Hello, welcome back to the "Hypertension Medical Course." I'm Jessica.
In the last lecture, we reviewed the main drugs for treating
hypertension. Logically, choosing an antihypertensive drug is not
difficult, and they are very effective, so taking the right medication
should be a matter of course. But what is the reality? In China, how
many people know they have high blood pressure but are not taking their
medication correctly? According to the "2019 China Cardiovascular
Disease Report," this figure exceeds 90%. Shocking, isn't it?
Although on the surface, the ways people take antihypertensive drugs
incorrectly are varied—some don't understand why they must take them,
some find it troublesome and don't want to, some are afraid of side
effects and dare not, and some stop taking them on their own after
their blood pressure has been stable for a few years, and so on.
But in fact, all these mistakes stem from one problem—people don't
understand their doctors. They don't understand what their doctors are
thinking, nor do they understand why the doctor chose a particular drug
for them and insists that they take it consistently.
Indeed, in the clinic, with many patients and limited time, we don't
have the time to answer all your questions or explain the underlying
reasons clearly. Today, I will give you all of this information to help
you develop the self-discipline to take your antihypertensive
medication correctly.
Five Common Misconceptions
First, many people are diagnosed with hypertension, and once it's
irreversible, their doctor will ask them to take antihypertensive
medication. At this point, many people have questions: I don't feel any
discomfort right now, so why should I pay for a problem that might
happen in ten years? Even if there is a risk, it's not certain that I
will be the one to have a heart attack or stroke!
This is a real thought for many people and the biggest reason for not
taking medication. But in reality, why do we insist that they take it?
As mentioned before, once you have hypertension, the risk of
cardiovascular and cerebrovascular diseases increases significantly.
Although this is a matter of probability from a population perspective,
for each individual, it is not a probability issue but a zero-sum
game—you either get it or you don't. We only have one heart and one
brain, and we cannot afford to take this chance. We dare not and should
not gamble on this. Therefore, weighing the pros and cons, it is of
course worthwhile to take the medication, and it is essential to do
so.
Many other people think, "I don't know if I will get cardiovascular
disease in the future, but all drugs have some toxicity. After taking
them for so many years, how much damage will they do to my body?"
In fact, this is a misunderstanding of the side effects of drugs.
Traditionally, we believe that the toxic side effects of chemical drugs
will slowly accumulate in the body. But this is not the case.
When you first start taking antihypertensive drugs, they do increase
the metabolic burden on the liver and kidneys, causing a series of
reactions in the body. But over time, our body will adjust and adapt,
treating the drug as a part of itself. Eventually, all the effects of
the drug on our body will become a part of our body. This is not a
process of accumulating toxicity as many people imagine, but a process
of us assimilating the drug, and the drug assimilating our body, until
we finally become one. Therefore, after the initial adjustment period
with the drug, there is no need to worry about this non-existent harm.
Of course, many people also get suspicious when their doctor prescribes
several types of antihypertensive drugs: Why do I have to take so many?
If one is effective, why take several? Won't that cause more side
effects?
Actually, no. The reason some people need to use several
antihypertensive drugs in combination is that a large number of studies
have confirmed that combination therapy is better for most hypertensive
patients. There are two reasons for this—
First, if blood pressure exceeds 160/100 mmHg or is 20/10 mmHg above
the target blood pressure, it is very unlikely that a conventional dose
of a single drug will lower it. In this case, combination therapy is
more effective than switching drugs back and forth.
Second, antihypertensive drugs also have certain side effects. If the
dose is doubled, the side effects will also double. However, if you use
combination therapy, that is, taking several antihypertensive drugs
together, the side effects will not only not accumulate but will also
cancel each other out.
For example, if a calcium channel blocker is combined with an
angiotensin-converting enzyme inhibitor or an angiotensin receptor
blocker, the common side effect of the calcium channel blocker—ankle
swelling—can be reduced or offset. Moreover, even a low-dose
combination is better than doubling the dose of any single drug. As for
how to combine them specifically, your doctor will make the right
choice for you.
Of course, although we have said that hypertension cannot be cured at
present, and once the window for reversal is missed, lifelong
medication is necessary. But many people still don't believe it. After
taking antihypertensive drugs for a period of time and finding that
their blood pressure is stable, they stop taking the medication on
their own. Two weeks later, their blood pressure is still normal, so
they think their hypertension is cured and stop taking the medication
altogether.
But did you know? This is not because the hypertension is cured, but
simply due to the delayed effect of the medication. Currently, the
metabolic period of antihypertensive drugs in the human body is very
long, and the delay in blood pressure lowering can sometimes last for
several months. For those who stop taking their medication on their
own, their blood pressure may indeed be fine for two or three weeks,
but within six months, it will return to its previous level. Therefore,
do not stop taking your medication on your own without your doctor's
guidance.
