Six major misunderstandings in hypertension care! Case lessons are too profound

More than 60% of the complications of hypertension in clinical practice are not due to the disease itself being difficult to treat, but because patients have stepped on common misunderstandings in nursing care. More than half of the patients with cerebral hemorrhage, stroke, and renal failure that I have seen in my 12 years of practice have fallen into these pitfalls. The lessons are really painful.

I was particularly impressed by Aunt Zhang who was brought to the emergency department a while ago. She is 67 years old. She is usually very strong and can dance square dances for two hours without stopping. She was semi-conscious when she was brought here. A CT scan showed that she had 20 ml of cerebral hemorrhage. After asking her family members, they found out that her blood pressure was 120/80 for half a month last month. She felt that she was "recovered" and secretly stopped all antihypertensive drugs. Many people have this illusion: if the blood pressure drops to the normal range, it is cured, and there is no need to take medicine. I have to be objective. There are indeed a very small number of newly diagnosed patients with mild hypertension. Through strict salt control, weight loss, and regular exercise, after continuous evaluation by doctors for more than 3 months, they can gradually reduce or even stop taking medication. However, this is a rare case. More than 90% of the cases are Epidemic hypertension requires long-term medication control. The risk of blood pressure rebound caused by voluntary withdrawal of medication is two to three times higher than the risk of not taking medication. Aunt Zhang is the best example. What could have been solved by taking a pill now costs thousands a day in the ICU. Do you think it is unfair?

Last week, a 32-year-old programmer came for a review. He was just discharged from our department last month. At that time, half of his body was numb after staying up late at night. He was found to have lacunar cerebral infarction. When his blood pressure was measured, it was 185/110. I asked him if he knew he had high blood pressure before. He said that last year, the unit’s physical examination showed that it was 160, but he didn’t feel anything. He was not dizzy or dizzy, so he didn’t take it seriously. Many people believe that "the body has self-awareness, and you are sick if you feel uncomfortable." To be honest, it really does not apply to high blood pressure. 70% of early-stage high blood pressure does not have any conscious symptoms, especially in young people, whose large blood vessels have good elasticity and strong compensatory ability. If you wait until you are in pain and faint before you think of measuring your blood pressure, target organ damage has often occurred. Now the proportion of patients in our department between the ages of 18 and 35 is approaching 20%. Don’t think that “hypertension is a disease of the elderly.” Young people stay up late, eat heavy takeaways, and drink milk tea, and their blood pressure soars even more than that of the elderly. Last year, there was a 28-year-old boy whose high blood pressure had been untreated for three years. When he came here, he already had hypertensive kidney disease and needed lifelong dialysis.

Speaking of which, a distant relative came to me for consultation. He said that the "antihypertensive tea" sold in the live broadcast room can be used to stop taking the medicine after 3 months of drinking. He spent thousands to buy a bunch of it and asked me if I could stop the amlodipine prescribed by the doctor. I showed him the database of the State Food and Drug Administration: Currently, no health products or dietary prescriptions have been certified as having clear antihypertensive effects. Don’t use your own blood vessels as guinea pigs. Of course, I don’t want to kill diet therapy with a stick. High-potassium vegetables and a low-salt diet can indeed help lower blood pressure, but the effect is very limited. It can only lower 2-5 mmHg at most. For patients with high blood pressure exceeding 140, this effect cannot achieve the control goal at all. If just drinking anti-hypertensive tea and wearing anti-hypertensive insoles can cure the disease, we doctors don’t have to study medicine for more than ten years, right?

Last time, a building materials business owner came to me and said that he was taking antihypertensive medicine every day, but his blood pressure was still 150/100, so he was taking the wrong medicine. When I asked him about his living habits, he drank half a catty of white wine every time he was socializing, and the food he ate was all heavy-tasting, and his belly was as big as a ball. I told him: If you don’t change your living habits, no matter how good the medicine is, it won’t be able to withstand what you are doing. There is a saying now that "lowering blood pressure depends entirely on medicines, and living habits do not need to be changed." However, the latest "China's Guidelines for the Prevention and Treatment of Hypertension" clearly states that lifestyle intervention is the basis for the treatment of hypertension. Throughout the entire process, if you take antihypertensive medicines here and stay up late eating pickles there, the blood pressure-lowering effect will be at least 30% off, which is equivalent to taking the medicine in vain.

There is another patient who left a deep impression on me. He was just diagnosed with a high blood pressure of 170. He felt that the medicine prescribed by the doctor was slow to take effect, so he doubled the dosage and even added another antihypertensive medicine privately. After taking it for two days, he became dizzy and couldn't stand. He fell and broke his head. When he came to the hospital, his blood pressure was only 90/50. Insufficient cerebral perfusion almost caused a cerebral infarction. Many people think that the faster and lower the blood pressure, the better. This is really wrong. In addition to the need for rapid blood pressure reduction in hypertensive emergencies, ordinary blood pressure reduction should be stable. It is enough to reduce blood pressure to the target value in 4-12 weeks. Especially for the elderly, if the blood pressure drops too fast and too low, it is easy to suffer from insufficient blood supply to the brain, which will induce cerebral infarction, and the gain outweighs the gain.

Oh, by the way, there are still many people who think that "as long as you take medicine, you don't need to measure your blood pressure." Last month, there was a patient who had been taking antihypertensive drugs for three years and had never had his blood pressure measured. When he came for a physical examination, he found that his blood pressure had always been 160, and he thought it was well controlled. Different people have different reactions to the same antihypertensive drug. Even for the same person, blood pressure will fluctuate when the season changes or the weight changes. It is best to measure the blood pressure 2-3 times a week, write it down, and show it to the doctor at the next follow-up visit. There is also a basis for adjusting the medicine. Otherwise, taking the medicine is like taking the medicine blindly, and you will not know whether it has any effect.

In fact, after all, high blood pressure is really not a terminal disease that cannot be cured. As long as you don't act blindly, don't believe in folk remedies, and follow the doctor's advice, most people can control it very well. I have seen an old man in his 80s suffer from high blood pressure for 30 years, and he has no complications at all if he has controlled it well. I have also seen a 30-year-old boy suffer a stroke and hemiplegia at a young age because he did not pay attention to it. In the end, it is all a matter of concept. Don't wait until you lie in the hospital bed to regret it, then it will be really too late.