Which high blood pressure medicines should not be taken first?

Many patients with hypertension accidentally discover abnormal blood pressure during physical examinations or treatment of other diseases. After diagnosis, they often want to take medication immediately, fearing that the condition will become serious and lead to cardiovascular problems. In fact, some people with hypertension do not need to take antihypertensive drugs in a hurry.

First of all, patients need to make it clear whether they meet the three conditions.

First, the blood pressure is only slightly elevated (140/90 mmHg ≤ actual measured blood pressure <160/100 mmHg) and it is the first time the condition is discovered.

Second, there are fewer than two risk factors, specifically: men > 55 years old, women > 65 years old; smoking or passive smoking; impaired glucose tolerance (often prediabetes); dyslipidemia; family history of premature cardiovascular disease; central obesity (abdominal fat).

Third, the following complications are not present: left ventricular hypertrophy shown on ultrasound; carotid artery atherosclerotic plaques; microalbuminuria or elevated blood creatinine; heart disease or cerebrovascular disease, such as coronary heart disease, myocardial infarction, cerebral infarction, atrial fibrillation, etc.; kidney disease; peripheral vascular disease; retinopathy; diabetes.

If the above conditions are met, after the diagnosis of hypertension, non-drug treatment should be carried out first by improving eating habits, environmental factors, etc. If the blood pressure is still high after 3 to 6 months, drug treatment can be considered. For moderate and severe hypertension patients with systolic blood pressure greater than 160 mmHg and diastolic blood pressure greater than 100 mmHg, drug antihypertensive treatment should be received immediately after diagnosis.

"Reasonable diet + regular exercise" is the safest way to regulate high blood pressure. You may wish to start from the following aspects.

Limit salt intake. The Dietary Guidelines for Chinese Residents (2016) recommends that the daily salt intake per person should be less than 6 grams. Hypertensive patients should eat a light diet, and low-sodium salt is recommended. You can prepare the 6 grams of salt per person per day in advance and supply it in a fixed amount. Eat as little pickled food and marinated products as possible. When cooking kelp, seaweed and other seafood, do not add extra salt. When dining out, dishes are often high in salt, so rinse them with water to remove some salt.

Exercise regularly and control your weight. Regular exercise helps obese hypertensive patients control their weight. It is best to ensure 3 to 5 medium-to-high-intensity aerobic exercises per week, such as brisk walking, cycling, Tai Chi, etc. Try to persist for more than 30 minutes each time and no more than 1 hour. However, it should be reminded that patients need to ensure that their blood pressure levels are relatively stable before exercising; if the blood pressure is too high, such as more than 180/120 mmHg, do not exercise temporarily to avoid cardiovascular and cerebrovascular accidents. In addition, try not to exercise in the morning.

Eat a balanced diet, quit smoking and limit alcohol intake. Avoid excessive intake of high-fat and high-oil foods. You can appropriately increase the intake of potassium-rich foods such as soy products, bananas, and apples, and eat "one pound of vegetables and half a pound of fruit" every day. Hypertensive patients are best to quit smoking and limit alcohol intake to avoid damage to the cardiovascular system.

It should be noted that early hypertension is hidden and does not cause pain or other discomfort, so it is not easy to arouse alarm. For healthy middle-aged and elderly people, if they experience unexplained dizziness, headache, high intraocular pressure and other symptoms, they should consider the possibility of hypertension. It is best to measure blood pressure in time to be alert and prevent blood pressure problems. Home self-testing is an important auxiliary means of hypertension treatment. If you are over 35 years old, it is best to measure your blood pressure every 3 to 6 months. If you already have hypertension, it is recommended to measure 1 to 2 times a day.

Generally speaking, a normal person's blood pressure will fluctuate throughout the day. During the day, blood pressure fluctuates at a higher level, and gradually decreases after 8 p.m. until 2-3 a.m., when blood pressure drops to the lowest level. In the early morning, blood pressure may rise sharply. If you measure it yourself, be sure to find the right time and measure it at the same time every day.

Hypertension is a cardiovascular syndrome caused by multiple causes and in a state of continuous progression. It can lead to changes in the structure and function of the heart and blood vessels, and even damage the brain, kidneys, and eyes. Therefore, hypertensive patients should go to a regular hospital for heart, kidney, and fundus examinations every six months, which will help to understand the severity of hypertension, facilitate timely adjustment of treatment plans, and rationally choose antihypertensive drugs such as calcium antagonists, beta-blockers, sartans, prils, and diuretics.

Patients do not need to worry about becoming "addicted" to antihypertensive drugs. For the sake of health, this is a necessary treatment and should not be rejected. (Zhang Mingyu, chief physician of the Department of Cardiology, the Fourth Affiliated Hospital of Harbin Medical University)