How to distinguish the first, second and third levels of hypertension prevention measures?

The essence of this tertiary prevention is a three-layer protection network divided into different risk groups based on the progression stage of hypertension. The core goals are progressive from "no disease" to "no aggravation" to "no serious adverse events".

Let’s start with the most common scenario of young office workers. If you haven’t been diagnosed with high blood pressure, or even just had your blood pressure measured in the normal high range of 130/80mmHg during your annual physical examination. You usually like to eat heavy takeaways, stay up late, and rarely exercise. All the interventions you do at this time are considered primary prevention, and the core is to prevent those who may induce high blood pressure. Nip risk factors in the bud, such as limiting salt intake to less than 5g per day, drinking less sugary drinks, taking time to run and swim twice a week, and not letting blood pressure really break through the diagnosis line. Nowadays, many community education has moved the focus of primary prevention to adolescents, because they are afraid that children who eat too much since childhood will have high blood pressure early after middle age.

If you are really unprepared and have reached the threshold for diagnosis of hypertension, or even found signs of early target organ damage such as carotid artery plaque and mild left ventricular hypertrophy during a physical examination, then the goal of prevention will change, and this is the category of secondary prevention. I met Zhang, a 42-year-old salesman, when I was doing missionary work in the community. He was diagnosed with grade 1 hypertension last year and did not have any basic diseases such as diabetes or hyperlipidemia. The doctors present at the time had two different opinions: one thought that he was still young and that he should first undergo a strict three-month life intervention, stop drinking, lose weight, and stay up less late. If his blood pressure could be stabilized within the normal range, he would not need to take medicine. ； The other group believes that as long as the diagnosis threshold is reached, medication should be taken as soon as possible and the blood pressure should be stabilized below 130/80mmHg for a long time, which can minimize the risk of organ damage. There is no absolute standard answer in clinical practice. It is based on the individual situation of the patient. The core purpose is to control the blood pressure stably and prevent the condition from getting more serious.

If the course of the disease continues and clear complications related to hypertension have appeared, such as lacunar cerebral infarction, heart failure, renal insufficiency, etc., then the focus of prevention will need to be adjusted again. This is the stage of tertiary prevention. Aunt Wang, who lives downstairs, is 68 years old and has suffered from high blood pressure for more than 20 years. She had a microstroke when she was young. Now, in addition to taking two antihypertensive drugs every day to keep her blood pressure under control at around 120/70mmHg, she also needs regular head CT and kidney function checks, as well as taking statins to stabilize plaques and aspirin for antiplatelets. To put it bluntly, this is to prevent more serious risks of death and disability such as secondary strokes, heart failure, and uremia, and to extend her lifespan as much as possible and improve her quality of life.

Many people always think that "prevention" is something that should only be done when you are not sick. In fact, these three layers of protection run through the entire cycle of hypertension. Only by finding the right intervention points at different stages can the harm of hypertension to the body be truly minimized.