Knowledge about hypertension care

There is no standard solution that is suitable for everyone. The core is to focus on the three keys of "complying with doctor's instructions, adjusting lifestyle, and regularly monitoring blood pressure." Without any one of them, it will be difficult to keep blood pressure within a safe range.

Aunt Zhang, who I met at a community free clinic last month, is 62 years old. She has suffered from high blood pressure for 8 years. She sets three alarm clocks every day to remind herself to take amlodipine. Her compliance is so good, but her blood pressure fluctuates around 150/90mmHg every time, and she keeps asking me if the medicine is not working. When I asked about her diet, I found out that she had pickled dried radishes for breakfast. After dancing in the evening, she also liked to eat salty kebabs with her old sisters. She always felt, "I'm taking medicine anyway, so it doesn't matter if I eat something salty."

When it comes to salt intake, in fact, academic circles have always had different views. Traditional guidelines uniformly require patients with hypertension to consume no more than 5g of salt per day, which is about the amount of an average beer bottle cap. However, many clinical studies in the past two years have pointed out that for people who have been engaged in heavy manual labor for a long time and sweat a lot every day, or for thin elderly patients with low blood sodium, excessive salt restriction can lead to hyponatremia, fatigue, dizziness and even orthostatic hypotension. If you really don't need to go up, just lock the salt shaker. If you are not sure about your situation, go to the hospital for a 24-hour urine sodium test to see how much salt you eat every day. It is not too late to adjust your diet plan.

Oh, by the way, when it comes to monitoring blood pressure, I have encountered more outrageous things. There used to be a 58-year-old taxi driver named Chen. The first thing he did when he got up every day was check his blood pressure. The value was always stable at 130/80mmHg. He felt that he had very good control. However, when he was running a long distance last month, his vision suddenly turned black and he almost hit the guardrail. After being sent to the hospital for 24-hour ambulatory blood pressure monitoring, it was discovered that his blood pressure had been soaring to 170/100mmHg from 1 to 4 in the morning. This was a typical case of latent nocturnal hypertension. Previously, I only measured my blood pressure in the morning, and no problem was found at all. In the past, many popular sciences told everyone to measure their blood pressure in the morning. In fact, for people who often stay up late, work shifts, and have sleep apnea, it is best to measure their blood pressure before going to bed or even in the early morning. Don't stick to one time point, otherwise it is easy to miss the diagnosis like Lao Chen.

There are also many people asking whether antihypertensive drugs should be taken in the morning or at night. There is no unified answer to this. Clinical opinions in the early years generally recommended eating on an empty stomach in the morning, because most people will have a blood pressure peak after getting up in the morning, which can just cover the peak. ； However, in recent years, more and more studies have shown that for patients with high blood pressure at night, taking long-acting antihypertensive drugs before going to bed can better suppress blood pressure fluctuations at night and reduce the risk of cardiovascular and cerebrovascular events. I met a patient before. He heard from his neighbor that taking medicine before going to bed was effective, so he secretly changed the time he took the medicine. However, his blood pressure was low in the early morning. Within three days of the change, he got up in the middle of the night to go to the toilet and fell in the bathroom. Fortunately, he only cut his forehead and nothing more serious happened. Really, don’t blindly listen to other people’s experiences when taking medicine. Do a 24-hour ambulatory blood pressure monitor and let the doctor decide based on your fluctuation patterns. It’s more reliable than anything else.

Many people have asked before, if you have high blood pressure, you can only walk and do Tai Chi, but not other exercises? In fact, opinions have changed in recent years. In the past, it was always believed that patients with high blood pressure should not engage in strength training. The current consensus is that as long as your blood pressure is stable below 160/100mmHg, and there are no serious emergencies such as aortic dissection or heart failure, doing light weight resistance training twice a week, such as lifting 1kg small dumbbells and doing silent squats against the wall, can actually improve blood vessel elasticity and help lower blood pressure more stably. But if your blood pressure has fluctuated particularly recently, don’t insist on practicing. Stabilize your blood pressure first.

To be honest, I have been working in chronic disease care for almost 10 years, and the most common pitfall I have seen is "stop taking medicine when your blood pressure is normal." The last time I met an Uncle Li, his blood pressure had been stable for three months. He secretly stopped taking the medicine and bought a "hypertension-lowering tea" sold online to drink every day. However, he suddenly felt dizzy last month and was sent to the hospital. When his blood pressure was measured at 190/110mmHg, he showed signs of lacunar infarction. He stayed in the hospital for a week before he came out. He said he didn't dare to mess around anymore. The vast majority of essential hypertension requires long-term medication to control it. Don’t think that it’s okay if you don’t have symptoms. High blood pressure can cause subtle damage to blood vessels. By the time you feel dizzy or have a headache, the damage has often already occurred.

In fact, in the final analysis, high blood pressure care is like adjusting a string with the right tightness for your body. Don’t be too anxious and don’t take it too seriously. No matter how good other people’s experience is, it is not as practical as measuring your own blood pressure several times and communicating with your doctor. If you pay more attention, it won't cause any big trouble for you. If you don't care or blindly believe in folk remedies, it will really show you the color.