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Do hypertensive patients need to take medicine?

Author：Dr.Sunny Kim

The onset of hypertension is insidious,most of the patients have no obvious symptoms, which is discovered by chance during physical examination or when they seek treatment for other diseases. Many people find their blood pressure high and wonder if they need medicine. They also think that long-term medication will have adverse effects on the body and they will have resistance to long-term medication for chronic diseases such as blood pressure medicines.

Today I would like to talk about which patients are allowed not to take medicine, under what circumstances need to take medicine, what are the precautions to take medicine.

1.    Which hypertensive patients are allowed not to take medication in the first place?

(1)   The average blood pressure is 140/90mmHg~160/100mmHg in patients with first detection of hypertension.

(2)   The following risk factors are less than 2:

a. Patients with smoking

b. Male > 55 years old, female>65 years old

c. Impaired glucose tolerance (pre-diabetes) or confirmed diabetes

d. Dyslipidemia

e. A family history of early cardiovascular disease

f. Obesity (especially visceral or abdominal obesity, waist-hip ratio:>0.9 for male, >0.8 for female is visceral obesity)

(3)   Who do not have any of the following organ damage and diseases:

a. Heart disease (left ventricular hypertrophy, coronary heart disease, myocardial infarction, etc.)

b. Cerebrovascular diseases (cerebral hemorrhage, ischemic stroke, etc.)

c.  Renal disease (diabetic nephropathy, microalbuminuria, elevated serum creatinine)

d. Peripheral vascular disease

e. Retinopathy

f.  Diabetes

g. Carotid artery plaque

If patients with hypertension meet the above three conditions at the same time, they are allowed not to take medication in the first place and the treatment method is mainly non-drug therapy, such as lifestyle improvement. For people with hypertension who cannot meet the above three conditions at the same time, it is recommended to start taking hypotensive drugs immediately

(4)   The following two special groups of people need to pay attention to the time of initiation of medication

a.    Starting drug treatment is not recommended until blood pressure is over 150/90mmHg in patients aged 80 years, some weak patients with blood pressure over 160/90mmHg are considered to start drug therapy.

b. People with diabetes should start lifestyle interventions when their blood pressure is 130/80-139/89mmhg and should take hypotensive drugs when their blood pressure is no lower than 130/80mmhg within 3 months

2.    How can lifestyle improvements help lower blood pressure?

(1)   Limit sodium intake: less than 6g of salt per person per day

(2)   Reasonable diet: reduce dietary fat, supplement the right amount of high quality protein, pay attention to supplement potassium and calcium, eat fresh vegetables and fruits.Eat poultry, fish, soy and nuts in moderation. Use less sugar, drink less sugary drinks and eat less red meat

(3)   Weight control: Try to keep BMI < 24; Waist-hip ratio should be: male <0.9, female <0.8

(*BMI= weight (kg) ÷ height (m)2)

(4) Quit smoking

(5) Abstaining from alcohol or limiting alcohol consumption

(6) Appropriate exercise: moderate intensity aerobic exercise such as jogging, brisk walking, swimming, mountain climbing, etc. 4~7 times a week, lasting 30 minutes to 1 hour each time

(7) Regular work and rest: maintain adequate sleep, regulate the mood, reduce mental pressure.

If the blood pressure does not fall below 140/90mmhg after 6 months of strict lifestyle intervention, it is recommended to start taking hypotensive drugs.

3.    What should notice when taking hypotensive medicine?

(1)   Patients who are already taking hypotensive medicines should not stop taking the medicines without doctor’s permission, nor should they add or decrease the dosage or change the drugs without doctor’s permission

(2)   Proprietary Chinese medicines or other medicines containing traditional Chinese medicine ingredients cannot replace western hypotensive medicines and can only be used as supplementary medicines.

(3)   Lifestyle interventions such as exercise, weight control, diet control, sodium restriction, smoking cessation and alcohol restriction should be continued even if you have started taking blood pressure medications

Starting medication at the right time and taking medicines in the right way will have greater benefits in preventing the occurrence of cardiovascular and cerebrovascular diseases and other complications, prolongating the life span and improving the quality of life.

Please do not reject the medication, but also do not reject early medication, lifelong medication。