The goal of hierarchical management of hypertensive patients

The harm of hypertension is not only the increase in blood pressure. If it is not treated, it will cause irreversible damage to the heart, brain, and kidneys. But high blood pressure is not terrible. As long as you control your blood pressure and stabilize it below the target value, you can stay healthy for a long time. The specific target value will vary from person to person.

Simple essential hypertension without comorbidities
For patients with pure essential hypertension, without diabetes, coronary heart disease, cerebral apoplexy, renal insufficiency, and those under 80 years of age, the blood pressure control target value is recommended to be less than 140/90mmHg, preferably less than 120/80mmHg.

At present, a large number of studies have confirmed that controlling blood pressure below 140/90mmHg can significantly reduce the incidence of cardiovascular and cerebrovascular events. Another study found that there is a U-shaped curve relationship between blood pressure and cardiovascular and cerebrovascular diseases, that is, blood pressure lower than 110/70mmHg may increase cardiovascular and cerebrovascular events. So blood pressure is not as low as possible.

Essential hypertension with comorbidities
If patients with hypertension also have diabetes or renal insufficiency, their blood pressure should be controlled below 130/80mmHg. For the elderly or patients with severe coronary heart disease and stroke at the same time, the blood pressure can be controlled below 140/90mmHg.

Patients with hypertension combined with diabetes, coronary heart disease, cerebral apoplexy or renal insufficiency have a significantly higher risk of recurring cardiovascular and cerebrovascular events. Current studies have found that strengthening blood pressure control for this group of people can reduce the risk of cardiovascular and cerebrovascular events.

Isolated systolic hypertension
Isolated systolic hypertension refers to the systolic blood pressure higher than 140mmHg and the diastolic blood pressure lower than 90mmHg. It is more common in elderly patients and is mainly related to the reduction of the elasticity of the large arteries and arteriosclerosis. In this type of hypertension, it is advisable to control the blood pressure below 140/90mmHg. For patients whose diastolic blood pressure is already too low (below 60mmHg) and systolic blood pressure is higher than 150mmHg, antihypertensive drugs are still needed. At least the systolic blood pressure should be controlled below 150mmHg and the diastolic blood pressure should not be less than 50mmHg.

Many elderly patients dare not take medication because of low diastolic blood pressure, which leads to high systolic blood pressure and stroke. It is really putting the cart before the horse. After 50 years of age, systolic blood pressure increases with age, while diastolic blood pressure decreases with age. Hypertensive patients over 60 years old do not have very high diastolic blood pressure. Most elderly stroke patients in our country develop symptoms due to high systolic blood pressure, so it is especially important to control systolic blood pressure. Therefore, elderly patients with high systolic blood pressure must be controlled with drugs, and antihypertensive drugs have little effect on normal or low diastolic blood pressure and can be used with confidence.

Isolated diastolic hypertension
Simple diastolic hypertension refers to systolic blood pressure <140mmHg, diastolic blood pressure >90mmHg. The control goal for these patients is diastolic blood pressure <90mmHg. The simple increase in diastolic blood pressure is mostly in the early stage of hypertension, which is more common in young people, and the short-term prognosis is better. But this does not mean that we can take it lightly. Simply high diastolic blood pressure can also increase the risk of cardiovascular and cerebrovascular events; if you do not face it and do not give treatment, simple diastolic hypertension will turn into classic hypertension, that is, systolic and diastolic The blood pressure of patients is increased; if the treatment is not timely, the complications will increase with age. Clinical data has shown that people with normal systolic blood pressure and diastolic blood pressure as high as 105-110mmHg are 3 to 5 times more likely to have cardiovascular and cerebrovascular complications than people with normal diastolic blood pressure (at 70-75mmHg). Therefore, for young and middle-aged hypertensive patients, the increase in diastolic blood pressure should arouse sufficient attention. However, this type of hypertension is not effective with medication alone, and various interventions such as diet control, exercise, weight loss, and medication should be integrated. Elderly hypertension For hypertensive patients aged >65 years, the blood pressure should be controlled below 150/90 mm Hg, and can be reduced to below 140/90mmHg if it can be tolerated. For patients over 80 years of age, blood pressure can be controlled below 150/90mmHg.

