[Nominal consultation] Blood pressure left or right? How to measure the most accurate?

At 6:30 p.m. on October 28, Sun Xiaoxia, Director of the Third Ward of Cardiovascular Medicine, Xianyang First People’s Hospital, and Li Huan, Deputy Director, walked into the live broadcast room of Huashang Daily-Ersanli Famous Doctors Online Consultation, and asked questions about cardiovascular medicine. , interact with the majority of netizens, and watch the exciting content together.

Question 1: What is high blood pressure?

Hypertension is a cardiovascular syndrome with elevated systemic arterial pressure as the main clinical manifestation, which can be divided into primary hypertension and secondary hypertension. The hypertension we usually talk about actually refers to primary hypertension, which is the most important risk factor for cardiovascular and cerebrovascular diseases. It often coexists with other cardiovascular risk factors such as obesity, smoking, and drinking, which can damage important organs. , such as the heart, brain, kidneys, fundus, peripheral arteries, will lead to structural and functional abnormalities of these organs, and even functional failure.

Question 2: How is high blood pressure diagnosed?

Diagnosing hypertension is actually not difficult. The diagnosis mainly depends on the office blood pressure, that is, the blood pressure measured by the medical staff in the medical institution according to the unified standard under standard conditions. The home self-measured blood pressure and ambulatory blood pressure can be used to assist the diagnosis. Office blood pressure If blood pressure is measured three times on different days, SBP ≥ 140 mmHg and/or DBP ≥ 90 mmHg, hypertension can be diagnosed. Of course, the premise is that you have to measure your blood pressure correctly.

Question 3: Left or right blood pressure? How to measure the most accurate?

Under normal circumstances, one-third of people have higher blood pressure on the left side than the right side, one-third of the people have a higher blood pressure on the right side than the left, and one-third of people have equal blood pressure on both sides. Therefore, when measuring blood pressure for the first time, both sides should be measured, and then the higher side shall prevail.

Question 4: Once diagnosed with high blood pressure, should I start taking medicine?

In all hypertensive patients once diagnosed, it is recommended that drug therapy be initiated immediately alongside lifestyle interventions.

For hypertensive patients only with systolic blood pressure <160mmHg and diastolic blood pressure <100mmHg and not complicated with coronary heart disease, heart failure, stroke, peripheral atherosclerosis, kidney disease or diabetes, the doctor can also suspend the administration according to the condition and the patient's wishes. A simple lifestyle intervention was used for up to 3 months, and if the target was not reached, drug treatment was started again.

Question 5: What is meant by lifestyle intervention for hypertension?

Lifestyle interventions can lower blood pressure, prevent or delay the onset of hypertension, and reduce the risk of cardiovascular disease. All patients with diagnosed hypertension: Lifestyle intervention should be initiated immediately and persisted long-term.

Six steps of a healthy lifestyle: limit salt, lose weight, exercise more, quit smoking, limit alcohol, and have a peaceful mind.

The main measures include: 1. Reduce sodium intake, and gradually reduce the daily intake of salt per person to


2. Control your weight and make BMI


3. Do not smoke, quit smoking completely, and avoid passive smoking.

4. Do not drink or limit alcohol consumption.

5. Moderate-intensity exercise, such as walking, jogging, tai chi, yoga; 5-7 times a week; each time lasts 30 minutes.

6. Reduce mental stress and maintain psychological balance. 

Question 6: In what range should the blood pressure of hypertensive patients be controlled?

Patients with general hypertension should be reduced to

0 mmHg. For high-risk patients with diabetes and proteinuria, if tolerated, blood pressure can be controlled below 130/80 mmHg. For the elderly over 80 years old, it can be controlled at 150/90 mmHg.

Question 7: Can I stop taking antihypertensive drugs after the blood pressure is normal?

This problem is actually a problem that many hypertensive patients are very concerned about. First of all, once high blood pressure is diagnosed, you must take medicine for life, and at the same time learn to monitor blood pressure yourself. Secondly, while monitoring blood pressure, antihypertensive drugs can be adjusted according to the characteristics of blood pressure fluctuations in different seasons, but they cannot be stopped by themselves.

Question 8: Can high blood pressure be cured?

Hypertension is actually a preventable and controllable disease. As long as we do the “six steps of healthy life” just mentioned, adhere to reasonable medication and monitor blood pressure, we can reduce the risk of hypertension, complications and death. risk.

