How to distinguish the first, second and third levels of hypertension prevention measures?

The core logic of distinguishing primary, secondary and tertiary prevention of hypertension is to set prevention and control targets according to different nodes in the occurrence and development of the disease, corresponding to different groups of people. The essence is the difference between the prevention and control points before and after, not the difficulty level of intervention measures.

When I do chronic disease education in the community, I often meet young people in their twenties and early thirties. Both parents have a family history of hypertension. They stay up late every day taking out milk tea, and their blood pressure often fluctuates around 135/85mmHg. They have not yet reached the diagnostic standard of hypertension. The intervention plans given at this time are all in the category of primary prevention - to put it bluntly, they are trying every means to prevent them from actually getting high blood pressure. There are still some differences in the academic circles on the scale of intervention for high-risk groups with normal high blood pressure. Some scholars believe that it is enough to make lifestyle adjustments and there is no need to take drugs in advance. Others believe that if you also have hyperlipidemia and diabetes, low-dose antihypertensive drugs can significantly reduce the risk of subsequent disease. More clinical data are currently being accumulated for verification.

But if there is no stop, if the blood pressure exceeds 140/90mmHg three times on different days, hypertension has been diagnosed, and the prevention and control at this time will enter the secondary prevention stage. Last year, there was a 40-year-old programmer in our area who was just diagnosed with a systolic blood pressure of 145mmHg and no other underlying diseases. I did not directly prescribe him any medicine. I asked him to stop drinking barbecue beer at night and walk to work for 20 minutes every day. Three months later, his blood pressure dropped to 128/78 during a follow-up check. He did not need to take medicine at all. Don’t think that secondary prevention is equal to lifelong medication. The core goal is to stabilize blood pressure within the standard line for a long time and prevent it from damaging blood vessels and affecting target organs such as the heart, brain, and kidneys. Many people think that they don’t need to care if they don’t have dizziness or headaches. I met a 38-year-old patient two months ago. He was diagnosed with high blood pressure and had not been intervened for 3 years. When he came for a physical examination, he already had protein in his urine, indicating that the kidneys had begun to be damaged. It would be much more troublesome to intervene at this time.

If complications related to hypertension have already occurred, such as myocardial infarction, cerebral infarction, kidney damage, fundus lesions, etc., subsequent intervention falls into the category of tertiary prevention. For example, for the patient who just mentioned urinary protein, the current intervention goal is not only to lower blood pressure, but also to try to delay the progression of kidney damage and avoid developing uremia. For patients who have already suffered from cerebral infarction, they must also try to reduce the risk of recurrence while ensuring the quality of life. Don't even go out for a daily walk. There are now different ideas for the management model of tertiary prevention. Some advocate the joint formulation of plans by multiple disciplines, such as cardiology, nephrology, and neurology departments to evaluate and adjust together. Others believe that for grassroots patients, stably controlling blood pressure below 130/80mmHg is the core. Overly complex plans may easily prevent patients from persisting.

In fact, if you look at it, you will understand that these three levels of prevention are three lines of defense along the entire progression chain of hypertension. The higher the line of defense, the higher the cost-effectiveness. A problem that can be solved by spending 1 yuan in primary prevention may not be able to return to the original health state even if it costs 100 yuan in tertiary prevention. Don’t wait until your body has problems before you think of paying attention to it.