V Physical exercise

(V) Physical exercise Regular physical exercise has important therapeutic effects, such as lowering blood pressure and improving glucose metabolism. It is recommended to engage in appropriate physical activity every day (about 30 minutes per day), and to have at least one session of aerobic exercise per week, such as walking, jogging, cycling, swimming, aerobics, dancing, and non-competitive rowing. A typical physical activity plan includes three stages: (1) 5 ~ 10 minutes of light warm-up activities. (2) 20 ~ 30 minutes of endurance activities or aerobic exercise. (3) A relaxation phase of about 5 minutes, gradually reducing exertion to allow the cardiovascular system’s response and the body’s heat production function to stabilize gradually. The form and intensity of exercise should be determined according to individual interests and physical condition. (VI) Reducing mental stress and maintaining psychological balance Mental or psychological stress triggers psychological stress response—that is, the body’s reaction to psychological and physiological stimuli in the environment. Long-term, excessive psychological reactions, especially negative ones, significantly increase cardiovascular risk. The main causes of increased mental stress include excessive work and life pressure, including depression, anxiety, social isolation, and lack of social support. Various measures should be taken to help patients prevent and relieve mental stress, as well as correct and treat pathological psychology; when necessary, patients are advised to seek professional psychological counseling or treatment. IX. Indications for antihypertensive drug therapy Patients with grade 2 or higher hypertension (≥ 160/100 mmHg). Patients with hypertension combined with diabetes, or those who already have target organ damage and complications in the heart, brain, or kidneys—any patient whose blood pressure remains persistently elevated for more than 6 months despite lifestyle improvements and still fails to achieve effective blood pressure control. From the perspective of cardiovascular risk stratification, high-risk and very high-risk patients must receive intensive antihypertensive drug therapy. X. Objectives of blood pressure reduction and achieving stable targets (---) Objectives of antihypertensive treatment The purpose of administering antihypertensive drugs to hypertensive patients is to effectively prevent or delay the occurrence of cerebrovascular and cardiovascular complications such as stroke, myocardial infarction, heart failure, and renal insufficiency by lowering blood pressure; to effectively control the progression of hypertension and prevent the occurrence of severe hypertensive conditions such as hypertensive emergencies and subemergencies. For every 5 mmHg reduction in diastolic pressure (and 10 mmHg reduction in systolic pressure), the risk of stroke and ischemic heart disease decreases by 40% and 14%, respectively; for every 10 mmHg reduction in systolic pressure (and 4 mmHg reduction in diastolic pressure), the risk of stroke and ischemic heart disease decreases by 30% and 23%, respectively. (II) Ways to achieve blood pressure targets Lowering blood pressure to the target level can significantly reduce the risk of cerebrovascular and cardiovascular complications. However, whether further lowering blood pressure after reaching the above treatment goals still provides benefits remains uncertain. Some studies show that reducing the diastolic pressure of coronary heart disease patients below 60 mmHg may increase the risk of cardiovascular events. Blood pressure should be lowered to the aforementioned target levels in a timely manner, but faster is not necessarily better. Most hypertensive patients should gradually reduce their blood pressure to the target level over several weeks to several months, depending on their condition. Younger patients with shorter disease duration can reduce blood pressure more quickly; however, elderly patients, those with longer disease duration, or those who already have target organ damage or complications should reduce blood pressure more slowly. (III) Timing of antihypertensive drug therapy High-risk, very high-risk, or grade 3 hypertensive patients should start antihypertensive drug therapy immediately; confirmed grade 2 hypertensive patients should consider starting drug therapy; grade 1 hypertensive patients can start antihypertensive drug therapy after several weeks of lifestyle intervention, if their blood pressure remains ≥ 140/90 mmHg. X. Antihypertensive drug therapy (---) Principles of antihypertensive drug therapy 1. Small doses In the initial stage of treatment, usually a smaller effective therapeutic dose should be used, and the dose should be gradually increased as needed. Antihypertensive drugs need to be used long-term or for life, so the safety of the drugs and the patient’s tolerance are important. The importance is no less than, or even greater than, the therapeutic efficacy of drugs. 