However, there is one exception, and that is seasonal blood pressure
fluctuations. We know that low temperatures cause blood vessels to
constrict, raising blood pressure. In most parts of our country, the
temperature difference between winter and summer is quite large, which
causes our blood pressure to be lower in the summer and higher in the
winter. Generally, systolic blood pressure can drop by 5 mmHg and
diastolic blood pressure by about 3 mmHg, and the change may be even
greater in the elderly. Therefore, if you have stage 1 hypertension,
your doctor may advise you to stop taking medication in the summer and
increase it in the winter. Just follow your doctor's advice.
Finally, some people feel that they have taken all the medications
prescribed by the doctor and do not feel any discomfort, so their blood
pressure must be under control and there should be no problem.
In fact, we take medication to reach a target, not just to comfort
ourselves. Only when blood pressure reaches the target can the risk of
cardiovascular and cerebrovascular diseases be minimized. Therefore,
in addition to taking medication regularly, you should also observe
three things after starting the medication—the effect, side effects,
and the downstream monitoring mentioned earlier.
The effect is simple: has your blood pressure reached the target value
set by your doctor? In the beginning, you should measure your blood
pressure twice a day, usually once in the morning and once before bed.
If your blood pressure has stabilized at the target value for a week,
you can switch to measuring it once every ten days. Then, remember to
see a doctor once a year. How to observe side effects? Generally, after
starting a new medication, you need to see a doctor again within two to
four weeks to recheck your blood pressure, heart rate, and blood
chemistry. The doctor will make a judgment. What about downstream
monitoring? You should go to the hospital at least once every two years
for a comprehensive check of organ damage.
If we distill the five issues above into a single principle of
self-discipline for taking antihypertensive medication correctly, it
would be a quote from the "Zuo Zhuan"—"Be prepared for danger in times
of peace. If you are prepared, you will have no worries."
Although modern medicine can treat hypertension relatively maturely,
many people still miss out on treatment because they are afraid of
seeing a doctor, have misconceptions about hypertension, or ignore it
because they don't see the harm. Only by being prepared for danger in
times of peace and taking action when you don't see the danger can you
best avoid the high blood sugar and high cholesterol that await you in
the future, and also prevent heart attacks and strokes at their source.
Two Common Minor Issues
In addition to the above, there may be two other minor issues that
bother you about how to take antihypertensive medication: the first is
frequently forgetting to take it, and the second is not knowing when to
take it. Let's talk about these as well.
First, the problem of frequently forgetting to take antihypertensive
medication.
Medicine has done a lot of research on this issue, and three methods
have emerged as the most effective: simple medication methods, linking
it to daily habits, and using a smartphone.
The simple medication method means choosing a once-a-day medication
whenever possible. If you need to combine two drugs, give priority to a
combination preparation, which is a single tablet containing two drug
ingredients, to avoid taking multiple doses or multiple drugs a day as
much as possible. Linking it to daily habits is also simple: tie it to
something you must do every day or an object you use. For example, if
you are going to bed at night, you can put a "remember to take your
medicine" sticker on the light switch. Finally, there is the
smartphone: you can set an alarm to take your medicine or download a
medication reminder app.
The second problem is the timing of medication. When is the best time
to take antihypertensive medication?
In 2019, a study of 20,000 people published in the "European Heart
Journal" found that—
Taking antihypertensive medication at bedtime not only better controls
nighttime blood pressure, but also improves morning and daytime blood
pressure. More importantly, it can even reduce the incidence of heart
attacks by about half.
Throughout the day, a person's blood pressure is constantly changing,
and the most important times to protect are nighttime and early
morning. Therefore, taking antihypertensive medication at bedtime is
naturally better. Moreover, because taking medication at bedtime
stabilizes blood pressure, the sympathetic nerve reflex is not
activated at night, allowing the blood vessels to be better protected
and repaired, and daytime blood pressure will be lower and more stable.
Therefore, if there are no special problems with your daytime blood
pressure, we would recommend that you take your antihypertensive
medication at bedtime.
In fact, in addition to figuring out the best time to take medication,
this study also verified our core idea of being prepared for danger in
times of peace. When treating hypertension, you can't just treat the
symptoms. High blood pressure during the day may just be the result and
feedback of high blood pressure at night; the source is still at night.
As long as you manage your nighttime blood pressure, your daytime blood
pressure will stabilize accordingly. Chasing and blocking is not the
best strategy; being prepared for danger in times of peace is the core
idea.
Next Lecture Preview
At this point, we have covered the ins and outs of hypertension.
Looking to the future, what changes can we expect in the field of
hypertension? In the next lecture, I will discuss this with you in
detail.
Key Points
Regarding the issue of taking antihypertensive medication, the
following four points should be noted:
First, once the window for reversal is missed, start drug treatment
firmly and adhere to it long-term;
Second, combination therapy can reduce side effects;
Third, after taking medication, you need to monitor whether your blood
pressure has reached the target;
Fourth: Taking antihypertensive medication at bedtime is more
effective.
Comments
Post a Comment