Summary of high blood pressure care

There is no universal standard answer for hypertension care. The core is the dynamic matching of "individualized lifestyle intervention + standardized medication + ambulatory blood pressure monitoring". All care plans that are divorced from the patient's age, basic diseases, and living habits are ineffective.

Last week I met 62-year-old Aunt Zhang at a community free clinic. She had been taking antihypertensive drugs for three years and was still dancing for an hour a day. However, her blood pressure fluctuated and was always unstable. She pulled me to ask if the medicine was wrong. After looking through her food records, I discovered that she ate homemade pickles for every meal. She also always said that she ate very lightly and even used less oil when cooking. Many people have fallen into this trap, thinking that salt control means adding less salt to vegetables, but they ignore pickles, added oil. Don’t think that invisible sodium in artificial meat products, takeout sauces and even milk tea is nothing. The sodium content in a 500ml cup of milk tea can reach 300mg, which is almost equal to the salt content of half a pickle. Drinking it every day will definitely not stabilize your blood pressure.

Speaking of which, we have to raise a question that has always been controversial: Do we need to take medicine immediately after detecting high blood pressure? Different guidelines and schools do have different opinions. In previous years, some European and American guidelines advocated starting drug intervention as soon as blood pressure reaches 140/90mmHg. However, the 2023 version of the "China Hypertension Prevention and Treatment Guidelines" clearly mentions that patients with grade 1 hypertension (systolic blood pressure 140-159mmHg/diastolic blood pressure 90-99mmHg), without diabetes, or heart, brain, and kidney target organ damage can be given a 3-6 month lifestyle intervention period first, and do not need to take medicine right away. ； Some clinical views of traditional Chinese medicine believe that early-stage hypertension in many young and middle-aged people aged 20-40 is mostly related to liver stagnation caused by long-term staying up late and emotional anxiety. Targeted adjustments to work and rest, emotional counseling, and a small amount of intervention to soothe the liver and regulate qi can bring blood pressure back to the normal range without even taking medicine. But a premise must be made clear here: all non-drug interventions must be based on regular monitoring of blood pressure and no target organ damage. Don't drag out the problem by not taking medicine.

Not long ago, I met a 28-year-old programmer. He was diagnosed with high blood pressure and immediately stopped eating all meat. He only ate vegetables and white rice every day. After half a month, his blood pressure did not drop. Instead, he went to the hospital because of hypokalemia. Many people have a deep misunderstanding of lifestyle intervention. It does not mean to say goodbye to eating meat completely, nor does it mean to force yourself to run five kilometers every day. I have seen people walking 20,000 steps a day to control blood pressure. Not only did their knees deteriorate, but the pain caused the blood pressure to soar for several days. If you really want to adjust your living habits, just give priority to changing the bad habit that affects your blood pressure the most: if you like to stay up late, first move your bedtime before 11 o'clock, if you eat takeout every day, ask the merchant to put less sauce, and if you like to drink, first replace white wine with a small amount of red wine. It is much easier to stick to it than changing all your habits at once.

Let’s talk about the medication issue that everyone is most troubled with. There are always people who say, “Once you take antihypertensive drugs, you can’t quit them.” This is half right and half wrong. It’s not that there is dependence on antihypertensive drugs, but that more than 90% of hypertension is primary. The cause is related to age, genetics, and long-term living habits. If the underlying problem is not solved, the drug will naturally rebound if the drug is stopped. But it is not absolutely impossible to stop. I have several patients in their 30s who have lost 20 pounds in weight and whose blood pressure has been stable below 130/80mmHg for six months. After the doctor’s evaluation, they gradually reduced the medication and finally stopped. Some people think that expensive imported drugs are definitely better than cheap domestic drugs, but not necessarily. Nifedipine sustained-release tablets that cost a few yuan a bottle are more effective than imported drugs that cost dozens of yuan as long as they are symptomatic. For example, patients with diabetes and kidney disease prefer ACEI/ARB drugs, which have better protection of target organs. Those with coronary heart disease are more suitable to choose β-blockers. The one that suits you is the best.

Let’s talk about a few tips found in clinical practice, which are more useful than many vague guidelines: If you are afraid of forgetting to take medicine, just put the medicine next to the tea cup you must take every day. It is more effective than setting ten alarm clocks.； Don’t measure blood pressure through thick sleeves in winter. Pulling them up can easily lead to insufficient blood supply to your arms. You can roll up the sleeves of close-fitting autumn clothes. The readings measured through a thin layer of autumn clothes will not be much different. ； Patients whose blood pressure has stabilized do not need to measure three times a day in the morning, noon and evening. They can only measure it once every 2-3 days in the morning after emptying their bladder on an empty stomach. Don't worry about the blood pressure count every day. Emotional stress itself will raise blood pressure.

After all, high blood pressure care is a long-term "customized" job. You don't need to blindly copy other people's work, and you don't need to be scared to sleep when you hear about high blood pressure. It is better to slowly understand the temperament of your own body than anything else. After all, we control blood pressure to live a good life, not to force a perfect value.