High blood pressure is very harmful, how can we prevent and treat it in daily life?

As we all know, hypertension is a common and frequently occurring disease in the world, and is known as a "silent killer" that endangers human health and life. According to the "China Cardiovascular Health and Disease Report 2020", there are currently 330 million cardiovascular patients in my country, of which 245 million are hypertensive patients, accounting for more than 70%. Many people therefore ask: How high does blood pressure have to be before medication is needed to control it? There are many hypertension drugs on the market, which one should I take? my country has a vast territory. Are there regional differences in the prevalence of hypertension? In response to these questions and confusions, Professor Gong Yongtai, a member of the Youth Work Committee of the Heart Failure Professional Committee of the Chinese Medical Association and director of the Intensive Care Unit of the Department of Cardiovascular Medicine, Qunli Campus of the First Affiliated Hospital of Harbin Medical University, gave professional interpretations and reasonable suggestions.

How to control the timing of starting medication for hypertension

Professor Gong Yongtai introduced that in late August this year, the World Health Organization (WHO) released the "WHO Guidelines for Drug Treatment of Hypertension in Adults". The guidelines clearly recommend the following three points: for individuals diagnosed with hypertension, with systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg, start taking antihypertensive drugs; for individuals with cardiovascular disease and systolic blood pressure of 130-139 mmHg, take antihypertensive drugs; for individuals without cardiovascular disease but with high cardiovascular risk, with diabetes or chronic kidney disease and systolic blood pressure of 130-139 mmHg, take antihypertensive drugs.

So, is it better to lower blood pressure as much as possible? Director Gong explained that, generally speaking, for people with severe vascular stenosis, such as patients with multiple coronary artery stenosis, bilateral neck stenosis greater than 75%, intracranial vascular stenosis, and elderly people over 80 years old with arteriosclerosis and pulse pressure difference greater than 100 mmHg, if their blood pressure drops suddenly (such as <100/70 mmHg), it may cause organ ischemia, induce or aggravate the condition, and lead to worse consequences.

In daily life, how can we identify whether our blood pressure has dropped too much, resulting in insufficient blood supply to organs? Gong Yongtai suggests that when blood pressure is less than 100/70 mmHg, we should observe the following phenomena: whether we feel dizzy, sleepy, and yawn constantly; for people with coronary heart disease, whether we feel chest tightness, and the number of precordial pains has increased more than before; for people with cerebrovascular disease, whether we have transient limb numbness or difficulty speaking or moving; whether we drink as much water as usual, but the urine volume has decreased significantly, and the blood creatinine has increased significantly. When the above symptoms and signs appear, we should be fully alert to whether the blood supply to the heart, brain, kidneys and other organs has dropped sharply due to the "slippery" blood pressure, and we need to correct it immediately.

How does the World Health Organization recommend antihypertensive drugs?

Professor Gong first explained that the World Health Organization's treatment guidelines are different from those in Europe and the United States. They are applicable to both developed and developing countries. They are a medication program that focuses more on the application of guidelines at the grassroots level, providing accessible blood pressure reduction methods for economically underdeveloped populations. Its purpose is to achieve "medical equity" for hypertensive patients. In the blood pressure reduction program, most of the recommended drugs are proven to be effective, safe, and have cardiovascular, cerebrovascular and renal protective drugs through clinical trials.

In the WHO hypertension medication guide, it is recommended to give priority to the combination of drug regimens for hypertension control: it can be A+C or A+D (A refers to RAS inhibitors, such as prils or sartans, C refers to calcium ion antagonists, and D refers to diuretics), but other combination regimens of the five major drug categories can also be used. Director Gong Yongtai explained: Specifically, it is recommended to use half the dose (half a tablet) of a single-tablet compound preparation (meaning that one tablet contains two drug ingredients) at the beginning of initial treatment. If tolerated, it can be increased to one tablet. If blood pressure still cannot reach the target, it is recommended to use three antihypertensive drugs in combination, and generally a single-tablet fixed combination preparation of A+C+D can be selected.

The above-mentioned single-tablet fixed compound preparations often have superimposed antihypertensive effects, offset side effects, good compliance and sustained efficacy, and the price of one tablet is lower than that of two tablets, which has a good price-performance ratio. Therefore, it has been highly praised by the World Health Organization. If the three-drug combination regimen still cannot achieve the target blood pressure, it is recommended to add spironolactone (if it cannot be tolerated, use amiloride or other diuretics in larger doses), or α-receptor blockers, B-blockers, and clonidine. It should be pointed out that the World Health Organization does not recommend the combined use of two RAS inhibitors.

