A large number of studies have shown that high blood pressure is a major risk factor for coronary heart disease, and as blood pressure increases, the incidence and mortality of coronary heart disease are on the rise. Research has confirmed that for people under 50 years old, diastolic blood pressure is the main risk factor for ischemic heart disease, while for people over 60 years old, systolic blood pressure is more predictive, and for people over 60 years old, the pulse pressure difference is a major risk factor for coronary heart disease. the most important predictor.
More than 60% of patients with coronary heart disease in my country have hypertension. Research shows that every 20 mmHg increase in systolic blood pressure (or 10 mmHg increase in diastolic blood pressure) increases the risk of fatal coronary events. double. If blood pressure is well controlled and managed, cardiovascular risks can be quickly reduced. If systolic blood pressure drops by 10 mmHg (or diastolic blood pressure drops by 5 mmHg), the risk of cardiac death in middle-aged and elderly people will be reduced by 50% to 60%. However, The blood pressure control compliance rate of patients with coronary heart disease and hypertension in my country is not high. In order to better manage blood pressure and reduce the occurrence of cardiovascular events, patients with coronary heart disease should pay attention to the following four points when managing blood pressure.
1. Blood pressure lowering target value:
my country’s 2018 Guidelines for the Prevention and Treatment of Hypertension recommend that patients with coronary heart disease should lower their blood pressure to 140/90 mmHg. If tolerated, it can be lowered to 130 /80 mmHg, but lowering the diastolic blood pressure below 60 mmHg should be avoided to avoid coronary hypoperfusion. The 2018 European Hypertension Guidelines recommend that, as tolerated, blood pressure should be controlled at 120-130/70-80 mmHg for people younger than 65 years old with coronary heart disease and hypertension, and at 130-140 mmHg for patients over 65 years old. /70 80 mmHg, can be used as a reference.
2. Principles for selecting antihypertensive drugs:
The principle of medication for treating coronary heart disease combined with hypertension is: on the basis of lifestyle intervention, it is necessary to control blood pressure to reduce the burden on the heart, It is also necessary to expand the coronary arteries to improve the blood supply to the myocardium, that is, to "lower blood pressure and protect the heart."
(1) If the patient has no contraindications or intolerance, β-blockers and ACEI/ARB are the first choices, but the combined use of ACEI and ARB is not recommended.
(2) If beta-blockers have contraindications or produce intolerable adverse reactions and there is no left ventricular dysfunction, long-acting non-dihydropyridine CCB (such as diltiazem) can be considered or verapamil).
(3) Diabetes is not a contraindication to the use of beta-blockers, but patients with left ventricular dysfunction, diabetes or chronic renal insufficiency are recommended to use ACEI or ARB.
(4) In view of the anti-angina and anti-atherosclerotic effects of CCB, it is recommended that β-blockers and CCB be used in combination with coronary heart disease patients with stable angina to reduce myocardial oxygen consumption. , reduce angina attacks.
3. Common adverse drug reactions:
(1) ACEI, such drugs include enalapril, benazepril, fosinopril, perindopril, Ramipril, etc., the most common adverse reaction is persistent dry cough. According to literature reports, its incidence rate ranges from 10 to 30%. It has nothing to do with the dose. The symptoms will not be relieved as the medication time is prolonged. Clinically, there have been patients If a cough occurs after taking such drugs, the drug factors are not taken into consideration after seeking medical treatment, resulting in misdiagnosis. Those who cannot tolerate it can switch to ARB, that is, Sartans. The adverse reactions of these drugs for dry cough are significantly reduced. Other adverse reactions include hypotension, rash, occasionally angioedema and dysgeusia. In addition, long-term use of ACEI/ARB may lead to an increase in serum potassium levels, and serum potassium and serum creatinine levels should be monitored regularly. It should be noted that these drugs are contraindicated in women with bilateral renal artery stenosis, hyperkalemia, and pregnancy.
(2) Beta blockers, commonly used include metoprolol, bisoprolol, carvedilol and atenolol. Common adverse reactions include fatigue, cold limbs, agitation, gastrointestinal discomfort, orthostatic hypotension, bronchospasm, aggravation of peripheral circulatory diseases, etc., and may also affect glucose and lipid metabolism. It should be noted that these drugs are contraindicated in patients with second- and third-degree atrioventricular block and asthma. Those who have been using such drugs for a long time should not stop the drug suddenly, otherwise it will cause a rebound in blood pressure and heart rate, induce hypertensive emergency or acute coronary syndrome. When the drug must be stopped, the dose should be gradually reduced.
(3) Peripheral edema, headache, dizziness, fatigue, facial flushing, constipation, hypotension, and gum hyperplasia can be seen in CCB. Individual patients may develop angina, which may be related to hypotension. Long-acting dihydropyridine CCBs should be used; non-dihydropyridine CCBs such as diltiazem and verapamil are contraindicated in patients with second to third degree atrioventricular block and heart failure.
4. Healthy lifestyle:
Patients with hypertension must adhere to a healthy lifestyle from beginning to end, which mainly includes reasonable diet, weight control, smoking cessation and alcohol restriction, moderate exercise, psychological balance, etc. .
(1) Reasonable diet, focusing on limiting salt intake, limiting total calories and nutritional balance. The most important key point of dietary therapy for hypertension is salt reduction. Global cardiovascular disease deaths are attributed to 1.65 million every year. Due to excessive sodium intake, the daily sodium intake of Chinese people is significantly higher than that of people in European and American countries. Therefore, salt intake must be limited to no more than 6g per person per day (after removing the rubber pad from the ordinary beer bottle cap) One capful is equivalent to 6g).
(2) Control your weight and avoid overweight and obesity. For patients with hypertension, you should "pay attention" to three points: pay attention to the difference between actual weight and ideal weight, pay attention to overall fat mass, and pay attention to fat in the whole body. distribution status. On the basis of ensuring the necessary calories every day, body fat can be decomposed through appropriate aerobic exercise. Obese people can lose 5% to 10% of their original body weight within 6 months to 1 year.
(3) Moderate exercise can lower resting blood pressure. The blood pressure-lowering effect of moderate and low-intensity exercise for more than 10 minutes can last for 10 to 22 hours. Long-term regular exercise can enhance the effects of exercise. Therefore, patients with hypertension should pay attention to increasing exercise, but patients whose resting blood pressure cannot be well controlled or exceeds 180/110 mmHg are temporarily contraindicated in exercise.
(4) Psychological balance, prevention and relief of psychological stress are important aspects of the prevention and treatment of hypertension and cardiovascular disease. There are always unsatisfactory things at every stage of life. For work and life pressure, it is necessary to find the right one. The excretion port can be solved by chatting with friends more, exercising more, etc. I am Nankai Pharmacist Liu, welcome to follow me.