Hypertension control methods

There is no universal formula for the control of hypertension. The core logic is a three-way linkage of "lifestyle adjustment as the basis, individualized medication as the core, and dynamic monitoring as the calibration." All plans must match the individual's disease course, age, and basic disease conditions. There is no "special method that can be used by everyone."

Aunt Zhang, whom I met during a follow-up for chronic diseases in the community last week, is a typical example. She has suffered from essential hypertension for three years, and has been taking nifedipine controlled-release tablets for a stable blood pressure of 130/80. Last month, she heard an old square dance sister say that valsartan does not hurt the kidneys, so she secretly changed the medicine and reduced the dosage by half. Within two weeks, she started to feel dizzy. When she came for the test, her systolic blood pressure had soared to 152.

Regarding the use of antihypertensive drugs, the academic community has always had two different practical ideas, and there is no absolute right or wrong: one is the "early intervention, early benefit" school, which advocates that as long as primary hypertension is diagnosed and the lifestyle adjustment does not fall to the target value after 3 months, drug treatment should be started immediately. Even young patients under 40 years old are not recommended to take it hard. The purpose is to reduce the irreversible damage of high blood pressure to target organs such as blood vessels, kidneys, and hearts as soon as possible. This is also the mainstream recommendation of the current domestic hypertension guidelines. The other is the "step-up" school, which prefers to target first-time patients whose systolic blood pressure has been in the range of 140-150 mmHg for a long time, who have no underlying diseases such as diabetes/hyperlipidemia, and who are younger than 40 years old. They give priority to a 6-12 month lifestyle adjustment window period. If they can lower their blood pressure through lifestyle, they will try not to use medication to avoid the potential metabolic burden caused by long-term medication. This idea is used more in the management of chronic diseases among young people in Europe and the United States.

When it comes to lifestyle adjustments, don't just say "eat less salt and exercise more". I have seen too many people shouting slogans for half a year, but their blood pressure has not dropped at all. Only when I asked them did they realize that they had stepped on an invisible trap. For example, many people do use less salt in cooking, but if they cook noodles with three spoons of light soy sauce and some pickled radish every day, and occasionally eat plums and pickled chicken feet as snacks, their daily salt intake has already exceeded the 5g upper limit recommended by the WHO. You must know that there are 1.6g of salt in 10ml of light soy sauce. What you think is a "light taste" is actually already exceeded.

There are different opinions on the blood pressure-lowering effect of exercise. Exercise physiology researchers recommend at least 150 minutes of moderate-intensity aerobic exercise per week, such as jogging, swimming, and cycling. This type of continuous exercise can clearly improve blood vessel elasticity, and the blood pressure-lowering effect can last for 8-12 hours. It is currently the most well-documented exercise program. However, scholars in the field of public health feel that this requirement is too harsh for ordinary people. After all, many people are unable to squeeze out a whole block of time for exercise after work after get off work. Instead, they recommend fragmented daily activities: such as taking one less elevator and climbing stairs, standing for 10 minutes during lunch break, and walking for 10 minutes more after get off work. As long as the daily cumulative activity reaches the standard, it can still have the effect of assisting in lowering blood pressure. The threshold is lower, and it is easier for everyone to persist.

Whether it is adjusting medication or changing lifestyle, the final effect depends on blood pressure monitoring, and there are many pitfalls here. I once met an uncle who was so anxious after he was diagnosed with high blood pressure that he measured his blood pressure once an hour. The blood pressure got higher and higher, which caused stress-induced hypertension. Even the doctor almost thought that his medicine was not working.

There is no unified requirement for monitoring frequency: if you have just been diagnosed and are in the process of adjusting medication, it is indeed recommended to measure once in the morning, noon and evening every day, and take the average of the two measurements each time to understand your own blood pressure fluctuations.； But if the blood pressure has been stable at the target value for three consecutive months, there is no need to measure it every day. Just take 2-3 days a week to measure the blood pressure in the morning and before going to bed. Over-monitoring will cause anxiety and increase blood pressure. Oh, by the way, be sure to sit down and rest for 5 minutes before measuring your blood pressure. Don’t hold your urine, and don’t measure it right after drinking coffee. Otherwise, the value will be inaccurate and the medicine will be adjusted in the wrong direction.

Oh, by the way, one more thing, more than 90% of hypertension is primary. There is currently no cure globally. All the anti-hypertensive teas and physical therapy devices that claim to "cure hypertension" are IQ taxes. Don't gamble with your body.

I have been managing chronic diseases for almost 8 years, and the most unfortunate patient I have ever seen is a patient whose blood pressure is well controlled, but who relies on folk remedies and stops taking the medicine without permission, and ends up with serious complications. In fact, the control of high blood pressure is really not that complicated. It is like customized maintenance for your own body. You cannot copy other people's maintenance list directly. Some people are sensitive to salt, some are more sensitive to exercise, and some need to rely on medication to stabilize it. A plan that can be maintained for a long time without bringing too much burden to life is the best plan for you.