Excuse me, doctor, I have an old man with high blood pressure. If the weather is bad,

Your elderly person suffers from hypertension accompanied by chest tightness, pain, and dizziness. It may be hypertension combined with coronary heart disease. Symptomatic treatment is required after diagnosis. Below I will introduce to you the diagnosis and treatment methods of hypertension for your reference: Hypertension Hypertension is divided into two categories: primary and secondary. The former accounts for more than 95% of the total number of hypertension and is called hypertension. Also called essential hypertension. The prevalence of hypertension among adults in my country is about 19%, and the prevalence among men and women is similar. As age increases, the prevalence of hypertension is also showing a significantly increasing trend. The causes of hypertension are generally believed to be related to heredity and long-term mental stress; the risk factors for hypertension are advanced age (over 55 years old), abdominal obesity (abdominal circumference greater than 85cm for men and greater than 80cm for women), and diabetes (fasting blood glucose greater than or equal to 7.0mmol/L or symptoms of diabetes at any time, blood sugar equal to or greater than 11.1mmol/L or oral glucose tolerance test 2-hour blood glucose greater than 11.1mmol/L), dyslipidemia (total cholesterol greater than 6.5mmol/L, triglyceride greater than 1.7mmol) /L, or high-density lipoprotein cholesterol (HDL-C) less than 0.91mmol/L), smoking (more than 1 time/week), drinking (more than 1 time/week), etc. Less than 5% of patients have secondary hypertension caused by kidney disease, brain tumors, adrenal disease, etc., which is called secondary hypertension. The key points of diagnosis and treatment of essential hypertension are listed below: "Diagnostic Key Points" 1. Blood pressure is based on the 1999 WHO/ISH diagnostic criteria. Systolic blood pressure is equal to or greater than 140mmHg and/or diastolic blood pressure is equal to or greater than 90mmHg (18.62/11.9kP )above. The ideal blood pressure should be 120/70mmHg. (16/9.3kPa). 2. Symptoms: headache, dizziness, tinnitus, palpitations, irritability, fatigue, or lightheadedness and unsteady walking. 3. Stages: Stage I: There is no clinical manifestation of heart, brain, or kidney damage, but the blood pressure reaches the standard for diagnosis of hypertension. The blood pressure can return to normal by resting without taking antihypertensive drugs. Stage II: Blood pressure reaches the standard of hypertension, blood pressure cannot return to normal without taking antihypertensive drugs, and one of the following is present: ① Left ventricular hypertrophy. ② Fundus arteriosclerosis. ③Proteinuria or slightly elevated plasma creatinine. Stage III: People whose blood pressure reaches the level of confirmed hypertension and have one of the following: ① Hypertensive encephalopathy or cerebral hemorrhage. ②Heart failure. ③Kidney failure. ④ Bleeding or exudation under the eyes, or papilloedema. 4. Pulse pressure: Pulse pressure is an indicator of large arteriosclerosis. The greater the pulse pressure, the greater the blood vessel stiffness. Large arteriosclerosis increases systolic blood pressure and decreases diastolic blood pressure. Increased systolic blood pressure increases left ventricular afterload and myocardial oxygen consumption, leading to left ventricular hypertrophy and impaired diastolic relaxation of the myocardium, thereby reducing ejection fraction. Multiple studies have proven that the risk of coronary heart disease in patients with hypertension is positively correlated with pulse pressure. For every 10 mmHg increase in pulse pressure, the risk of coronary heart disease increases by 25% to 35%. Measuring pulse pressure can help predict heart failure in patients with coronary heart disease. "Key Points of Prevention and Treatment" 