Hypertension nursing courseware

The core of hypertension care has never been to “hard-press the values to the normal range”, but to conduct full-scenario life intervention + regular monitoring + early screening of complications based on individual conditions. If done properly, at least 70% of hypertension-related risks of myocardial infarction, stroke, and renal failure can be avoided in advance.

Last week I met Xiao Zhou, a 32-year-old Internet practitioner at a community chronic disease follow-up site. His physical examination showed that his systolic blood pressure was 152 mmHg. He waved the physical examination report and said, "I don't feel anything, so don't worry about it. I'll wait until I finish the project." This kind of thinking is really the most common "high-risk misunderstanding" I have encountered in the five years of chronic disease care. High blood pressure is different from colds and fevers. It will not give you signs of pain or dizziness as soon as it comes up. By the time you really have a splitting headache and chest tightness, the inner walls of blood vessels have been washed out by the continuous high pressure, making them look like plastic water pipes that have been used for a long time and are so brittle that they will break if you poke them.

Many people are resistant to taking antihypertensive drugs. They either think that "once they take it, they will be unable to stop it for the rest of their lives", or they think that everything will be fine after taking the medicine and they can make hot pot milk tea as they please. First of all, it must be said that the current domestic mainstream clinical guidelines do recommend that patients with grade 2 and above hypertension take medication regularly throughout their lives, but this is not "drug dependence". It means that your blood pressure regulation mechanism has gone wrong and you need drugs to help stabilize it. Just like a person with myopia who wears glasses, it is not that you can't take them off, but that your eyesight is not good. There are also different academic opinions here. In recent years, some studies in Europe have suggested that young patients with new-onset grade one hypertension and no underlying diseases may have a chance to stop taking medication if they can reduce their weight to a normal range within 3 months and maintain a regular schedule. However, this proportion is less than 20%. Don’t bet that you are the chosen one. Following the doctor’s advice always comes first.

Let’s talk about the food issue that everyone is most confused about. Previous guidelines required patients with high blood pressure to eat no more than 5g of salt per day, which is almost the amount of a beer cap. Now there is a new study that suggests that there is no need to limit the number of 5g. The key is to avoid "invisible salt" - such as pickles, processed meat, milk tea, and salt in breaded bread. Many people only add 3g of salt in cooking every day. As a result, they eat takeout every day and eat more than 10g of invisible salt. There is also controversy about low-sodium salts. Most cardiovascular departments will recommend that patients with normal renal function switch to low-sodium salts. Reducing sodium and supplementing potassium are indeed effective in controlling blood pressure. However, teachers in the nephrology department will repeatedly emphasize that patients with excessive creatinine must not use low-sodium salts. Failure to excrete potassium can cause hyperkalemia and, in severe cases, sudden death. No method is a panacea, and it depends on your own physical condition.

Measuring blood pressure is easy to say but difficult to say. I have seen too many people measure blood pressure with "invalid values": they measure it just after climbing the stairs and taking a breath, holding in their urine, with their arms raised higher than their heart, and the values that come out fluctuate high and low, scaring themselves. When we train the elderly in our community, we will teach you to sit for 5 minutes before taking the test, do not talk or use your mobile phone, put your arms flat on the table, at the same level as your heart. Take the test once in the morning on an empty stomach and once before going to bed at night. Write it down in a small book and show it to the doctor when you go for a follow-up visit. It is 10 times more useful than the value you take temporarily in the hospital. There used to be an Aunt Zhang. Her blood pressure was always high and low for no reason. Later, she wrote down what she ate every day, what time she went to sleep, and her blood pressure. We looked through the records and found that her blood pressure was high on the day she finished square dancing. Later, she changed the time of aerobics from morning to evening, and the intensity dropped, and her blood pressure stabilized quickly.

There is also the issue of exercise. In the past, everyone thought that patients with high blood pressure should not move, fearing that blood pressure would spike if they moved, but now the actual situation is different: if your blood pressure is usually controlled below 140/90mmHg, brisk walking, jogging, Tai Chi or even moderate strength training can help you lower blood pressure; but if the systolic blood pressure has been above 180mmHg for a long time and is not under control, really don’t run around, adjust the medicine first, and then move slowly after the blood pressure is stable. I met an old man before. I heard that exercise can lower blood pressure. He got up at five o'clock every morning and ran three kilometers. As a result, he had a stroke and was sent to the hospital. This was because his blood pressure had a morning peak in the morning. When he went out for a run without taking medicine, his blood pressure shot up to over 200 and his blood vessels burst.

In fact, after so many years of high blood pressure care, my biggest feeling is that there is no unified standard answer to this matter. Others take medicines that work, but you may take serious side effects. Others can lower blood pressure by walking 10,000 steps, but you may get dizzy after walking 5,000 steps. Don't believe in those "one-step-lowering blood pressure" remedies on the Internet, and don't mix up your own medicines blindly. Communicate more with your bedside doctor and community nurse, and integrate nursing care into your daily life. It's better than anything else.