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*Only for medical professionals to read for reference.
Hypertension is one of the important causes of stroke.
Studies have shown that for every 10mmHg decrease in systolic blood pressure, or 5mmHg decrease in diastolic blood pressure, the risk of death is reduced by 10% to 15%, the risk of stroke is reduced by 35%, the risk of coronary heart disease is reduced by 20%, and the risk of heart failure is reduced by 40%.
Prevention and control of hypertension is one of the core strategies to curb the prevalence of cardiovascular and cerebrovascular diseases in my country.
1 Measure blood pressure correctly 1.
Do not smoke, drink coffee or tea, etc.
within 30 minutes before the measurement, empty your bladder, and rest quietly for at least 5 minutes.
2.
Measure the blood pressure of both upper arms at the first visit, and usually measure the side with the higher reading in the future.
If the difference between the bilateral measurements exceeds 20mmHg, the possibility of subclavian artery stenosis should be excluded.
3.
Measure twice in each outpatient clinic, with an interval of 1 to 2 minutes, and record the average of the two times.
If the difference between the two times is greater than 10mmHg, measure the third time, and record the average of the last two times.
2 Diagnostic criteria for hypertension in the office and outside the office .
3 Emergency treatment with blood pressure ≥180/110mmHg 1.
Blood pressure ≥180/110mmHg, clinical symptoms without acute heart, brain, and kidney complications: oral short-acting antihypertensive drugs, such as captopril 12.
5~25mg, or tartrate 25 mg of torolol can be taken orally, and the administration can be repeated after 1 hour.
Observe in the outpatient clinic until it drops below 180/110mmHg; Note: It is not recommended to take nifedipine sublingually for rapid blood pressure reduction.2.
Recommendations for initial referral 1) Blood pressure is significantly increased ≥180/110mmHg, which cannot be controlled after short-term treatment; 2) Suspected new cardiac, brain, renal complications or other serious clinical conditions; 3) Pregnant and lactating women; 4) Age of onset <30 years; 5) Proteinuria or hematuria; 6) Hypokalemia caused by non-diuretics or low-dose diuretics (serum potassium <3.
5 mmol/L); 7) Paroxysmal elevated blood pressure, Accompanied by headache, palpitation, and hyperhidrosis; 8) The difference in systolic blood pressure of the upper limbs is more than 20mmHg; 9) The diagnosis requires further examination in the higher-level hospital.
4 Antihypertensive goals 1.
In general hypertensive patients, blood pressure should be reduced to below 140/90mmHg; 2.
In patients with diabetes, coronary heart disease, heart failure, chronic kidney disease and proteinuria, if they can tolerate their blood pressure, their blood pressure should be reduced to 130 /80mmHg; the blood pressure of patients from 3.
65 to 79 years old drops below 150/90mmHg, if tolerated, the blood pressure can be further reduced to below 140/90mmHg; the blood pressure of patients above 4.
80 years old drops to below 150/90mmHg.
5 Six Steps to a Healthy Lifestyle Six Steps to a Healthy Lifestyle: Limit salt to lose weight and exercise more, give up smoking and alcohol with a calm mentality.
6 Timing of starting drug treatment Once all hypertensive patients are diagnosed, it is recommended to start drug treatment immediately while lifestyle intervention.
For hypertensive patients with only systolic blood pressure <160mmHg and diastolic blood pressure <100mmHg without coronary heart disease, heart failure, stroke, peripheral atherosclerosis, kidney disease or diabetes, the doctor can also temporarily delay the administration according to the condition and the patient's wishes.
Use simple lifestyle intervention for up to 3 months, if the target is still not met, then start drug treatment.
7 Commonly used antihypertensive drugs and their advantages and disadvantages 1.
Angiotensin converting enzyme inhibitor (ACEI) and angiotensin II receptor blocker (ARB) (abbreviation: A) have clear antihypertensive effects, especially suitable for patients In patients with heart failure, post-myocardial infarction, diabetes, and chronic kidney disease, there is sufficient evidence to prove that the prognosis can be improved.
For patients with proteinuria, it can reduce urine protein and has renal protection, but it is contraindicated in patients with bilateral renal artery stenosis, severe renal insufficiency with creatinine (Cr) ≥3mg/dl (265μmol/L) and hyperkalemia.
It is contraindicated in patients with pregnancy or planned pregnancy.
The usage, indications, contraindications and adverse reactions of ACEI drugs are commonly used at the grassroots level.
The usage, indications, contraindications and adverse reactions of ARB drugs are commonly used at the grassroots level.
2.
