Scientific Management of Hypertension, a Disease of Modern Life: Basic Understanding, Graded Diagnosis, and Blood Pressure Management Guidelines

Hypertension: Basic Knowledge

1. What is Hypertension? The human heart acts like a pump, pumping blood into the arterial system. The flowing blood exerts pressure on the blood vessels, known as blood pressure. When the heart contracts, it ejects blood into the arteries; the highest pressure generated at this time is called systolic pressure (commonly known as high pressure). When the heart relaxes, the blood pressure in the arteries drops to its lowest value, called diastolic pressure (commonly known as low pressure). The difference between systolic and diastolic pressure is called pulse pressure. The "Guidelines for the Prevention and Treatment of Hypertension in China" defines hypertension as: a systolic blood pressure ≥140 mmHg and/or a diastolic blood pressure ≥90 mmHg without the use of antihypertensive medication. Blood pressure is measured three times at different times, and the average value is taken. A diagnosis of hypertension is made when the average systolic blood pressure is equal to or greater than 140 mmHg, or the average diastolic blood pressure is equal to or greater than 90 mmHg. The standard way to express blood pressure is with systolic pressure first, followed by diastolic pressure, usually expressed as: Systolic/Diastolic (mmHg) or Systolic/Diastolic (kPa). mmHg is millimeters of mercury, and kPa is kilopascals; the conversion between mmHg and kilopascals is: 1 mmHg = 0.133 kPa. For example, blood pressure 120/80 mmHg (15.96/10.6 kPa).

2. How is blood pressure classified? Based on different blood pressure levels, blood pressure can be divided into the following four categories:

① Normal blood pressure: Systolic pressure <120 mmHg and diastolic pressure <80 mmHg.

② High-normal blood pressure: Systolic pressure 120–139 mmHg and diastolic pressure 80–89 mmHg.

③ Hypertension: Systolic pressure ≥140 mmHg or diastolic pressure ≥90 mmHg.

④ Isolated systolic hypertension: Systolic blood pressure ≥140 mmHg and diastolic blood pressure <90 mmHg. Normal blood pressure is the ideal blood pressure level. People with blood pressure in the high-normal range have a very high probability of developing hypertension in the future, and their risk of stroke or myocardial infarction is significantly higher than those with normal or ideal blood pressure. Although these individuals do not yet need antihypertensive medication, they should monitor their blood pressure changes and improve their lifestyle, such as a reasonable diet, limiting salt intake, controlling weight, and engaging in appropriate exercise, to avoid developing hypertension.

3. How is hypertension classified? Hypertension can be classified into three grades based on blood pressure levels. The higher the blood pressure level, the higher the grade, and the greater the patient's risk. Different antihypertensive drugs are selected and used based on the presence or absence of other risk factors. The purpose of classifying blood pressure and grading hypertension is to rationally select antihypertensive drugs and better assess patient prognosis. Blood Pressure Classification and Hypertension Staging

4. What are the symptoms of hypertension? Hypertension often presents with no symptoms in its early stages, or the symptoms are mild and may only be discovered during a physical examination or blood pressure measurement for other reasons. Some people have relatively low blood pressure but experience many symptoms, while others have high blood pressure but few symptoms. Common symptoms are as follows:

① Dizziness: Dizziness is the most common symptom. It often occurs when suddenly squatting or standing up; some are transient, while others are persistent.

② Headache: Headache is also a common symptom of hypertension, often described as persistent pain or throbbing pain. It frequently occurs upon waking in the morning and gradually lessens after getting up and moving around or after meals. The pain is often located in the temples and occipital region.

③ Irritability, palpitations, and insomnia: Patients may be irritable, sensitive, and easily agitated; insomnia is common, often manifesting as difficulty falling asleep or early awakening, shallow sleep, vivid dreams, and easy startling. ④ Difficulty concentrating and memory loss: Often not obvious in the early stages, but gradually worsens as the condition progresses.

⑤ Numbness in the limbs: Commonly seen in the fingers and toes, or a crawling sensation on the skin, or tension and soreness in the neck and back muscles. Some patients often experience decreased finger dexterity. Generally, improvement is possible with appropriate treatment. However, if the numbness is persistent, long-lasting, and fixed in a particular limb, and accompanied by limb weakness, cramps, or throbbing pain, prompt medical attention is necessary to prevent cerebrovascular disease.

⑥ Bleeding: Less common, such as nosebleeds, conjunctival hemorrhage, retinal hemorrhage, and cerebral hemorrhage.

5. What are the treatment principles for hypertension? The treatment principles for hypertension include the following:

① Adhere to early, active, and long-term treatment;

② Combine non-pharmacological and pharmacological treatments;

③ Combine traditional Chinese medicine and Western medicine treatments;

④ The selection of antihypertensive drugs should be individualized, starting with single drugs and small doses, based on the principles of slow action, long-lasting efficacy, few side effects, and ease of use;

⑤ Combination therapy or compound preparations have synergistic effects and can reduce adverse reactions;

⑥ Unless in an emergency, avoid drastic blood pressure reduction, especially for patients with long-term hypertension or elderly patients with hypertension;

⑦ Generally, once blood pressure is controlled for more than one year, medication can be gradually reduced or the dosage decreased, and a maintenance dose should be taken consistently.

6. What is the purpose of treating hypertension? A persistent state of hypertension will threaten the normal function of many important organs in the body. Its main harm is damage to the heart, brain, kidneys, and blood vessels, as well as the resulting complications in these organs. Therefore, the main goal of hypertension treatment is to minimize the mortality and disability risk associated with cardiovascular and cerebrovascular diseases, and to reduce the occurrence of other complications. It has been proven that effective blood pressure control can significantly reduce the incidence of cardiovascular and cerebrovascular accidents (myocardial infarction, cerebral infarction), lower mortality, and prolong patient life.

7. What blood pressure levels should different hypertension patients maintain?

The current target blood pressure values ​​are as follows:

① For patients with ordinary hypertension, blood pressure should be strictly controlled below 140/90 mmHg.

② For patients with coronary heart disease, blood pressure should be lowered to below 130/80 mmHg.

③ For patients with diabetes and kidney disease, blood pressure should be lowered to below 130/80 mmHg; antihypertensive treatment for diabetic patients should begin at ≥130/80 mmHg.

④ For diabetic patients with ischemic heart disease, blood pressure should be lowered to below 120/180 mmHg.

⑤ For elderly patients, systolic blood pressure should be lowered to below 150 mmHg. If tolerated, it can be further reduced. When diastolic blood pressure is <70 mmHg in the elderly, attention should be paid to signs of insufficient organ perfusion, such as fatigue, dizziness, drowsiness, and transient ischemic attacks.

⑥ For unilateral carotid artery stenosis >70%, systolic blood pressure should not be lower than 130 mmHg; for bilateral carotid artery stenosis >70%, systolic blood pressure should not be lower than 150 mmHg, otherwise the risk of cerebral ischemia will increase. Antihypertensive treatment should strive to achieve these standards. Newly diagnosed patients generally respond quickly to medication, while patients with a long history of the disease often require several weeks to months. Modern antihypertensive drugs have a gradual effect, often requiring 4-5 weeks to reach maximum efficacy. Treatment should consider individual circumstances and, based on the patient's tolerance, aim to lower blood pressure as much as possible.