With the improvement of living standards and the change of lifestyle, the incidence rate of hypertension is on the rise year by year and getting younger and younger. Middle-aged people aged 40-50 will become the main force of hypertension.
Many hypertensive patients, especially young and middle-aged patients, obviously have their blood pressure rising, but they are often unwilling to face the reality and do not admit that their blood pressure is high. This kind of escape not only cannot solve the problem, but may also aggravate the disease.
Moreover, getting hypertension does not mean taking medicine for a lifetime, so let’s talk about what to take medicine for hypertension in detail.
Some high blood pressure, can not take medicine
Let’s first talk about which patients can not take medicine:
1. White coat hypertension
White coat hypertension refers to that patients only measure high blood pressure (blood pressure ≥ 140/90 mmHg) in hospital clinics, while family self-measured blood pressure and/or ambulatory blood pressure are normal (< 135/85 mmHg). White coat hypertension is relatively a [benign state] and can not take antihypertensive drugs first.
However, this kind of patients are easy to be affected by pressure, emotion and the outside world at ordinary times, resulting in blood pressure fluctuation, so we must not ignore the monitoring of blood pressure. At the same time, attention should also be paid to life, such as maintaining emotional stability, quitting smoking, low-salt diet, exercise and weight loss, and regular follow-up 24-hour ambulatory blood pressure.
2. People with normal blood pressure after lifestyle adjustment
Hypertension, especially primary hypertension, is generally related to heredity and unhealthy lifestyle. Many patients can improve their lifestyle, such as low-salt and low-fat diet, quitting smoking and drinking, avoiding staying up late and losing weight, so that their blood pressure can reach normal level.
I once admitted a very typical patient, a male in his 40s, who was obese and loved smoking but not exercising. When he did not take medicine, his blood pressure was 200/100 mmHg. Only when he took 4 or 5 antihypertensive drugs did he barely reach the standard (about 140/90 mmHg).
Later, I repeatedly reminded him to attach importance to weight loss and improve his lifestyle. Later, his blood pressure gradually stabilized, slowly reduced his medicine, and finally stopped taking medicine. After stopping taking medicine, he insisted on a healthy life and his blood pressure remained normal. As a doctor, I am happy for him.
3. Partial secondary hypertension
5 ~ 10% of hypertension is secondary hypertension, i.e. Hypertension with definite etiology. After finding out the etiology and effectively removing or controlling the etiology, hypertension as secondary symptom can be cured or obviously relieved.
The need to take antihypertensive drugs
1. Blood pressure is still higher than 140/90 mmHg through lifestyle improvement.
2, heart, kidney, brain and other organs damaged.
Therefore, when hypertension is first discovered, doctors will advise patients to have at least biochemical examination (including renal function and electrolyte), urine protein and electrocardiogram. This is to check whether the patient has organ damage.
- Hypertension can lead to proteinuria, kidney damage and even uremia, and kidney diseases can also lead to hypertension, so it is very important to regularly check urine protein and serum creatinine. Electrocardiogram is also very important, because hypertension causes myocardial hypertrophy, when there is no obvious abnormality in cardiac ultrasound, electrocardiogram may have slight changes.
If there is organ damage, it means that the risk of cardiovascular and cerebrovascular accidents increases. In order to reduce the risk, drugs must be used to actively control blood pressure.
We must not be afraid to take medicine. If blood pressure is not controlled for a long time, the consequences are often very serious and cannot be reversed. It will be too late to regret not taking medicine early.
There was a man in his 40s in our ward who did not control his high blood pressure because he felt that he had no symptoms. He did not come to see a doctor until he had chest tightness and asthma.
Echocardiography showed that the shape of the heart had been abnormal, And the function is obviously declining. Renal function examination results also show serious damage, which is the result we are most afraid of. Heart problems can also be slowly adjusted by controlling blood pressure and adding drugs to improve heart function. Once kidney damage occurs, most of them will be weak and will finally have to be dialyzed or wait for kidney transplantation.
3. Hidden hypertension
Hidden hypertension refers to normal blood pressure measured in hospitals and clinics, while blood pressure outside clinics (family self-measured blood pressure and 24-hour ambulatory blood pressure) is higher than normal. Such patients are often complicated with diabetes, elevated blood creatinine, proteinuria, etc., which can cause damage to organs such as heart, kidney, brain, etc. and require oral antihypertensive drugs.
Remember to take your blood pressure after taking the medicine.
Some patients with hypertension think that everything is OK after taking medicine, but in fact it is not. Hypertension needs self-management most, and self-measurement of blood pressure is the most important part of self-management.
It is best to measure blood pressure three times a day:
- After getting up in the morning; 4: 00-6: 00 p.m.; Before going to bed at night.
In particular, early morning blood pressure control is very important. Poor early morning blood pressure control is the main cause of cardiac, cerebral and renal complications.
Doctors adjust the dosage and usage of antihypertensive drugs according to the patient’s self-measured blood pressure results. Can achieve better curative effect. Don’t feel troublesome, a 90-year-old man I treated can strictly monitor his blood pressure, and young people should pay more attention to it. He will take his own blood pressure results every time he comes to see a doctor, and his blood pressure has been controlled fairly well.
It is hoped that every patient with hypertension can face up to hypertension, actively seek the help of doctors, manage his blood pressure and keep healthy.