Beta blockers (abbreviation: B) can reduce heart rate, especially suitable for patients with rapid heart rate, for patients with myocardial infarction or heart failure, can improve the prognosis; for patients with coronary heart disease and exertional angina pectoris , Can reduce the symptoms of angina pectoris.
But note that it should be used with caution in the early stage (within 24 hours) after acute myocardial infarction.
The acute phase of heart failure (shortness of breath, sitting breathing, inability to lie down) is not suitable for application, and should be used after the condition is stable.
In the acute phase of myocardial infarction or heart failure, it is not recommended to use β-blockers at the primary level.
Α-β receptor blockers with β-blocking effect, such as carvedilol, arotinol, labetalol, etc.
, are also suitable for the above-mentioned populations.
Beta blockers can reduce heart rate and are contraindicated in patients with severe bradycardia, such as heart rate <55 beats/min, sick sinus syndrome, second-degree or third-degree atrioventricular block.
Disabled for patients with bronchial asthma.
High-dose application may affect glucose and lipid metabolism.
Highly selective β1 receptor blockers and α-β receptor blockers, such as bisoprolol, metoprolol, carvedilol, etc.
, can affect glucose and lipid metabolism Less affected.
3.
Calcium channel blockers (CCB) (abbreviation: C) are most commonly used for lowering blood pressure are dihydropyridine calcium channel blockers, such as amlodipine, nifedipine sustained-release tablets or controlled-release tablets, felox Diping sustained-release tablets and so on.
These drugs have a strong antihypertensive effect, are well tolerated, have no absolute contraindications, and have a relatively wide range of applications.
Simple systolic hypertension in the elderly is more suitable.
Common adverse reactions include headache, facial flushing, ankle edema, rapid heartbeat, and gum hyperplasia.
4.
Diuretics (abbreviation: D) Thiazide diuretics are more commonly used, especially for the elderly, patients with isolated systolic hypertension and heart failure.
The main adverse reaction of thiazide diuretics is hypokalemia, and as the dosage of diuretics increases, the incidence of hypokalemia also increases.
Therefore, it is recommended to use low doses, such as hydrochlorothiazide tablets 12.
5 mg, once a day . Diuretics combined with ACEI or ARB drugs can offset or reduce the adverse effects of low potassium.
Generally, thiazide diuretics are contraindicated in patients with gout.
Severe heart failure or chronic renal insufficiency may require the application of loop diuretics (such as furosemide) and potassium supplementation.
At this time, it is recommended to refer to a higher-level hospital for further diagnosis and treatment.
8 Hypertension medication regimen 1.
Hypertension medication regimen without comorbidities: 2.
Hypertension medication regimen with comorbidities: 9 Blood lipid management goals for hypertensive patients The lipid-lowering goals for hypertension with related diseases or conditions are shown in the table below.
Statins are generally well tolerated, but they may cause adverse reactions such as myopathy, rhabdomyolysis, and elevated transaminases, and the risk increases as the dose increases.
For patients with initial medication, blood lipids, transaminase and creatine kinase should be rechecked within 6 weeks.
After there is no adverse reaction and LDL-C reaches the standard, it can be adjusted to once every 6 to 12 months.
10 Long-term follow-up management of hypertension 1.
Follow-up frequency: Patients with blood pressure reaching the standard should be followed up at least once every 3 months; patients with blood pressure not reaching the standard should be followed up once every 2 to 4 weeks.
2.
Whether there are any newly diagnosed comorbidities in the follow-up, such as coronary heart disease, heart failure, stroke, diabetes, chronic kidney disease or peripheral atherosclerosis, etc.
Physical examination (check blood pressure, heart rate, etc.
, overweight or obese people should monitor weight and waist circumference), lifestyle assessment and recommendations, understand medication compliance and adverse reactions, and adjust treatment if necessary.
3.
Annual evaluation All patients should undergo an annual evaluation every year.
In addition to regular physical examinations, weight and waist circumference should be measured at least once a year.
It is recommended to perform necessary auxiliary examinations every year, including blood routine, urine routine, biochemical (creatinine, uric acid, alanine aminotransferase, blood potassium, blood sodium, blood chloride, blood sugar, blood lipids), and electrocardiogram.
Those who have conditions can choose to do: ambulatory blood pressure monitoring, echocardiography, carotid ultrasound, urine albumin/creatinine ratio, chest X-ray, fundus examination, etc.
This article Source: drug evaluation center author: Gcplive Editor: Mr.
Lu Li Copyright Notice This article is reproduced welcome to forward circle of friends - End - Call for Papers Call for Papers to Channel-mail: yxjsjbx@yxj.
org.
cn please specify: [contribution] hospital departments + +Name submissions are in the form of word documents, and the remuneration is favorable.
