High blood pressure prevention reference

First, more than 90% of cases of essential hypertension can be delayed or even avoided by adjusting lifestyle.； Secondly, for high-risk groups such as those with family history, overweight, and long-term high-salt diet, the effect of stratified intervention 2-5 years in advance is 3.7 times that of conventional health education (data from WHO 2021 Cardiovascular Disease Prevention Report) ； Third, there are differences in the prevention paths of different academic systems. There is no universal “perfect solution” and needs to be flexibly adjusted based on individual tolerance.

Last week, I met a 32-year-old Internet programmer at a community free clinic. Both his parents were diagnosed with high blood pressure under the age of 50. His own blood pressure measured for three consecutive months has been hovering at 135/85mmHg, which is a normal high value. The young man cherished his life. He checked a bunch of strategies on the Internet and directly reduced his daily salt intake to less than 2g. He also forced himself to run 5 kilometers every day after get off work. As a result, he suffered a gout attack and went to the hospital in half a month. The uric acid level soared to 680 μmol/L.

When it comes to this, you can actually find that the recommendations of different guides are really not the same thing. For example, the American Heart Association's 2023 updated guidelines for the prevention of hypertension directly set the optimal daily sodium intake recommendation at 1500mg, which is about 3.75g when converted into salt. It also said that if it can be reduced to this level, the risk of hypertension can be reduced by another 20%. But our 2023 version of China's guidelines for the prevention and treatment of hypertension is not so strict. The recommendation is that the average daily salt intake should not exceed 5g - after all, most of the sodium intake of Chinese people comes from the salt added during cooking, unlike in European and American countries, which mostly comes from processed foods. Moreover, many domestic nutrition experts have mentioned that for heavy manual workers and people who sweat for a long time in southern summer, if the sodium intake is too low, they may easily suffer from electrolyte imbalance, fatigue, and may also affect the metabolism of sugar and lipids, which is not worth the gain.

In addition to the controversy over food, the choice of exercise regimen is also a point of confusion for many people. In the past few years, everyone assumed that only aerobic exercise can lower blood pressure. The 2022 study in The Lancet, which included 13 cohorts and nearly 200,000 people, also confirmed that 150 minutes of moderate-intensity aerobic exercise per week, such as brisk walking, cycling, and Tai Chi, can reduce the risk of hypertension by 35%. But a new study published by the Department of Sports Medicine at Beijing Sport University last year added a new conclusion: For obese people with a BMI over 28, adding light weight strength training twice a week, such as lifting small dumbbells, wall squats, and core exercises, has a blood pressure-lowering effect that is 12% better than simply doing aerobics. This is something I usually mention when prescribing exercise to people at high risk of obesity. After all, many people get out of breath after running two steps. It is easier to persist by starting with sitting and lifting dumbbells.

As for the most controversial issue of "should you take antihypertensive drugs in advance when the normal high value is high?", the guidelines on both sides are quite different. The AHA's 2021 guidelines recommend that as long as your blood pressure is in the 130-139/80-89mmHg range and you have more than two cardiovascular risk factors (such as hyperlipidemia, diabetes, smoking), you can take ARB antihypertensive drugs in small doses for prevention. Their 12,000-person cohort study shows that doing so can reduce the risk of heart infarction and cerebral infarction by 21% in 10 years. However, our domestic guidelines clearly do not recommend it. Based on a large domestic sample survey, more than 60% of people with high normal values ​​can return their blood pressure to the normal range as long as they adhere to lifestyle adjustments for 3-6 months. Premature medication may cause side effects such as hypotension, dry cough, and elevated blood potassium, and the price/performance ratio is too low.

If you want to check the original evidence-based materials for yourself, I have compiled several core reference documents recognized in the industry, which are usually read when doing clinical intervention. There is no irritating content:

1. World Health Organization (WHO). "Global Cardiovascular Disease Prevention Report 2021" [R]. Geneva: World Health Organization Press, 2021. Basic epidemiological data come from here, and the reference value is very high.

2. Chinese Guidelines for the Prevention and Treatment of Hypertension Revision Committee. "China Guidelines for the Prevention and Treatment of Hypertension (2023 Revised Edition)" [J]. Chinese Journal of Cardiovascular Disease, 2023, 51(11): 1023-1065. The prevention, diagnosis and treatment of hypertension in all domestic medical institutions must be based on this standard, which has the strongest applicability.

3. American Heart Association. 2023 AHA Guideline for the Prevention of Hypertension [J]. Hypertension, 2023, 80(4): e98-e169. The latest guidelines of the American Heart Association can be used as academic reference, but do not need to be copied completely. After all, there are considerable differences in race and diet.

4. The Lancet. Physical activity and risk of hypertension: a pooled analysis of 13 prospective cohort studies [J]. Lancet, 2022, 399(10335): 1563-1572. It has one of the largest sample sizes in the current study on the association between exercise and hypertension, and the data is highly reliable.

5. Institute of Sports Medicine, Beijing Sport University. Research on the effect of strength training intervention on blood pressure control in obese people [J]. Chinese Journal of Sports Medicine, 2024, 43(2): 89-96. The latest domestic exercise intervention research, the samples are all Chinese, and the reference significance is greater than foreign studies.

After working in community chronic disease management for almost 10 years, my biggest feeling is that there is really no need to adopt such a strict "ascetic" model to prevent hypertension. There’s no need to force yourself to eat boiled vegetables that are completely tasteless. If you like spicy food, add more chili pepper and less salt. It’s totally fine. ； There is no need to run for several kilometers. Taking a 20-minute walk after meals every day, standing several times to get water, and climbing two floors at work are better than not moving at all. After all, a plan that can be sustained is a truly useful plan.