Hypertension control technology

The currently recognized most effective hypertension control technology is by no means a single drug treatment or lifestyle adjustment, but a "layered personalized intervention + dynamic monitoring calibration" combination plan based on individual causes, comorbidities, and tolerance. There is no universal template suitable for everyone.

I have been working in the community chronic disease management position for almost 6 years. I have followed up more than 400 patients with hypertension. I have seen too many people make mistakes: they either treat antihypertensive drugs as a scourge, and would rather take health tea worth thousands of yuan than take the medicine prescribed by the doctor.； Either you copy other people's antihypertensive prescriptions and apply them to yourself. After taking it for half a year, your blood pressure fluctuates and you don't know what's wrong. I just met a 62-year-old Uncle Zhang last month. He was squatting in the yard watering flowers when he stood up and fell unconscious. He was sent to the emergency room to have his blood pressure measured as high as 180/110. When I asked him, I found out that he had heard from his neighbors that anti-hypertensive drugs hurt his kidneys, so he secretly stopped taking the medicine and switched to "pure natural anti-hypertensive tea". After drinking it for three months, he never had his blood pressure checked once, which almost caused an accident.

The current intervention technology in the industry is actually two lines running in parallel. In Western medicine, ambulatory blood pressure monitoring has become the most popular in recent years. In the past, you had to carry a 24-hour monitoring box and go to the hospital. Now many compliant wearable devices can control the error within 5mmHg, and you can see your blood pressure fluctuation curve at any time. For patients with early morning hypertension and white coat hypertension, it is much more accurate than going to the hospital once in a while to take a test. There is also renal artery sympathetic nerve ablation for refractory hypertension, but this technology has been controversial. Some experts believe that the recurrence rate is close to 30% after 3 years, and it is not recommended to be performed routinely. Some experts believe that it can significantly reduce the heart rate of patients who cannot control their blood pressure after taking more than three types of sufficient antihypertensive drugs. Regarding the risk of cerebrovascular events, I followed up a 48-year-old patient who had this surgery last year. His blood pressure was still stuck at 150/95 after taking 4 kinds of medicines before the operation. Now he only needs to take 1 basic antihypertensive drug to stabilize it at around 130/80. The effect is indeed there, but it is not suitable for everyone.

Don’t think that the intervention techniques of traditional Chinese medicine are all IQ taxes. Last year, our community conducted a control group of 120 elderly patients with first-level hypertension without comorbidities. One group only received regular diet and exercise guidance, and the other group did auricular acupuncture twice a week and practiced Baduanjin for half an hour every day. After 3 months, the blood pressure compliance rate of the latter group was 27% higher than that of the former group. For example, Aunt Li, who often comes to our station to receive medicine, had swollen ankles after taking nifedipine. After switching to valsartan, she could not sleep due to coughing. Later, she added auricular pressure beans and asked her to press the Taichong acupuncture point for 5 minutes before going to bed every day. Now half a tablet of valsartan can stabilize her blood pressure at 130/80, and her cough problem has been relieved a lot. Everyone she meets says this method is very useful.

As for the question that everyone has been arguing about for almost ten years: "Should high blood pressure require lifelong medication?", there is actually no absolute answer. Evidence-based doctors will tell you that 90% of essential hypertension has unknown causes and must be controlled with long-term medication to avoid damage to the target organs of the heart, brain, and kidneys. ； Doctors who believe in lifestyle intervention will say that for early-stage first-grade hypertension without complications, blood pressure can be lowered to normal by 3-6 months of dietary and exercise adjustments, without the need for medication at all. There are two situations in the cases I have come across: last year, there was a 27-year-old Internet operator. His physical examination showed that his blood pressure was 148/96 and his BMI was 28. He usually ate heavy takeaways and stayed up until two or three o'clock. It was common for him to make a simple list. The plan: Eat no more than 5g of salt every day, do 150 minutes of brisk walking or jogging every week, go to bed before 12 o'clock, and lose 15 pounds in 3 months. The young man really followed it. After 3 months, he checked again and his blood pressure was 128/82. He didn't take any medicine. But I have also seen people who have to endure it. 55-year-old Brother Wang was diagnosed with high blood pressure of 165/100. He was afraid that taking medicine would damage his kidneys and he had to endure it for two years. Last year, proteinuria was found in the physical examination, and his kidneys have been irreversibly damaged. Now he regrets it.

To be honest, many people can’t control their blood pressure. It’s not because of technical incompetence, but because they don’t pay attention to the details. When it comes to measuring blood pressure, eight out of ten people get it wrong: I take it right after climbing the stairs and sit down, with the cuff tied outside my thick sweater, my legs crossed, my arms raised higher than my head, and the measured value fluctuates. If you take it to the doctor, the doctor can't give you medicine. Don't bother, just buy a regular upper-arm blood pressure monitor. If your arms are thick, be sure to buy an extra-large cuff. Sit for 5 minutes before taking the test. Don't smoke or drink strong tea. Place your arms flush with your heart. Only then will the measured value be useful.

I often tell the patients who come for follow-up visits that controlling high blood pressure is actually the same as adjusting the pressure of old water pipes at home: the water pipes have been used for decades and have aged. If you suddenly adjust the pressure too low, the water in the home will not be enough. If you suddenly adjust the pressure too high, the pipes will burst easily. You have to try slowly to find the pressure value that suits you. Keep an eye on it and fix any leaks and unblock them if they are blocked. There is no magical technique that can be used once and for all. To put it bluntly, don't follow the trend, don't be perfunctory, and don't be lazy. Don't believe in any folk prescription that will be good once you take it, and don't insist on it and refuse to intervene. Slowly adjust it according to your own situation. It is more reliable than anything else.