Analysis of Ideal Blood Pressure Control Targets and Principles of Antihypertensive Treatment
How low should blood pressure be lowered?
Numerous studies have shown that starting from 110/75 mmHg, there is a continuous positive correlation between elevated blood pressure levels and cardiovascular disease risk. After antihypertensive treatment, the lower the blood pressure, provided the patient can tolerate it, the lower the risk of cardiovascular and cerebrovascular events. For ordinary hypertensive patients, blood pressure should be lowered to at least below 140/90 mmHg; for young people, or patients with diabetes, kidney disease, or stable coronary heart disease, blood pressure treatment should be more individualized, generally lowering it to below 130/80 mmHg. Blood pressure after a stroke should also generally be lowered to below 140/90 mmHg. For the elderly, systolic blood pressure should be lowered to below 150 mmHg, and if tolerated, further reduction is possible, but it should not be lower than 120/70 mmHg.
What are the principles of using antihypertensive drugs?
The purpose of using antihypertensive drugs is to minimize the damage caused by hypertension. Therefore, the vast majority of people need to take medication for life. The principle of antihypertensive drug use is to lower blood pressure steadily and effectively, avoiding large fluctuations in blood pressure, and minimizing or avoiding adverse reactions. Therefore, the following principles should be followed when using antihypertensive drugs:
(1) Start with a small dose. If effective but not achieving the expected effect, the dose can be gradually increased. The goal is to achieve optimal efficacy while minimizing adverse drug reactions.
For patients with grade 2 or higher hypertension, a standard dose can be used initially.
(2) Use long-acting drugs whenever possible: To effectively prevent target organ damage, blood pressure should be stable within the target range for 24 hours. Once-daily administration of long-acting drugs with effects lasting 24 hours is strongly recommended. If using intermediate- or short-acting drugs, they should be administered 2-3 times daily.
(3) Combination therapy: Utilize the different characteristics of drugs by administering them in small doses in combination. This reduces adverse drug reactions and increases efficacy. In actual treatment, patients with grade 2 or higher hypertension or hypertensive crisis often require combination therapy with antihypertensive drugs to achieve target blood pressure.
(4) Individualized principle: Select antihypertensive drugs that are suitable for patients based on their specific conditions, tolerance, personal wishes, or long-term tolerance.
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