The goal of treatment for hypertension patients.
Usually, the higher the blood pressure, the greater the risk of cardiovascular disease. The main purpose of treating hypertension is to minimize the total risk of cardiovascular disease incidence and mortality, prolong life, improve quality of life, and reduce organ damage. It is also necessary to treat all identified reversible risk factors, including smoking, dyslipidemia, and diabetes. While treating hypertension, it is important to reasonably control concurrent clinical conditions.
The blood pressure of ordinary hypertensive patients, including systolic pressure and diastolic pressure, should be strictly controlled below 140/90mmHg; patients with diabetes and kidney disease should reduce it even lower, to below 130/85mmHg, and the systolic pressure of the elderly should be reduced to below 150mmHg, which can be further reduced if tolerable. If self-measuring blood pressure, the systolic pressure during the day should be 10~15mmHg lower than at the clinic, and the diastolic pressure should be 5~10mmHg lower.
However, it doesn’t mean that the lower the blood pressure, the better. If the blood pressure is too low, the incidence of ischemic heart disease or stroke will increase. Even for hypertensive patients without symptoms, active treatment should be provided. Some patients may not have symptoms until they stop taking blood pressure medication, and then experience headaches or discomfort. For these patients, when reducing blood pressure, the process should be slow to allow the patient to adapt to the lowered blood pressure.
Why is it necessary to classify the severity of hypertension patients?
In the treatment of hypertension, factors such as the patient’s blood pressure level, combined risk factors, clinical conditions, and economic situation are taken into account. The more risk factors a patient has, the more severe their condition is. If the patient also has other clinical conditions, their absolute risk of developing major cardiovascular diseases increases, necessitating a stronger response to treat these risk factors. Based on this, hypertension patients can be divided into low-risk, moderate-risk, high-risk, and very high-risk groups. When considering the treatment of hypertension patients, doctors should first examine the patients and assess their risk level to determine which group the patient belongs to, allowing for the selection of appropriate treatment plans.
For high-risk and very high-risk patients, regardless of their economic situation, medication for hypertension and co-existing risk factors and clinical conditions must be started immediately. For patients at moderate risk, observation of the patient’s blood pressure and other risk factors should be done first, including lifestyle interventions. If the systolic pressure is still higher than 140mmHg after 3 to 6 months, medication should be started. For patients at low risk, the observation period is longer, with lifestyle interventions ongoing. If the systolic pressure is still greater than 140mmHg after 6 to 12 months, medication should be commenced.
The treatment for hypertension includes the following three aspects:
- Monitoring blood pressure and various risk factors.
- Changing lifestyle (non-drug treatment). All patients, including those who need or do not need drug treatment, should change their lifestyle. To achieve the purpose of lowering blood pressure, the following measures are taken: losing weight, quitting smoking and limiting alcohol intake, limiting sodium intake, increasing physical activity, and adopting a healthy diet (including eating more vegetables, fruits, and fish, and reducing total fat and saturated fat intake).
- Drug treatment. Lowering blood pressure, controlling other risk factors and clinical conditions.
Studies have shown that a decrease of 10-14mmHg in systolic blood pressure and 5-6mmHg in diastolic blood pressure can reduce the risk of stroke by 20%, coronary heart disease by 16.67%, and overall cardiovascular disease by 33.33%.