1. Western medicine: 1. Calcium channel blockers, the first choice is nifedipine tablets or sustained-release tablets or controlled-release tablets 10 to 30 mg, 1 to 3 times a day; or nitrendipine tablets 10 to 20 mg , taken orally 2 to 3 times a day. Or lacidipine (Lexipine) 4 mg/tablet/time/day, or levamlodipine besylate tablets 2.5 mg to 5 mg, taken orally 1 to 2 times a day. 2. Angiotensin-converting enzyme inhibitor, captopril tablets (short-acting) 12.5 mg to 25 mg; or enalapril (medium-acting) 5 mg, 1 to 2 times a day; or perindopril tablets ( Asta, long-acting) 2 to 4 mg/day; or benazepril (Lotin) 5 to 10 mg/day. Recently, some scholars advocate the combination of simvastatin and benazepril for the treatment of mild and moderate primary It is more effective in lowering blood pressure than benazepril alone and is better tolerated. It is especially suitable for patients with hypertension and hyperlipidemia. In addition, angiotensin II receptor antagonists, such as valsartan ( Diovan) 80~160mg, taken once a day; or Telmisartan (Mecanol) 40~80mg, taken orally once a day. Those who cough after taking angiotensin-converting enzyme inhibitors can switch to this medicine. 3. For high blood pressure with a fast heart rate, beta-blockers can be given, such as metoprolol tartrate tablets (Betoprolol) 25 mg to 100 mg, 1 to 2 times a day. Or atenolol tablets, 25 to 50 mg, taken orally 2 to 3 times a day. 4. As a diuretic, indapamide tablets (Shoubishan) can be used, 2.5 mg, taken once a day. 5. Enteric-coated aspirin tablets 75 to 100 mg, once a day. In order to reduce gastric acid secretion and prevent gastroduodenal mucosal damage or bleeding, omeprazole enteric-coated capsules 20 mg/day or ranitidine 150 mg/day can be taken orally for a long time. Especially for patients who are over 60 years old, or have a history of gastroduodenal ulcers, or who have taken non-steroidal drugs in excessive doses, for too long, or at the same time as hormones, they need to take additional ranitidine or oxysteroids. Meprazole to reduce the irritation of nonsteroidal drugs to the gastrointestinal mucosa. 6. Vitamin B6 tablets, 2 tablets, twice a day. 7. Folic acid, 10 to 20 mg, taken orally 2 to 3 times a day.

The drug is an antioxidant. Research in recent years has shown that long-term oral administration can reduce the risk of cardiovascular disease. It is especially suitable for elderly patients with hypertension and coronary heart disease. Some clinical reports have shown that elderly people taking this drug for more than 3 years can reduce the risk of cardiovascular disease. The risk of stroke is reduced by more than 37%. For patients with hypertension, it is recommended to take folic acid in addition to conventional oral antihypertensive drugs. For healthy elderly people, it is also recommended to take 5 mg of folic acid orally 2 to 3 times a day. 2. TCM Syndrome Differentiation and Treatment 1. Liver stagnation transforms into fire, and wind and yang are disturbed. Main symptoms: headache and dizziness, flushed face and eyes, irritability, dry and yellow stools, bitter mouth and dry throat, red tongue and stringy pulse. Treatment Principles: Clear and purge liver-fire, supplemented by nourishing yin. Recipe: Gendan Xiegan Decoction plus or minus: 10 grams each of gentian, skullcap, gardenia, and chrysanthemum, 20 grams each of Rehmannia glutinosa, Cassia, oyster, and Prunella vulgaris. Modification: For headache, add 30 grams of Cassia or Mother of Pearl. If the stool is hot and dry, add 30 grams of gypsum and 6 grams of rhubarb. For muchi, add 10 grams each of red peony root and white grass root. For limb tremors, add 30 grams each of white peony root and uncaria root. Decoction in water. 