Summary of high blood pressure care

The core essence of hypertension care has never been to “bring the value to the normal line and then be done”, but to minimize the risk of damage to target organs such as the heart, brain, and kidneys through personalized adaptation of life adjustments, standardized medication, and dynamic monitoring, and ultimately improve the long-term quality of life. This is the most direct conclusion after I have worked in community chronic disease management for 7 years and followed more than 2,000 cases of hypertension patients.

Let’s talk about the medication issue that everyone is most concerned about. At present, there is actually no completely unified standard for meeting the standard: the mainstream view in cardiology is more towards “the earlier the standard is met, the more beneficial it will be.” Especially for young and middle-aged people under 65 years old and without underlying complications, it is recommended to take medication as soon as possible after diagnosis and stabilize blood pressure below 130/80mmHg, which can minimize long-term vascular damage.； However, the consensus in the Department of Geriatrics in recent years is more towards "loose standards". Elderly people over 80 years old with insufficient blood supply to the brain and carotid artery stenosis do not need to stick to the 130 line, and can be lowered to 140/90 or even 150/90. Last month, I met an 82-year-old Uncle Zhang. I had heard someone say that the lower the blood pressure, the better. I added half a pill without permission. Every time he took it, he felt dizzy. When he went downstairs for a walk, he fell and broke his head. Later, he adjusted the dosage of the medicine and relaxed the standard value to about 145, but he never suffered from dizziness again. Don't blindly rely on other people's medication standards. Some people can control it by taking half a tablet of nifedipine, while some people need to adjust the dosage by taking two combined medicines. This is like wearing shoes. Only you know whether they fit your feet or not.

After talking about the differences in medication, let’s talk about life care, which is most likely to be confused by oneself. In the past, all guidelines required that daily salt intake should be controlled within 5 grams. New research in the past two years has actually adjusted it: if you are salt-sensitive (your blood pressure will immediately rise by more than 10mmHg the next day after eating a salty meal), then strict salt restriction is definitely not bad. ； But if you are not sensitive to salt, there is really no need to eat all the dishes that are so bland and bitter. Sister Wang, who ran a noodle shop downstairs, did not even dare to put soy sauce after she was diagnosed with high blood pressure. After half a month of eating, her body was so weak that she could not lift a noodle bowl. When she was tested, her blood pressure was even higher than before. Later, she was adjusted to 6 grams of salt per day, which is about the amount of a beer cap, and she was allowed to eat her favorite sauce duck once a week, and her blood pressure stabilized at over 130. There is also the matter of exercise. Walking 10,000 steps a day does not mean you are healthy. For patients with coronary heart disease, walking too much can easily cause angina pectoris. Young people who are fatter can play more ball games and run more. Elderly people with poor joints can walk for 20 minutes and do Tai Chi every day. Don't work hard just to make up the number of steps.

Many people think that measuring blood pressure at home every day is enough. In fact, the values ​​measured by most people are not accurate at all: they measure it just after climbing up the stairs while gasping for breath, when they are holding in their urine, or when their arms are placed lower than the heart. The value can be 20mmHg different, which is a waste of time to scare themselves. There are different opinions in the industry regarding whether to do 24-hour ambulatory blood pressure: one group thinks that it is enough to do a routine physical examination once a year, while the other group thinks that it should be done at any time as long as you have a headache in the morning or feel dizzy in the afternoon after taking medicine. My own experience is, don’t worry about the more than 100 yuan. If your blood pressure fluctuates a lot recently, you can find out whether your blood pressure is higher in the morning or at night after one test. It is more effective than blindly measuring it at home for a week. By the way, there is another point that many people ignore, which is the impact of emotions on blood pressure. Last month, an aunt had a fight with her daughter-in-law, and her blood pressure soared to 180. She couldn't bring it down even after taking two antihypertensive medicines. Afterwards, she sat in my office crying for half an hour, and the blood pressure dropped to 140 without adding any medicine and taking another test. So don't just focus on what you eat and drink. Get angry when you need to, take a walk when you need to, and swallow all your emotions.

After all, high blood pressure is a chronic disease that lasts a lifetime. Nursing care is not a temporary fix for a physical examination, but a long-term process of getting in touch with your body. Don't believe in those "three-day antihypertensive prescriptions" on the Internet, and don't just buy the medicines that others take when you see them working. Instead, spend more time with your contracted doctor and slowly find a rhythm that suits you. It will be more effective than any panacea.