Hypertension care PPT

There is no universal formula for hypertension care. The core is the synergy of "individualized lifestyle intervention + standardized medication use as prescribed by doctors + ambulatory blood pressure monitoring". The ultimate goal is to stabilize blood pressure within the target range for a long time and reduce damage to target organs of the heart, brain, and kidneys. Any extreme approach that only relies on medication or dietary taboos will not achieve good nursing results.

I have been doing chronic disease management in a community health service center for almost 6 years, and I have seen too many patients who have taken detours. For example, Aunt Zhang, who came to the free clinic last month, has been taking amlodipine for three years. Her blood pressure still fluctuates around 150/95mmHg every time she is measured, and she feels dizzy from time to time. After careful questioning, I found out that she ate pickled radish and drank porridge every day, danced in the square for an hour immediately after taking the medicine every morning, and went home after sweating all over. It was like relying on medicine alone, and her bad habits had not changed at all. How could her blood pressure be stable?

Speaking of dietary taboos, there is actually quite a controversy now. Many family members wish that the patient would not be able to touch salty or oily food at all, and would not even allow pickles to be served. On the contrary, the elderly will be depressed and avoid eating secretly, which will cause the blood pressure to rise faster. There are also some elderly people who think, "I've already taken medicine and can eat whatever I want." According to the recommendations of the 2023 version of the "China Guidelines for the Prevention and Treatment of Hypertension", in fact, the daily salt intake should be controlled within 5g, which is about the amount of a mediocre beer bottle cap. If you really want to eat pickled or braised food, as long as you add less salt to other dishes that day, the total intake will not exceed it.

Speaking of which, I have to mention the drug pitfalls that many people have stepped on. Last week, an old man came to me and said that his feet had been swollen for almost a week and it was difficult to walk. After some research, I found out that he saw that his neighbor was taking amlodipine and it was effective in lowering blood pressure. He secretly stopped taking valsartan for two years and followed suit and changed medicines. As a result, he developed lower limb edema, a common adverse reaction of calcium ion antagonist antihypertensive drugs. You should know that antihypertensive drugs are now divided into five categories. Preliminary and Sartan drugs are recommended first for patients with diabetes and chronic kidney disease. Dipine drugs are suitable for elderly patients with simple systolic hypertension. Patients with prostatic hyperplasia can also choose α-blockers. There is no "best antihypertensive drug", only the one that is most suitable for you. By the way, there is no unified conclusion in the academic circles on the timing of medication for young patients with initial mild hypertension. One group believes that there is no need to take medication after three months of lifestyle intervention, weight loss, salt control, and exercise. Once the blood pressure has dropped, the other group believes that early medication can protect blood vessels earlier and reduce the risk of long-term myocardial infarction and stroke. The specific choice depends on whether the patient has risk factors such as family history, obesity, and hyperlipidemia. There is no need to set rigid standards.

In addition to taking medicines and dietary taboos, blood pressure monitoring also requires a lot of attention. Many people take the test once in the morning on an empty stomach. If it is normal, they feel fine throughout the day. Last year, I met an uncle Wang who had typical "twilight hypertension". Every test in the morning was within 130/80mmHg. By 5 or 6 p.m. He felt dizzy and had a headache. At first, he thought it was a cervical spine problem. After doing 24-hour ambulatory blood pressure monitoring, he found that his blood pressure could reach 160/100mmHg in the evening. Later, he moved the medicine he originally took in the morning to 2 o'clock in the afternoon, and it stabilized in half a month. And there is really no need to insist on going to the hospital to measure blood pressure. Many people get nervous when they see people wearing white coats. The measured blood pressure is 20mmHg higher than normal, which is often called "white coat hypertension". However, it is not as accurate as measuring at home. Buy a certified upper-arm electronic blood pressure monitor, sit for 5 minutes without talking before taking the test, and keep your arms at the same level as the heart. The measured value will be very reliable.

Oh, by the way, there is another point that many people overlook, that is, blood pressure is easy to fluctuate when the seasons change, especially when the temperature drops in autumn and winter. When blood vessels shrink, many people whose blood pressure is originally stable will have their blood pressure drift. At this time, do not add or reduce medicines casually. First, measure for 3 days in a row. Write down the values ​​and ask the doctor for adjustment. Last winter, I met more than 20 patients in one week who randomly added medicines to cause hypotension. They were dizzy and fell down, but the gain outweighed the gain.

In fact, to put it bluntly, high blood pressure care is like adjusting a scale. One side is the dosage of medicine, and the other side is lifestyle habits. There is no need to pursue perfect values, and there is no need to copy other people's experiences. Just slowly adjust to a rhythm that suits you. If you are really unsure, ask a family doctor in the community, which is much more reliable than searching for random folk prescriptions on the Internet.