: get up and walk for 2 minutes every hour of sitting, walk an extra subway stop to and from get off work, go downstairs for a 10-minute walk after eating, and the cumulative amount of activity per day is enough to consume 200 calories. The effect of preventing high blood pressure is not much different from jogging for half an hour every day. Two years ago, there was a retired accountant in our community. His high pressure used to hover around 145 all year round, and he didn't like to exercise. Later, he changed his habit: he walked 10 minutes longer to take his grandson to and from school every day. He replaced the salty kimchi he had eaten for 20 years with cucumbers. After half a year, he took another test and found that the high pressure was stable at 129. I thought it was amazing.

Let’s talk about the treatment issue that everyone is most concerned about, “Should I take antihypertensive drugs? ”There are indeed different clinical tendencies on this matter in the academic community. One school of thought believes that if it is the first time that blood pressure is elevated and the value is between 140-159/90-99, there are no symptoms such as dizziness or headache, and there is no target organ damage to the heart, brain, and kidneys, a three-month lifestyle adjustment period can be given first. If the blood pressure can be reduced to below 130/80 after adjustment, there is no need to take medicine. ； Another school of thought believes that as long as the measurement exceeds 140/90 three times in a row on different days, even young people are advised to first use a small dose of antihypertensive drugs to lower their blood pressure to avoid irreversible hardening of blood vessels under long-term high pressure. This is more prudent than making lifestyle adjustments such as forcefully carrying on. There is no absolute right or wrong between these two solutions. The core depends on your own situation: if you have strong self-discipline and stop staying up late when you are told to stop staying up late, and control salt when told to control salt, then you can try to adjust your lifestyle first. ； If you don’t have a regular schedule at ordinary times, it’s better to take the medicine in small doses earlier, which will have fewer side effects.

Many people are afraid of dependence on antihypertensive drugs. To be honest, this is the most common misunderstanding I have heard. Think about it, antihypertensive drugs help you reduce the pressure on your blood vessels, and they are not drugs. Where does the dependence come from? The reason why many people take it for a long time is because your blood vessels are no longer able to regulate their blood pressure within the normal range, and they need the help of drugs instead of becoming dependent on them. I have met several young patients with primary hypertension who stayed up late at night and gained weight. After taking a small dose of Betaloc for 3 months, and losing 20 pounds of weight, their work and rest routine became regular. It has been almost 2 years since they stopped taking the medicine, and their blood pressure has been very stable without any problems.

There is another common pitfall: if other people’s antihypertensive drugs are effective, I will buy them too. Don’t try it randomly. The choice of antihypertensive drugs depends on individual circumstances: for example, patients with diabetes will give priority to Sartan or Prilim, which can also protect the kidneys. ； Most young patients with hypertension are accompanied by fast heart rate, so β-blockers are more suitable. ； If older men also have prostatic hyperplasia, choosing α-blockers can also improve urinary problems. There is no "best antihypertensive drug", only the one that suits you best.

To be honest, after so many years of chronic disease management, I have seen too many people who did not take high blood pressure seriously and ended up suffering from strokes and kidney failure. I have also seen people who were so anxious that they could not sleep well even if their blood pressure was measured eight times a day. You think of your blood vessels as rubber water pipes at home. If the water pressure is too high for a long time, the wall of the pipe will either become harder and harder, or it will burst one day. Lowering blood pressure is never to make the numbers on the physical examination report look good, but to protect important organs such as your heart, brain, and kidneys from damage.

Finally, there is nothing special to say. Spending an extra 30 seconds to measure your blood pressure during your annual physical examination is much more effective than buying a bunch of health products. If it is really found out that your blood pressure is high, don’t scare yourself by blindly searching through Baidu, and don’t insist on not seeing it. Find a cardiologist to explain your situation clearly, and use whatever plan is suitable for you. It’s that simple.