Practice diagnosis and treatment of hypertension

2021-02-05 12:00 AM

When the blood from the heart is pumped into the arteries creating the highest pressure, the reading is called the systolic blood pressure. This is the larger number placed before the marker

Hypertension is a condition in which the pressure of the blood flow to the artery walls is higher than normal. Normally, blood pressure is still slightly increased or decreased slightly depending on the active status of the body. For example, when exercising, jogging ... blood pressure will be slightly higher than when resting, sleeping ... However, the term "hypertension" is used to refer to a condition. normal, meaning that the increase in blood pressure on the artery wall has reached a level that is much higher than normal. Hypertension happens to anyone, but the incidence of it is often higher in men than in women and occurs in middle age to old age more than in younger people. A lot of people have high blood pressure but do not know it, just because there are no regular check-ups, and therefore the disease is not treated,

As mentioned, a normal person's blood pressure fluctuates as well. When we're running or doing vigorous activity, blood pressure goes up a bit. When we are anxious and stressed, our blood pressure rises. When we smoke cigarettes, drink alcohol ... blood pressure also increases. On the contrary, when we relax, rest, sleep ... blood pressure drops. Because of this natural fluctuation, before measuring blood pressure to a patient who has just arrived from afar, doctors usually recommend that the patient sit or lie down for about 15 minutes so that the blood pressure returns to normal before measuring.

Blood pressure is measured using 2 different readings, in millimetres of mercury, abbreviated as mmHg, but more often just two numbers separated by a bar, such as: 140 / 90.

When blood from the heart is pumped into the arteries creating the highest pressure, the reading is called the systolic blood pressure. This is the larger number placed before the marker.

When the heart stops at rest between contractions, the blood pressure drops to its lowest, the so-called diastolic blood pressure. This is the smaller number placed after the marker. In the above example, the patient's systolic blood pressure is 140 mmHg and the diastolic pressure is 90 mmHg.

Reason

About 90% of patients have an unexplained hypertension, known as primary hypertension. Although there is no obvious cause, high blood pressure is very often associated with factors such as obesity, alcoholism, inactive lifestyle or high levels of anxiety and stress ... Infusion may also be involved, as hypertension is often seen in families where many people already have the disease.

About 10% of people with hypertension have a specific cause, known as secondary hypertension. The most common causes are:

Aortic stenosis (congenital).

Preeclampsia.

Kidney disease.

Adrenal gland disease.

Because some medications, such as birth control pills, have oestrogen known to increase your risk of high blood pressure.

Thyroid disease.

Diabetes.

Diagnose

Hypertension is diagnosed based on blood pressure readings. However, due to the natural fluctuation in blood pressure as mentioned above, the definitive diagnosis must be based on the values ​​of 3 consecutive measurements in 3 days, at 3 different times of day. If these measurements show the same results or the differences are not significant, it can be concluded whether the patient has high blood pressure or not. On the other hand, even when there are conclusions and treatment conducted, regular monitoring of the patient's blood pressure is still a mandatory requirement.

However, if the first measurement shows very high blood pressure with one of the complications of hypertension, such as hypertensive retinopathy, treatment may be immediately considered.

Hypertension usually has no obvious symptoms, only unless it has gotten too high for signs such as headache, shortness of breath, dizziness and visual disturbances. Therefore, the diagnosis of hypertension is mainly based on the detection and monitoring through many periodic blood pressure measurements. People at high risk of high blood pressure such as the elderly, people with kidney disease, alcoholics, obese people ... need to be periodically checked blood pressure to promptly detect and treat. Normal people should also have their blood pressure checked annually to make sure they are still normal.

The determination of hypertension is not entirely the same for each person. For example, in the elderly, the blood pressure tends to be a bit high compared to the young, in people with high shape, blood pressure is also a bit high compared to short people ... And if a person is living in a state of stress. straight, worry, the high blood pressure cannot conclude that there is a disease. The following indicators are for reference only, other associations with high blood pressure as outlined above should be considered.

The blood pressure reading of an adult in normal healthy condition is around 110/75. If the results are measured 3 times in a row for 3 days and at 3 different times, the values ​​are higher than normal but:

Lower than 150/90: No treatment is needed, but should have periodic monitoring and examination.

160/100 higher: Ask patient to have their blood pressure checked 3 times over the next 2 weeks.

150/90 to 160/100: Ask patient to have their blood pressure checked 3 times over the next 3 to 6 months.

