Not all high blood pressure patients must take antihypertensive drugs

Hypertension is a very common disease that is characterized by a persistent increase in arterial blood pressure above the normal range and can be accompanied by complications in target organs such as the heart, brain and kidneys. For patients with hypertension, because of the persistent elevation of blood pressure, they generally have to take long-term  antihypertensive drugs and reduce the occurrence of complications, but very few patients can do without long-term medication.

1. What are the specific hypertensive patients who can do without long-term  antihypertensive drugs?

• Some patients with secondary hypertension

Hypertension includes two categories: primary hypertension and secondary hypertension, of which secondary hypertension is the elevation of blood pressure caused by a clear cause, such as acute and chronic nephritis, pheochromocytoma, primary aldosteronism, aortic stenosis, hyperthyroidism, etc. For patients with secondary hypertension, when we treat the underlying disease, blood pressure can often return to normal, or even achieve a cure, without the need for long-term  antihypertensive drugs.

• some patients with primary grade 1 hypertension

Primary hypertension is the most common type of hypertension, and its specific pathogenesis is not clear. It is considered to be caused by multiple factors such as genetics and environment, and once diagnosed, it requires active lifestyle improvement and treatment  antihypertensive drugs. For newly diagnosed primary hypertension, if the blood pressure level does not exceed 160/100mmHg, both patients with grade 1 hypertension and no other cardiovascular risk factors or complications, they can suspend the use of antihypertensive drugs and first carry out lifestyle intervention for up to three months, if the blood pressure control reaches the standard, then the lifestyle intervention can be continued, if the blood pressure is still high, then the use of blood pressure lowering drugs must be started.

2. The most important pathological changes in hypertension occur in the small arteries throughout the body. 

Simply put, the small arteries are generally contracted, have thickened walls, narrowed lumens, and lost elasticity for various reasons, causing greater resistance to blood flow through them, and the normal pressure no longer allows blood to pass through these small arteries properly, and blood pressure rises.

The key is that these changes are qualitative and irreversible!  

Almost all contemporary formal treatments for hypertension are based on  antihypertensive drugs and are aimed at "control" rather than "cure".

3. Some people ask, why do I have to lower my blood pressure? 

Simply put, lowering blood pressure is not about the blood pressure itself, but about avoiding more serious problems.

This is because if blood pressure is poorly controlled over time, abnormally high blood pressure is extremely destructive to every organ in the body, especially the heart, brain, kidneys, and eyes. The result of all this damage can have a serious impact on life expectancy and quality of life. For every 20 mmHg rise in blood pressure, the risk of death doubles.

4. High blood pressure needs to be lowered or you will face many dangers.

The effect of blood pressure lowering needs to be monitored by long-term standardized blood pressure measurement, not by feeling, but by looking at the numbers.

When the effect of lowering blood pressure is not good, it is necessary to see a doctor and adjust the treatment plan until the standard is reached.

The best way to lower blood pressure varies from person to person and from condition to condition, but for most people, systolic blood pressure is below 140 mmHg and diastolic blood pressure is below 90 mmHg. For patients over 60 years of age, or those with kidney disease or coronary heart disease, there are different goals for lowering blood pressure, as prescribed by the doctor.

5. Adhering to a good lifestyle, hypertensive patients can avoid taking  antihypertensive drugs?

Many people already know that exercise, weight loss, smoking cessation, low salt and low fat diet ...... which are good lifestyles, can help a lot in improving hypertension and preventing various cardiovascular and cerebrovascular diseases. So another view has emerged that by adhering to a good lifestyle, hypertensive patients can avoid taking antihypertensive drugs.

This argument is overly optimistic. In fact, the effect of these lifestyles is far from a "cure" for hypertension. Even a completely healthy lifestyle is only likely to return early, mild hypertension to normal. And, if you don't take your medication and exercise with very high blood pressure, you are also prone to cardiovascular emergencies! Lifestyle and antihypertensive drugs work in tandem, remember!

6. In fact, it is the fluctuations in blood pressure that are more harmful than high blood pressure.

Too many people with hypertension make a big deal out of this. Take antihypertensive medication for a while, take their blood pressure, see that it's normal, stop taking it, or take it again after a while.

This approach can lead to dramatic fluctuations in blood pressure. Patients with hypertension have poorer vascular elasticity and regulation than normal people, and dramatic fluctuations in blood pressure cannot be buffered like normal people, which is very dangerous, and their risk of brain hemorrhage/infarction can be as high as 6.2 times that of people with well-controlled blood pressure!

The newer contemporary antihypertensive drugs have minimal side effects when used regularly and are not a problem when taken for long periods of time under medical supervision. The consequences of interrupting treatment or reducing dosage are serious!

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