confesión de un hipertenso ¿cómo prevenir crisis de salud?

Author: Chen Weiwei National Center for Cardiovascular Diseases Fuwai Hospital, Academy of Chinese Medical Sciences Department of Disease Prevention and Control Professor

Review: Wu Yezhe National Center for Cardiovascular Diseases Fuwai Hospital, Academy of Chinese Medical Sciences Hypertension Center Professor

To effectively prevent and control the harms of hypertension, the most fundamental strategy is to be aware of your blood pressure.

Do you know why your blood pressure is so important? Let’s start by discussing the reversibility of hypertension. It can be said that all hypertension is reversible, and the reversal of hypertension can be divided into three states:

Reversal and cure: This refers to secondary hypertension caused by certain diseases, such as hyperfunctioning pheochromocytoma and hypertension due to renal artery stenosis. Hypertension can be cured through surgical removal of the tumor or interventional treatment of renal artery stenosis, thereby eliminating the cause of hypertension.

Control reversal: This relates to primary hypertension that has persisted for many years, which can achieve long-term and even lifelong effective control of hypertension through a combination of medications and lifestyle modifications.

Recovery reversal: This refers to the new onset of hypertension, which can be detected in time. By eliminating factors that raise blood pressure and adopting a healthy lifestyle, elevated blood pressure can be maintained at normal levels without the need for long-term medication. Regardless of the type of reversal, it is crucial for your health. The two phrases I frequently emphasize are: hypertension is indeed terrifying; if not controlled and reversed, it can lead to an average of ten years of life lost and is one of the leading causes of premature death. However, hypertension may not be terrifying, as long as blood pressure is maintained under normal control long-term, your health outcome will be similar to that of a person without hypertension.

However, regardless of the type of reversal, it is crucial to know your blood pressure, especially in the case of new hypertension onset. It is essential to know the year when your blood pressure increased. Hypertension that has persisted for many years cannot be reversed due to some degree of arteriosclerosis.

Indeed, if you do not pay attention to your blood pressure and remain ignorant, then all preventive and controlling measures are futile. Therefore, knowing your blood pressure is a vital task. This is also why when setting up the 'National Hypertension Day' event, the first awareness theme was 'Know Your Blood Pressure.' In 2015, this theme was once again proposed during World Hypertension Day and National Hypertension Day, and it served as the common theme for the following five years of hypertension day activities. Thus, it is evident how important it is to understand your own blood pressure.

I want to emphasize that this knowledge should include at least three levels:

Understand the meaning of different blood pressure values.

Know your past blood pressure levels.

Know the trend of changes in blood pressure levels.

I have been a specialist cardiologist all my life, and every time I discover that a patient's blood pressure is elevated, there is one question I always ask: 'Have you measured your blood pressure before?' Their answer is usually straightforward: 'Yes, I measured it.' I then ask, 'What was the blood pressure value they measured for you?' Often, their response is that they do not know. Some vaguely suggest, 'I think it was normal' or 'It seemed like they said it was a little high'.

For them, this response is easy and natural. However, it complicates things for us, the doctors. Because a doctor cannot diagnose hypertension based on just one blood pressure reading; the diagnostic standard for hypertension is clearly defined as 'three blood pressure measurements on different days that are in a state of hypertension.' In addition, it is necessary to clearly identify the patient’s condition at the time of measurement since blood pressure values represent completely different meanings depending on the state.

Do not assume that only patients with hypertension need to know their blood pressure. For those without hypertension, it is also important to understand their blood pressure values. The phrase 'it seems normal' can have multiple interpretations and meanings. Previously, a blood pressure measurement below 140/90 mmHg did not mean it was normal; this includes what is known as high normal blood pressure, which some refer to as prehypertension, representing a group of individuals who must be closely monitored. People with high normal blood pressure are very prone to developing hypertension, and without effective intervention, half of them may become hypertensive within 5 to 10 years. In clinical practice, I also place special importance on the prehypertension population, helping them analyze the causes of increased blood pressure. Scientific research indicates that most hypertensive patients are attributed to four major risk factors: namely, overweight or obesity, high salt intake, excessive alcohol consumption, or long-term psychological stress. Through analysis and evaluation, individuals can be guided to timely eliminate risk factors that contribute to rising blood pressure and encouraged to adopt a science-based healthy lifestyle, which may reverse slight increases in blood pressure and prevent the onset of hypertension. It can be stated that prehypertension is the best opportunity window for reversal and recovery.

The values of blood pressure measurements represent at least three levels of meaning: elevated blood pressure, high normal blood pressure, and normal blood pressure.

A measurement value ≥ 140/90 mmHg indicates that your blood pressure is abnormally elevated, making it essential to carry out rigorous tracking and multiple measurements. An accurate diagnosis should be made based on established standards to determine if hypertension is present. Additionally, it is necessary to assess whether there has been damage to organs and tissues, such as arteriosclerosis or proteinuria, as a consequence of hypertension. It is also recommended to conduct 24-hour dynamic blood pressure monitoring to rule out the possibility of 'white coat hypertension.' In individuals with high normal blood pressure readings, dynamic monitoring could reveal the existence of hidden nocturnal hypertension or isolated morning hypertension, which is often overlooked. This dynamic monitoring evaluates your true blood pressure levels and the characteristics of its variability, enabling identification of the periods of greatest fluctuation throughout the day. A clear evaluation of these types of fluctuations is vital for long-term treatment and effective control of hypertension.

High normal blood pressure refers to blood pressure that lies between 120 and 139 mmHg systolic and between 80 and 89 mmHg diastolic. This indicates that you belong to a group of individuals at higher risk of hypertension. In our country, at least one-third of adults have their blood pressure in this range, making them a 'reserve army' of hypertensives. The vast majority of these individuals, as they age or lead an unhealthy lifestyle, will sooner or later become hypertensives. The recommendation is to measure blood pressure at least every six months and closely monitor the onset of hypertension. Furthermore, from now on, it is crucial to adopt and maintain a healthy lifestyle, including a light diet, quitting smoking, moderating alcohol consumption, increasing physical activity, and controlling weight, to effectively prevent the onset of hypertension.

If the measurement results show normal blood pressure (blood pressure values <120/80 mmHg), that is very good, but it does not mean that one can be lax. Regular blood pressure monitoring (at least once a year) is necessary to observe trends in blood pressure changes. A common phenomenon in the modern population is that blood pressure tends to increase as one ages.

Everyone should understand their blood pressure and regularly monitor changes in blood pressure to maintain their blood pressure health.

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