Then, if the results from after the fourth measurement give the values:

Lower 150/90: No treatment is needed, but it is recommended that patients have their blood pressure checked periodically.

The diastolic blood pressure (lower index) is regularly kept between 90 and 99, and treatment is needed if one of the high risks of cardiovascular disease is associated with:

Older: from 60 years old.

Drug addiction.

Alcoholism.

High cholesterol.

Have a family history of high blood pressure.

Have diabetes.

If there is no risk of any of the above risks, treatment may not be needed, but blood pressure monitoring should be continued and non-pharmacologic hypotension should be instructed. Follow-up for the next 6 months if it shows that the diastolic blood pressure is higher than above, then drug therapy must be conducted.

Regular diastolic blood pressure is between 100 and 110, and treatment should be initiated if any of the following conditions are present:

Left ventricular hypertrophy is determined by chest radiography (CXR) or electrocardiogram (ECG).

Transient ischemic attack.

Have ever had a stroke, angina, or heart attack.

Renal failure (increased creatinine, proteinuria, haematuria).

Peripheral vascular disease.

Retinopathy caused by increased blood pressure.

If you do not have any of the symptoms of any of the diseases listed above, you may not need treatment but must continue to monitor your blood pressure weekly, and then monthly to detect changes. If then the blood pressure falls below 160/100, it can be identified as mild hypertension and only need to continue monitoring and instructing the patient on non-drug hypotension. If the diastolic blood pressure continues to be above 100, drug therapy should be instituted.

If blood pressure is consistently higher than 160/110, medication should be treated.

If the diastolic pressure is greater than 120 and continues to rise after each blood pressure measurement, potentially malignant hypertension, see a specialist or recommend hospital treatment.

Treatment

Non-pharmacological hypotension measures should be administered to all patients with hypertension or slightly elevated blood pressure, as there are no such side effects as medication. These measures include:

Reduce energy consumption (calories) in daily meals, balanced nutrition properly to lose weight to achieve a moderate, ideal body weight.

Do not drink or minimize alcohol intake.

Reduce the amount of salt you eat at each meal, and try to eat less than usual.

Ability to exercise body, exercise, play sports with strength, can apply methods of exercising body movement regularly such as jogging, cycling ...

Quit smoking.

Reduce the amount of fat in your diet, especially saturated fat and cholesterol.

Drug therapy should be conducted in a stepwise manner, that is, from mild to severe. It is possible to start with a drug of the thiazide group (such as hydrochlorothiazide, bendrofluazide) with the main effect of diuretic, thereby lowering blood pressure. Contraindications to the thiazide group are diabetes and gout.

If the thiazide group is contraindicated or ineffective in lowering blood pressure, one of the drugs of the beta sympathomimetic group (such as atenolol, nadolol ...) can be used. Contraindications to the beta blocker group of drugs are diabetes, heart failure, asthma (asthma), and peripheral vascular disease. In the absence of contraindications, but the drug is not effective in controlling blood pressure, it is possible to use a combination of these two drugs to help increase the effectiveness of lowering blood pressure.

If both groups of drugs are contraindicated or proved ineffective, one of the drugs in the calcium-channel blocker group (calcium-channel blocker) such as nifedipine, verapamil ... or take a drug in the renin-angiotensin system (ACE inhabitor) inhibitor, such as captopril.

In the absence of contraindications but the use of drugs alone that do not provide effective blood pressure control, a combination of all 3 or 4 groups of drugs above may be considered with appropriate doses. The goal of treatment is to lower blood pressure below 150/90.

Regularly check your blood pressure to make sure you know the effectiveness of taking medications. Also, can apply the following combination regimen: If the first group of drugs is not effective, give the second group of drugs. If still not effective, double the dose of the second group of drugs. If still not effective, combine with a third and fourth group of drugs. Consider the possibility of referring the patient to a specialist or recommending hospital treatment.

Some of the following cases also need to consider recommending the patient to hospital treatment or referral to a specialist:

Patients with hypertension at a very young age, under 35 years old, with one or more risks of cardiovascular diseases.

Blood pressure rises suddenly.

Secondary high blood pressure (increased creatinine, proteinuria ...).

Uncontrollable blood pressure, blood pressure continues to rise while taking medication.

Drug therapy should be terminated when it is determined that blood pressure has been consistently maintained below 150/90 and that there are no symptoms of any associated illness. The dose should be reduced gradually before stopping completely.

Patients should have regular blood pressure monitoring after treatment to ensure timely detection of signs of recurrence.