Edit WeChat: chenaFF0911
Hypertension is one of the important causes of stroke.
Studies have shown that for every 10mmHg decrease in systolic blood pressure, or 5mmHg decrease in diastolic blood pressure, the risk of death is reduced by 10% to 15%, the risk of stroke is reduced by 35%, the risk of coronary heart disease is reduced by 20%, and the risk of heart failure is reduced by 40%.
Prevention and control of hypertension is one of the core strategies to curb the prevalence of cardiovascular and cerebrovascular diseases in my country.
1 Measure blood pressure correctly 1.
Do not smoke, drink coffee or tea, etc.
within 30 minutes before the measurement, empty your bladder, and rest quietly for at least 5 minutes.
2.
Measure the blood pressure of both upper arms at the first visit, and usually measure the side with the higher reading in the future.
If the difference between the bilateral measurements exceeds 20mmHg, the possibility of subclavian artery stenosis should be excluded.
3.
Measure twice in each outpatient clinic, with an interval of 1 to 2 minutes, and record the average of the two times.
If the difference between the two times is greater than 10mmHg, measure the third time, and record the average of the last two times.
2 Diagnostic criteria for hypertension in the office and outside the office .
3 Emergency treatment with blood pressure ≥180/110mmHg 1.
Blood pressure ≥180/110mmHg, clinical symptoms without acute heart, brain, and kidney complications: oral short-acting antihypertensive drugs, such as captopril 12.
5~25mg, or tartrate 25 mg of torolol can be taken orally, and the administration can be repeated after 1 hour.
Observe in the outpatient clinic until it drops below 180/110mmHg; Note: It is not recommended to take nifedipine sublingually for rapid blood pressure reduction.2.
Recommendations for initial referral 1) Blood pressure is significantly increased ≥180/110mmHg, which cannot be controlled after short-term treatment; 2) Suspected new cardiac, brain, renal complications or other serious clinical conditions; 3) Pregnant and lactating women; 4) Age of onset <30 years; 5) Proteinuria or hematuria; 6) Hypokalemia caused by non-diuretics or low-dose diuretics (serum potassium <3.
5 mmol/L); 7) Paroxysmal elevated blood pressure, Accompanied by headache, palpitation, and hyperhidrosis; 8) The difference in systolic blood pressure of the upper limbs is more than 20mmHg; 9) The diagnosis requires further examination in the higher-level hospital.
4 Antihypertensive goals 1.
In general hypertensive patients, blood pressure should be reduced to below 140/90mmHg; 2.
In patients with diabetes, coronary heart disease, heart failure, chronic kidney disease and proteinuria, if they can tolerate their blood pressure, their blood pressure should be reduced to 130 /80mmHg; the blood pressure of patients from 3.
65 to 79 years old drops below 150/90mmHg, if tolerated, the blood pressure can be further reduced to below 140/90mmHg; the blood pressure of patients above 4.
80 years old drops to below 150/90mmHg.
5 Six Steps to a Healthy Lifestyle Six Steps to a Healthy Lifestyle: Limit salt to lose weight and exercise more, give up smoking and alcohol with a calm mentality.
6 Timing of starting drug treatment Once all hypertensive patients are diagnosed, it is recommended to start drug treatment immediately while lifestyle intervention.
For hypertensive patients with only systolic blood pressure <160mmHg and diastolic blood pressure <100mmHg without coronary heart disease, heart failure, stroke, peripheral atherosclerosis, kidney disease or diabetes, the doctor can also temporarily delay the administration according to the condition and the patient's wishes.
Use simple lifestyle intervention for up to 3 months, if the target is still not met, then start drug treatment.
7 Commonly used antihypertensive drugs and their advantages and disadvantages 1.
Angiotensin converting enzyme inhibitor (ACEI) and angiotensin II receptor blocker (ARB) (abbreviation: A) have clear antihypertensive effects, especially suitable for patients In patients with heart failure, post-myocardial infarction, diabetes, and chronic kidney disease, there is sufficient evidence to prove that the prognosis can be improved.
For patients with proteinuria, it can reduce urine protein and has renal protection, but it is contraindicated in patients with bilateral renal artery stenosis, severe renal insufficiency with creatinine (Cr) ≥3mg/dl (265μmol/L) and hyperkalemia.
It is contraindicated in patients with pregnancy or planned pregnancy.
The usage, indications, contraindications and adverse reactions of ACEI drugs are commonly used at the grassroots level.
The usage, indications, contraindications and adverse reactions of ARB drugs are commonly used at the grassroots level.
2.
