Mild patients take medicine on time and take their blood pressure.

Patients with mild hypertension who meet the international diagnostic standards should take medicine according to the doctor's regulations. At present, the understanding of the medical community is that early intervention in drug treatment is still expected to reduce and stop taking drugs in the future. Never stop taking drugs or reduce the dosage just because your blood pressure drops slightly.

Text/Hong

Many people, once diagnosed as hypertension by doctors, are often reluctant to take medicine, although they meet the conditions of clinical medication, thinking that their blood pressure is only a little higher, hoping that their efforts can reduce their blood pressure to the value before hypertension.

In this regard, Wang Zongdao, an attending physician in the Department of Cardiology at National Taiwan University Hospital, pointed out that lifestyle adjustment can indeed lower blood pressure. Usually, doctors will first understand the living habits of patients. If they smoke, eat salty food, do not exercise or are overweight, they will advise patients to quit these bad factors. However, the antihypertensive effect of non-drug therapy generally appears slowly. For patients who have been diagnosed with hypertension, whether they need to take medicine immediately depends on the patient's blood pressure.

At present, the medical community believes that drug therapy should be intervened as soon as possible, because early medication to reduce blood pressure to the target value can immediately reduce the risk of cardiovascular and cerebrovascular diseases in hypertensive patients. Moreover, if the effect of non-drug treatment gradually appears in the future, it is still expected to reduce the drug and stop the drug. The idea that China people are worried that western medicine will hurt their kidneys is totally inapplicable to antihypertensive drugs. In fact, antihypertensive drugs can reduce the damage caused by hypertension by regulating blood pressure, and some antihypertensive drugs even have the function of directly protecting the kidneys.

Q When should I start taking antihypertensive drugs to control my blood pressure?

If the doctor does judge that there is hypertension, the next step is to discuss the treatment strategy with the doctor. Lai Zhihong, an attending physician in the Department of Cardiology, Shuanghe Hospital, said that if the systolic blood pressure measured at home usually exceeds 135mmHg or the diastolic blood pressure exceeds 85 mmHg, if the systolic blood pressure measured at the hospital exceeds 140 mmHg or the diastolic blood pressure exceeds 90mmHg, the medication conditions are met. If the blood pressure exceeds 160mmHg and 100mmHg, even two antihypertensive drugs are needed.

In addition, because the incidence of hypertension is related to age, its pattern is also related to age. In patients over 55 years old, if systolic blood pressure increases and diastolic blood pressure decreases, it is likely to be related to arteriosclerosis; Once over 60 years old, when judging the treatment method, the blood pressure value should be based on systolic blood pressure. As long as the systolic blood pressure rises, it must be treated to reduce the risk of stroke.

Q For general hypertensive patients, what antihypertensive drugs do doctors prescribe most often?

There are many antihypertensive drugs in clinic. First-line drugs include the following:

◎ B Sympathetic nerve blocker: It is very effective for patients with coronary heart disease, arrhythmia or nervousness, but it may cause side effects such as tracheal contraction, slow heartbeat, heart failure, or increased blood sugar and blood lipid. If patients are complicated with diabetes, heart failure, hyperlipidemia, asthma, peptic ulcer and other diseases, they should be avoided as much as possible.

◎ Diuretics: Although the price is cheap, the effect of lowering blood pressure is not bad. Because it will reduce blood potassium, increase uric acid and increase blood lipid, it is necessary to evaluate whether the patient is accompanied by other dyslipidemia before taking the medicine. Because of the characteristics of diuretics, you should choose the morning time when taking the medicine to avoid going to the toilet frequently in the middle of the night.

◎ Calcium blocker: It has a good antihypertensive effect and is widely used in clinic, which has a significant protective effect on stroke.

Angiotensin conversion inhibitors and angiotensin receptor blockers;

Sympathetic nerve blocker A: Because it can relax the muscles at the bladder outlet and make urination smoother, it is suitable for patients with prostatic hypertrophy.

Wang Zongdao pointed out that these drugs have high safety and tolerance, and can be used alone or in combination. Up to 90% patients with hypertension can get good blood pressure control through these drugs.

Q: What is the most important principle in determining patients with mild hypertension who need to take antihypertensive drugs?

If the doctor's overall evaluation suggests taking medicine, taking medicine on time is the most important principle to keep blood pressure stable without ups and downs. According to the survey, as many as 40% of hypertensive patients don't know, even if they know they have hypertension, only half of them are well controlled, that is to say, only about 30% of hypertensive patients are well controlled. Even though the control rate of hypertension has an upward trend in recent years, it is still far below 50%, and there is still room for efforts.

Drugs can effectively control blood pressure. It is not common for blood pressure to soar again after taking antihypertensive drugs, except for short-term blood pressure increase caused by factors such as mood or exercise, or blood pressure increase caused by kidney problems, taking painkillers and cold medicines.