Elderly hypertensive patients are mostly pure systolic hypertension. It is enough to emphasize that the systolic blood pressure is up to the standard to avoid excessive lowering of blood pressure; if it can be tolerated, the blood pressure can be gradually reduced to the standard to avoid rapid blood pressure. Because most elderly people have arteriosclerosis, the self-regulation mechanism of cerebral circulation has been weakened. If blood pressure drops too fast or blood pressure drops too much, it is easy to cause ischemic stroke.

Pregnancy-induced hypertension
The blood pressure control target for patients with pregnancy-induced hypertension is 130~140mmHg for systolic blood pressure and 80~90mmHg for diastolic blood pressure. For such patients, non-drug therapy is the first choice, and drug therapy should be initiated when blood pressure is ≥150/100mmHg. The treatment strategy, the duration of medication and the choice of medication depend on the degree of blood pressure rise and the assessment of the harm caused by the blood pressure rise. The main purpose of treatment is to ensure the safety of mother and child and the smooth progress of pregnancy.

Refractory hypertension
This type of hypertension is also called refractory hypertension, which means that after a reasonable dose of 3 antihypertensive drugs (including diuretics) is applied in a reasonable dose on the basis of improving lifestyle, the blood pressure is still not up to the standard, or at least 4 drugs are required. Make blood pressure up to standard, accounting for 15% to 20% of people with hypertension. The goal of blood pressure control for these patients is still below 140/90mmHg.

The reasons why blood pressure cannot reach the standard include the following: incorrect blood pressure measurement method; white coat hypertension (it is very important to identify such patients. If you blindly add antihypertensive drugs, it can easily lead to hypotension, which can be measured by home blood pressure monitoring or 24-hour ambulatory blood pressure. Discovery); the patient did not insist on taking antihypertensive drugs, or the antihypertensive drugs were used at the wrong time, or the antihypertensive drugs were selected incorrectly; the patient had chronic pain or anxiety; the patient had an unhealthy lifestyle, such as excessive salt intake, obesity, etc. . If the above factors are excluded, the possibility of secondary hypertension should be considered, and screening should be actively carried out. If the blood pressure is not well controlled, you should first find the reasons from the above aspects, rather than blindly taking a lot of medicine or changing the medicine at will.

Hypertensive crisis
Hypertensive crisis refers to the sudden and significant increase in blood pressure (more than 180/120mmHg) in primary or secondary hypertension under certain triggers, accompanied by heart, brain and kidney insufficiency. Patients with this type of hypertension are very likely to face life-threatening risks due to heart failure, stroke, and renal failure, and must go to the emergency room of the hospital for rescue immediately. Generally, in the initial stage (within a few minutes to 1 hour), the average arterial pressure drop should not exceed 25% of the pre-treatment; then it will drop to about 160/100mmHg within 2-6 hours; if it can be tolerated, it will gradually decrease in the next 24 to 48 hours normal level.

This happens mostly because the patient has not adhered to medication or undertreatment. Therefore, even if the blood pressure of patients with hypertension is under normal control, do not stop the drug at will; after the blood pressure has been lower than 110/70mmHg for a long time, it can be stopped as appropriate under the guidance of the doctor.

High blood pressure in children
With the improvement of living conditions, the number of small fat tuns is increasing, and obesity and hypertension are closely related, so the incidence of high blood pressure in children has also increased significantly. Therefore, children should take blood pressure regularly from the age of 3. It is generally believed that the blood pressure of preschool children should be lower than 110/70mmHg; the blood pressure of school-age children should be lower than 120/80mmHg; the blood pressure of adolescents under 18 should be lower than 130/90mmHg. High blood pressure can be diagnosed if it is higher than the above blood pressure.

>> Nouns explain systolic and diastolic blood pressure
If the heart is regarded as a water pump, blood is water, and blood vessels are water pipes connected to the water pump. When the water pump is started, water pressure is added to the water pipes and the water pump, which is equivalent to blood pressure. Since the blood vessels are divided into arteries, capillaries and veins, there are also arterial blood pressure, capillary blood pressure and venous blood pressure. Generally speaking, blood pressure refers to arterial blood pressure.

When the heart contracts, greater pressure is generated in the large arteries. We call the pressure at this time systolic pressure, or high pressure. When the heart relaxes, the arteries rely on the pressure generated by the elastic retraction of the large arteries to push the blood pressure to continue to flow forward. At this time, the blood pressure is called diastolic pressure, or low pressure.