Beta blockers (abbreviation: B) can reduce heart rate, especially suitable for patients with rapid heart rate, for patients with myocardial infarction or heart failure, can improve the prognosis; for patients with coronary heart disease and exertional angina pectoris , Can reduce the symptoms of angina pectoris.
But note that it should be used with caution in the early stage (within 24 hours) after acute myocardial infarction.
The acute phase of heart failure (shortness of breath, sitting breathing, inability to lie down) is not suitable for application, and should be used after the condition is stable.
In the acute phase of myocardial infarction or heart failure, it is not recommended to use β-blockers at the primary level.
Α-β receptor blockers with β-blocking effect, such as carvedilol, arotinol, labetalol, etc.
, are also suitable for the above-mentioned populations.
Beta blockers can reduce heart rate and are contraindicated in patients with severe bradycardia, such as heart rate <55 beats/min, sick sinus syndrome, second-degree or third-degree atrioventricular block.
Disabled for patients with bronchial asthma.
High-dose application may affect glucose and lipid metabolism.
Highly selective β1 receptor blockers and α-β receptor blockers, such as bisoprolol, metoprolol, carvedilol, etc.
, can affect glucose and lipid metabolism Less affected.
3.
Calcium channel blockers (CCB) (abbreviation: C) are most commonly used for lowering blood pressure are dihydropyridine calcium channel blockers, such as amlodipine, nifedipine sustained-release tablets or controlled-release tablets, felox Diping sustained-release tablets and so on.
These drugs have a strong antihypertensive effect, are well tolerated, have no absolute contraindications, and have a relatively wide range of applications.
Simple systolic hypertension in the elderly is more suitable.
Common adverse reactions include headache, facial flushing, ankle edema, rapid heartbeat, and gum hyperplasia.
4.
Diuretics (abbreviation: D) Thiazide diuretics are more commonly used, especially for the elderly, patients with isolated systolic hypertension and heart failure.
The main adverse reaction of thiazide diuretics is hypokalemia, and as the dosage of diuretics increases, the incidence of hypokalemia also increases.
Therefore, it is recommended to use low doses, such as hydrochlorothiazide tablets 12.
5 mg, once a day . Diuretics combined with ACEI or ARB drugs can offset or reduce the adverse effects of low potassium.
Generally, thiazide diuretics are contraindicated in patients with gout.
Severe heart failure or chronic renal insufficiency may require the application of loop diuretics (such as furosemide) and potassium supplementation.
At this time, it is recommended to refer to a higher-level hospital for further diagnosis and treatment.
8 Hypertension medication regimen 1.
Hypertension medication regimen without comorbidities: 2.
Hypertension medication regimen with comorbidities: 9 Blood lipid management goals for hypertensive patients The lipid-lowering goals for hypertension with related diseases or conditions are shown in the table below.
Statins are generally well tolerated, but they may cause adverse reactions such as myopathy, rhabdomyolysis, and elevated transaminases, and the risk increases as the dose increases.
For patients with initial medication, blood lipids, transaminase and creatine kinase should be rechecked within 6 weeks.
After there is no adverse reaction and LDL-C reaches the standard, it can be adjusted to once every 6 to 12 months.
10 Long-term follow-up management of hypertension 1.
Follow-up frequency: Patients with blood pressure reaching the standard should be followed up at least once every 3 months; patients with blood pressure not reaching the standard should be followed up once every 2 to 4 weeks.
2.
Whether there are any newly diagnosed comorbidities in the follow-up, such as coronary heart disease, heart failure, stroke, diabetes, chronic kidney disease or peripheral atherosclerosis, etc.
Physical examination (check blood pressure, heart rate, etc.
, overweight or obese people should monitor weight and waist circumference), lifestyle assessment and recommendations, understand medication compliance and adverse reactions, and adjust treatment if necessary.
3.
Annual evaluation All patients should undergo an annual evaluation every year.
In addition to regular physical examinations, weight and waist circumference should be measured at least once a year.
It is recommended to perform necessary auxiliary examinations every year, including blood routine, urine routine, biochemical (creatinine, uric acid, alanine aminotransferase, blood potassium, blood sodium, blood chloride, blood sugar, blood lipids), and electrocardiogram.
Those who have conditions can choose to do: ambulatory blood pressure monitoring, echocardiography, carotid ultrasound, urine albumin/creatinine ratio, chest X-ray, fundus examination, etc.
This article Source: drug evaluation center author: Gcplive Editor: Mr.
Lu Li Copyright Notice This article is reproduced welcome to forward circle of friends - End - Call for Papers Call for Papers to Channel-mail: yxjsjbx@yxj.
org.
cn please specify: [contribution] hospital departments + +Name submissions are in the form of word documents, and the remuneration is favorable.
Edit WeChat: chenaFF0911