Lai Zhihong said that there are many antihypertensive drugs available in clinic, but generally speaking, each drug can only reduce systolic blood pressure 10mmHg and diastolic blood pressure by about 5mmHg. If the patient belongs to the first stage of hypertension, basically only one drug needs to be taken. In Taiwan Province Province, about 30% patients only need one drug to reduce their blood pressure to the standard value, but as many as 70% patients need two or more drugs to control their blood pressure. Therefore, the dosage of drugs is closely related to blood pressure.

Q: What tests will doctors do for patients before deciding to take antihypertensive drugs?

When diagnosing hypertension and prescribing drugs, doctors will conduct several tests according to the situation. In addition to referring to the most important blood pressure monitoring values, they will also conduct urine tests, draw blood, do electrocardiogram, and take chest X-rays when necessary.

Lai Zhihong pointed out that if the blood pressure is high, proteinuria may appear in the urine, which means that the patient's renal function has been damaged. Blood is drawn to determine whether the patient has three high syndromes such as cholesterol and diabetes. If there is any difference in auscultation, the patient can also be asked to do ECG and take X-rays to diagnose whether there is myocardial hypertrophy.

Q how should patients with mild hypertension who have taken antihypertensive drugs abide by life and diet?

If blood pressure continues to rise, the first priority is to lower it first. Drugs are the most effective choice, but even patients with primary hypertension who have already taken antihypertensive drugs can't ignore the importance of life adjustment.

Lai Zhihong emphasized that "SABCDE" has been introduced internationally, in which the systolic blood pressure can be reduced by about 10 mmHg as long as the body weight is reduced, which is equivalent to the effect of a antihypertensive drug. Therefore, even if you are already taking medication to control blood pressure, you should not underestimate the contribution of life adjustment to lowering blood pressure and adjusting medication.

In addition, we should pay attention to diet, the oil intake is mainly unsaturated fatty acids, and eat more vegetables and fruits. Reduce salt intake, drink less and quit smoking. Exercise five days a week and at least 30 minutes a day can reduce the risk of myocardial infarction. Aerobic exercise is the first choice for exercise, such as brisk walking, jogging and sweating.

Many hypertensive patients will worry that they will never get rid of antihypertensive drugs when they hear the doctor's advice. In fact, as long as they try to adjust their lives, they can still stop taking drugs in the future even after taking them. In order to serve as a reference for doctors to adjust their medication at the next visit, even if they have taken the medicine, they should still measure their blood pressure every morning and evening, record the results and discuss with the doctors.

Q when is the best time to take antihypertensive drugs, early in the morning or before going to bed?

In the past, patients often took antihypertensive drugs during the day, because blood pressure tended to rise during daytime activities, but some studies found that the correlation between blood pressure at night and cardiovascular diseases was higher than during the day. In other words, the higher the blood pressure at night, the higher the incidence of cardiovascular diseases.

Lai Zhihong pointed out that if your blood pressure is high when you get up during the day, it means that your blood pressure will rise slowly in the middle of the night. Therefore, it is more appropriate for this kind of hypertension patients to take antihypertensive drugs at night than during the day.

But when to take antihypertensive drugs depends on the patient's own situation. If the work pressure is high, the blood pressure may rise during the day, and you should still take medicine during the day.

Q After taking antihypertensive drugs on time, blood pressure is still high. Can I eat it again?

Patients with primary hypertension can basically control their blood pressure by taking only one drug. If the blood pressure is still too high after taking the medicine, it is recommended to take a rest and then measure it. If you continue to be high, you can go back to the doctor and discuss with him to find out the cause of high blood pressure. It is not advisable to add medicine rashly.

There are many factors that affect blood pressure changes, and climate is one of the reasons. Wang Zongdao said that when doctors prescribe drugs, they will also make adjustments according to climate change. For example, blood pressure tends to rise in winter, and it may be necessary to increase medication. Blood pressure may also change due to external conditions such as emotional changes or exercise. Don't be too nervous if your blood pressure rises temporarily because of mood or exercise. Take a rest and calm yourself down. Don't add medicine yourself.

For example, some patients feel dizzy and think that their blood pressure is rising. Although dizziness may be caused by hypertension or anemia, the high dose of antihypertensive drugs may lead to low blood pressure and may also lead to dizziness. Some patients mistakenly think that their blood pressure is not well controlled and feel dizzy, but self-medication will lower their blood pressure.

Wang Zongdao suggested that when patients have symptoms such as dizziness after taking medicine, they should first measure their blood pressure, make clear the relationship between blood pressure and symptoms, and then think about the next treatment strategy. Patients with primary hypertension who have just started to receive drug treatment will have more frequent follow-up visits because they need to evaluate the acceptance of drugs and the effect of lowering blood pressure. After the medication is stable, you can continue to take the medicine, but the patient must follow the doctor's advice and not increase or decrease the medicine on his own, so as not to make the blood pressure unstable.

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