Bai Chief Physician, Yancheng Hospital of Traditional Chinese Medicine, Jiangsu Province
Dad's 70th birthday is coming. After summing up, the filial children and grandchildren decided to give their father a special gift-take him to the hospital for a thorough health check-up so that he can enjoy his old age healthily.
In the consulting room, I received my father and his grandson Daming. After a check-up, I said to my father, "Dad, your blood pressure is always high, but on the whole, your health is good and rare."
"I have high blood pressure?" Dad was surprised.
"Yes, your old diastolic blood pressure is 70 mm Hg, but the systolic blood pressure is 170 mm Hg, which is greater than the standard value 140 mm Hg. You are suffering from simple systolic hypertension and need some treatment. " I'm sure.
"Can't the systolic blood pressure of the elderly be higher?" Daming interjected: "I remember hearing people say that the standard value of normal systolic blood pressure will increase by 10 units for people over 40 years old. Doctor, my grandfather, he just has a high systolic blood pressure. Does he need medication? "
"Daming, it seems that you usually pay great attention to learning medical knowledge." I nodded and said to Daming, "However, the idea that the standard systolic blood pressure can increase with age is quite old. The latest medical point of view is that the elderly like your grandfather, even if it is simple systolic hypertension, need active treatment. " Daming bowed his head at my words and said nothing more.
Dad said disapprovingly, "this medical thing is the same every day, and I can't tell which one to believe." My own body knows. It's good. What medicine to take! Let your blood pressure be high! "
"This is wrong. Some people have good physical fitness, even if they have some minor problems, they will not be reflected for a while. However, if we take it lightly, our condition will get worse, and minor illnesses will become serious illnesses. You can't always take it lightly! At present, the number of patients with hypertension in China has exceeded 654.38+0 billion, making it a major hypertension country in the world. Among them, hypertension in the elderly accounts for 60% ~ 70%. Systolic hypertension like you is a common type of hypertension in the elderly. This kind of isolated systolic hypertension accounts for 6% in people aged 60-69, 65,438+02% in people aged 70-79 and 65,438+09% in people aged 80-90. In other words, the older you get, the higher the incidence of isolated systolic hypertension. " I tried my best to convince my father, but his stubborn temper seemed to come back and he refused to take medicine for treatment anyway. At that time, the two of us were arguing, and the clinic was in an awkward position.
"What is the main harm of hypertension to the health of the elderly?" Daming looked at me, then at his father, and asked a very important question carefully, which pulled me out of embarrassment. I said, "One of the most dangerous factors of hypertension is to cause a stroke, which is what we often call a stroke, which is five times the incidence of myocardial infarction. Every year in China, the number of stroke patients caused by hypertension reaches 1 0.5 million, and about110,000 people die here. 75% of those who survive will lose their labor force, and 40% of them will be severely disabled. "
"Is it so serious?" Dad was surprised. He almost cried.
"It's really serious!" There is no doubt that I said to my father: "The current situation of hypertension in the elderly in China is high incidence, high disability rate and low control rate. According to the statistical report of the Ministry of Health and the Chinese Academy of Preventive Sciences, although more than 80% of elderly hypertensive patients over 65 know their condition, most of them do not pay enough attention to it and refuse to receive medication. The control rate of hypertension is only 28%. Therefore, some people say that the control of systolic blood pressure in elderly hypertensive patients is facing severe challenges, which is very reasonable. " At this point, my father stopped talking. Maybe he is reassessing his decision.
"Doctor, how can my grandfather's upper pressure (systolic pressure) and lower pressure (diastolic pressure) differ so much? There are as many as 100. Is there any problem? " Daming asked me anxiously.
"That's a good question. Understanding this problem is very beneficial to enhance the awareness of antihypertensive fitness for the elderly. " I explained to them through the topic: "The difference between the upper pressure and the lower pressure is called pulse pressure. The pulse pressure of elderly hypertensive patients is closely related to the risk of illness. Someone has done experiments. When the systolic blood pressure is constant at 65438 0.60 mm Hg, the incidence of cardiovascular events in patients with low diastolic blood pressure (such as 75 mm Hg) is higher than that in patients with high diastolic blood pressure (such as more than 90 mm Hg), and the incidence of cardiovascular events increases by 65438 0.2% after two years. This shows that the greater the pulse pressure, the greater the risk of hypertension. According to the analysis, the risk of cardiovascular events in elderly hypertensive patients with pulse pressure greater than 70 mm Hg is several times higher than that in patients with pulse pressure less than 50 mm Hg. When systolic blood pressure is greater than160mmhg and diastolic blood pressure is less than 70mmhg, the mortality rate of patients is the highest. Therefore, some medical experts regard systolic blood pressure and pulse pressure as strong predictors of mortality. "
"What is the reason for the increase of pulse pressure in our elderly people?" Dad chimed in.
