There are three general levels:
First-degree hypertension, where the systolic blood pressure is between 140mmHg and 159mmHg and the diastolic blood pressure is between 90mmHg and 99mmHg.
Grade II hypertension between 160mmHg and 179mmHg. Diastolic blood pressure is between 100mmHg and 109mmHg.
Tertiary hypertension is a systolic blood pressure greater than 180 mmHg and a diastolic blood pressure greater than 110 mmHg. So clinically, we all want our patients to have an ideal blood pressure, which is around 120/80 mmHg.
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(A) Treatment of primary hypertension
1. Treatment objectives and principles
The main goal of hypertension treatment is to achieve blood pressure, and the ultimate goal of antihypertensive treatment is to minimize the incidence of cardiovascular and cerebrovascular disease and mortality in patients with hypertension. Antihypertensive treatment should establish a target value for blood pressure control. On the other hand, hypertension often exists in combination with other risk factors for cardiovascular and cerebrovascular diseases
(1) Improvement of life behavior? ①Reduce and control body weight. ② Reduce sodium intake. ③Supplement calcium and potassium salt. ④Reduce fat intake. ⑤Increase exercise. ⑥ Quit smoking and limit alcohol consumption. ⑦ Reduce mental stress and maintain psychological balance.
(2) Individualization of blood pressure control standard? Due to the different etiology, the pathogenesis of hypertension is not the same, clinical medication is treated separately, and the most appropriate drugs and dosage are selected to obtain the best therapeutic effect.
(3) Synergistic control of multiple cardiovascular risk factors? Although blood pressure is controlled in the normal range after antihypertensive treatment, multiple risk factors other than elevated blood pressure still have an important impact on prognosis.
2. Antihypertensive drug therapy
The recommended antihypertensive drugs for initiation and maintenance therapy should be used in patients with detected hypertension, especially those that can be controlled for 24 hours and achieved by administering them once a day, which should be based on 4 principles, i.e., starting with a small dose, giving preference to longer-acting agents, combining drugs, and individualization.
(1) Types of antihypertensive drugs? ①Diuretics. ② β-blockers. ③Calcium channel blockers. ③Calcium channel blockers. ④Angiotensin-converting enzyme inhibitors. ⑤ Angiotensin II receptor blockers.
The choice of a single drug or a combination of drugs should be based on the patient's risk factors, target organ damage, and comorbid clinical diseases. The principles for selecting antihypertensive drugs are as follows:
1) use blood pressure drugs with half-life of 24 hours and above and capable of controlling blood pressure for 24 hours with a single daily dose, such as amlodipine, to avoid poor control of blood pressure in the early morning of the medical origin due to improper choice of treatment regimen;
2) use drugs that are safe, can be adhered to for a long period of time, and are capable of controlling the blood pressure for every 24 hours, so as to improve the patient's treatment adherence;
3) use medications with good clinical trial evidence of cardio-cerebral benefit and that can actually reduce long-term cardio-cerebral vascular events, reduce cardio-cerebral vascular events, and improve the quality of survival of hypertensive patients.
(2) Treatment options? Most patients without complications or comorbidities can use thiazide diuretics and beta-blockers alone or in combination. Treatment should start with a small dose and gradually increase the dose incrementally. When actually used in clinical practice, the patient's cardiovascular risk factor status, target organ damage, complications, comorbidities, antihypertensive efficacy, adverse effects, etc., will affect the choice of antihypertensive drugs.
(2) Treatment of secondary hypertension
Mainly for the treatment of the primary disease, such as hypertension caused by pheochromocytoma, the blood pressure can be reduced to normal after tumor resection; renal vascular hypertension can be dilated renal artery through interventional therapy. For those whose primary disease cannot be cured by surgery or whose blood pressure is still high after surgery, appropriate antihypertensive drugs should be used for antihypertensive treatment in addition to other treatments for the cause of the disease.
/baike.baidu.com/item/%E9%AB%98%E8%A1%80%E5%8E%8B "target="_blank "title="Only support the selection of a link to take effect when the">Baidu Encyclopedia - Hypertension