Hypertension control mechanism

The current mature hypertension control mechanism in China, which has been implemented in the public health system and clinically verified in the past 10 years, is essentially a full-cycle closed loop covering "pre-hospital screening and early warning - personalized intervention in the hospital - long-term post-hospital follow-up". The core principle is "hierarchical management, one person, one policy". There is no unified implementation standard that applies to all groups of people.

A while ago, I followed up with Dr. Zhang from the Chronic Disease Department of the Community Health Service Center for half a month. My deepest feeling is that the success of this mechanism is not just a matter of a few lines of words in the guide, but the result of countless practical pitfalls. In the past, many people's understanding of hypertension was that "high blood pressure means you are dizzy." If you wait until symptoms appear to check, irreversible problems such as thickening of blood vessel walls and kidney damage have often been combined. Therefore, the first step of control is to directly sink the screening port to the lowest level: free blood pressure monitors are placed at the entrance of community health service stations all year round, and free blood pressure measurement activities are notified every quarter in the property group. Many takeout counters and subway stations have even installed self-service pressure measurement equipment, just to fish out those borderline hypertensive patients without symptoms.

When it comes to screening criteria, there has been a lot of controversy in the industry over the past two years. In 2017, the American Heart Association lowered the diagnostic threshold for hypertension from 140/90mmHg to 130/80mmHg. At that time, many domestic scholars also called for integration with international standards. However, until now, our clinical guidelines still use the 140/90 standard. Behind the scenes is a game of views between two schools of thought: Those who support the downward adjustment believe that early intervention can eliminate the risk of cardiovascular and cerebrovascular diseases at an earlier stage, especially for young and middle-aged people in their thirties and forties. Early control will benefit early. ； The opposing faction believes that China has a large base of elderly patients with hypertension, and many elderly people over 70 years old have insufficient blood supply to the brain. Forcing blood pressure below 130 may increase the risk of dizziness, falls, and even ischemic stroke. One-size-fits-all simply does not work.

I really understand this. Last year, Dr. Zhang had a 67-year-old aunt. After hearing the popular science on the Internet that a blood pressure above 130 is high blood pressure, she secretly added half a tablet of antihypertensive medicine. After taking it for three months, her blood pressure was stable at 127/76, but she felt dizzy at every turn. She had to hold on to the wall when going out to buy groceries. Later, she went to the hospital to adjust the dosage of the medicine and controlled her blood pressure to around 140/90, but nothing happened. You see, there is no absolute standard answer to the control of high blood pressure. It is essentially the same as pumping air into a bicycle. Road bikes need to pump high pressure to save effort, and mountain bikes need lower tire pressure to withstand earthquakes. It all depends on your own "car condition."

When it comes to intervention plans, there is currently no unified clinical routine. Evidence-based doctors believe more in the conclusions of big data: as long as hypertension is diagnosed, combined with hyperlipidemia, diabetes or family history of cardiovascular and cerebrovascular diseases, drug treatment can be started directly without delay. Existing data shows that standardized medication can reduce the risk of stroke by 35% and the risk of myocardial infarction by 20%, and the benefits far outweigh the side effects of the drugs. ； Doctors who prefer natural intervention usually give a three-month adjustment period to patients under the age of 35 who have no underlying diseases and only occasionally have excessive blood pressure measurements and often stay up late to drink milk tea. They require daily salt intake of no more than 5 grams, at least 150 minutes of moderate-intensity exercise per week, and less late nights. I have seen several programmer patients whose blood pressure returned from 145/95 to 120/80 after adjusting their work schedules and walking three kilometers every day without taking any medicine.

As for the post-hospital follow-up link that is most easily overlooked, it is the key to whether this mechanism can be implemented. To be honest, antihypertensive drugs are now very mature. It is not difficult for doctors to prescribe drugs. What is difficult is getting patients to obey the doctor's instructions. The most exaggerated thing I saw when I followed Dr. Zhang to his home was a 72-year-old man who put his antihypertensive medicine and his grandson's calcium tablets in the same medicine box. He took them for half a month, and his blood pressure soared like a roller coaster. I thought the medicine was not effective, but if it hadn't been discovered during the follow-up, something serious would have almost happened. Many communities now equip high-risk elderly patients with smart blood pressure monitors, and the measured data are automatically synchronized to the backend of the family doctor. Once the threshold is exceeded three times in a row, the doctor will call directly to ask about the situation, which is more effective than keeping an eye on family members.

Oh, yes, there is another interesting phenomenon. Our community established a mutual aid group for patients with hypertension last year. Everyone checks in and walks in the group every day, posts their blood pressure values, and reminds each other not to eat too salty food. Dr. Zhang occasionally posts some popular science in the group. When statistics are compiled at the end of the year, the blood pressure compliance rate of patients in the group is more than 20% higher than that of those who are not in the group. You see, no matter how good the mechanism is, it has to fall on "people" in the end, right?

To put it bluntly, the hypertension control mechanism has never been a set of cold, standardized procedures, nor is it a set of rules used to block people. Its core has always been "how to let ordinary people stabilize their blood pressure within a safe range" - if you can keep your mouth shut and move forward, and can stabilize your blood pressure without taking medicine, then of course it is good.； If you still can't get better after adjusting your lifestyle, it's not a shame to take medicine obediently. The best plan is the one that suits you.