Guidelines for the Goals, Misconceptions, and Selection of Blood Pressure Monitors in Antihypertensive Treatment

Almost all population groups can benefit from active and appropriate antihypertensive treatment. However, due to the different physiological and pathological underlying conditions of different populations, the goals of antihypertensive treatment also differ slightly. Therefore, in clinical practice, factors such as other comorbidities of the patient should be comprehensively considered to determine the ideal antihypertensive target. Ideal antihypertensive target: Blood pressure in all hypertensive patients should be reduced to <140/90 mmHg, with 138/83 mmHg being more ideal. For mild cases, control at 120/80 mmHg is preferable. Young and middle-aged adults should aim for <130/85 mmHg, while elderly patients should aim for <140/90 mmHg. Those with isolated systolic hypertension should also control their systolic blood pressure below 140 mmHg. However, different approaches should be taken if there is concurrent diabetes or damage to organs such as the heart, brain, or kidneys: Stroke patients, regardless of whether it is cerebral hemorrhage or cerebral infarction, should gradually resume antihypertensive treatment once their condition stabilizes, and their blood pressure should be controlled below 140/90 mmHg. For hypertensive patients with diabetes, a more stringent blood pressure target is set: below 130/80 mmHg, or the lowest level the patient can tolerate. Simultaneously, blood glucose levels must be controlled more strictly to minimize their harm to the cardiovascular system. In cases of concurrent renal insufficiency, it is recommended to lower blood pressure to below 130/80 mmHg without affecting renal blood perfusion or worsening renal function. If the patient already has renal impairment or proteinuria exceeding 1 gram/24 hours, blood pressure should even be lowered to below 125/75 mmHg. Similarly, long-acting antihypertensive drugs with a slower onset of action should be preferred, and close monitoring of renal function is essential.

The hypertension we usually refer to is primary hypertension, which accounts for more than 90% of hypertension patients. Because its causes are not fully understood, current drug treatments for hypertension can only control it, not cure it. Therefore, even if blood pressure drops to normal, it does not mean that hypertension is cured; lifelong treatment is required. Medication should not be stopped even after blood pressure returns to normal; otherwise, it will sooner or later return to pre-treatment levels, causing "withdrawal syndrome" or inducing serious cardiovascular, cerebrovascular, renal, or vascular diseases. The correct approach is to gradually reduce the types and dosages of medications under the guidance of a physician after blood pressure has been effectively controlled at a normal level for one year, achieving the most ideal therapeutic effect with the minimum amount of medication.

Some patients with hypertension often ask their doctors to prescribe fast-acting antihypertensive drugs, or arbitrarily increase the dosage and frequency of their medication, hoping to lower their blood pressure to normal in a short period of time. This desire to treat the disease is understandable, but this hasty approach is wrong and often leads to adverse consequences, even life-threatening ones. The principle of lowering blood pressure is to be effective and stable, with stability being particularly important. Blindly pursuing a lowering effect while neglecting blood pressure stability can lead to insufficient blood supply to the heart, brain, and kidneys, resulting in serious consequences. Elderly patients, in particular, should avoid using drugs with excessively strong or large blood pressure-lowering effects, and should not use multiple antihypertensive drugs irregularly, as this can cause blood pressure to drop too quickly and drastically, affecting blood supply to the brain and causing adverse reactions such as orthostatic hypotension. Fluctuations in blood pressure are often a trigger for stroke. A rapid decrease in blood pressure can cause cerebral vasospasm or slow blood flow, leading to an increase in local clotting factors, especially platelet deposition, which can cause thrombosis and increase the risk of ischemic cerebrovascular disease. The correct approach is to cooperate with your doctor, consistently monitor your blood pressure, and choose or adjust antihypertensive medications according to your blood pressure readings under the guidance of your doctor. By adhering to medication regimens without being too hasty, you can maintain stable blood pressure and reduce the occurrence of complications.

There are three common types of blood pressure monitors: mercury sphygmomanometers, barometric sphygmomanometers, and electronic sphygmomanometers. What are the differences between these three types, and how should one choose one for home use?

Mercury sphygmomanometers offer the advantages of accurate and reliable measurement, but their disadvantages include being relatively heavy, inconvenient to carry, and requiring professional user training. Gyroscopes, shaped like clocks, are easy to carry and use a dial to indicate blood pressure changes; they are simple to operate. However, their accuracy is not as high as mercury sphygmomanometers, and they are more difficult to repair. Electronic sphygmomanometers are lightweight, portable, and easy to operate, but their disadvantages include susceptibility to ambient noise, cuff movement, and variations in measurement location (arm or wrist) and body position (sitting or lying down), leading to inaccuracies in the measured blood pressure readings.

Most electronic blood pressure monitors currently on the market can accurately measure blood pressure and meet the general needs of family healthcare.

Electronic blood pressure monitors come in three types: arm-type, wrist-type, and finger-type. All three types should be suitable for most people. Wrist and finger-type monitors are convenient to use and carry, making them suitable for business trips and travel. However, they are not suitable for people with circulatory disorders, such as diabetes, hyperlipidemia, and hypertension, as these conditions can accelerate arteriosclerosis and lead to peripheral circulatory problems.