Hypertension prevention and care

For the vast majority of people, more than 90% of the risk of essential hypertension can be reduced by 40% through daily care. Patients with diagnosed grade 1 hypertension without target organ damage have a 70% chance of stabilizing their blood pressure within the normal range through standard lifestyle intervention alone, and do not need to take antihypertensive drugs for the time being.

Last week, I met a 42-year-old Internet practitioner at a community free clinic. He still had a mechanical keyboard lanyard hanging on his arm. His systolic blood pressure was between 145 and 150 for three consecutive days. His parents were both hypertensive patients with a 20-year medical history. He turned pale on the spot and said that he would need to take medication for the rest of his life before he reached 45. I didn't write a prescription for him, I just listed a few very detailed life adjustment requirements and asked him to come back for a review in 3 months. Last week, he went out of his way to see me and his blood pressure was measured to be 128/79. Even he couldn't believe it.

There are actually different opinions on the intervention point of hypertension in the academic circles: one group believes that as long as hypertension is confirmed by three consecutive measurements on different days, drug treatment should be started immediately to lower the blood pressure to a safe range as soon as possible to avoid damage to organs.； The other group believes that patients with systolic blood pressure below 160, diastolic blood pressure below 100, and no target organ damage such as heart, kidney, fundus, etc. can be given a 3-6 month life intervention window period without rushing to take medicine. Judging from the clinical practice at the domestic grassroots level, the applicability of the latter is actually higher - after all, many people's newly diagnosed high blood pressure is caused by eating and drinking, and has not yet reached the level of organic disease.

Don’t believe the amazing “hypertension-lowering food list” posted online. It’s pure nonsense that eating celery and onions every day can lower blood pressure. Two months ago, I met a 62-year-old aunt who ate cold celery every meal, but her blood pressure was still 150. When I asked her, I found out that she eats fermented bean curd and pickled radish with every meal, and she had no idea about invisible salt. The daily upper limit of 5g of salt we are talking about is calculated by taking into account all the sodium in soy sauce, kimchi, processed snacks, even noodles, and bread. If you drink a bowl of salty soy milk with soy sauce in the morning, and eat a bag of potato chips at noon, the limit of these two alone is almost 5g. Add in the salt in cooking, and it will be strange if it does not exceed the limit. Oh, by the way, regarding the question of whether to eat fatty meats, a few years ago the academic community called for the complete elimination of saturated fats. In the past two years, new research has come out. As long as you don’t eat fat meats all the time, it is perfectly fine to eat them once or twice a week. Instead, eat some unsaturated fatty acids such as deep-sea fish and nuts in moderation, which can also help maintain the elasticity of blood vessels. I have a friend who has been a vegetarian for 3 years. It was found that the elasticity of the blood vessel walls is not as good as that of my old patient who ate braised pork twice a week.

You don’t have to force yourself to get a fitness card and run 5 kilometers every day. I have a patient with an old knee injury that hurts even after running two steps. He walks his golden retriever around the neighborhood for 40 minutes every day after dinner, trying to shake his arms while walking. After walking for half a year, his low blood pressure dropped from 95 to 82, which is much more stable than those who run a half-marathon on weekends and usually lie still. There are now studies saying that proper strength training, such as lifting a 1kg small dumbbell and doing several sets of wall squats every day, is no worse than aerobic exercise in lowering blood pressure. However, this depends on the person. If your blood pressure is high, don’t do the kind of strength training that requires holding your breath, such as deadlifts and planks until your face is red. Instead, it will suddenly increase your blood pressure, which is not worth the gain.

Don't think, "I just need to sleep for 8 hours." I used to work as a night shift nurse in an emergency department. She slept from 10 a.m. to 6 p.m. every day after getting off work. She actually slept for 8 hours. However, her blood pressure fluctuated around 140 for six consecutive months. This was because her work and rest were completely contrary to the human body's circadian rhythm of blood pressure - our blood pressure is originally high during the day and low at night. If the day and night are reversed for a long time, the renin-angiotensin system is always in an excited state, and the blood pressure will naturally be unstable. However, this does not mean that night owls will definitely suffer from high blood pressure. Some naturally night-type people go to bed at 2 a.m. and wake up at 12 noon every day. They have a regular schedule and good sleep quality, and the impact on blood pressure is not that big. The most terrifying thing is to stay up until 3 o'clock today, start at 9 o'clock tomorrow, and go to bed at 10 o'clock the day after tomorrow. The schedule is so messed up that it's like opening a blind box. It's strange that the blood pressure is not high.

If you have been diagnosed with high blood pressure and need to take medicine for a long time, don't think that everything will be fine after taking medicine. I have an old patient who takes three types of antihypertensive drugs, drinks white wine every now and then, and smokes a pack of cigarettes a day. Last month he suffered a cerebral hemorrhage and was admitted to the ICU. After he was rescued, half of his body was in poor condition, and now he avoids alcohol when he sees it. Don’t just cut down or stop taking medicine casually. In summer, many people stop taking medicine when their blood vessels expand and their blood pressure drops. In autumn, when the temperature drops sharply, blood vessels contract and their blood pressure soars to 180 without even realizing it. It’s easy for something to happen. Of course, it does not mean that once you take antihypertensive drugs, you cannot stop them for the rest of your life. If your blood pressure measured at different times is stable below 120/80 for more than 3 months, and there is no damage to the target organs when you go to the hospital to check, you can gradually reduce the drug or even stop the drug under the doctor's evaluation. I have several patients who rely on long-term life care. They have stopped taking the drug for more than 3 years, and their blood pressure has been very stable.

In fact, high blood pressure is not as scary as everyone thinks. Don’t be so frightened that you dare not eat anything as soon as you find out. Hold the blood pressure monitor and check it ten times every day. The more nervous you are, the higher your blood pressure will be.； Don’t take it seriously. If you don’t feel dizzy or uncomfortable, don’t worry about it. Many high blood pressures quietly damage organs. By the time you have symptoms, it will be too late. Oh, by the way, last time a patient asked me whether drinking Pu'er tea can lower blood pressure. I told him that if you drink Pu'er tea every day and give up Coca-Cola, it will definitely lower blood pressure. If you drink tea and eat fat meat and salted eggs, no tea will be of any use. If there is a family history of hypertension in your family, it is best to check your blood pressure several times a year after the age of 35. Don’t wait for the physical examination at work to check. Early detection and early care are better than anything else.