2 minutes to read about high blood pressure, it is not terrible, the terrible thing is that you always ignore it
According to statistics, the prevalence of hypertension among adults in China is 25.2%, with 270 million patients and 2 million deaths related to hypertension each year. Hypertension is the most important risk factor for the morbidity and mortality of heart disease, stroke and kidney disease, and about 70% of stroke deaths and about 50% of myocardial infarction deaths in China are closely related to hypertension. Deaths due to cardiovascular and cerebrovascular diseases account for more than 40% of total national deaths. So, what is considered hypertension? What do people with hypertension need to pay attention to? Are the health supplements and dietary treatments circulating on the Internet helpful in treating hypertension? In order to answer these popular hypertension questions, family doctors online interviewed Dr. Chen Luyuan, director of the Guangdong Institute of Cardiovascular Diseases.
Dr. Chen Luyuan, Chief Physician, Guangdong Institute of Cardiovascular Diseases
Concept: What is hypertension?
Hypertension is one of the most common chronic diseases and a major risk factor for heart, brain and kidney disease. In what range is blood pressure considered high? Three blood pressure measurements on non-same day with blood pressure ≥ 140/90 mmHg are diagnosed as hypertension. However, from time to time in life, we often encounter situations where the blood pressure is normal when measured at home, but it increases when we go to the hospital. What happened? Can this situation be considered hypertension?
Chen Luyuan, director of this type of "white coat hypertension", the patient to the hospital to see the doctor will be nervous, blood pressure soaring, but back home is normal, this kind of outpatient blood pressure measured value is not enough to become the diagnosis of hypertension evidence. The diagnosis of hypertension cannot be made by one or two outpatient measurements. There are limitations to such incidental blood pressure measurements, which can only represent the blood pressure status of the person being measured at the time, and cannot reflect the usual true blood pressure and the trend of blood pressure changes throughout the day.
Definitive diagnosis: You can't look at a single blood pressure measurement, you need 24-hour ambulatory monitoring
24h ambulatory blood pressure monitoring, that is, the subject wears a specific blood pressure recorder, the instrument automatically records blood pressure for 24 hours at regular intervals, and the subject carries out normal daily activities (such as general activities, work, eating, resting and sleeping) at the time of monitoring. From the data results, the observation of blood pressure in the state of daily activities can also reflect the changes in blood pressure before and after taking medication and in the external environment, which can both diagnose hypertension and evaluate the efficacy of antihypertensive drugs.
Director Chen Lu Yuan said that, in theory, all adult hypertensive patients need to do 24-hour blood pressure measurement. In Canada, there is a rule that any individual with suspected hypertension should have an out-of-office blood pressure measurement (including 24-hour ambulatory blood pressure monitoring or home blood pressure monitoring) to determine the initial diagnosis. 24-hour ambulatory blood pressure monitoring is the best way to confirm a diagnosis of hypertension, however, because of the lack of awareness of 24-hour hypertension monitoring among physicians in China. We recommend that patients with mild or moderate high blood pressure proposed by the initial in-office measurement should preferably undergo blood pressure measurement at home or 24-hour ambulatory blood pressure monitoring to be diagnosed with hypertension.
Typing: There are fluctuations in blood pressure over 24 hours, and there are four types of blood pressure
Studies have found that blood pressure fluctuates throughout the day depending on the time of day and physiological state. With the difference between day and night fluctuations, the medical community has divided the types of blood pressure fluctuations into four types.
First, the "arytenoid" blood pressure. Most normal people and most hypertensive patients, blood pressure fluctuation curve is "ladle-shaped", that is, daytime blood pressure is high, low blood pressure at night, daytime blood pressure is about 20% higher than nighttime blood pressure. Because the dynamic curve of blood pressure during the day and night is similar to the ladle, it is called ladle-type blood pressure.
Second, "non-ladle type" blood pressure. Daytime and nighttime blood pressure is about the same, no significant drop in blood pressure at night, called non-ladle type.
Third, the nighttime blood pressure is higher than the daytime blood pressure is called anti-ryptoid blood pressure.
Fourth, the daytime blood pressure is 20% or more higher than the nighttime blood pressure is called super aryepiglottic blood pressure.
Director Chen Luyuan pointed out that aryepiglottic blood pressure is normal, non-ascending blood pressure is bad, and anti-ascending and super-ascending blood pressure are even worse. How do you know which type of blood pressure fluctuation you belong to? Do 24-hour ambulatory blood pressure monitoring.
Causes: 90% of hypertension cannot be found!
There are two types of hypertension according to the cause: primary hypertension and secondary hypertension. Those who cannot find the exact cause of elevated blood pressure are called primary hypertension; those who can find the exact cause of elevated blood pressure are called secondary hypertension.
