Editor choice

Talk about the management of patients with hypertension

Expert introduction:

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Zeng Yihong

The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, deputy chief physician of the Department of Cardiology.

In 2006, he graduated from the graduate student of Guangzhou University of Traditional Chinese Medicine. He has been engaged in clinical and scientific research and teaching in the Department of Internal Medicine. He is especially good at diagnosis and treatment of gastrointestinal diseases, exogenous cough, fever, hypertension, hyperlipidemia, cardiovascular and cerebrovascular diseases. Liposia and coronary heart disease have in -depth research. They have presided over three provincial and ministerial projects, published more than 20 academic research papers in core journals at home and abroad.

As a doctor in the Department of Cardiology, patients with high blood pressure in outpatient patients have accounted for most of the country. After so many years of efforts, whether it is a pharmacy, a private clinic, or a community hospital, it is expanding the free measurement of blood pressure. More and more people know that blood pressure is blood pressure. This concept knows high blood pressure.

Even so, the results of the fourth crowd of hypertension, awareness rate, treatment rate and control rate survey in China are still unsatisfactory, respectively, 27.8%, 51.5%, 45.1%, and 16.9%. High, the treatment rate and control rate are far from reaching standards. We also know that blood pressure and coronary heart disease, stroke incident, and the risk of cardiovascular disease death are continuous, independent, and direct correlation. The systolic blood pressure increases by 20mmHg or every 10 mmHg of the systolic pressure. Essence Therefore, the incidence and mortality of cardiovascular and cerebrovascular diseases in my country remain high, and it has not ushered in an inflection point for a long time.

Next, I will talk about the management of patients with hypertension from daily experience and the recommendation of the guide.

The first is the diagnosis of hypertension: In the absence of antihypertensive drugs, it is not 3 times to measure the blood pressure of the diagnosis in a day, and the systolic blood pressure ≥140mmHg and (or) systolic blood pressure ≥90mmHg. It should be noted that if the patient had hypertension in the past, because of high blood pressure, blood pressure was lower than 140/90mmHg, and it was still diagnosed as hypertension.

The classification of blood pressure is currently divided into level 1, level 2, and level 3. The larger the level, the greater the dangerous

Normal blood pressure: systolic blood pressure <120mmHg and (or) diastolic pressure <80 mmHg;

Normal high value: systolic blood pressure 120 ~ 139 mmHg and (or) diastolic pressure 80 ~ 90 mmHg;

Level 1 hypertension (mild): systolic blood pressure 140 ~ 159 mmHg and (or) diastolic pressure 90 ~ 99 mmHg;

Grade 2 Hypertension (moderate): systolic blood pressure 160 ~ 179 mmHg and (or) diastolic pressure 100 ~ 109 mmHg;

Level 3 hypertension (weight): systolic blood pressure ≥180 mmHg and (or) diastolic blood pressure ≥110 mmHg;

Simple contraction period Hypertension and simple diastolic hypertension are literally meaning

As a first -line doctor, this is the most basic to remember, and we must choose the medication plan according to the patient’s level 1, 2, and 3.

It is worth noting that high blood pressure in white coats is also very common. When diagnosing hypertension, we must also pay attention to the patient’s family blood pressure. Once the diagnosis is hypertension, it is treated immediately.

The fundamental purpose of the treatment of hypertension is to reduce the total risk of cardiopathy and vascular complications and death. The benefits of antihypertensive treatment mainly come from the reduction of blood pressure. On the basis of improving the lifestyle of patients (the diet of my country’s high sodium and low potassium is an important risk factor that causes high blood pressure), according to the patient’s risk, to formulate antihypertensive strategies, and correct the risk factors of patients, target organs damage Coexist with patients. In the case of conditions permit, we should adopt the treatment strategy of strengthening blood pressure to obtain the maximum cardiovascular and cerebrovascular benefits.

Of course, the antihypertensive target is below the normal value. If the tolerance is tolerated, it will benefit more below 130/80mmHg.

Timing of the use of antihypertensive drugs: For patients with level 2 and 3 high blood pressure, I suggest that the antihypertensive treatment is enabled (immediately) as soon as possible. For patients with a level 1 hypertension, a lifetime intervention can be performed for a period of time. If the basis of improvement of the lifestyle, the blood pressure still exceeds 140/90mmHg, and the antihypertensive treatment should be initiated in time.

To communicate with patients to intervene in lifestyle, you can slightly summarize the usual communication method with patients:

1. Diet with less salt, the amount of salt eats daily is less than 6g (almost the amount of salt in all dishes in a day cannot exceed one beer cover.);

2. Balanced diet, which is to eat a uniform amount. You can refer to the dietary pyramid we can see usual;

3. Do not smoke, quit smoking! And avoid inhaling second -hand smoke. Smoke damage to blood vessels is very great!

4. Do not drink alcohol, the latest guide also mentioned that drinking is harmful to the body. The statement of drinking and softening blood vessels is unscientific at present;

5. Middle-intensity exercise 4-7 times a week, 30-60 minutes each time, the middle intensity sweats slightly;

6, good mentality, maintain a good mood.

These are my daily life intervention that I communicate with patients.

It is worth noting that it is not good for taking antihypertensive drugs, so you don’t need to pay attention to lifestyle. The intervention of lifestyles should continue to implement the entire process of treatment. Patients who begin to lower blood pressure should also emphasize the treatment while intervention. Talk about the timing of blood pressure and antihypertensive treatment, and then talk about the commonly used antihypertensive drugs.

Five common types of antihypertensive drugs: calcium ion channel blockers (CCB), vascular tensionase conversion enzyme inhibitors (ACEI), vascular tension body antagonists (ARB), β -blockers, diuretics. And compound preparations composed of five major antihypertensive drugs.

