Hypertension nursing courseware

There is no universal formula for high blood pressure care that applies to everyone. The core logic is that "individualized lifestyle intervention is the basis, standardized medication according to doctor's instructions is the core, and ambulatory blood pressure monitoring is the basis for adjustment." Any approach that only relies on a single means (such as taking medicine without controlling your mouth, not taking medicine and relying solely on exercise) will be difficult to stabilize blood pressure within the standard range for a long time.

I have been doing chronic disease management in a community health service center for almost 7 years. The most typical example I encountered was Aunt Zhang who I met at a free clinic last year. She was 63 years old. She had been taking valsartan for 4 years and could not walk 10,000 steps a day. However, her blood pressure still fluctuated up and down, reaching as high as 165/95. I was so scared that I thought she was drug-resistant. I looked through her food record book and discovered that she had a small plate of pickled radish and porridge for breakfast every day. The amount of salt in this meal alone was almost the upper limit of the recommended daily intake. It's weird to think that her blood pressure can be stabilized.

When it comes to salt restriction, there are actually different voices in the academic circles in the past two years. We have always told all patients that they should not eat more than 5g of salt per day, but last year when experts from the Department of Geriatrics came to visit, they came up with a point: For the elderly over 75 years old, with degraded kidney function and poor appetite, there is no need to be so stuck. Relaxing to 6g is no problem. On the contrary, the risk of hyponatremia caused by strict salt restriction is more harmful than slightly higher blood pressure. I later adjusted the salt restriction requirements for several old men who met the situation, and indeed they reported that their meals tasted better, they were in better spirits, and their blood pressure did not fluctuate greatly. This thing really cannot be generalized.

Don’t think that everything will be fine if you control salt well. I have seen too many young patients in their early 30s who cook less at home and don’t eat much salt. They drink two cups of iced milk tea every day and stay up late playing games until two or three o’clock. The physical examination still shows high blood pressure, and the high blood pressure reaches 150. Do you think they are unfair? Some people also asked me whether drinking celery juice can reduce blood pressure, saying that many bloggers on the Internet recommend it. Objectively speaking, the apigenin in celery does help to dilate blood vessels, but you have to drink celery juice to reach the effective dose that can lower blood pressure. You have to eat more than ten kilograms of celery a day, and your stomach has to be drunk. It can only be used as a small supplement to adjust your diet. If you are diagnosed with high blood pressure, using it instead of taking medicine is purely a joke on your own body.

Many people’s misunderstanding about taking medicine is the real source of trouble. I just met an uncle last month. He took the medicine for half a year and measured his blood pressure to be stable at 130/80. He felt better and stopped the medicine immediately. As a result, he was hospitalized due to cerebral infarction within two weeks. Fortunately, the medicine was delivered in time and there were no major sequelae. Some people think that the more expensive antihypertensive drugs are better, and they can buy whatever their neighbors eat. In fact, it is completely unnecessary: ​​patients with diabetes prefer ACEI/ARB, which protects the kidneys and lowers blood sugar. ； Elderly men with prostatic hyperplasia choose α-receptor blockers, which can solve two problems for one dollar, which is much more cost-effective than buying expensive imported drugs. There is no unified standard for taking medicine. Others say it is better to take it in the morning. If you do an ambulatory blood pressure monitoring and find that your blood pressure is high at night, then it is more appropriate to take it before going to bed. You must listen to the doctor's advice on these, don't make up your own mind.

Oh, by the way, there are still many people who are confused about whether to choose mercury or electronic blood pressure monitors for home use. Personally, I 100% recommend the upper arm electronic blood pressure monitor. The mercury bag is not only easy to break, but also has the risk of mercury leakage. It is impossible for ordinary people to measure it accurately. I have seen many family members pinch the air bag at the wrong speed. A difference of 10 millimeters of mercury is normal. As long as the electronic ones are from regular manufacturers, go to the community hospital for calibration once a year. They are very accurate. My mother uses a basic model that costs tens of yuan. She has been using it for 5 years, and it is within 2 mmHg of the one measured in the outpatient clinic. Last time, an old man climbed five floors to the outpatient clinic. He rolled up his sleeves and took a test. The high voltage was 160. He was so scared that he had to be hospitalized. I asked him to rest on a chair for 15 minutes without checking his phone or talking. The next test was 132. You said that these small details were not done and the measured values ​​were all in vain.

In fact, to put it bluntly, high blood pressure is like a naughty and chronic little beast. If you figure out its temper and follow it, it will stay calm and not cause trouble. If you fish for three days and dry the net for two days, you will only take medicine when you think of it. If you can't think of it, you will eat and drink. If it gets angry, it will get angry. Complications such as cerebral infarction, myocardial infarction, and renal failure are all caused by it. The tip I usually give to patients’ families the most is to put the medicine box and blood pressure registration book on the shoe cabinet at the entrance, or next to the toothbrush where you brush your teeth. They are places that must be touched every day, and you can just take the medicine. It will work even if you set 10 alarm clocks.

Of course, there is no need to be too anxious. One of the patients I care for is an old man in his 80s. His blood pressure has been controlled for more than 20 years. He still goes to the park to do Tai Chi every day. As long as you find the right method that suits you, it will not affect your normal life at all.