Question 9: How to treat high blood pressure? What treatments are available?

The fundamental goal of hypertension treatment is to reduce the overall risk of cardiovascular, cerebral, renal, and vascular complications and death from hypertension. On the basis of improving lifestyle, the administration of antihypertensive drugs should be determined according to the overall risk level of hypertensive patients, and at the same time intervene in correctable risk factors, target organ damage and coexisting clinical diseases. When conditions permit, intensive antihypertensive treatment strategies should be adopted to obtain the greatest cardiovascular benefit. Therefore, the treatment of hypertension is actually long-term lifestyle intervention + drug treatment.

Question 10: We have just talked about lifestyle intervention, so what are the antihypertensive drugs?

There are five main types of antihypertensive drugs, summed up as ABCD.

A: ACEI/ARB, which is the **pril/**sartan we have seen, such as enalapril/valsartan.

B: B-receptor blockers, also known as **dolols, such as metoprolol.

C: Calcium channel antagonists, which are the **dipines we see, such as nifedipine.

D: Diuretics, the only diuretics used to lower blood pressure are hydrochlorothiazide and indapamide.

In addition to these five categories of antihypertensive drugs, there are also antihypertensive drugs and compound preparations that act on the central nervous system.

Question 11: How to choose antihypertensive drugs?

To put it simply, as long as there are no contraindications, the five types of antihypertensive drugs we just talked about can be used. When choosing antihypertensive drugs, we need to achieve long-term, combined and stable blood pressure reduction, individualized treatment, and economic costs.

Starting from the disease itself: we recommend combined medication to synergize blood pressure and reduce adverse reactions; long-acting preparations should be selected, that is, drugs that are taken orally once a day, because long-acting preparations can better achieve the purpose of stable blood pressure; at the same time Also, take the medicine for a long time. For patients with different comorbidities, the focus of our drug selection will be different, because what we need is to maximize the protection of target organs and reduce complications and death. Individualization is to choose an antihypertensive drug that is suitable for oneself according to the patient’s own assessment, and the right one is good. To give a few simple examples, for patients with cerebral infarction, our first choice is CCB, because CCB can reduce the recurrence of cerebral infarction; for patients with diabetes, our first choice may be ACEI/ARB; for Simple elderly systolic hypertension, we can choose CCB or diuretics.

Combined with the economic cost, we also need to consider the patient’s economic affordability. Although long-acting preparations are better than short-acting preparations, at that time, if the patient cannot insist on oral administration for a long time, the final benefit is still insufficient. Because the benefit of antihypertensive therapy mainly comes from the reduction in blood pressure itself.

Question 12: Are there any side effects of taking antihypertensive drugs?

We must pay attention to contraindications in the process of use. Do not rise to the challenge, there are clear contraindications to use it. As long as our antihypertensive plan is suitable for you, and we achieve regular follow-up and long-term follow-up, then the risk of complications and death will certainly be reduced, so the benefits of taking antihypertensive drugs outweigh the harm!

Question 13: I was diagnosed with high blood pressure when I was only 30 years old, what should I do?

First, secondary hypertension must be ruled out. If you can’t find the cause of primary hypertension, stick to keeping your blood pressure under control.

More and more young people are getting high blood pressure because of lifestyle problems.

To treat high blood pressure, you must first change your unhealthy lifestyle, quit smoking, quit drinking, lose weight, eat healthy, exercise more, stay up late, and learn to release stress.

The good news is that with many early-stage high blood pressure, with a healthy lifestyle, blood pressure can return to normal.

Those who should take medicine should not avoid taking medicine, take medicine to control blood pressure, and those who are healthy will not affect anything. Poor control of blood pressure, myocardial infarction and stroke a few years later. Which is more cost-effective, you can actually calculate the account yourself.

Question 14: Will high blood pressure be passed on to children?

Hypertension is a genetically predisposed disease. If the parents have high blood pressure, the child is more likely to develop high blood pressure, but whether it will happen depends on the living environment.

Both parents have high blood pressure, or parents develop high blood pressure very early (such as before the age of 50), the child is more likely to have high blood pressure.

From a genetic point of view, high blood pressure belongs to polygenic inheritance, that is to say, many genes are related to high blood pressure, but it is not very clear which gene plays a role in a person. It is possible that on the basis of the existence of problems in many genes, combined with environmental factors, the blood pressure is increased.

