High blood pressure care ABCDE

The ABCDE of hypertension care to be discussed in this article is essentially an implementable nursing framework that has been used clinically for more than ten years and has been repeatedly verified by hypertension guidelines in China, the United States, and Europe. The five letters correspond to the five core directions of antithrombotic treatment, blood pressure control, blood lipid control, diet and weight management, and exercise and smoking cessation. There are no complicated thresholds. As long as they are strictly implemented, the risk of cardiovascular and cerebrovascular events (myocardial infarction, cerebral infarction, and cerebral hemorrhage) in patients with hypertension can be reduced by more than 60%.

Let’s first talk about A, which is the easiest to get into trouble, which is Antiplatelet antithrombotic treatment. The most commonly used one is aspirin, which everyone often hears about. I would like to mention here that not all patients with high blood pressure need to take aspirin - there are indeed differences in the recommendations of different guidelines: the European ESC guidelines clearly require that only patients with a 10-year cardiovascular and cerebrovascular event risk of ≥10% and no high risk of bleeding need to take aspirin. Some primary hospitals in China may prescribe it to patients who are diagnosed with high blood pressure. Don't take it blindly. I just met a 62-year-old aunt in the clinic last week. She was just diagnosed with grade 1 hypertension. She has no underlying diseases such as diabetes or hyperlipidemia. The 10-year risk is only 3%. The community prescribed aspirin for two months. She had acid reflux every day. When she came to me, she stopped immediately after asking. After half a month, the acid reflux was gone. There is no need to suffer this problem.

Many people think that for high blood pressure, just controlling blood pressure is enough, but that is totally wrong. So in the second part, let’s talk about C, Cholesterol blood lipid control. There is an Uncle Zhang in the community where I live. He has been hypertensive for 5 years. His blood pressure is usually well controlled, usually around 130/80. Last winter, he suddenly had a myocardial infarction and had a stent inserted. Later, when I looked through his physical examination report, I found that his low-density lipoprotein had been floating around 3.8mmol/L. I asked him why he didn't take statins. He said, "I have high blood pressure and not high blood fat. Taking that thing will hurt the liver." Do you think it's unfair? Nowadays, many patients are indeed afraid of the side effects of statins and would rather take thousands of yuan of "blood vessel clearing" health care products than take medicine. Objectively speaking, as long as the transaminase does not exceed 3 times the normal value during the period of taking, statins are very safe. If you are really intolerant, there are ezetimibe and PCSK9 inhibitors to choose from. Don't just ignore blood lipids. Hypertension + hyperlipidemia will double the speed of blood vessel blockage.

After talking about two easily overlooked points, let’s talk about the core B of the core, Blood Pressure blood pressure control. Don’t think that blood pressure control is just about taking antihypertensive drugs and lowering it to 140/90. There are a lot of things to consider here. The first is the target value. Now there are different views: for patients under 65 years old, we generally recommend trying to lower it to below 130/80mmHg, which will provide the greatest benefit. ； But if you are an elderly person over 80 years old, you don’t need to force it to this value. Lowering it to 140/90 is enough. If it is too low, it will easily lead to insufficient cerebral perfusion, and the risk of dizziness and falls will be much higher. Two years ago, I met a 78-year-old man. He secretly added half a tablet of antihypertensive medicine and lowered his blood pressure to 110/60. When he went out to buy groceries, he fell dizzy, fractured his femoral neck, and lay in bed for three months. It was really not worth the loss. There is also the "priority control of blood pressure in the early morning" that has been particularly advocated by the academic community in recent years. This means that priority is given to controlling the blood pressure measured when you wake up in the morning before you get out of bed or take medicine. It is more effective than measuring your blood pressure randomly several times during the day. After all, 70% of cardiovascular and cerebrovascular events occur between 6 and 10 in the morning.

Don’t think that nursing is all about taking medicine and going to the hospital. The next D, Diet & Weight, diet and weight management are all small things in our lives. Doing it well is more effective than taking half an extra antihypertensive drug. Nowadays, everyone talks about the DASH diet. To put it bluntly, it means eating more whole grains and fresh vegetables, low in sodium and high in potassium, and no more than 5g of salt per day, which is about the amount of a beer bottle cap. Many people say that I don’t add salt to my cooking, so the salt in your soy sauce, pickles, soybean curd, or even takeout food doesn’t count? I once had a young patient who ate a bowl of soybean noodles for lunch every day. It looked like there was no salt in it, but a spoonful of soybean paste contained 3g of salt. This was more than half the daily amount. How could his blood pressure be lowered? The same applies to weight. It is best to control the BMI below 24. The waist circumference should not exceed 90cm for men and 85cm for women. Of course, there are also low-carb diet enthusiasts who say that there is no need to control salt to control weight, just cut off carbon. This is definitely wrong. High sodium itself will cause water and sodium retention to increase blood pressure. Even if you are of normal weight and eat 10g of salt a day, your blood pressure will still be high.

Finally, E, Exercise & Cessation of smoking, exercise and smoking cessation is not to say that it is the least important, but many people think that it is the "icing on the cake". In fact, it is the most cost-effective way of care. You don’t need to run a marathon or do iron training. You just need to get 150 minutes of moderate-intensity exercise every week. Brisk walking, jogging, Tai Chi, and square dancing all count. However, you should be careful not to do strenuous exercise when your blood pressure is not stable (for example, it is still above 160/100). I met a young man who was newly diagnosed with hypertension two years ago. His blood pressure was 180 and he ran 5 kilometers. He was sent to the ICU for cerebral hemorrhage. It was too dangerous. Quitting smoking doesn’t just mean you don’t smoke. Second-hand smoke and third-hand smoke are equally harmful. There was a patient who didn’t smoke but his wife smoked at home every day. His blood pressure couldn’t be stabilized even after adjusting medicine three or four times. Finally, his wife went to the balcony to smoke. After two months, his blood pressure became normal. Some people also ask me, "I have been smoking for thirty or forty years, is it still useful to quit now?" ”To be honest, it is really useful. One year after quitting smoking, the risk of cardiovascular and cerebrovascular diseases can be reduced by 50%. After 10 years of quitting, the risk is similar to that of someone who has never smoked. It is never too late to quit.

In fact, this ABCDE framework, to put it bluntly, is not mysterious. It just needs to do all the little things you can think of and do. Don't believe in any folk prescription that "can cure high blood pressure in three months", and don't think that taking antihypertensive drugs every day will make everything fine. We deal with high blood pressure for a lifetime, and taking it slowly and steadily is better than anything else.