High blood pressure control measures

The core logic of hypertension control has never been a one-size-fits-all “hard blood pressure reduction”, but rather aims at achieving long-term and stable blood pressure standards. Lifestyle adjustment is the basis, individualized medication is the core, and dynamic monitoring and calibration is the support. The specific measures need to be tailored based on age, underlying diseases, and blood pressure tolerance. There is no "standard answer" that suits everyone.

To be honest, the first reaction of many newly diagnosed hypertensive patients is "Can I not take medicine?" ”, This is really not a fantasy - I met a 52-year-old Chen at a community free clinic before. His blood pressure at the first diagnosis was 148/95. He had no other basic diseases except being overweight, drinking a few sips of wine, and could not live without pickles. He was afraid that he would be "dependent" on taking medicine, so he discussed with the doctor to try a lifestyle intervention for three months. I replaced my daily two taels of white wine with a 40-minute brisk walk after meals. I moved the pickle jar at home from the dining table to the top of the cupboard. I cut my monthly salt purchase in half. When I checked again in three months, my blood pressure dropped steadily to 130/82. Even the doctor praised him for his good execution. However, don’t think that lifestyle modification is a panacea. There are actually many controversial points here: for example, some people say that you should never drink coffee if you have high blood pressure. However, existing studies say that 1-2 cups of black coffee a day can reduce cardiovascular risks, and some say that sensitive people can have their blood pressure soar by 10mmHg after one sip. To put it bluntly, you don’t need to copy other people’s experience. You can measure your blood pressure after drinking it. If there is no obvious fluctuation, you don’t need to quit completely, which will only make life more miserable. It is also always emphasized that "the daily salt intake should not exceed 5g". If you have eaten heavy food for half your life and suddenly reduced it to light food, you will become anxious and insomnia and affect your blood pressure. Just slowly adjust it downwards. Only effective control is the control that you can stick to.

Of course, don't insist on not taking medicine. I met a 62-year-old Aunt Zhang two years ago. Her blood pressure was 158/97 when she was first diagnosed. The doctor prescribed amlodipine and she refused to take it. She secretly spent more than 8,000 yuan to buy so-called "pure natural antihypertensive tea". After drinking it for half a year, she felt dizzy every day. She suddenly fell at home and was sent to the doctor. She was found to have lacunar cerebral infarction and her blood pressure had soared to 172/102, so she was willing to take antihypertensive medicine. There are also different academic trends regarding the use of antihypertensive drugs: European and American guidelines recommend that newly diagnosed high-value patients directly take a single-pill compound preparation. One pill contains two antihypertensive ingredients with different mechanisms. There is no need to remember to take several types, and compliance is higher. ； Many domestic clinicians prefer to prescribe a small dose of a single drug to elderly patients with poor tolerance to try it first to avoid the side effects of dizziness and fatigue caused by lowering blood pressure too quickly. There is no absolute right or wrong between the two options. The core is to match the actual situation of the patient. A special reminder: Don’t believe the rumor that “antihypertensive drugs damage the liver and kidneys and require regular replacement.” As long as you take them without side effects and your blood pressure can be stable, then this drug is suitable for you. Changing medications indiscriminately can easily lead to blood pressure fluctuations, and the damage to blood vessels is much greater than the side effects of antihypertensive drugs.

Many people have taken medicines and adjusted their lifestyles properly, but they still panic every day, saying that their blood pressure test at home goes up and down. In fact, it is most likely that the method of measuring is wrong. I saw too many people during the free clinic. They just climbed up the third floor and sat down to take a test while gasping for air. Their arms were still raised in the air. When the test came out at 150, they were so scared. After resting for 10 minutes and taking the test again, it returned to 135. It was purely a waste of worry. The industry now actually recommends 24-hour ambulatory blood pressure monitoring for qualified patients, which is much more accurate than a single test in the clinic or scattered measurements at home. It can also rule out "white coat hypertension", a special situation that makes you nervous when you see a doctor. There is no need to be obsessed with the monitoring frequency of "once every morning and evening." If your blood pressure has been stable within the standard line for one or two consecutive months, just test it two or three days a week. Staring at the blood pressure monitor every day will make you more anxious, and the more your blood pressure is measured, the higher it will be.

There is another point that is easily overlooked: not everyone needs to lower their blood pressure below 130/80. Nowadays, there is still controversy in the academic circles for the elderly over 80 years old. One group thinks that it is enough to lower it to 140/90. If it is too low, it may lead to insufficient blood supply to the brain and the risk of falling. ； The other group thinks that if tolerated, lowering it to 130/80 can better reduce cardiovascular risk. You really need to discuss the specific reduction with your attending doctor. Don't just look at the blood pressure lowering goals of young people and set yourself a target.

I have been managing chronic diseases for almost 8 years, and I have seen too many patients who either ignore high blood pressure as a trivial matter and only regret it when they have a stroke or myocardial infarction, or treat it as a scourge, dare not eat or move every day, and live extremely tired lives. In fact, high blood pressure is one of the most "behaved" chronic diseases. As long as you are aware of your body's rhythm and find a control plan that suits you, it will basically not cause you any big trouble.