According to the risk degree of cardiovascular and cerebrovascular diseases in patients with hypertension, the overall risk degree of patients with hypertension (table 14) is first evaluated, and the patients are judged to be in "low risk", "medium risk", "high risk" or "extremely dangerous" for management.
Table 14 risk stratification of cardiovascular and cerebrovascular diseases in patients with hypertension
① Patients with hypertension and other risk factors or diseases (high-risk and extremely dangerous people) should be treated with drugs immediately.
② For people at moderate risk, monitor blood pressure and other risk factors for several months to get more information, and then decide whether to start drug treatment.
③ For the low-risk population, observe the patients for a long time before deciding whether to start drug treatment.
Specific strategies include lifestyle adjustment, medication, strengthening patients' self-management of blood pressure and improving patients' compliance with treatment.
(2) Adjust lifestyle
A healthy lifestyle is equally important for the prevention and management of hypertension, which cannot be replaced by drugs. It can lower blood pressure, increase drug efficacy, reduce drug dosage and reduce the risk of cardiovascular and cerebrovascular diseases. Therefore, lifestyle adjustment should be implemented for all patients, including those who need medical treatment. These adjustments include weight loss, smoking cessation and alcohol restriction, balanced diet (rich in potassium and calcium, limited in sodium salt) and increased physical activity. See table 15 for the specific requirements of lifestyle adjustment and antihypertensive effect.
Table 15 Specific requirements for lifestyle adjustment and antihypertensive effect
(3) drug therapy
(1) The initial drug dose should be small, starting from the lowest effective dose to reduce adverse reactions. If the response to the low dose of a single drug is good, but the blood pressure is still not controlled, as long as the patient can tolerate it, the dose of the same drug can be increased.
② Proper combination of drugs can achieve the maximum antihypertensive effect and minimize adverse reactions. Usually, the second drug is added in small doses, rather than increasing the dose of the original drug. Both the first and second drugs are allowed to be used in a small dose range, which can better avoid adverse reactions. In this case, you can benefit from a fixed low-dose combination. The effective drug combinations for treating hypertension are: diuretics and β -blockers; Diuretics and ACE antagonists (or angiotensin II antagonists; Calcium antagonists and beta blockers; Calcium antagonists and ACE inhibitors, as well as alpha-blockers and beta-blockers.
③ If the first drug is ineffective or poorly tolerated, you should choose to use different drugs instead of increasing the dosage of the original drug or adding a second drug of the same kind.
(4) Long-acting drugs with efficacy lasting for 24 hours, once a day. The advantage of this drug is that it can help adhere to medication and reduce the fluctuation of blood pressure, thus gently controlling blood pressure and minimizing cardiovascular diseases and target organ damage.
(4) Self-management of hypertension
The specific tasks of hypertension self-management include measuring blood pressure regularly, quitting smoking, losing weight, regular physical exercise, reasonable diet, neuroregulation, taking medicine according to doctor's advice, etc.