Health guidance for preventing complications of high blood pressure

For patients with high blood pressure to avoid disabling and fatal complications such as myocardial infarction, cerebral infarction, renal failure, fundus lesions, etc., the core solution is to "stable and long-term control of blood pressure within an individualized target range, and at the same time targeted intervention in early signs of target organ damage that have occurred." Currently, there are no folk remedies or health products that can replace the role of standardized blood pressure control.

Why do you come to such a straightforward conclusion right from the start? I just met 62-year-old Uncle Zhang in the clinic last week. He has had high blood pressure for 8 years. He has always felt that "not dizzy means good blood pressure." He usually only checks his blood pressure an hour after taking antihypertensive medicine in the morning. Every time, it is 135/85. He feels that his control is very standard. The result of the physical examination report is that the urine microalbumin is three times higher than the standard, and the fundus examination shows stage II arteriosclerosis. I asked him to wear a 24-hour ambulatory blood pressure monitor, only to find that his blood pressure fluctuated at 162/96 from 2 a.m. to 4 a.m. every day, and he didn't feel it at all. This is a typical example of "it seems to be up to standard but in fact the blood pressure control is ineffective", and there are early signs of complications.

Many people ask me how low my blood pressure should be. There is currently no unified "standard answer" in the academic community: the US ACC/AHA guidelines have recommended that all patients with high blood pressure lower their blood pressure to below 130/80mmHg in recent years. China's 2023 version of the hypertension guidelines recommends that general adult patients first drop their blood pressure to below 140/90mmHg. If tolerated, lowering the blood pressure to 130/80mmHg will bring greater benefits. For frail elderly people over 80 years old, many geriatricians support relaxing the blood pressure to 150/90mmHg to avoid postural hypotension caused by blood pressure lowering too low, which may lead to fractures and cerebral hypoperfusion. To put it bluntly, your stress control goals must be set based on your age, underlying diseases, and physical tolerance. Don’t impose other people’s standards.

When it comes to controlling blood pressure, many people's first reaction is to take antihypertensive drugs. In fact, drugs are only part of the equation, and lifestyle adjustments are not small at all. However, there are many opinions on life intervention. For example, everyone knows that salt should be restricted. The mainstream recommendation is to consume no more than 5g of salt per day. However, some clinical studies have pointed out that if you are a manual worker who works outdoors for a long time and sweats a lot, you don’t have to do this to avoid hyponatremia, which may cause fatigue and dizziness, which is dangerous. There is also exercise. Many popular sciences say that you should do 30 minutes of moderate-intensity aerobic exercise every day. However, I often tell patients who do not exercise at all, don’t just run 5 kilometers. If you walk around the neighborhood for 10 minutes after meals every day for a month, it is much safer than sudden strenuous exercise that causes a sudden rise in blood pressure. The core of exercise is long-term persistence, not one-time achievement.

Oh, by the way, the monitoring advice I give to patients has never been "take a test every morning, noon and night and write it down in a notebook". It's too troublesome for most people to insist on it. It's better to buy an electronic blood pressure monitor that can automatically synchronize data, and do it 2 days a week. Sit down for 5 minutes before each test and don't check your phone. Just take the test once in the morning, noon and night. If the measurement exceeds your target value three times in a row, go to the doctor to adjust the medicine. Occasionally, a high blood pressure may be just after climbing the stairs or quarreling with someone, so don't panic.

Many people measure their blood pressure every year but never check the relevant indicators of target organ damage. This is actually missing the most critical step. Complications of hypertension do not appear suddenly. There is a window period of several years from the beginning of hardening of blood vessels to mild damage to kidney function and plaques in the carotid arteries. Checking urine microalbumin, carotid artery ultrasound, electrocardiogram, and fundus every year does not cost a few hundred yuan. If the problem can be detected early, such as when microalbumin first appears in the urine, the antihypertensive drugs can be adjusted to Sartan/Pril, which has a renal protective effect. Early damage can be completely reversed. When edema and creatinine increase, it will be too late to intervene.

Finally, I would like to mention a pitfall that everyone often steps into nowadays: many people think that "medicines are three parts poisonous". They heard that celery juice, deep-sea fish oil, and natto can lower blood pressure, so they secretly stopped the anti-hypertensive medication. Last year, I met a 58-year-old aunt who stopped taking the anti-hypertensive medication after taking deep-sea fish oil for 3 months. She had a sudden cerebral hemorrhage and was sent to the ICU. She was rescued but could not move half of her body. This is not to say that these health products are completely useless. They may have a certain role in assisting in regulating lipids and softening blood vessels. However, there is currently no evidence-based medical evidence to prove that they can be used alone to control blood pressure and prevent complications. Do not put the cart before the horse.

In fact, preventing complications from high blood pressure is really not that complicated. You don’t have to worry about not being able to eat well or sleep well every day, and don’t take it completely seriously. After all, it is one of the most controllable chronic diseases. Find a reliable doctor to make a plan that suits you, and just implement it well. The ultimate goal of controlling blood pressure is to live a good life, not just to make up a few numbers, right?