Research now shows that even if you have a family history of hypertension, if you pay attention to your life, you can completely overcome genes and avoid high blood pressure.

For those whose parents have high blood pressure, it is important to understand that they are more likely to develop high blood pressure and pay more attention. You can’t break the jar and take it for granted that you will also have high blood pressure.

Question 15: Can I live longer if I have high blood pressure?

Of course longevity.

Many hypertensive patients have such doubts. Some people think that if high blood pressure is not cured, they will definitely not be able to live as long as healthy people. But this view is wrong.

First, as age increases, more people suffer from high blood pressure. By the age of 90, basically, more than 90% of people will have high blood pressure. Isn’t 90 years old enough to live long?

But for young and middle-aged hypertension, if not treated, of course, it will affect life expectancy, and the earlier you get high blood pressure and the higher the blood pressure, the greater the impact on life expectancy. However, the vast majority of hypertensive patients can be satisfactorily controlled after comprehensive treatment, and well-controlled hypertension can prevent damage to the body and can live a long life.

Hypertensive patients want to live a long life and have six steps to a healthy lifestyle: limit salt, lose weight, exercise more, quit smoking, limit alcohol, and keep a calm mind.

Question 16: What is coronary heart disease, how can coronary heart disease be prevented, and what should be paid attention to in life?

Coronary heart disease is short, its official name is coronary atherosclerotic heart disease, sometimes called ischemic heart disease. Coronary heart disease refers to the heart disease caused by atherosclerosis of the coronary arteries, resulting in stenosis or occlusion of the lumen, leading to myocardial ischemia, hypoxia or necrosis.

Its typical symptoms are crushing pain in the precordial area that can linger to the neck, jaw, arms, back, and stomach. Coronary heart disease may also experience dizziness, shortness of breath, sweating, chills, nausea and other uncomfortable symptoms. In severe cases, heart failure, syncope or death may occur, so it is better for the elderly to stay with a special person24 hourly escort.

Question 17: What are the causes of coronary heart disease in life?

The first dyslipidemia: dyslipidemia is one of the important factors leading to arteriosclerosis and an independent risk factor for coronary heart disease. How to avoid dyslipidemia? This is to start with our living habits. We should eat regularly, avoid high-salt, high-fat and high-oil diets, eat more crude fiber, foods rich in vitamins, and eat some protamine appropriately. For example: chicken, fish, etc., avoid too greasy diet, such as fried food.

The second is obesity: obesity will increase the risk of coronary heart disease, so high-sugar and high-fat diets are not acceptable, and you must control your weight.

The third is smoking and drinking: Smoking is a major risk factor for coronary heart disease. Tobacco contains nicotine, which can increase the heart rate, increase myocardial oxygen demand, constrict peripheral blood vessels and coronary arteries, and increase blood pressure. The increased concentration of carbon monoxide in the blood reduces the ability of blood to carry oxygen, promotes platelet adhesion and increases fibrinogen content, and promotes and aggravates atherosclerosis. Smoking can also reduce high-density lipoprotein cholesterol and accelerate the incidence of coronary heart disease. Drinking is also to be controlled, as the saying goes, a small drink is good, a big drink hurts your health.

There is high blood pressure, diabetes and impaired glucose tolerance, can also lead to coronary heart disease.

Question 18: Which exercises are suitable for patients with coronary heart disease?

1. Walking: You can walk for 45 to 60 minutes each time or walk 1000 to 2000 times a day. When jogging, you should make preparations first, wear sneakers that fit your feet, keep a relaxed pace when running, pay attention to the ground and surrounding environment, and prevent Fall and fall.

2. Swimming: If you have good physical strength, and you have the conditions to persist in swimming for a long time, you can engage in this physical activity, but you should be prepared for exercise, and you should avoid exercising for too long to prevent muscle spasms.

3. Taijiquan: Taijiquan movements are soft and smooth, gentle and relaxing, which is an effective health care method. Long-term practice can achieve the purpose of strengthening the body and preventing diseases.

5. Cycling: When exercising, the height of the seat and the curvature of the handlebars should be adjusted well. When driving, keep the upper body slightly forward to avoid grasping with force. It is advisable to exercise in the sports field.

China Business Daily reporter Yang Ning editor Wu Wenwen