Evaluation of hypertension control measures

There is no standardized management and control plan suitable for all groups. Low-risk (grade 1 hypertension, no complications and family history) groups can achieve the standard by giving priority to lifestyle intervention. People with medium and high risk (grade 2 and above hypertension, combined with diabetes/kidney disease/cardiovascular and cerebrovascular history) need to adhere to "drug + lifestyle" combined intervention. All plans need to be dynamically adjusted according to individual tolerance and underlying diseases. A one-size-fits-all management and control approach will increase the risk of adverse events.

The controversy over the control of hypertension first focused on the "timing of drug initiation." Researchers in the field of public health are more inclined to relax the medication threshold: as long as three measurements on different days meet the diagnostic standard of 140/90mmHg, it is recommended to initiate low-dose drug intervention as early as possible. The core basis is domestic follow-up data of the past 20 years showing that early medication can reduce the risk of stroke by 32%. But on the clinical frontline, many specialist doctors will adopt a more flexible attitude: I just received a 31-year-old Internet operator last month. His blood pressure measured for a week was between 142-148/90-93mmHg, and his BMI was 27.9. He usually eats heavy braised chicken and snail noodles every meal, and he stayed up 4 days a week to change the plan. He had no family history of hypertension and no target organ damage. I did not prescribe him any medicine at that time. I only required him to control his daily salt intake within 5g, jog for 30 minutes three days a week, and go to bed before 12 o'clock. After a follow-up visit three months later, his blood pressure had stabilized at 125-130/78-82mmHg, and no drug intervention was needed.

When it comes to lifestyle intervention, many people's first reaction is to drink antihypertensive tea and eat celery root. In fact, the effect of these folk remedies is minimal. Among the interventions that have been clinically proven to be effective, salt restriction has the highest benefit. Epidemiological surveys in the northern region show that the average daily salt intake of local residents can reach more than 11g. As long as the salt intake is reduced by 2g per day, systolic blood pressure can be reduced by 2-8mmHg. This effect is even more obvious than the antihypertensive effect of many low-dose single drugs. Don’t believe it, I have an old patient who used to eat pickled radishes every meal, and his daily salt intake was estimated to be 15g. Later, he gave up pickling radish and replaced it with a 2g salt spoon. He put up to two spoons each time he cooked. In one month, his systolic blood pressure dropped by 6mmHg, which is more effective than taking half a tablet of antihypertensive pills. However, a different point of view should be mentioned here: for patients with chronic renal failure and hyponatremia, blindly restricting salt will aggravate electrolyte imbalance. Therefore, you cannot hear others saying that salt restriction is good and only dare to add half a gram of salt in a meal. You have to combine it with your own physical condition.

Speaking of the effect of drug control that everyone is most concerned about, the most discussed topic in the industry now is "whether to use a single-pill compound preparation for initial treatment." Guidelines from more than ten years ago generally recommended starting with a single drug at a low dose. If the effect is not good, then add more drugs or increase the dosage. However, in the past two years, more and more clinical data show that for high-risk patients with blood pressure exceeding 160/100mmHg, a single-tablet compound preparation with two antihypertensive ingredients is used from the beginning. The antihypertensive target rate is 40% higher than that of single-drug sequential treatment. Moreover, the drug is only taken once a day. Patients are not easy to forget and the compliance is much better. Aunt Zhang, who lives downstairs in my house, used to take two single pills. Sometimes she would forget to take one of them in the morning when she was in a hurry to dance in the square. Her blood pressure would fluctuate high and low. After switching to a single-pill compound medicine last year, her blood pressure has been stable at around 130/80mmHg for six months, and her old problem of dizziness has rarely occurred. Of course, this does not mean that a single drug is not good. Many patients with grade 1 hypertension can be well controlled by taking half a tablet of valsartan. There is no need to use compound medicines, and there is no need to pursue so-called imported special medicines. I have many elderly patients in their 70s who have been taking nifedipine sustained-release tablets for a few yuan a bottle for more than ten years. Their blood pressure is very stable and there are no obvious side effects. The one that suits them is the best.

Finally, I would like to talk about a pitfall that many people have stepped on: many patients feel that their blood pressure has been normal for one or two months, so they stop taking the medicine without authorization. This approach is very risky, but it is not absolutely impossible to stop taking the medicine. I had a 42-year-old male patient before. When he was diagnosed with hypertension, his blood pressure was 150/95mmHg, and he also had mild fatty liver. It took him half a year to lose 32 pounds, run 5 kilometers three times a week, quit smoking, and control salt very well. After slowly reducing the dosage to zero, he has stopped taking the medicine for almost two years, and his blood pressure has been stable below 125/80mmHg, which is completely fine. Therefore, there is no absolute saying that "if you have high blood pressure, you will need to take medicine for the rest of your life", and there is no absolute saying that "you can cure all high blood pressure through lifestyle". It all depends on individual circumstances.

To be honest, the management of high blood pressure is essentially a process of adapting to your own body. Don’t always think about copying other people’s work. Just follow the medicines your neighbors take, and follow the remedies your friends say are useful. Everyone’s weight, dietary preferences, underlying diseases, and tolerance to medicines are different. Regularly seeing your own follow-up doctor to adjust the plan is the safest way.