Hello, welcome back to the "Hypertension Medical Course." I am Jessica.
In my clinic, when patients first learn they have hypertension, the
most common questions I get are: "Dr. Jessica, can my hypertension be
cured? Do I really have to take medicine for life?"
From previous lessons, you may realize that as long as we live long
enough, our blood vessels will inevitably deteriorate, and hypertension
becomes unavoidable. So, to be honest, a complete cure for hypertension
is as elusive as conquering aging or achieving immortality.
But does this mean medicine is powerless? Once you have hypertension,
must you take medication for life?
Not necessarily. If the goal is a permanent cure, never to have
hypertension again, that’s impossible. But if the goal is
reversal—returning blood pressure to age-appropriate levels without
medication and maintaining it for years or decades—that is achievable.
Even if hypertension eventually develops in your seventies or eighties,
at least you’ve delayed it for decades, avoiding life-threatening
damage during your prime years.
So, how can we achieve reversal? Who is eligible? When is the golden
period for reversal? This lesson will answer these questions from the
perspective of overall hypertension treatment strategy.
Source Management
Reversing hypertension is like flood control. In medicine, there are
three approaches: source management, midstream interception, and
downstream monitoring. Let’s start with source management.
Like many chronic diseases, hypertension develops gradually. Many
people ignore it until their blood pressure is already high—either
prehypertension or confirmed hypertension. What should we do?
As long as blood pressure isn’t extremely high or cardiovascular risk
isn’t very high, most cases are reversible if we seize the window of
opportunity.
How?
Source management means addressing the root causes. As mentioned
before, aside from unchangeable factors like genes and age, most
triggers are lifestyle-related: don’t smoke, don’t drink excessively,
eat less salt, exercise more, avoid air pollution, etc. Therefore, the
best way to reverse hypertension is lifestyle modification—diet,
exercise, and stress reduction. I’ll cover these in detail in Lessons
7, 8, and 9.
There are no miracle drugs or secret remedies here, but lifestyle
modification is the cornerstone of hypertension treatment, effective at
every stage—from prehypertension to complications like stroke or
hypertensive nephropathy.
Midstream Interception & Downstream Monitoring
With proper lifestyle changes, 62% of people can return their blood
pressure to normal. But some won’t succeed, and their risk continues to
rise. What then?
If blood pressure is already very high (over 160/100 mmHg) or
cardiovascular risk is very high, reversal is no longer possible. But
with medication, we can stabilize blood pressure and prevent organ
damage.
It’s like flood control: when the flow is too strong, source management
isn’t enough. We need midstream dams (medication) and downstream
monitoring (organ protection).
The key is that as long as blood pressure is controlled, organ damage
can be prevented. That’s why antihypertensive drugs are essential. No
matter what other benefits a drug claims, its main purpose is to lower
blood pressure. If it does, it’s a good drug.
But medication alone isn’t enough. If blood pressure isn’t controlled,
organ damage continues. So, besides medication, we must monitor for
complications—heart, kidney, arteries, eyes, as well as blood sugar and
lipids, since high glucose and lipids often accompany hypertension and
amplify risks.
In summary, there are three strategies: source management (lifestyle),
midstream interception (medication), and downstream monitoring
(complication surveillance).
Hypertension Treatment Flowchart
It sounds simple, but when is reversal possible, and when is it not?
Many think it depends solely on blood pressure—if it’s very high (over
150/90 mmHg), reversal is impossible; if it’s lower, it’s possible.
That’s not the case. Reversal and treatment are based on risk
stratification, with numbers as a reference.
For example: Mr. Zhang’s blood pressure is 150/90 mmHg with obesity,
smoking, and diabetes. Mr. Li’s is 160/90 mmHg with no other risk
factors. Although Mr. Li’s pressure is higher, Mr. Zhang’s risk is
greater due to multiple factors, so he needs stricter treatment.
With this principle, let’s discuss reversible and irreversible periods.
Refer to the risk stratification table from Lesson 4 for clarity.
First, if blood pressure exceeds 160/100 mmHg, reversal is clearly
impossible.
At this level, the body is already in the high-risk zone for
cardiovascular events. The risks of continued high blood pressure far
outweigh any medication side effects. Immediate medication and
lifestyle changes are necessary, along with downstream monitoring.
Conversely, if blood pressure is below 160/100 mmHg, whether
prehypertension or grade 1 hypertension, reversal is possible.
Analyze further:
If there are many risk factors or complications (obesity, high
cholesterol, diabetes, heart attack), and the cardiovascular risk is
high or very high, reversal isn’t possible—start medication
immediately. The risk table from Lesson 4 shows when high or very high
risk occurs, even in prehypertension or grade 1.
If the risk is low or moderate, reversal is possible, but with
different approaches:
- Low risk: try lifestyle modification alone, but set a deadline. If
blood pressure normalizes in 3–6 months, reversal is successful; if
not, start medication.
- Moderate risk: try lifestyle modification, but observe for only 1
month. If blood pressure remains high, start medication immediately.
Among reversible cases, prehypertension (120/80–140/90 mmHg) is the
golden period. With timely lifestyle changes, most people can reverse
it.
Currently, 41.3% of Chinese adults are in prehypertension—almost one in
two. But many ignore it, missing the chance for reversal and becoming
dependent on medication. So, after age 25, measure your blood pressure
at least once a year. If you’re in prehypertension, make a lifestyle
plan and stick to it.
Normally, hypertension treatment has a clear goal. Most guidelines
recommend below 140/90 mmHg; if tolerated, aim for 130/80 mmHg.
But, as discussed, targets should be individualized. For those aged
65–79, start with below 150/90 mmHg, then gradually lower if tolerated.
For those over 80, below 150/90 mmHg is sufficient.
One thing is clear: both systolic and diastolic pressure must be
persistently and simultaneously below target—not just sometimes or
almost there. Otherwise, the risk of heart attack and stroke remains
high, negating treatment benefits.
Preview of the Next Lesson
This lesson emphasized that lifestyle modification is the foundation of
hypertension treatment. The next three lessons will cover diet,
exercise, and stress reduction in detail.
I am Jessica. See you next time.
Key Points
1. There are three strategies for hypertension treatment: source
management, midstream interception, and downstream monitoring.
2. If blood pressure is below 160/100 mmHg and risk is not high,
reversal is possible. If not reversed during this period, lifelong
medication may be needed.
3. If blood pressure exceeds 160/100 mmHg or risk is high, reversal is
impossible—start medication and monitoring immediately.
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