What medicine should be taken to prevent coronary heart disease due to high blood pressure?

There is clear evidence-based evidence at present. The core of medication for preventing coronary heart disease in patients with hypertension is to first stabilize and control blood pressure below 130/80mmHg for a long time. Long-acting calcium channel blockers (also known as long-acting dipines), ACEIs (precipitates) or ARBs (sartans) are preferred. If combined with atherosclerotic plaques and excessive blood lipids, statin lipid-lowering drugs are also needed. If high-risk indications are met, low-dose aspirin should be added as directed by the doctor.

Lao Zhang, whom I met at a community free clinic last week, is a representative example. He is 47 years old and has a history of hypertension for four years. He forgets to take antihypertensive medicine when he is busy. His blood pressure is basically around 140-150/90mmHg. This physical examination showed that there are 3mm soft plaques in the carotid artery. He always said that his chest feels tight after working overtime, and he is worried that he will have a myocardial infarction one day. He asked me if I should add some "heart-protecting medicine". In fact, many people have misunderstandings and think that they need to take special medicine to prevent coronary heart disease. In fact, the most important thing is to stabilize blood pressure first. Choosing the right antihypertensive medicine is equivalent to killing two birds with one stone. Dipine drugs such as long-acting amlodipine and nifedipine controlled-release tablets can not only lower blood pressure steadily for 24 hours, but can also relieve coronary artery spasm and "unblock" the heart blood vessels.” ； In addition to lowering blood pressure, drugs such as Purin or Sartan can also repair the vascular endothelium damaged by hypertension and reduce the probability of blood lipid deposition on the blood vessel wall. They are much more protective of the heart than ordinary short-acting antihypertensive drugs.

The most discussed topic now is whether to take aspirin regularly. In fact, there have been different opinions in the academic circles. The previous guidelines would recommend patients with high blood pressure and high-risk factors to take aspirin. Now it is more precise: if you only have high blood pressure, no plaque, no diabetes, and no high blood lipids. , is not even 50 years old yet, and taking aspirin hastily will increase the risk of gastrointestinal bleeding. Two months ago, there was a 52-year-old female patient. I heard from an old sister that taking aspirin can prevent myocardial infarction. I bought it and took it for more than three months. As a result, she had a duodenal ulcer and was hospitalized for a week, which was not worth the loss. Only patients who are assessed to be at high risk for coronary heart disease, such as those with clear arterial plaques, long-term low-density lipoprotein higher than 3.4mmol/L, or patients with diabetes, need to take low-dose aspirin under the premise of stable blood pressure control.

Many patients with high blood pressure still ignore the issue of lipid lowering. I often compare it to patients. High blood pressure is like using a high-pressure water gun to flush the wall all year round. The blood vessel walls have been washed into pits. If the blood lipids are high, low-density lipoproteins dig into the pits like sand, and slowly pile up into plaques to block the coronary arteries. That is coronary heart disease. Therefore, as long as patients with high blood pressure are found to have low-density lipoprotein exceeding 2.6mmol/L, they must consider taking statins to lower this indicator. Don't think that it is just "slightly high" and don't care. It will be too late when the plaque grows to block the blood vessels.

Not everyone has the same medication plan. If your resting heart rate is above 85 beats/min all year round and you get flustered when you move even a little bit, your doctor may give you a small dose of beta-blocker, which can not only assist in lowering blood pressure, but also reduce the oxygen consumption of the heart, and can also reduce the risk of coronary heart disease. To put it bluntly, there is no unified standard answer for medication. It is determined based on each person's blood pressure and combined risk factors. Don't just follow other people's prescriptions and don't think that everything will be fine after taking the medicine. No matter how good the medicine is, it can't stop the deterioration of blood vessels after eating high-fat and high-salt meals or staying up late and smoking cigarettes.