What is the ideal blood pressure level? A comprehensive analysis of 24-hour stable blood pressure control.

What is the appropriate blood pressure level to aim for?
Once hypertension is diagnosed, blood pressure should be controlled as much as possible within the normal range. For young, mildly hypertensive patients, blood pressure should be controlled below 135/85 mmHg, and for elderly patients, below 140/90 mmHg; those with isolated systolic hypertension should also have their systolic blood pressure controlled below 140 mmHg.

Studies show that for every 5 mmHg reduction in diastolic blood pressure, the patient's mortality rate is significantly reduced by 32%, stroke by 44%, diabetic complications by 24%, and microvascular complications by 37%. Experts have found that the lowest blood pressure group has a significantly reduced incidence of cardiovascular events and the slowest rate of renal function decline. Therefore, the ideal blood pressure control target is 130/80 mmHg.

Treatment for hypertension is lifelong. Even if blood pressure is controlled within the ideal range, antihypertensive treatment should not be stopped to prevent potential dangerous complications.

How can blood pressure be kept stable throughout the day? This is a question that every hypertensive patient is very concerned about, and it is also something that clinicians have been striving to achieve. 24-hour ambulatory blood pressure monitoring has now become an important indicator for diagnosing and evaluating the effectiveness of treatment in hypertensive patients.

Observations have shown that patients with mild to moderate essential hypertension have two blood pressure peaks and two troughs in a 24-hour period: the lowest point is between 1 and 2 a.m., after which blood pressure gradually rises; the first peak is between 6 and 8 a.m., after which it begins to decline; the second trough is between 12 and 1 p.m., after which blood pressure begins to rise again; the second peak is between 6 and 8 p.m., which is also the highest point of the day, after which blood pressure gradually decreases again.

We all know the dangers of hypertension and its complications; the higher the blood pressure, the more severe the complications. In recent years, medical experts have noted the relationship between nighttime blood pressure and complications. Hypertensive patients whose nighttime blood pressure drops by more than 10% are considered to have a "dipper" blood pressure pattern, while those whose nighttime blood pressure drops by less than 10% have a "non-dipper" pattern. Many studies have shown that the incidence of cardiovascular and cerebrovascular complications is much lower in those with a dipper pattern than in those with a non-dipper pattern. This actually indicates that nighttime blood pressure is closely related to hypertensive complications.

We often see this phenomenon: some patients, despite diligently taking their medication, still experience acute cardiovascular and cerebrovascular events. These phenomena occur for two reasons: first, the use of short-acting antihypertensive drugs, and second, failure to administer medication according to the pattern of blood pressure fluctuations. Short-acting antihypertensive drugs only last for a few hours, and by early the next morning, the drug concentration in the blood is very low or even absent. Combined with not taking medication promptly, the first peak blood pressure in the morning cannot be controlled.

To maintain stable blood pressure throughout 24 hours, it is essential to administer medication rationally according to the pattern of blood pressure fluctuations and the duration of action of the antihypertensive drugs in the body. It is emphasized that the first dose of medication each day should be taken at 6:00 AM upon waking. If using a medium-acting drug, a second dose should be taken between 5:00 PM and 6:00 PM; if using a short-acting antihypertensive drug, those with elevated blood pressure only during the day should take an additional dose at 12:00 PM and again between 5:00 PM and 6:00 PM; for those with elevated blood pressure at night, it is best to use long-acting or medium-acting antihypertensive drugs.