Hypertension prevention grading standards

The current clinical classification standard for hypertension prevention in my country is based on the three-level prevention framework of the 2023 version of the "China Guidelines for the Prevention and Treatment of Hypertension". Based on blood pressure levels, risk factors, target organ damage and complications, the population is divided into four risk levels, corresponding to intervention measures of different strengths. The core goal is to reduce the risk of hypertension and complications through layered management.

Last week, I met a 32-year-old Internet programmer at a community free clinic. His blood pressure was measured at 138/86mmHg, and his BMI was 28. He has smoked for 10 years. He stayed up until two or three o'clock every day and didn't go to bed. He clutched the consultation sheet and asked me, "Does this count as high blood pressure?" Do you want to take medicine? ”In fact, his condition happens to be stuck in the core group range of primary prevention - that is, hypertension has not been diagnosed yet, but it is in the normal high value range of 120-139/80-89mmHg, and there has not been any target organ damage. I have been doing chronic disease management at the grassroots level for 5 years, and I have seen too many people at this stage who don't take it seriously. They always think, "I just stay up late recently, I just need to rest for two days." When it really crosses the diagnosis line of 140/90mmHg, it will be much harder to reverse it. Oh, by the way, there is another academic controversy here: the European and American ACC/AHA guidelines lowered the diagnosis line for hypertension to 130/80mmHg as early as 2017. Many young cardiovascular doctors also recognize this standard and believe that moving the intervention line forward early can significantly reduce the long-term risk of myocardial infarction and cerebral infarction among young people. ； However, many senior doctors at the grassroots level feel that this standard is too strict. my country still uses the 140/90mmHg diagnosis line. After all, nearly 30% of young people are suddenly classified as high blood pressure groups, which may easily lead to excessive anxiety and excessive medical treatment. The two views are still being reconciled in clinical practice.

When hypertension is really diagnosed, it enters the category of secondary prevention. At this time, the classification will be more detailed: only elevated blood pressure without any other risk factors is considered low risk. As long as the lifestyle is adjusted for 3 months and it does not decrease, then take medicine.； Those with 1-2 risk factors (such as smoking, hyperlipidemia, family inheritance, age over 45 years old) are considered to be at moderate risk, and it is best to start drug intervention as soon as possible ； Those who have already experienced target organ damage (such as trace amounts of protein in the urine, plaques in the carotid arteries, and left ventricular hypertrophy) are considered high risk and must strictly control their blood pressure below 130/80mmHg. ； If you already have complications related to high blood pressure (such as coronary heart disease, cerebral infarction, renal insufficiency), you will be directly classified as high risk. Not only must your blood pressure be controlled, but the complications must also be treated simultaneously. Just like Uncle Zhang in our community, who is 62 years old and has a blood pressure of only 150/95mmHg. It doesn’t look high, but he already has a history of diabetes for 5 years.

Oh, by the way, there is a misunderstanding that many people have to correct here: Low risk does not mean "safe". In the past two years, I followed up a 28-year-old young man whose simple blood pressure was 145/90mmHg and had no risk factors. He took advantage of his youth and drank heavily every day and stayed up all night, saying that he was "low-risk and no need to worry about it." Last winter, he had a sudden myocardial infarction and was sent to the emergency room. He had to put in two stents to save his life. To put it bluntly, the classification is to give you a warning, not to grant you a license.

If complications related to hypertension have already occurred, it has entered the stage of tertiary prevention. The core at this time is no longer "not getting sick", but minimizing the risk of disability and death and improving the quality of life. I used to take care of a 70-year-old aunt who had never had her blood pressure measured before. Her first attack was a cerebral hemorrhage. After she was rescued, she could not move the left side of her body. The intervention at this time was not only as simple as taking antihypertensive drugs, but also required regular heart color ultrasound, kidney function, fundus examination, and rehabilitation training. Just like a car has been hit once, not only the damaged parts must be repaired, but all vulnerable parts must be checked regularly to prevent another accident.

When we follow up on chronic diseases, we often say that the grading standards of high blood pressure are never used to label people, but to help you figure out what you should do now: if you are not at the high blood pressure line, stay up less late, smoke less, and don't get sick.； If you have been diagnosed, just monitor your blood pressure and take medicine on time. Don’t regret it after complications arise. Keep a reliable electronic blood pressure monitor at home and measure it two or three times a week. It is more effective than any expensive health care product.