2. Whenever possible, use long-acting formulations. Preferably, choose long-acting medications that require only once-daily administration and provide sustained 24-hour blood pressure reduction, in order to effectively control nocturnal and morning blood pressure surges and more effectively prevent cardiovascular and cerebrovascular complications. If intermediate- or short-acting formulations are used, then dosing should be administered 2–3 times daily to achieve stable blood pressure control. 3. Combination therapy. To enhance antihypertensive effects without increasing adverse reactions, when monotherapy at low doses fails to achieve satisfactory results, two or more antihypertensive drugs can be used in combination. In fact, for hypertension grade 2 or higher, combination therapy is often necessary to reach the target blood pressure. For patients with blood pressure ≥160/100 mmHg or those classified as moderate risk or above, initial treatment may involve a low-dose combination of two drugs, or the use of a fixed-combination formulation at a low dose. 4. Individualization. Select antihypertensive medications that are suitable for each patient based on their specific clinical condition, tolerability, personal preferences, and long-term ability to adhere to treatment. (II) Types of Antihypertensive Drugs Diuretics, beta-blockers, calcium channel blockers (CCBs), angiotensin-converting enzyme inhibitors (ACEIs), and angiotensin II receptor blockers (ARBs). See Table 2-4. XII. Characteristics of Antihypertensive Drug Actions (---) Diuretics 1. Thiazide class (1) Mechanism of antihypertensive action: First, by promoting urinary sodium excretion, plasma and extracellular fluid volume decrease, cardiac output reduces, and after several weeks returns to normal; this also reduces intravascular sodium ions, leading to vasodilation and exerting an antihypertensive effect. (2) Common preparations and dosages: Hydrochlorothiazide, 12.5 mg each time, 1–2 times daily; Table 2-4 Clinical Selection of Common Antihypertensive Drug Types

Category | > Indications | > Contraindications | +------------+----------------+ | | > Absolute | > Relative contraindications | | > Contraindications | Calcium channel block | > Elderly hypertensive peripheral vascular disease | > None | > Rapid-type arrhythmia | > | | > Chronic heart failure inhibitor (II | > Isolated systolic hypertension stable angina | | | > Pain | | Hydropyridine | > | | | > Carotid atherosclerosis | | class ) | > | | | > Coronary atherosclerosis | | Calcium channel block | > Angina pectoris | > Second to third degree | > Heart failure | > | > Atrioventricular conduction | inhibitor (non | > Carotid atherosclerosis | > Block | | > Supraventricular tachycardia | | Dihydropyridine | | | | | | class ) | | | Vasoconstriction | > Heart failure angina pectoris | > Pregnancy | | > | > | Enzyme conversion | > Post-myocardial infarction left ventricular hypertrophy | > Hyperkalemia | | > | > | inhibitor | > Left ventricular dysfunction | > Bilateral renal artery | | > Carotid atherosclerosis | > Pulmonary stenosis | (ACEI) | > Non-diabetic nephropathy | | | > | | | > Diabetic nephropathy | | | > | | | > Proteinuria/microalbuminuria | | | > Metabolic syndrome | | Vasoconstriction | > Diabetic nephropathy | > Pregnancy | | > | > | I receptor blocker | > Proteinuria/microalbuminuria coronary heart disease | > Hyperkalemia | | > | > | blocker | > Heart failure | > Bilateral renal artery | | > | > Pulmonary stenosis | (ARB) | > Left ventricular hypertrophy | | | > | | | > Atrial fibrillation prevention | | | > | | | > Cough caused by ACEI metabolic syndrome | | Thiazide diuretics | > Heart failure elderly hypertension | > Gout | > Pregnancy | > Advanced elderly hypertension | | | > | | | > Isolated systolic hypertension | | Xiang diuretics | > Renal insufficiency heart failure | | Diuretics (aldosterone | > Heart failure | > Renal failure | antagonist ) | > Post-myocardial infarction | > | | | > Hyperkalemia | Receptor blockade | > | > Atrioventricular conduction | > Disease | > Post-myocardial infarction | > Block | >