[Source: Health Times]
Light up the star
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The expert of this article: Chen Luyuan, Chief Physician of the Department of Cardiology of Guangdong Provincial People's Hospital, Vice Chairman of the Council of the China Hypertension Alliance, and Vice President of the Hypertension Branch of the Chinese Geriatrics Society
If you are overweight or obese, nervous and anxious all day long, lack of exercise, long-term insomnia, smoking and drinking from time to time, and eating habits high in salt and fat, despite being young in your 30s, be sure to monitor your blood pressure, especially the diastolic blood pressure value, which is often called "low blood pressure", you are likely to be a high-risk group for hypertension.
"Young" is not a contraindication to hypertension, and hypertension, which has always been labeled as a "geriatric disease", has not a lot of young and middle-aged people, but it is only a "hidden symptom" and "young" and other interference factors, and many young people do not know that they have hypertension. Regarding the overall diagnosis and treatment of young and middle-aged hypertensive patients, Professor Chen Luyuan mentioned the most that it is "difficult to find" and "difficult to manage".
Symptoms of hypertension are atypical in young people
Most of the young and middle-aged hypertension patients have mild abnormal blood pressure, basically no obvious symptoms, sometimes dizziness, headache and other physical discomfort, young people will not think of hypertension, many young and middle-aged hypertension are found in physical examination or random blood pressure measurement.
Professor Chen Luyuan suggested that even if there are no symptoms, if the diastolic blood pressure (low pressure) rises significantly, it is necessary to be vigilant, which is also a characteristic of hypertension in young and middle-aged people.
He explained that young people (because there is no arteriosclerosis) have good elasticity of large arteries, and the artery walls can well buffer the impulse of blood flow during cardiac contraction, but the resistance of small and medium-sized arteries increases, so high pressure (systolic blood pressure) tends to be normal, diastolic blood pressure (low pressure) tends to increase, and the proportion of sympathetic nervous system overactivation in young hypertensive patients is higher than that in older patients with hypertension, often accompanied by an increased heart rate.
Compared with the elderly, young people rarely have the habit of measuring blood pressure regularly, so they cannot detect abnormalities in blood pressure in time. For the diagnosis of hypertension in young and middle-aged people, Professor Chen Luyuan gave a monitoring method in three scenarios, and it is not a one-time measurement result that can determine whether there is hypertension.
Office measurements: blood pressure is measured three times, the average of the second and third times is taken, and if the ≥ is 140/90 mm Hg, the diagnosis of hypertension can be confirmed.
Home self-test: Elevated blood pressure is not diagnostic of hypertension by a home measurement, and should be measured at home for a week, the average value is calculated, and hypertension can be diagnosed if it is ≥ 135/85 mm Hg.
Wear an ambulatory blood pressure monitor: Measure blood pressure over a 24-hour period to calculate the average blood pressure throughout the day, and if it ≥ 130/80 mm Hg, hypertension can also be diagnosed.
If the blood pressure is 130-139/80-89 mmHg, it is recommended to measure it every 3 months. If you have already diagnosed hypertension and your blood pressure is stable within the target range, you don't need to measure your blood pressure at home every day, one day a week, but once in the morning and once in the evening. The key is for young and middle-aged people to have the habit and awareness of regular monitoring of blood pressure to detect abnormal blood pressure as early as possible and reduce cardiovascular damage.
Hypertension in young people is difficult to manage
"Among the patients I treated, young and middle-aged patients with hypertension had poor compliance." Professor Chen Luyuan said that the poor management of hypertension in young and middle-aged people is partly due to the lack of lifestyle intervention and partly due to inactive drug treatment.
1. Poor lifestyle
In terms of lifestyle, there is no change in bad habits, such as staying up late for a long time, liking to eat takeaway with high oil and salt, sitting for a long time and not exercising, smoking or excessive drinking, and being in a high-pressure and stressful work environment, anxiety is not released, and these risk factors have not been intervened and corrected, and the compliance rate of hypertension is often not ideal.
2. Stop taking and eating drugs
In terms of drug treatment, young and middle-aged patients with hypertension often do not follow the doctor's instructions to take drugs, reduce drugs by themselves, stop drugs, etc., feel that there is no discomfort in the body and can not be treated, and they also feel that they are young and have to take "life" medicine from now on and are very worried about the side effects of drugs.
Professor Chen Luyuan explained that for young and middle-aged hypertensive patients without comorbidities, the five commonly used antihypertensive drugs (diuretics, β-blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors, and angiotensin receptor antagonists) can be used as initial treatment, especially for young and middle-aged people with high "low pressure", and β-receptor blockers and RAS inhibitors with α receptor blocking effect can be preferentially used. If the heart rate > 80 beats per minute, β blockers may be preferred, and ACE inhibitors and angiotensin receptor antagonists may be preferred.
As the fourth and latest generation of β-receptor blockers, Bevanolol hydrochloride tablets can not only reduce blood pressure, but also slow down the heart rate.
In fact, patients with hypertension with blood pressure of more than 160/100 mm Hg (grade 2 or 3), as well as high-risk patients with multiple risk factors for cardiovascular disease, or patients who do not respond to monotherapy, can start combined drug therapy to avoid target organ damage caused by hypertension and reduce the occurrence of cardiovascular and cerebrovascular adverse events.
Control your blood pressure and improve your lifestyle first!
Professor Chen Luyuan said that the blood pressure lowering target for all hypertensive patients should be < 140/90 mm Hg, and if the patient can tolerate it, the target can be lowered to <130/80 mm Hg. However, this does not mean that if high blood pressure is detected, you need to take medication.
For the first time to detect grade 1 hypertension, that is, blood pressure at 140-159/90-99 mm Hg, also known as mild hypertension, it is recommended to carry out lifestyle intervention for three months, keep your mouth shut and open your legs, and then start medication after three months if the blood pressure does not come down.
Blood pressure of 150-159/95-99 mmHg requires lifestyle intervention and medication at the same time. Medical therapy should be started immediately in patients with blood pressure greater than 160/100 mm Hg (grade 2 or 3) or who are at high risk of cardiovascular disease.
Lifestyle interventions include:
1. Limit salt intake, increase potassium-rich foods (fresh fruits, vegetables and legumes) and reduce fat and cholesterol intake;
2. Weight control (waist circumference: male
3. Quit smoking and limit alcohol;
4. Increase the amount of exercise, such as jogging, cycling or swimming;
5. Reduce mental and psychological stress. ①
References: (1) Expert Consensus on the Management of Hypertension in Young and Middle-aged Chinese Adolescents, Hypertension Group of the 10th Committee of the Cardiovascular Branch of the Chinese Medical Association, October 2019
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