Hypertension Prevention and Management Paper

There is no universal "standard answer" for the prevention and management of hypertension. 90% of essential hypertension can be delayed or avoided through early intervention. Scientific management of diagnosed patients can reduce the risk of cardiovascular and cerebrovascular complications by more than 70%. The core logic is "individualized layered intervention + penetration of all life scenarios + dynamic program adjustment", which cannot be achieved by relying solely on drugs or a certain lifestyle adjustment.

What particularly impressed me was the 42-year-old programmer Lao Zhang who I met at the community free clinic last year. When he got the physical examination report, he saw that the systolic blood pressure was 147mmHg and the diastolic blood pressure was 96mmHg. I showed him other test results. Except for mild fatty liver, his blood lipids and blood sugar were normal, and he had no family history of early-onset hypertension. He stayed up until one or two o'clock all year round, ate takeaways high in oil and salt, drove all the way to and from get off work, and averaged less than 2,000 steps per day. I didn't ask him to rush to prescribe medicine at that time, but only made a list of adjustments without quantitative indicators: first, move the bedtime from 1 o'clock to 11:30, make a unified note on takeout "put less salt and don't add sauce", get off the subway two stops in advance at least three days a week and walk home, and there is no need to deliberately diet and exercise. Don't tell me, he really did as he was told. He came to the community for a review last month. His blood pressure was stable at 128/82mmHg and he didn't take any medicine.

Interestingly, there have been different voices in the academic community regarding the issue of "whether to take medication immediately for critical hypertension": Guidelines updated in Europe and the United States in recent years tend to initiate drug treatment immediately as long as the blood pressure exceeds 140/90mmHg three consecutive times on different days and does not decrease after 3 months of lifestyle intervention, to avoid long-term blood pressure fluctuations that silently damage the heart, brain, kidneys and other target organs.； Many domestic doctors who are deeply involved in grassroots chronic disease management prefer to give young and middle-aged patients with no underlying diseases or family history a longer adjustment window. Even 6 months is no problem. After all, once antihypertensive drugs are started, most patients do need to take them for a long time. If they can be adjusted through lifestyle adjustments, there is no need to increase the metabolic burden on the body. My own experience is that the degree should be adjusted according to your own situation. If you are like Lao Zhang, who has no problems except high blood pressure and can work hard to change your bad habits, then you can wait. ； If you already have diabetes, coronary heart disease, or have an immediate family member who was diagnosed with high blood pressure before the age of 50, don't force yourself to take the medicine. For example, Aunt Li in the previous community was 67 years old and had a 10-year history of diabetes. When her blood pressure was found to be 152/98mmHg, we directly suggested that she start medication, along with a regimen of salt control and walking after meals. Now for more than half a year, her blood pressure has been stable at around 130/80mmHg, and even her blood sugar has stabilized a lot.

Many people ask me if I have any tips for preventing high blood pressure. I never say "no more than 5g of salt per day" or "150 minutes of moderate-intensity exercise per week". These empty words sound correct but are difficult to implement. Seriously, how can ordinary people have the time to use a kitchen scale to count grams every day? Just remember a few things that are easy to do: replace the salt shaker at home with a 2g-limited salt spoon, and a family of three should not consume more than 4 tablespoons of salt a day. Pickles, soy sauce, oyster sauce, and invisible salt in takeout must all be taken into account. Don’t think that it will be fine if you don’t add salt separately. Last time, a young man said that he never added salt when cooking at home. As a result, his blood pressure was still high. When I asked him, I found out that he always added light soy sauce. One spoonful of light soy sauce contains more than 1g of salt. If he added three or four spoons a day, the salt would already exceed the standard. There is also exercise. You really don’t need to buy a fitness card worth thousands of dollars. If you can stand up, don’t sit. If you can walk, don’t take the car. Don’t lie on the sofa for an hour after eating and watch short videos. Walk around the neighborhood with your family for 20 minutes. The amount of exercise saved in a week is already enough. Oh, by the way, there is another point that many people ignore: don’t stay up late for a long time and don’t hold back your emotions. I have met several young men who eat and exercise normally, but they work overtime until two or three o’clock every day. Before the project is launched, they are so anxious that they can’t sleep all night, and their blood pressure keeps rising. The impact of emotions on blood pressure is really much greater than you think.

If you are really diagnosed with high blood pressure, don’t panic. Nowadays, many people tend to go to two extremes: one is to not take it seriously at all, and don’t need to take medicine if they think they are not dizzy or uncomfortable. It will be too late to regret it when symptoms of myocardial infarction and stroke appear.； The other is to take it too seriously, measuring blood pressure eight times a day. If the blood pressure is slightly higher, they will become extremely nervous. Instead, the blood pressure will get higher and higher. Regarding the frequency of blood pressure measurement, there is no unified conclusion in the academic community: some studies believe that measuring blood pressure twice a day in the morning and evening can better monitor blood pressure fluctuations and facilitate doctors to adjust medication. ； Some studies have also pointed out that measuring blood pressure too frequently can induce anxiety and actually increase blood pressure. My general advice to patients is that when they are just adjusting their medication or changing their lifestyle habits, they should take measurements three days a week, half an hour after getting up (without eating or smoking) and once before going to bed at night. Just write down the values ​​and show them to the doctor. ； If your blood pressure has been within the normal range for a month or two, it’s okay to measure it once a week. You don’t have to make yourself suffer every day. I met a patient two months ago. When he was first diagnosed with high blood pressure, he measured his blood pressure ten times a day. He panicked when his systolic blood pressure reached 140. I asked him to put away his blood pressure monitor and only measure it once every Sunday morning. However, when he measured it again half a month later, the value stabilized below 130. There are still many people who believe that "taking antihypertensive drugs can cause dependence and damage the liver and kidneys" and secretly stop taking them. One thing must be made clear here: antihypertensive drugs themselves are not dependent. It is your blood pressure that needs drug control. Moreover, the current first-line antihypertensive drugs have been clinically proven for decades. The probability of side effects is less than 1%, which is much smaller than the risk of long-term high blood pressure that damages the kidneys and blood vessels. Don't be petty.

In the six years I have been working in community chronic disease management, I have seen too many people who have taken a detour due to high blood pressure. I have also seen many elderly people in their 80s who have had high blood pressure for 20 or 30 years. They take good medicine and eat well, and now they can still go hiking with the senior group. To put it bluntly, high blood pressure is an "alarm for a slow life." If you take good care of your body, it will not cause you too much trouble. If you are really not sure what to do, find a reliable doctor. Don't search for fragmented knowledge on the Internet and try blindly. A plan that suits others may not necessarily suit you.