Antihypertensive treatment should fully take into account individual

Gong Yongtai believes that the drug regimen recommended by the WHO is a universal drug regimen, and "individualization" must be fully reflected in clinical practice. Although the "Guidelines" recommend the combination regimen from the beginning, for elderly people over 80 years old and frail, newly diagnosed hypertension patients with systolic blood pressure below 150 mmHg, and those with orthostatic hypotension, they can consider taking a single drug (one drug) first.

During medication, different people react differently to drugs, so there should not be the wrong understanding that "he takes it well, so I have to take it too". Professor Gong warned that if there are people with postural (standing) hypotension, do not use rapid antihypertensive drugs. After taking the medicine, you must go from lying to standing slowly to avoid falling after suddenly standing up. For the elderly with carotid artery sclerosis or plaques, calcium ion antagonists are recommended first; for obese people with diabetes, angiotensin converting enzyme inhibitors or sartans are the best choice; and for middle-aged people with fast heart rate (resting heart rate greater than 80 times) and high low blood pressure, and patients with coronary heart disease and heart failure, B-blockers are recommended. Many people worry that this type of drug will slow the heart rate too much. In fact, it is very safe to have a heart rate of more than 55 times during the day.

As for patients with hypertension, about 70% need to take two drugs. From the perspective of high compliance and simple and convenient medication, taking a single fixed combination tablet will be more effective than taking two tablets.

Is the prevalence of hypertension higher in cold-region populations?

In fact, environmental factors are also one of the important factors affecting blood pressure levels. Director Gong Yongtai explained that lower ambient temperatures can cause blood pressure to rise within hours to days. Although the increase in individual blood pressure is limited (5-15 mmHg), from a broader perspective, the blood pressure levels of billions of people around the world are disturbed by cold temperatures every day, contributing to the frequent occurrence of hypertension and related diseases.

Population and climate studies over the past few decades have shown that blood pressure levels are negatively correlated with ambient temperature. A survey of more than 500,000 Chinese people showed that for every 10°C drop in ambient temperature, systolic blood pressure levels increased by 5.7 mmHg; further analysis found that systolic blood pressure levels in winter were about 10 mmHg higher than in summer. A research project in Michigan, USA, included more than 2,000 cardiac rehabilitation patients. Multivariate regression analysis confirmed that 1-7 days before admission, when the outdoor temperature dropped to an average of 10.7°C, systolic blood pressure levels increased by about 3.6 mmHg.

A recent multicenter study in China included 23,000 patients with cardiovascular disease and followed them up for 7 years. It was found that blood pressure levels in winter were significantly higher than in summer. When the ambient temperature was below 5°C, the systolic blood pressure level increased by about 6.2 mmHg for every 10°C drop in temperature. Regression analysis found that the mortality rate of cardiovascular events in winter was about 41% higher than in summer. Other scholars have also found that the prevalence of new hypertension in the rural population in Zhejiang Province, my country, with an average age of 52.3 years, was as high as 14.1% in winter compared with the highest temperature in July, while the hypertension control rate dropped to 13.0%.

Other population studies from the Netherlands and Italy have also reached similar conclusions. Therefore, Director Gong Yongtai particularly emphasized that people in cold regions should pay attention to keeping warm, improve their diet and lifestyle, and actively monitor and control their blood pressure to reduce the potential risks of hypertension and related diseases. (Yi Xiaofeng)

Brief introduction of Gong Yongtai****Chief Physician

Doctor of Medicine, Chief Physician of Cardiology, Researcher, and Master Supervisor. Member of the Youth Work Committee of the Heart Failure Professional Committee of the Chinese Medical Association, member of the Oncology Cardiology Group of the Cardiovascular Physician Branch of the Chinese Medical Association, and instructor of the National Interventional Diagnosis and Treatment Training for Cardiovascular Diseases and Coronary Heart Disease Intervention Training. He has accumulated rich experience in the field of interventional treatment of complex coronary artery lesions. He won the first prize in the China region of the 8th "Annual Wonderful TRI Case Competition" and the national finals champion of the 3rd "Complex Lesion Case Competition Most Educational CTO Case". He presided over 2 National Natural Science Foundation projects, published 11 SCI-indexed articles as the first author or corresponding author, published 2 translated works (deputy translator-People's Medical Publishing House), and won 2 second prizes for scientific and technological progress in Heilongjiang Province. He was selected as the academic backbone of the first batch of "Head Goose" team of the Heilongjiang Provincial Government.