2. Main symptoms of liver and kidney yin deficiency and liver yang hyperactivity: dizziness and tinnitus, insomnia and dreaminess, irritability, red urine, low back pain and leg soreness, and even numbness of limbs, nocturnal emission, dark red tongue, stringy pulse thin. Treatment Principles: To nourish liver and kidney yin, and to subdue yang. Recipe: Zhengan Xifeng Decoction plus or minus: 30 grams each of Rehmannia glutinosa, Rehmannia glutinosa, mulberry, Radix Polygonatum sibiricum, and Achyranthes chinensis, 10 grams each of Dendrobium, Asparagus, and Lycium barbarum, and 15 grams each of keel bone, oyster, and Achyranthes bidentata. Additions and subtractions: For dizziness, add 20 grams each of magnetite and prunella vulgaris, for palpitation, add 30 grams of mother-of-pearl, for constipation, add 10 grams of black sesame, for numbness of limbs, add 30 grams of mulberry branches, and for 10 grams each of Trachelospermia and Prunella vulgaris. Decoction in water. 3. Deficiency of both yin and yang, main symptoms of deficiency and yang inversion: headache, dizziness, tinnitus, blurred vision, red face, dry mouth, spontaneous sweating, insomnia and dreaminess, backache and leg weakness, muscle twitching, cold limbs, shortness of breath, Polyuria at night, red tongue with white coating, stringy and thin pulse. Treatment principles: Nourish kidney yin, warm kidney yang. Recipe: Fugui Dihuang Pills (Shenqi Pills) Additions and subtractions: 25 grams of Rehmannia glutinosa, 10 grams each of Alisma, Cornus, Paeoniae, Chinese yam, Poria, and Aconite, and 3 grams of cinnamon powder (taken as a drink). Decoction in water. In the prescription, Liuwei Dihuang Pills are used to nourish kidney water to control yang hyperactivity, and Gui Yi Mingmen Fire is added to eliminate yin and cold. 4. Menopausal hypertension in women. Main symptoms: irregular menstruation, low back pain, frequent urination, headache and dizziness. This is due to the imbalance of Chong and Ren. Principles of treatment: Tune, supplement and charge. Recipe: Erxian Decoction plus or minus: 10 grams each of curculigo, fairy spleen, Morinda officinalis, Angelica sinensis, Anemarrhena, Polygonatum, Ligustrum lucidum, Eucommia ulmoides, Loranth, Achyranthes bidentata, Cortex Phellodendri, and Alisma. Decoction in water. Curculigo, epimedium, and Morinda officinalis warm yang and nourish the kidney, and are supplemented with Phellodendron cypress, Anemarrhena, etc. to nourish yin and clear away heat, to release phase fire, and Angelica sinensis, etc. to regulate Chong and Ren. This prescription is also very effective in treating syndromes caused by low female hormone secretion. Take Chinese medicine decoction, and once the condition is stable, you can switch to Western medicine for maintenance. When taking Western medicine for hypertension, in principle, the medicine cannot be stopped, and the dosage can be adjusted or reduced. The elderly should try not to take compound antihypertensive drugs orally, because most compound antihypertensive drugs contain diuretics and sedatives, and long-term use may lead to potassium deficiency or mental and neurological adverse reactions. 3. Single prescriptions are available for reference or selection: 1. For patients with both yin and yang deficiency, or deficiency and yang deficiency, the following prescriptions can be taken: ⑴ 25 grams of Rehmannia glutinosa, 12 grams of Cistanche deserticola, 10 grams each of mulberry and achyranthes. Decoction in water. ⑵ Fugui Dihuang Pill, 1 pill, taken twice a day. ⑶Quanlu pills, 1 pill, taken 2 times a day. 2. For those with liver and kidney yin deficiency and liver yang hyperactivity, you can take the following medicine: ⑴ 15 grams each of Rehmannia glutinosa, Tribulus terrestris, and Achyranthes bidentata. Decoction in water. ⑵Dabuyin Pill, 1 pill, taken twice a day. ⑶Qiju Dihuang Pills, 1 pill, taken 2 times a day. ⑷Liuwei Dihuang Pills, 1 pill, taken 2 times a day. ⑸Naoliqing, 15 capsules, taken 2 times a day. ⑹ Qingxuan Pill, 1 pill, taken 2 times a day. ⑺ 30 grams of Aoki incense, grind into