Comprehensive Plan for the Prevention and Treatment of Isolated Systolic Hypertension: Key Points of Non-pharmacological Intervention, Precision Medication, and Long-Term Follow-up Observation

40. How to treat isolated systolic hypertension? For mild isolated systolic hypertension, non-pharmacological treatment should be initiated for 2-3 months in the early stage. The following measures are often taken: (1) Do not smoke and drink alcohol. The harmful components in tobacco and alcohol can cause damage to the heart and blood vessels, making it difficult to lower blood pressure. (2) Pay attention to the combination of work and rest, avoid excessive physical and mental activities, maintain a cheerful mood and sufficient sleep; participate in appropriate cultural and sports activities to achieve harmony of mind and body and balance of the internal environment of the body, which is conducive to the recovery of blood pressure to normal levels. (3) The diet should be reasonable, with light and low-fat as the principle. Eat less animal fat and its offal, eat more fresh fruits and vegetables, and pay attention to supplementing foods with more calcium, such as dried shrimp, milk, dairy products, kelp, etc.; obese people need to control their food intake and weight. (4) If the patient is accompanied by tension, anxiety, insomnia, dreaming, etc., a small dose of sedative-hypnotic drugs can be taken, such as diazepam (Valium) and calming and brain-nourishing liquid. If blood pressure remains at a high level after taking the above measures, drug treatment will be necessary in addition to the above non-drug treatments.

41. How to treat isolated systolic hypertension with medication? Commonly used drugs include the following categories: (1) Calcium channel blockers. Such as nifedipine (controlled-release tablets), acetaminophen, etc., especially suitable for patients with hypertension accompanied by coronary heart disease, angina pectoris, and those with diabetes, hyperlipidemia and renal insufficiency. (2) Low-dose diuretics, such as hydrochlorothiazide (hydrochlorothiazide) and indapamide. (3) Angiotensin-converting enzyme inhibitors. Such as captopril, benazepril, fosinopril, perdopril, etc. Because they have the effect of reversing target organ damage, they are particularly suitable for hypertensive patients with cardiomegaly and heart failure. (4) β-blockers. Such as atenolol (amyloidin), metoprolol, etc., often used for patients with hypertension complicated by coronary heart disease, myocardial infarction, tachycardia, etc. Contraindicated in patients with heart failure, bradycardia, sick sinus syndrome and bronchial asthma. For patients with edema, in addition to taking the above-mentioned medications and controlling salt intake, low-dose diuretics can be used, as they not only promote diuresis and reduce swelling but also lower blood pressure. In patients with isolated systolic hypertension, diastolic blood pressure is usually within the normal range; therefore, the use of antihypertensive drugs will inevitably lower diastolic blood pressure simultaneously. Thus, when selecting antihypertensive drugs, it is important to start with low doses and use them cautiously, generally aiming to control systolic blood pressure between 140 and 160 mmHg (18.7 to 21.3 kPa). Calcium channel blockers or ACE inhibitors can be used, and a small amount of thiazide diuretics can be added if necessary. Isolated systolic hypertension primarily affects elderly patients, and since the baroreceptors of the elderly are less sensitive, drugs such as guanethidine, alpha-blockers, and labetalol should be avoided to prevent orthostatic hypotension.

42. What Aspects Should Hypertensive Patients Pay Attention to? The blood pressure measured when each hypertensive patient visits the hospital only reflects a single moment of blood pressure throughout the day. Hypertension is a lifelong condition, and doctors cannot infer a patient's overall health from a single moment's blood pressure reading. Furthermore, blood pressure constantly changes depending on each patient's medication regimen, dosage, blood pressure rhythm, exercise level, and emotional state. Therefore, hypertensive patients need to learn to observe their own blood pressure fluctuations in daily life to provide doctors with more comprehensive information during consultations, laying a good foundation for further diagnosis and treatment. Specifically, first, pay attention to your symptoms. Hypertensive symptoms are not specific and are sometimes mild, such as mild dizziness, headache, and fatigue. Patients should be vigilant and measure their blood pressure promptly upon noticing these symptoms to determine whether the blood pressure level is low or high at the time of the symptom. This is very helpful for doctors to adjust medication dosage and type. Moreover, these symptoms can frequently remind you not to forget to take your medication. Additionally, pay attention to the time of day these symptoms occur-morning, afternoon, or evening-and their relationship to medication. For example, dizziness and headache accompanied by elevated blood pressure before taking medication may indicate that the medication's duration of action is short, and the blood concentration is insufficient to control blood pressure at the ideal level before medication is taken. In this case, it is necessary to switch to a medication with a longer duration of action or increase the frequency of medication. If dizziness occurs within several hours after taking medication (i.e., during the peak effect period), there are two possibilities: first, even at the peak effect, blood pressure cannot be satisfactorily controlled, requiring an increase in medication; second, conversely, dizziness is a manifestation of low blood pressure, requiring a reduction in medication. It is evident that inattentive observation can easily mislead treatment. Attention should also be paid to the characteristics of the symptoms and any complications. For example, whether each episode of dizziness is related to body position, whether the episode occurs suddenly, whether there is emotional excitement, facial flushing, sweating, etc., and whether one's pulse rate is frequently rapid. These are important references for doctors in selecting medication, determining dosage, and screening for secondary hypertension. Patients who have just started antihypertensive treatment should also pay attention to whether they experience any unusual discomfort after taking medication, as this may be related to adverse drug reactions. There are many types of antihypertensive drugs, but patients may not tolerate one or more of them. If a patient experiences unusual discomfort after taking medication, they should consult the drug's instructions to determine if it's related to the medication. If necessary, they should see a doctor for follow-up and timely medication adjustment. Finally, it's important to remember that patients with hypertension are also prone to many other diseases, such as cerebrovascular diseases. Don't hastily attribute all symptoms to high blood pressure, delaying the diagnosis and treatment of other complications. Therefore, familiarity with the common symptoms of hypertension is essential. If, in addition to hypertension, a patient also has other diseases such as cerebrovascular disease, diabetes, heart disease, peripheral vascular disease, bronchial asthma, etc., the doctor's choice of medication will differ. Therefore, patients must provide this information to their doctor during consultations. In conclusion, hypertension treatment requires individualization. Only when patients carefully observe their condition and truthfully report it to their doctors can doctors better understand the patient and determine the most suitable treatment plan.

43. Are there significant side effects from long-term use of a single antihypertensive drug? Is it okay to frequently change medications? Many patients are very concerned about the side effects of antihypertensive drugs. Some believe that short-term use of an antihypertensive drug has fewer side effects than long-term use of the same drug, and therefore frequently change medications. Some patients may buy and take any drug that has a good antihypertensive effect, without paying attention to the type of drug or its side effects. In fact, depending on the patient's situation, there may be more than one antihypertensive drug suitable for them. However, even so, frequent changes in medication are not recommended unless the drug is intolerable. Antihypertensive drugs have been developed over decades. During this process, drugs with significant side effects have been gradually phased out. Therefore, as long as the medication is prescribed by a regular hospital outpatient clinic, and is taken at a reasonable dosage and frequency, the side effects are generally minimal for most people. Some medications may affect electrolytes, blood sugar, and blood lipids. As long as regular check-ups are performed as required by the doctor (especially in the early stages of medication), and the antihypertensive effect is good with no special discomfort, it can be taken long-term. Unless the antihypertensive effect is unsatisfactory or intolerable, medication should generally not be changed easily. Otherwise, constantly switching medications in a short period of time makes it difficult to determine the true efficacy and adverse reactions of each drug for each patient, and ultimately, a suitable drug cannot be found.