The majority of people with hypertension have primary hypertension, accounting for about 90%, and 10% have secondary hypertension. Diseases that cause secondary hypertension include sleep apnea syndrome, chronic kidney disease, renal artery stenosis, certain endocrine diseases such as primary aldosteronism, and others.
Complications of hypertension: Stroke, damage to target organs!
I. Stroke
Hypertension is known to be the primary risk factor for stroke (commonly known as stroke). The main referral of hypertension in China is stroke. The risk of stroke in hypertension is six times higher than in normotensive people, and 70% of stroke patients have a history of hypertension.
Director Chen Luyuan said that some people do not know they have hypertension at all because they have no symptoms and do not have any treatment until after a stroke; some people know they have hypertension but do not standardize treatment; in addition, there are some people who have effectively lowered their blood pressure but still had a stroke. Why is this? There are several reasons.
First, they are treated but do not keep their blood pressure within the ideal range, which is below 140 mmHg.
Second, taking antihypertensive drugs to control blood pressure in the normal range does not mean that you can avoid stroke, because there is a "ceiling effect" of antihypertensive treatment, these patients still have a higher chance of stroke than normal people without hypertension, of course, significantly lower than patients with untreated hypertension; third, hypertension is one of the risk factors for stroke Third, hypertension is one of the risk factors for stroke, but not the only one, there are other causes of stroke, such as: smoking, high blood pressure, obesity, diabetes, etc. Therefore, even if blood pressure is lowered, it does not mean that a stroke will not occur.
Target organ damage
Sustained high blood pressure for a long time will produce damage to the body's organs and blood vessels, medically known as "target organ damage", the common target organ damage are mainly 3: 1.
1, blood vessels: arterial plaque and atherosclerosis
Hypertension causes excessive pressure on the blood vessel wall, and the long-term effect will cause damage to the vessel wall and contribute to the occurrence and development of atherosclerosis. Many patients have carotid plaque and some have coronary plaque, so hypertension is again an important factor in the development of coronary artery disease.
2. Heart: appearance of left ventricular hypertrophy
In hypertension, the peripheral vascular resistance increases, forcing the heart to enhance contraction and complicating left ventricular hypertrophy, which leads to left ventricular enlargement and eventual heart failure over time.
3, kidney: the appearance of proteinuria
Kidney problems are manifested as protein can be found in the urine of patients, and over time, kidney function damage occurs, and serious cases develop to uremia.
Myths: Three common misconceptions to pay attention to!
A, no symptoms of hypertension can ignore it
Director Chen Lu Yuan said that if hypertension is not seen without symptoms, it can develop into a clinical event in as little as 5-6 years or as long as 20 years, including stroke, myocardial infarction, heart rate failure, lower extremity artery occlusion, kidney failure, etc. Hypertension is a syndrome in which elevated blood pressure is the main clinical manifestation. Patients with only high blood pressure alone, without other risk factors and target organ damage, account for only 5-6% of the hypertensive population. Hypertension is more often found in people with obesity, diabetes, coronary artery disease, and chronic kidney disease. Among our inpatients, there are many patients who have hypertension, diabetes, coronary heart disease, stroke and poor kidney function at the same time. Most of them develop hypertension in the early or middle stage without active treatment.
Second, worry about antihypertensive drugs have adverse reactions do not take drugs
"It's a drug, it's poisonous", "there are no symptoms of disease as far as possible not to take drugs", these concepts have harmed many people. People think too seriously about the side effects of antihypertensive drugs. Every western medicine has side effects, even vitamins, if the excess may also produce side effects. Chinese medicine has the same problem, even if there is a lack of corresponding research. The incidence of side effects of drugs is low, usually around 1%-10%, and most patients tolerate antihypertensive drugs well. Just because a few people have adverse reactions, you cannot assume that taking the medication is bad. Even if someone takes antihypertensive drugs to appear certain minor uncomfortable situation, but at least he made the blood pressure down by taking drugs, greatly reducing the risk of stroke, myocardial infarction, heart failure, damage to kidney function, which is also more good than bad, and there are so many kinds of antihypertensive drugs, but also can change the drug.
Third, too believe in prescriptions, health products, dietary therapy
The overwhelming advertising of health products, prescriptions and dietary therapy has also harmed many people. Many false advertisements on the Internet claim that hypertension is a course of treatment, eating a few months of Chinese medicine or using a therapeutic device, you can cure hypertension without side effects. In fact, 85%-90% of hypertension, so far, is not found the cause, which depends on precision medicine to solve. In that case, it is obviously absurd to say that taking a few courses of treatment will cure it! In addition, there are many causes of hypertension, if everyone can be cured by taking only one antihypertensive drug, do all patients have the same cause?
