Hypertension nursing education content

The first is to control the blood pressure stably and below 130/80mmHg for a long time (adjust the target value according to the doctor's advice if you have underlying diseases such as diabetes and kidney disease), the second is to avoid all risk factors that may induce a sudden rise in blood pressure, and the third is to insist on long-term standardized intervention and not interrupt it at will. If these three points are done correctly, more than 90% of patients with hypertension can effectively avoid serious complications such as myocardial infarction, cerebral infarction, and renal failure.

Uncle Zhang, who I met at a community free clinic last week, is the most typical counterexample. He was found to have high blood pressure of 152/96mmHg. After taking medicine for two months, the test was 130/80. He felt that he was "well" and stopped taking the medicine. He went out drinking and fishing with his old friend every day. After half a month, he became dizzy and couldn't stand and was sent to the emergency room. When his blood pressure was measured, it was 187/102. Fortunately, he was sent to the hospital in time and nothing happened. Many patients wonder whether "once you take antihypertensive drugs, you can't stop them for the rest of your life." In fact, there is currently no absolutely unified statement in the industry: For patients with newly discovered mild hypertension (high pressure 140-159, low pressure 90-99), no target organ damage, and no other underlying diseases, about 30% of the cases we come into contact with rely on 3 months of strict lifestyle intervention, and the blood pressure has been stabilized and lowered to the normal range, and no subsequent medication is required. ； But if you have already suffered from myocardial hypertrophy, urinary protein and other injuries, or your blood pressure is still not up to standard after 3 months of life intervention, then really don’t insist on not taking medicine. The incidence of side effects of the current mainstream long-acting antihypertensive drugs is less than 2%, which is much lower than the probability of liver and kidney damage if you have long-term high blood pressure. I usually remind patients that it is best to take antihypertensive drugs on an empty stomach when they get up in the morning. Don’t wait until you finish breakfast and forget about it. It can just suppress the morning peak blood pressure between 6 and 10 o’clock, which is much more effective than taking it at noon.

After talking about taking medicine, let’s talk about food. Many people pat their chests and say, “I use very little salt in cooking every day.” In fact, most of them eat invisible salt without realizing it. The small porcelain spoon we usually use to drink soup contains 5g of salt, which is exactly the recommended daily intake for healthy adults. You ate a piece of soybean curd with porridge in the morning, ordered a takeaway braised chicken at noon, and went out for a bowl of braised beef noodles in the evening. The daily salt intake is at least 10g, so it would be strange if it does not exceed the standard. Others think, "I don't eat salt, so it's okay to use soy sauce for seasoning." There are 1.6g of salt in 10ml of soy sauce, not to mention oyster sauce, hot pot dipping sauce, processed meat products and other salt-heavy consumers. Usually, check the sodium content on food packaging. Multiply it by 2.5 to get the corresponding salt amount. Knowing it in advance is better than anything else. Oh, by the way, many people ask, "Isn't it said that drinking a small amount of red wine can soften blood vessels?" The old previous guidelines did mention the potential benefits of a small amount of drinking, but the latest 2023 version of the Chinese Guidelines for the Prevention and Treatment of Hypertension has been clearly updated: Even a small amount of drinking can raise blood pressure, regardless of whether it is red or white. Stop if you can, but if you really can't, don't exceed 1 tael of white wine a day, no more than 2 taels of red wine, and stay completely alcohol-free for at least 3 days a week. This is already a requirement to retreat to the bottom line.

Oh, by the way, many people ask whether people with high blood pressure can exercise? It's really not suitable for everyone. Aunt Li downstairs dances square dance for 40 minutes every day for half a year. Her high pressure has dropped from 150 to 138, and she has even reduced her medication by half. But if your blood pressure has exceeded 180/110mmHg, just rest at home and don’t force yourself to go out for a run. Blood vessels are already thinned by pressure, and it is easy to cause accidents during strenuous exercise. Especially in winter, don’t go out for morning exercises at five or six o’clock before dawn. The cold wind will cause blood vessels to constrict, which will coincide with the morning peak blood pressure. Every winter, I meet several cases of stroke patients who do morning exercises. Waiting for the sun to come out before going out after 9 o’clock is better than anything else.

Many people always think that measuring blood pressure at home is inaccurate and they have to go to the hospital to measure it. This is actually a misunderstanding. There are indeed two voices in the industry: one believes that office blood pressure is the gold standard for diagnosis, and the other believes that self-measurement of blood pressure at home and ambulatory blood pressure can better reflect the patient's daily true blood pressure level. Now we recommend patients to measure their own blood pressure at home. An upper-arm electronic sphygmomanometer will do. Don't buy the wrist type. Many people have poor peripheral circulation, and the measured blood pressure can be 20mmHg different. It is a waste of money and delays. Don't cross your legs when taking the test, don't take the test just after climbing the stairs or after eating. Sit back in a chair and place your arms at the same level as your heart. Take two consecutive measurements one minute apart and take the average. Write it down in a small book and show it to the doctor during your follow-up visit. It will be much more useful than the "white coat hypertension" value you measured nervously in the hospital.

Another point that people tend to overlook is emotions. Last week, an aunt had a fight with her daughter-in-law. She became dizzy and couldn't stand on the spot. She sent her to have her blood pressure measured and it was 192. She almost had an accident. Don't take small things seriously at ordinary times, such as raising flowers, dancing, or going for a walk with your old friends. When your mood is stable, your blood pressure will naturally be stable as well. Also, don’t stay up late. Many young patients with high blood pressure I have met have nothing wrong with them. They just stay up until one or two o’clock every day and go to bed. Their blood pressure will be at least 10mmHg higher the next day after staying up late. This is really not a scare.

After all, high blood pressure is a "chronic disease". If you get along well with it, take medicine as required, keep your mouth shut, and move your legs, you will still be fine after 20 or 30 years. If you always take a chance, stop taking medicine indiscriminately, and believe in folk remedies, you will still suffer. If you are unsure about something, don’t search Baidu blindly. Ask a community doctor or specialist directly, which is more reliable than anything else.