Hypertension can increase the risk of some cardiovascular complications, such as stroke, coronary heart disease and congestive heart failure. Effective treatment of hypertension can significantly reduce the incidence of cardiovascular events, complications and mortality. But the treatment of hypertension is a complex task, and it is also very difficult to make clear what is hypertension. In recent years, more and more evidence shows that lower blood pressure is also dangerous, which changes our understanding of optimal blood pressure.
Existing studies have shown that diastolic blood pressure is no longer the main determinant of blood pressure, systolic blood pressure and pulse pressure have replaced diastolic blood pressure as the main determinant of blood pressure. Evidence suggests that systolic blood pressure, pulse pressure and diastolic blood pressure are all part of the blood pressure characteristics of patients, and the age of patients determines the relative importance of these three measurements. Recent analysis shows that diastolic blood pressure is still the strongest predictor of cardiovascular events in people younger than 50 years old; in people younger than 60 years old, systolic blood pressure and diastolic blood pressure have the same predictive value for cardiovascular events, but ≥ Systolic pressure and pulse pressure are the most important predictors of mortality and complications of cardiovascular disease in people aged 60. In this age group, increased pulse pressure is the most important risk factor, but it is almost always accompanied by systolic hypertension. If systolic blood pressure > 120 mmHg and remains unchanged, the risk increases with the increase of pulse pressure (at this time, diastolic blood pressure decreases). In patients over 60 years old, systolic blood pressure was positively correlated with risk, while diastolic blood pressure was negatively correlated with risk. At a certain systolic blood pressure, the lower the diastolic blood pressure, the greater the risk of cardiovascular disease. The reason why diastolic blood pressure is negatively correlated with the risk of cardiovascular disease is that the physiology of cardiovascular system changes with age. From middle age, the aorta gradually becomes stiff, systolic blood pressure increases and diastolic blood pressure decreases. The parallel increase of systolic and diastolic blood pressure can reflect the increase of peripheral vascular resistance.
Prevention is the most effective way to deal with hypertension. In general, about 41% of the people whose blood pressure is higher than the normal high limit (systolic blood pressure 130-139 mmHg or diastolic blood pressure 85-89 mmHg) will develop into long-term hypertension within four years. Therefore, people with blood pressure higher than the normal high limit should also receive antihypertensive treatment.
Lifestyle change is an appropriate way to reduce the risk of blood pressure related cardiovascular events. Regular exercise (at least 3 times a week, 30 minutes each time), low-fat, high fiber diet, especially more fruits and vegetables, can reduce systolic blood pressure by 8 mmHg and diastolic blood pressure by 3 mmHg. Reducing sodium intake by 44 mmol every 24 hours can reduce diastolic blood pressure by 0.9 mmHg and systolic blood pressure by 1.7 mmHg.
The best treatment for hypertension (hot) studies have shown that although diastolic pressure drop to ≤ 80 mmHg does not further reduce the risk of cardiovascular events. However, severe cardiovascular events (myocardial infarction, stroke or death due to cardiovascular disease) did not increase, even when diastolic pressure drop reached 70 mmHg. Its clinical significance is that if active treatment of systolic hypertension leads to a decrease in diastolic blood pressure, even if the diastolic blood pressure drops to 70 mmHg is safe.
Studies have shown that systolic blood pressure should be reduced to < 150 mmHg and diastolic blood pressure should be reduced to < 90 mmHg for patients with hypertension at all stages. JNC VI suggested that most patients with stage 1 systolic hypertension should start drug therapy if the change of lifestyle can not reduce the systolic blood pressure below 140 mmHg. Patients with stage 2 and stage 3 hypertension should start drug therapy immediately. JNC IV suggested that SBP should be maintained at < 140 mmHg and DBP should be maintained at < 90 mmHg.
For patients with diabetes, blood pressure should be strictly controlled. UK Prospective Diabetes Study (UKPDS) and hot study pointed out that systolic blood pressure should be reduced to 140 mmHg and diastolic blood pressure should be reduced to 80 mmHg. Strict control of blood pressure can reduce diabetes related complications and mortality. Whether lower blood pressure is suitable for patients with type 2 diabetes remains to be further studied.
Previous studies have shown that diuretics and beta blockers can reduce the incidence of cardiovascular events and mortality in patients with diastolic hypertension. JNC Ⅳ suggests that the elderly should not use beta blockers alone, unless the comorbidity requires beta blockers. The elderly can be treated with diuretics first, and they can also choose dihydropyridine calcium antagonists for isolated systolic hypertension. The captopril prevention study (CAPPP) showed that captopril seems to be as effective in reducing the incidence of cardiovascular events as diuretics and beta blockers. However, this study also showed that captopril seems to increase the risk of stroke, while other studies have not reported that angiotensin-converting enzyme inhibitors increase the risk of stroke.
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