In addition, the grape seeds that are hot on the internet also claim to lower blood pressure, is that really true? Director Chen Lu Yuan said that to prove whether grape seeds can lower blood pressure, controlled experiments have to be done. There is no evidence to prove that grape seeds can lower blood pressure. When someone claims to have a therapeutic effect, one has to first determine if the patient really has high blood pressure? Many people have a transient increase in blood pressure, not true hypertension. For example, increased stress in students before exams can increase blood pressure, and increased blood pressure during roller coaster rides are the result of special circumstances. Grape seeds have health benefits, but there is no evidence to prove that they can lower blood pressure.
Others believe that food therapy can cure high blood pressure, for example, celery. Chen Lu Yuan, director of the celery does contain antihypertensive ingredients, a study had extracted these ingredients from celery to do research, however, the content of antihypertensive ingredients is low, you need to eat 2-3 pounds per person per day, 365 days a day to eat to have a hypotensive effect.
Medication: a mouthful of water a medicine, a single tablet compounded into the trend
Chen Luyuan, director of the commonly used antihypertensive drugs have six categories, including single-tablet compound preparations, which is a drug with two antihypertensive ingredients, antihypertensive effects add up to reduce adverse reactions. As about 70% of hypertensive patients need a combination of drugs to lower blood pressure, the single tablet combination has been recommended by more and more doctors and more and more patients welcome. It is in line with the simple treatment model of "one pill, one sip of water" and easy to adhere to for a long time. Therefore, the advantages of single tablet compounding are that it can enhance the antihypertensive efficacy of the drug, improve patient compliance, reduce the psychological pressure of patients and the safety of medication, and reduce medical costs.
Is it better for patients to take their medication in the morning or at night? Due to the fluctuation and variation of blood pressure over 24 hours, it is clinically recommended to take medication at the following times.
1, arytenoid hypertension can be taken early in the morning, which can also reduce the occurrence of morning peak hypertension.
2、Patients with non-arytenoid or anti-arytenoid hypertension may consider taking medication after dinner if necessary, which is effective in controlling nocturnal blood pressure elevation.
3、On the contrary, in case of deep arytenoid or super arytenoid hypertension, do not take medication in the morning to avoid excessive lowering of blood pressure during the day.
Prevention: How to keep away from hypertension?
I. Monitor blood pressure. Normal adults are recommended to have their blood pressure measured at least once every 2 years. People who are prone to hypertension (such as those with blood pressure of 130-139/85 mmHg, obesity, lack of exercise, and high blood lipids) are recommended to have their blood pressure measured once every six months.
Second, blood pressure should be measured at the first visit for adults aged 18 years. Hypertension Day screening found that 60% of patients in China are unaware of their high blood
High blood pressure. Since many hypertensive patients are asymptomatic, it is recommended that blood pressure needs to be measured at the first visit regardless of what the patient sees.
Third, limit salt intake. A high-salt diet significantly increases the risk of hypertension. The World Health Organization has set a daily salt intake of 5g, or one beer bottle cap of salt, and the standard in China is 6g.
Fourth, adhere to exercise, regular physical activity can prevent and control hypertension, such as: walking, tai chi, swimming, etc..
V. Eat more vegetables and fruits and less fast food, and try to eat at home, which can help to control the intake of fat, salt and sugar.
Six, limit alcohol consumption: no alcohol or a small amount of alcohol.
Seven, quit smoking: smoking is harmful to health, should be quit as soon as possible.
Eight, when sudden changes in temperature occur, pay attention to increase or decrease clothing.
Note: A few words of advice for patients with hypertension
1, most patients need to take antihypertensive drugs for a long time and regularly, antihypertensive treatment to meet the target.
2, the blood pressure target of antihypertensive treatment: general hypertension patients will be to 140/90mmHg or less, elderly hypertension over 65 years of age will be to 150/90mmHg or less, if tolerated, can be reduced to 140/90mmHg or less; young people or general diabetes, cerebrovascular disease, coronary heart disease stable angina, chronic kidney disease patients, if tolerated should be further to 130/ 80mmHg or less; patients with coronary artery disease whose diastolic blood pressure is as low as 60mmHg should be lowered with caution.
3, primary hypertension generally can not be cured. Do not blindly believe in small advertisements or false scientific propaganda, can not use health care products, health care chat or food therapy instead of antihypertensive drug treatment.
4, most hypertension can be controlled, control of hypertension can significantly reduce the incidence of cardiovascular and cerebrovascular disease and mortality.