"The increase of systolic blood pressure and pulse pressure in the elderly is actually the result of the increase of aortic hardness in the elderly. Under normal circumstances, the aorta can buffer the flow fluctuation and pressure fluctuation caused by left ventricular ejection, so that the peripheral vascular pressure will not rise too high during systole and will not drop too low during diastole. When the stiffness of the aorta increases, the adaptability decreases and the expansibility decreases, its buffering function will inevitably decrease, which will inevitably lead to an increase in systolic blood pressure and a decrease in diastolic blood pressure, thus increasing pulse pressure. "
"So, what medicine should I take?" Dad asked with concern that he had decided to receive treatment, which made Daming and I very happy.
"Don't worry, listen to me slowly. Doctors found in large-scale clinical trials of systolic hypertension in the elderly that the use of calcium antagonists, such as nifedipine sustained-release tablets, lacidipine and Mailuopu, can reduce the risk of stroke in the elderly by 42%, coronary heart disease by 26%, heart failure by 29% and all cardiovascular risks by 365,438 0%. Angiotensin converting enzyme inhibitors, such as captopril, enalapril and Lotensin, can also effectively reduce systolic hypertension in the elderly. In addition, angiotensin receptor antagonists, such as Devin and Irbesartan, are a little expensive, but they can effectively reduce systolic hypertension in the elderly, improve vascular endothelial function and correct abnormal vascular structure and function, thus effectively reducing the occurrence and death of cerebrovascular events. For dad, I think you can take 1 tablet Baixintong every day, then come to the clinic frequently to measure your blood pressure, and then adjust the medicine and dosage according to the reaction and effect after taking the medicine. "
I wrote a prescription, and Daming helped my father. Half an hour later, they came back again.
I was about to speak when my father said, "Doctor, thank you for giving me such a vivid health lesson." I will listen to the doctor and take good care of my health in the future. I think I can still live a good life for ten or twenty years. I really appreciate it． "I quickly stood up and said," nothing, dad, this is all I should do. "I also wish you a long and healthy life."
Taking medicine for hypertension is inevitable.
Our reporter Jiang
As we all know, patients with hypertension must take medicine for a long time to stabilize their blood pressure. But suddenly one day, the newspaper published "it is a fact that hypertension is no longer taking drugs for a long time". Do you believe it or not? Wang Lao, who lives in Shenyang, is stumped by such a question. Mr. Wang Lao's wife suffered from hypertension for many years and took medicine for many years. But in February last year, 65438, he saw an advertisement of traditional Chinese medicine in the newspaper, saying that taking this medicine 10 can show obvious curative effect, and taking 1 ~ 2 months can make him recover, so he stopped using this medicine and other antihypertensive drugs. Mr. Wang Lao then wanted to ask the reporter for help.
The reporter dialed the telephone number in the advertisement, and a female doctor told the reporter that this medicine has exact curative effect. Generally, more than 85% of patients can be cured clinically, and this medicine and other antihypertensive drugs can be stopped after taking the medicine for an average of 2 months. In order to convince the reporter, she also cited an example. A 70-year-old man did not take any antihypertensive drugs for 8 months after taking this medicine. When the reporter asked her if this dose of Chinese medicine could really guarantee that her blood pressure would not rebound after not taking medicine for a long time, she said that some of the words in the advertisement were propaganda, and some people might still rebound, so she had to take medicine again for treatment.
In this regard, the reporter interviewed Professor Sun Ningling, a hypertension expert from Peking University People's Hospital. Professor Sun said with certainty that hypertension can't be cured, but it can be controlled by drugs. But at present, there is no large-scale experiment to prove that patients with hypertension can stop taking drugs for a long time. The treatment method is mainly western medicine, supplemented by traditional Chinese medicine. Low-risk patients may be able to lower their blood pressure through traditional Chinese medicine or other means, but individuals cannot represent the whole. It is impossible for middle-risk and high-risk patients to lower blood pressure with traditional Chinese medicine, and only western medicine combined with traditional Chinese medicine can be used.
In addition, experts advise patients not to watch advertisements to take medicine, and advertisements are often suspected of excessive hype. Taking medicine according to the advertisement may not be effective in lowering blood pressure. The second possibility is improper medication, which may cause harm to the body, so take medicine under the guidance of a doctor.