Guidelines for the Prevention and Treatment of High Blood Pressure

The prevention and control of hypertension has never been as complicated as everyone thinks. The critical group of people who are not sick can nip 80% of the risk in the bud by accurately adjusting their lifestyle. Patients who have been diagnosed can effectively avoid more than 90% of serious complications such as stroke, kidney failure, heart failure, etc. as long as they adhere to the dual-track plan of "lifestyle intervention + personalized medication" and stabilize their blood pressure below 130/80mmHg for a long time.

Last week, a 32-year-old Internet programmer came to the outpatient clinic. His physical test showed that his blood pressure was 145/96mmHg. When he took the report, he panicked. The first thing he said when he sat down was, "Doctor, do I have to take medicine for the rest of my life?" ”I looked through his physical examination report. In addition to his high blood pressure, his body mass index was 27.8, his waist circumference was 93cm, and his blood lipids were also at the critical level. I asked about his living habits. He took out takeaways that were heavy on salt and oil, and drank 2 cups of iced American style with sugar every day. It was normal to stay up until one or two o'clock. Last month, he didn't even go downstairs a few times in order to catch up on projects - typical "borderline high blood pressure of his own making."

Many people's understanding of the prevention of high blood pressure is still limited to the three words "eat less salt". In fact, there are many ways to do this. A topic that has been hotly debated in academic circles in the past two years is whether to strictly limit salt for the entire population. Traditional guidelines require everyone to limit their daily salt intake to less than 5g, which is about the amount of a beer bottle cap. However, in recent years, studies have pointed out that about 20% of the population is salt-insensitive. Even if they eat more salt, their blood pressure will not fluctuate significantly. A blanket salt restriction may put these people at risk of hyponatremia. But in our general environment in China, more than 70% of people are salt-sensitive. In addition, invisible salt in take-out and processed foods is hard to prevent. It is more prudent for ordinary people to try to control the amount of salt. I usually tell patients that there is no need to weigh the scale every time, use less sauce and less light soy sauce when cooking, and when eating take-out, rinse the water once more, and they are basically fine.

Oh, by the way, what is more easily ignored than salt is the intake of free sugars and trans fatty acids. Think about it, drinking milk tea, eating cream cakes, and nibbling fried chicken every day will increase your weight. For every 1 cm thicker waistline, the risk of elevated blood pressure increases by 2%, which is more direct than the impact of eating salt. Some people also ask whether to prevent high blood pressure, you have to go to the gym and run 5 kilometers every day? Really not. In the past, there was a school of sports medicine experts who advocated that high-intensity exercise must be done three times a week to effectively control stress. Now more clinical data shows that even fragmented activities are useful, such as getting off the bus two stops before get off work and walking for 20 minutes, standing up and stretching for 2 minutes every hour while sitting in the office, and running two laps in the park with your children on weekends, which is enough to get 150 minutes of moderate-intensity activity per week. I used to have a 58-year-old patient. He applied for a fitness card and went there three times before getting tired and gave up. Later, he and his wife walked around the community for 40 minutes every day after dinner, and chatted with old neighbors. In half a year, he lost 8 pounds. His previously critical blood pressure was directly stabilized at 120/75mmHg, which is much more useful than taking health supplements.

Of course, not everyone can bring their blood pressure back by adjusting their lifestyle. If your blood pressure is still above 140/90mmHg after strict adjustment for 3 months, or you have reached level 2 hypertension (≥160/100mmHg) just after being diagnosed, then you have to talk about taking medicine.

There is also a topic that has been controversial for many years: Do you need to take medicine for life if you have high blood pressure? The traditional view is that the cause of essential hypertension is unknown and requires lifelong medication to control blood pressure and avoid complications. ； However, in recent years, more and more clinical cases have shown that newly diagnosed patients with grade 1 hypertension do not have underlying diseases such as diabetes, kidney disease, or arteriosclerosis. As long as their subsequent lifestyle adjustments are adequate and their blood pressure is stable within the normal range for a long time, they can gradually reduce or even stop taking medication under the guidance of a doctor. There is no need to be intimidated by the label of "lifelong medication."

But I have to pour cold water on it. After all, only a few people can stop taking medicine. Most people still have to take medicine according to the doctor's instructions. What they are most afraid of is the kind of patients who "stop taking medicine when my blood pressure is normal" and "I'll take less because the medicine is 30% toxic." Last month, a 62-year-old aunt was admitted to the emergency department. She secretly stopped the antihypertensive medicine because she thought her blood pressure was stable. She suffered a sudden cerebral hemorrhage only half a year later. Although she was rescued, the left side of her body was paralyzed. What a pity. In fact, the current antihypertensive drugs have been iterated for many generations, and the side effects have long been controlled to very low levels. Compared with the damage caused by high blood pressure to the body, the side effects are basically negligible. You can think of blood pressure as the pressure of the water pipes at home. If the pressure is too high for a long time, either the wall of the water pipe is worn out (cerebral hemorrhage), or the water pump (heart) is overloaded every day and finally stops working (heart failure). Taking antihypertensive drugs is to help you adjust the pressure to a safe range and protect your organs. Don't put the cart before the horse.

Oh, by the way, there is another pitfall that many people step on: I always think that the blood pressure measured in the hospital is accurate. In fact, it is quite the opposite. Many people get nervous when they see people wearing white coats at the hospital. The measured blood pressure may be 20mmHg higher than the actual blood pressure. This kind of "white coat hypertension" does not require taking medicine at all. Just test it several times at home. Just buy an upper-arm type electronic sphygmomanometer, sit there and rest quietly for 5 minutes before taking the test, don't smoke and don't drink strong tea, put your arms at the same level as your heart, and the measured value will be much more reliable than a single measurement in the hospital.

To put it bluntly, high blood pressure has never been a "senile disease." Nowadays, I meet young people in their twenties who are diagnosed with borderline high blood pressure every week. To put it bluntly, the prevention and control of high blood pressure can be explained in one sentence: Don’t take chances, don’t force yourself to do it, change the bad habits that need to be changed, and take the medicine that needs to be taken, which is more effective than any folk prescription.