The gold standard for hypertension treatment: individualized blood pressure targets and scientific pharmaceutical services.

Hypertension Treatment: Beyond Blood Pressure Reduction – Comprehensive Prevention and Treatment to Protect the Cardiovascular and Cerebrovascular Systems. Treatment of hypertension must consider other risk factors simultaneously. Blood pressure reduction therapy must be individualized. The goal of hypertension treatment is to reduce the overall risk of cardiovascular and cerebrovascular disease incidence and mortality, making it a crucial aspect of cardiovascular and cerebrovascular disease prevention and treatment. Based on current evidence, the target blood pressure for different conditions is as follows: For ordinary hypertensive patients, both systolic and diastolic blood pressure should be strictly controlled below 140/90 mmHg; for patients with coronary heart disease, it should be lowered to below 130/85 mmHg; for patients with diabetes and kidney disease, it should be lowered to below 130/80 mmHg; for diabetic patients with ischemic heart disease, blood pressure should be lowered to below 120/80 mmHg; for elderly patients, systolic blood pressure should be lowered to below 150 mmHg, and 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; 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 increases.

Antihypertensive treatment should strive to achieve the above standards. New patients generally respond quickly to medication, while older patients often require several weeks to months. Modern antihypertensive drugs have a gradual effect, often requiring 4-5 weeks to reach peak efficacy. Treatment should be tailored to individual circumstances, observing responses and adjusting blood pressure as much as possible based on patient tolerance, as blood pressure above 115/70 mmHg already begins to damage the cardiovascular system. Non-pharmacological treatments include promoting a healthy lifestyle, eliminating behaviors, habits, and diets detrimental to mental and physical health, thereby reducing the risk of hypertension and other cardiovascular diseases.

The basic principles of antihypertensive drug treatment: Primary hypertension is mostly a lifelong condition. In the early stages (blood pressure 140-150/90-94 mmHg), non-pharmacological measures (salt restriction, weight loss, smoking cessation, alcohol restriction, dietary adjustments, appropriate exercise, mental and emotional well-being, and sufficient sleep) should be implemented first, with close monitoring of blood pressure for 3-6 months. If blood pressure still cannot be lowered to normal (<140/90 mmHg), drug treatment should be initiated. The common function of antihypertensive drugs is to lower blood pressure; all antihypertensive drugs, when taken at the recommended dosage, will have roughly the same blood pressure-lowering effect. However, the rate of blood pressure reduction, the stability of blood pressure reduction, the duration of blood pressure reduction, and the rebound effect of missed doses or discontinuation of medication often vary. The frequency, severity, and duration of side effects also differ. Recent guidelines for the prevention and treatment of cardiovascular and cerebrovascular diseases and their risk factors have begun to emphasize individual differences in these medications, the long-term preventive and therapeutic advantages of new antihypertensive drugs, and their importance in developing individualized hypertension treatment plans for patients. The principles of drug treatment are as follows:

1. Select drugs proven effective by evidence-based medicine. Choose the most effective drugs proven through appropriate research, that is, drugs proven to be highly effective, low in toxicity, inexpensive, and easy to take through large-scale, prospective, multicenter, randomized, controlled, double-blind, long-term follow-up observations based on evidence-based medicine.

2. Treatment should be based on risk stratification and risk level. Different treatment plans should be developed for each patient based on their risk level. In low-risk cases, lifestyle modifications should be the primary focus, with observation for 6 months; in intermediate-risk cases, observation for 6 months is recommended, and if not controlled, medication should be started; in high-risk cases, drug treatment should be started immediately; in very high-risk cases, strong antihypertensive therapy should be started immediately.

3. Individualized principle. When selecting medication, the principle of individualization must be followed. Drugs should be chosen rationally and cautiously based on the patient's age, the physiological function of vital organs (liver and kidney function), and coexisting diseases.

4. Use long-acting drugs whenever possible. Because fluctuations in blood pressure can reduce the effectiveness of antihypertensive cardiovascular protection, long-acting, sustained-release, or controlled-release formulations should be chosen whenever possible.
5. Most people require combination therapy. When the efficacy of a single antihypertensive drug is unsatisfactory, two or more drugs should be used in combination therapy depending on the condition.

Commonly used antihypertensive drugs in clinical practice. Currently, commonly used antihypertensive drugs mainly fall into five categories: calcium channel blockers, diuretics, beta-blockers, angiotensin-converting enzyme inhibitors (ACEIs), and angiotensin II receptor blockers (ARBs). Older antihypertensive drugs are gradually being phased out due to their numerous side effects.

1. Calcium channel blockers. By inhibiting calcium channels in myocardial and vascular smooth muscle cells, they reduce calcium entry into the cells, causing these tissues to lack the calcium needed for contraction, thereby dilating blood vessels and lowering blood pressure. These drugs effectively reverse left ventricular hypertrophy and increase perfusion to the brain, heart, and kidneys. They also have varying degrees of effects such as dilating coronary arteries, reducing pulmonary hypertension, antiarrhythmic effects, antiplatelet aggregation, and protecting the vascular endothelium. Therefore, they are more suitable for elderly hypertensive patients with coronary heart disease, coronary artery spasm, nocturnal angina, and chronic obstructive pulmonary disease.

2. Diuretics. Diuretics have a mild and long-lasting antihypertensive effect and are inexpensive and readily available. Elderly hypertensive patients, especially those with reduced sodium and water balance and decreased renal function, are prone to sodium and water retention and generally respond well to diuretics. As a combination therapy for antihypertensive diseases, low-dose adjuvant or intermittent use of diuretics is safer and more reasonable, particularly suitable for isolated systolic hypertension. Commonly used diuretics include potent (e.g., furosemide), moderate (e.g., thiazides), and weak (e.g., spironolactone).