High blood pressure is still high during prevention period

Either the "preventive measures" you thought did not reach the threshold of effective intervention, or the primary focus of secondary hypertension was not detected, or frequent stress states offset the effect of the intervention - many people have diligently practiced prevention for more than half a year, but in fact they have stepped on cognitive misunderstandings at the root.

I met 62-year-old Uncle Zhang at a community free clinic last week. He was holding a thermos cup soaked in Gynostemma pentaphyllum and said that he had been preventing high blood pressure every day for the past three months: he walked 2,000 steps around the community every day after meals, without touching any fat. He also quit smoking after 30 years of smoking. The result was a blood pressure of 165/98, which was 10 mmHg higher than the physical examination three months ago. I asked a few more questions and found the problem: he had to eat pickled radishes for every meal, and drank two taels of home-brewed liquor every night. When I asked him why he didn't quit, he said confidently: "I've already walked away and quit smoking. What's wrong with a few sips of wine and some pickles?" ”

In fact, "pseudo prevention" like Uncle Zhang's is really too common. Don’t think that if you make a cup of chrysanthemum and wolfberry and walk two thousand steps, you are serious about prevention. If you turn around and show off two packs of spicy strips, or drink two ounces of wine with pickles, all you have done is in vain. There has always been a consensus in the field of chronic disease management in Western medicine: lifestyle intervention for hypertension is a set of combinations, and it may be useless if any link is missing. For example, many people know that they need to control salt, but they only count the salt sprinkled in cooking, not the invisible salt in light soy sauce, oyster sauce, pickles, and even bread and biscuits. The World Health Organization requires that daily salt intake should not exceed 5g, which is about the amount of a beer cap. The average adult in our country eats more than 10g of salt every day. Many people claim that they are "eating lightly", but in fact, the amount of salt in just one takeaway meal exceeds the standard. Some people equate prevention with taking health care products. They buy a lot of fish oil and lecithin, then stay up late to watch TV shows until one or two o'clock. The blood vessels are always in a state of tension. How can the blood pressure be lowered?

However, according to the chronic disease management logic of traditional Chinese medicine, emotions have to be taken into account in this matter. I have met many aunties who are very anxious about preventing high blood pressure. They can measure their blood pressure seven or eight times a day. If it is slightly higher, they will become restless. Instead, they fall into an endless cycle of "the higher the blood pressure, the higher the blood pressure, and the higher the blood pressure, the more panicked". According to traditional Chinese medicine, this state is classified as "stagnation of liver qi and hyperactivity of liver yang". The mood is always tense. Even if the diet and exercise are in place, the blood pressure cannot be stabilized. There used to be a 58-year-old aunt like this. After controlling her diet and exercising for two months, her blood pressure was still fluctuating. Later, she stopped looking at the blood pressure monitor every day. She danced square dances for two hours every afternoon, and teamed up with her old sisters to enjoy flowers for half a month. When she was retested, her blood pressure dropped directly to the normal range of 130/80.

Nowadays, the opinions on the prevention of hypertension on the Internet are very mixed, and many opinions are very noisy. In fact, most of them are irrelevant. For example, some people say that "red meat must not be eaten to prevent high blood pressure." However, many voices in the clinical nutrition field believe that as long as you do not eat fatty meat or processed meat products, eating about 100g of lean beef and lean pork every day will not affect blood pressure at all. On the contrary, not eating red meat at all will lead to iron deficiency anemia, which will aggravate blood pressure fluctuations. Some people say that you must walk 10,000 steps a day. I met an old man who had degenerative knee disease before. He walked hard to lower his blood pressure. Every time he walked, his knees hurt so much that he couldn't sleep. Instead, the pain stress caused his blood pressure to soar. Later, he changed to swimming for half an hour every day. His knees no longer hurt, and his blood pressure gradually stabilized.

Of course, there is another situation that is most easily overlooked, that is, you have secondary hypertension. For example, renal artery stenosis, adrenal adenoma, and sleep apnea syndrome (the kind where you snore while sleeping until you suddenly wake up holding your breath). These diseases cause elevated blood pressure. Lifestyle intervention is basically useless. The original disease must be cured first. Last year, a 32-year-old young man came to me and said that he had controlled diet and exercise for three months, but his blood pressure was still around 150/100. I asked him to have an adrenal CT scan, and it turned out that he had a small adenoma of about 1 cm. Within a week after minimally invasive surgery, his blood pressure returned to the normal level of 120/80.

I have been managing chronic diseases in the community for almost 8 years. I have seen too many people whose blood pressure is still high during the prevention period. Most of them have one thing in common: they regard "preventing high blood pressure" as several KPIs to be completed. Taking enough steps every day and eating less fat will count as completing the task. Prevention is not integrated into daily life at all. You say that you walk for 20 minutes every day and spend the remaining 10 hours on the sofa scrolling through your phone, or you control salt for five days during the workday and then go out for a hot pot and barbecue with friends on the weekend to make up for it. It is surprising that this kind of fragmented intervention can be effective.

In fact, blood pressure is a very "sensitive" thing. Don't panic if you occasionally get high once or twice. If you really adjust your lifestyle in a down-to-earth manner for a month or two, but your blood pressure is still unstable, don't insist on not going to the hospital. Check for secondary factors when you need to, and take medicine when you need to follow the doctor's instructions. Don't be fooled by the rumors on the Internet that "you must not take medicine to lower blood pressure." After all, your body is your own, right?