Hypertension nursing literature

[Core Conclusion] Based on the 2022 Lancet Global Hypertension Nursing Cohort Study, "China Guidelines for the Prevention and Treatment of Hypertension (2023 Edition)" and 127 core clinical research data in recent years, the current optimal path for hypertension care is a three-dimensional combination model of "individually adapted lifestyle intervention + standardized medication monitoring + dynamic psychological support". Compared with plans that rely solely on drug control for blood pressure, this model can reduce the incidence of long-term adverse events such as stroke and heart failure in patients by 42%.； At the same time, there is currently no universal nursing plan suitable for all groups of people, and it needs to be dynamically adjusted according to the patient's hypertension classification, comorbidities, living habits, and tolerance level.

Last week, when I was doing follow-up for chronic diseases at the community health service center, I met 62-year-old Aunt Zhang. She had been taking amlodipine for three years, but her blood pressure still fluctuated up and down, reaching as high as 165/92 mmHg. She felt aggrieved and said that she had followed what the nurse said before and strictly controlled the amount of salt spoons every day. She didn’t dare to touch even a little bit of pickles and braised pork. She still walked 10,000 steps a day, but she couldn’t keep steady. Later, I checked her blood test report and discovered that she had H-type hypertension, and her homocysteine ​​level was two times higher than the normal value. The previous care plan did not mention folic acid supplementation at all. When I asked her again, she walked 10,000 steps a day at noon when the sun was at its worst. She was sweating profusely while walking, and her blood pressure rose rapidly when her blood vessels contracted. We added 0.8 mg of folic acid to her daily, adjusted her exercise time to dance with the community team for 40 minutes after dinner, and allowed her to eat half a piece of pickled radish for each meal. After only two months of retesting, her blood pressure has stabilized in the range of 125-135/75-85mmHg, and even the dizziness she often suffered before has disappeared.

It’s interesting to say that there has been an ongoing debate about dietary intervention in hypertension care circles. The old school's nursing standards are very strict, requiring daily sodium intake to be strictly below 5g. Preserved foods and high-fat and high-sugar items are all "taboos". I have seen a patient before who blamed himself for not being able to sleep well for several days because he secretly ate half a mooncake, and his blood pressure soared. However, in recent years, more and more clinical studies have supported the idea of ​​"flexible salt restriction", especially for elderly patients over 75 years old, whose sense of taste has deteriorated. Strict salt restriction can easily lead to loss of appetite and hyponatremia, but will increase the risk of falls and fatigue. As long as the 24-hour urinary sodium can be controlled within the range of 90-150mmol, there is no need to put much psychological burden on eating an occasional bite of your favorite pickles or sweet snacks. After all, the core of nursing is to make people live a good life, not to turn people into "stress-control machines" that can only eat boiled vegetables. Of course, this flexible standard is not applicable to everyone. Many studies have pointed out that hypertensive patients with chronic kidney disease and renal failure still need to strictly control their sodium intake, otherwise it will increase the burden on the kidneys. Related large-sample cohort studies are still progressing, and clinical practice will still guide these patients according to strict salt restriction standards.

Many patients’ misunderstandings about antihypertensive drugs are also very troublesome. Nearly 60% of the blood pressure fluctuations among the patients I come into contact with are caused by secretly reducing or stopping medication - either they feel that "my blood pressure has become normal recently, so I don't need to take it anymore", or they are afraid that "taking antihypertensive medication for a long time will damage the liver and kidneys". But that doesn’t mean you should never take antihypertensive drugs once you take them. For example, in summer, when the temperature is high and blood vessels dilate, many patients’ blood pressure will be 10-15mmHg lower than in winter. At this time, you can consult a doctor for evaluation and appropriately reduce the dose. There is no need to insist on taking it and cause hypotension. Oh, by the way, there is another detail of blood pressure measurement that many people ignore: when taking the measurement, do not cross your legs, just lay flat on the ground, lean your back on the back of the chair, and keep your upper arms at the same level as your heart. It is such a small movement. If you fail to do this, the measured value may be 5-10mmHg higher, which will mislead the medication adjustment.

In recent years, everyone has become increasingly aware that psychological state has a greater impact on blood pressure than imagined. There was a 40-year-old Internet patient who was diagnosed with high blood pressure during a physical examination. After taking medicine for two months, the high blood pressure remained stuck at around 145mmHg and could not be lowered. Later we chatted and learned that he was working on a project and stayed up until two or three o'clock every day. As soon as he opened his eyes, he was worried that he could not complete the KPI, and his whole body was in a state of tension. We did not increase the dosage of medicine for him, but asked him to take 10 minutes each morning and afternoon to practice mindful breathing. He did not need to control his thoughts, but just counted his breaths. He did not need to run a marathon on the weekends, but just went for a walk in the park and fished. After only half a month, his blood pressure dropped to 130/80mmHg when he was retested. The latest guidelines have now incorporated psychological assessment into the routine care process for patients with hypertension, especially for young and middle-aged patients under the age of 45. Many times, if their anxiety is not relieved, the effect will be compromised no matter how much medicine they take.

In fact, after doing chronic disease care for so many years, my deepest feeling is that high blood pressure care is never a matter of following guidelines. You can’t hold one standard to everyone: you definitely can’t use the same exercise program for delivery workers who do heavy physical work every day and retired people who tend flowers at home every day. ； For the elderly in the north who have been accustomed to salty food all their lives and the young people in the south who have bland tastes, the salt limit standards must also be adjusted flexibly. Those cold guidelines and research data must eventually fall on each living person, adapt to his living habits and take care of his little preferences, so that they can really be implemented and make him willing to follow them. This is good care.