It also talks about the common drugs, respective strengths and common side effects of the five major categories of antihypertensive drugs.

Calcium ionic channel block (CCB): ammonia ammonia ammonia, levotapopatopophyla, nifedonopopine, nifedpine horizontal interpretation tablets, non -Luo Di omnipotential tablets, non -Luo Di equality;

Vascular tensional converter enzyme inhibitors (ACEI): Katopoli, Pei Pully, Hillary Pully, etc.;

Vascular tension body antagonists (ARB): Sagastan, chorosacha, Elyshadam, Kandeda, etc.;

β -blockers: Merotor Pinghe, Merosol Slow -release tablets, Bosolol, Bolly, etc.;

Diuretics: hydrochlorozine, osmoroli, ammonooli, azine ketone, etc.

Only a little clinical that can be selected more clinically.

Briefly talk about the clinical effects of the five categories of antihypertensive drugs

Calcium ion channel blocking agent (CCB) has good antihypertensive effects in clinical clinical clinic, great antihypertensive strength, and long maintenance time. It can be used with other antihypertensive drugs, which is more assured in clinical use. And dihydrial pyridine CCB does not have absolute taboos. Therefore, it is used more clinically. The more representative drugs are Luo Huoli (ammonia sulfonate 地), which has a long -term antihypertensive (half -life 36 hours), steady pressure reduction, no absolute taboos, and relatively small side effects. Pressure, now the collection of drugs has reduced the burden of patients. Byevilia (niopizen horizontal control), the pressure reduction speed is relatively fast, the laser punching technology is also very stable. Most patients can reduce the blood pressure for 24 hours, but it is necessary to pay attention to it, patients with gastrointestinal adhesion, and use cautious gastrointestinal adhesion, as well as Patients with heart failure are disabled.

Acei: ACEI’s best role is to have good target organs protection and cardiovascular key prevention effects, that is, it is often said that the kidneys can be protected. It is especially suitable for patients with glycogen, heart failure, and proteinuria. Young men and women should pay attention to it, you can’t use your babies! The outpatient clinic is clear.

Vascular tension body antagonists (ARB): ARB and ACEI can have a protective effect on the kidneys. ARB can reduce the incidence of cardiovascular complications in patients with cardiovascular disease. Young men and women should pay attention to it, you can’t use your babies! The outpatient clinic is clear.

β -blockers: β -blockers are mainly used to reduce heart rate and have always sympathetized nerve activity. The antihypertensive effect is actually not strong. It has a protective effect on target organs. However, if the long -term application is stopped, there will be blood pressure rebound. Athletes and chronic pulmonary patients with caution!

Diuretics: The antihypertensive effect is not obvious, but it is used as an elderly hypertension and the effects of hypertension during the simplicity period. It is often used for joint medication. The side effects of CCB are also used clinically: ankle edema.

Common adverse reactions list:

Calcium ion channel block (CCB): ankle edema, headache, and flushing of the face;

Vascular tensional converter enzyme inhibitors (ACEI): cough (about 20%-30%of patients with this side effect), elevated blood potassium, vascular edema;

Vascular tension body antagonist (ARB): elevated blood potassium, headache; headache;

β -blocker: bronchial spasm, heart function suppression;

Diuretics: decreased blood potassium (increased), decreased blood sodium, electrolyte disorders, increased blood uric acid

The use of clinical Chinese drugs is generally:

Single medicine

→ Poor control → Single medicine sufficient dose

No matter how bad

→ Single medicine sufficient dose + other antihypertensive drugs

No matter how bad

→ combined with sufficient dose

Generally, the hypertension control of level 2 will consider combined medication.

Considering that the patients around us generally do not take medicine obediently. Therefore, the less the number of medicines, the less the amount of medicine, the higher the compliance of the patient, so the general dose of the medicine is generally combined.

Common union:

Two United: CCB+ACEI or CCB+ARB is the most commonly used

Sanlian: ACEI + diuretics + CCB; ARB + ​​diuretics + CCB is the most commonly used

The use of antihypertensive drug compound preparations are also a better way of medication to enhance patient compliance.

Chinese medicine has also recently had better curative effects, such as Zhenju’s pressure -lowering tablets and Eucommia.

Finally, the blood lipid control of patients with hypertension is also a very important thing

As mentioned earlier, the fundamental purpose of our treatment of hypertension is to reduce the total danger of cardiopathy and vascular complications and death.

A large number of randomly controlled clinical trials show that lipid -lowering therapy (Cat Antin therapy) can significantly reduce the risk of mortality and cardiovascular incidents of patients with abnormal blood lipids and cardiovascular events.

Therefore, the heatin treatment of patients with hypertension is also very necessary

<!-2664: Cardiovascular terminal page ) To be reduced to 2.6mmol/L, for patients with high risk, the LDL-C (low density lipoprotein cholesterol) need to be reduced to 1.8 mmol/L. The 2019 ESC guide is recommended The target value of protein cholesterol) is 1.6mmol/L.

For patients with hypertension patients, the treatment of first -level prevention can effectively prevent the incidence of cardiovascular events. So in a word, everyone can remember: Heeting treatment is to reduce the occurrence of cardiovascular and cerebrovascular events, not to reduce LDL-C. Studies have shown that the patient’s LDL-C is normal, but the patient’s benefit is obvious.

The condition of hypertension patients in the clinic is often complicated, and it is accompanied by merging diseases, so the challenges facing our doctors are even greater. The overall level of hypertension management of our country needs to be improved. May all peers treat the patients in their hands, and also hope that the inflection point of China’s cardiovascular and cerebrovascular incidents will come soon.

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