powder, take 1 gram each time, 3 times a day, after meals, 3 months is a course of treatment. ⑻ 30 grams of corn silk, decoct in water and take it. ⑼100 grams of cucumber seedlings after autumn, instead of tea every day. ⑽ Soak peanuts in vinegar for more than a week, and take 3 to 5 pills every night before going to bed. It can be eaten for a long time. 3. For those whose liver stagnation turns into fire and Fengyang is disturbed, the following prescriptions can be taken: ⑴ 60 grams of chrysanthemum, boiled in water instead of tea. ⑵ 30 grams of Prunella vulgaris, 15 grams each of Kudingcha, chrysanthemum, and Cassia, decoct in water and take it as tea. ⑶Longdan Xiegan Pills, 12 grams (generation), 2 times a day. ⑷Bezoar Shangqing Pill, 1 pill, taken twice a day. 4. Medication selection for hypertension: 1. For middle-aged and young people or those with high renin type, beta-blockers such as atenolol, metoprolol (betaloc) and angiotensin-converting enzyme inhibitors are preferred. Agents (enalapril, etc.); while the elderly or those with low renin type are preferred calcium antagonists (such as dipine) or diuretics (indopamide, aminostildine). 2. Beta-blockers or calcium blockers are the first choice for hypertension complicated with coronary heart disease. 3. For hypertension accompanied by renal insufficiency, calcium blockers and renin-converting enzyme inhibitors are preferred. Beta-blockers should not be used. 4. People with high blood pressure, hyperlipidemia, diabetes or gout should not use diuretics and beta-blockers. 5. Combination of Chinese and Western medicine has better therapeutic effect. 5. Non-drug treatment: 1. Adjust eating habits: advocate a three-low and three-high diet (low salt, low fat, low sugar, high protein, high vitamin, and high fiber). Eat less sweets and fried foods to avoid hyperlipidemia. Banning smoking and alcohol will help reduce the incidence of cardiovascular and cerebrovascular diseases such as hypertension. 2. Keep exercising and lose weight, which is beneficial to patients with hypertension. Choose uninterrupted activities that suit you, such as Tai Chi, Tai Chi sword and brisk walking, which are more suitable for the elderly. Maintain 6 to 8 hours of sleep and take a half-hour to 1 hour lunch break.

3. Mental treatment: Use "contentment and happiness" to adjust your mentality and maintain the balance of yin and yang. Qigong can adjust the balance of yin and yang. Overcome selfishness, fame and fortune, and the five desires and six objects (the five desires: money, color, fame, food, and sleep. The six objects: color, sound, smell, taste, touch, and law). Gu Dade said: To be a human being, one must "cultivate the five virtues internally and cultivate the six harmonies externally." (Five virtues: gentleness, kindness, prudentness, thrift, and tolerance). (Six Harmonies: Seeing and understanding together, precepts and cultivating together, body and living together, speech and no quarrels, intention and pleasure, benefit and balance). By maintaining a pure mind, you can achieve a balance of yin and yang and have a good mentality. In short, people can always think about others but not themselves. They should not be sick, and they will recover quickly if they are sick. 5. Acupuncture and antihypertensive method Main points: Baihui, Fengchi, Neiguan, Sanyinjiao. Matching acupoints: Liver stagnation to transform fire, Fengyang ascending disturbance type: add Xingjian, Xiaxi; Liver and kidney yin deficiency, liver yang hyperactivity: add Taichong, Taixi, Ganyu, Shenshu; Phlegm-dampness internal resistance type: Add Fenglong, Zhongwan, Touwei, Gongsun; deficiency of both yin and yang, inverse type of deficiency and yang: add Guanyuan, Zusanli. Replenish and relieve diarrhea. Leave the needle in for 20 to 30 minutes, once a day, and the course of treatment is 2 to 4 weeks.

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