Heart failure (hereinafter referred to as heart failure) is a common complication of hypertension. Epidemiological studies have shown that 40% to 50% of heart failure is caused by hypertension. The antihypertensive treatment can greatly reduce the incidence of heart failure in patients with hypertension, and can also reduce the cardiovascular events in patients with hypertension and heart failure, reduce the mortality rate, and improve the prognosis.
Lower than 130/80mmHg is the target of antihypertensive therapy
Given that the risk of cardiovascular disease progression is significantly increased when hypertension is not controlled, hypertension can be regarded as a precursor of heart failure. In 2003, the American Heart Association proposed the stage of heart failure (stage A is high blood pressure, stage B has structural changes in the heart, stage C has chronic heart failure, and stage D is end-stage heart failure), which emphasizes the prevention of heart failure And the importance of risk factor management.
In a prospective survey of community population in Minnesota, the United States, 2029 residents aged ≥45 years were followed up with a median time of 5.5 years. The results showed that the population in stage A/B was as high as 56%; for 5-year survival Rate survey found that the survival rate of patients in stage A/B is above 95%, while the survival rate of patients in stage C is 75%, and the survival rate to stage D is only 20%. In other words, high-risk patients with heart failure are a huge population, and early identification of the A/B population is essential to reduce the incidence of heart failure, mortality and improve prognosis. There is a huge population of hypertension in our country. Without early intervention, the incidence and mortality of heart failure will rise significantly.
Clinical trials have shown that in high-risk patients with cardiovascular disease, by reducing blood pressure to 120/80mmHg, major cardiovascular events can be significantly reduced, and the risk of central failure can be reduced by 38%. Therefore, the initial treatment blood pressure threshold for patients with stages A, B, and C should be set to be less than 130/80mmHg, and it is better to control it below 120/80mmHg under the premise of safety and tolerance.
3 Attention during medication
Drugs are the main way of antihypertensive treatment. Although all types of antihypertensive drugs can lower blood pressure, there are significant differences between different types of drugs in reducing the incidence or progression of heart failure. More importantly, some drugs can induce or aggravate heart failure and should be avoided as much as possible. Meta-analysis related to antihypertensive therapy shows that in the prevention of heart failure, angiotensin-converting enzyme inhibitors (ie Pris, ACEI)/angiotensin II receptor antagonists (sartans, ARB), Beta blockers and aldosterone receptor antagonists. Combination therapy is recommended, ACEI/ARB combined with β-receptor blockers, or ACEI/ARB combined with β-receptor blockers and aldosterone receptor antagonists.
Attention should be paid to the specific medication process-
1. Low-dose initial
ACEI or ARB, beta blockers and (or) diuretics combined use, hypotension may occur during initial treatment. Therefore, it must be started with a small dose (ACEI or ARB from 1/4 the regular dose, β-blockers from 1/8 the regular dose), and the dose is increased every 1 to 2 weeks. After adjusting to the appropriate dose, insist on taking it for a long time and avoid sudden withdrawal.
ACEI/ARB, β-receptor blockers and aldosterone receptor antagonists can further reduce the mortality and hospitalization rate of patients with heart failure. It has become the basic treatment plan for patients with heart failure with reduced ejection fraction, but cannot be used at the same time ACEI+ARB+aldosterone receptor antagonist.
For patients with heart failure with fluid retention, diuretics are the only drugs that can fully control and effectively eliminate fluid retention, and are an essential part of the standard treatment of heart failure.
2. Observe resting heart rate
beta-blockers can improve heart function, reduce ventricular muscle weight and volume, improve ventricular shape, and delay or reverse myocardial remodeling. However, excessively large initial doses and rapid dose escalation of β-blockers often lead to worsening of heart failure.
Resting heart rate is one of the indicators for evaluating effective β-receptor block. Usually, the resting heart rate is controlled at a dose of 55-60 beats/min as the target dose or the maximum tolerated dose. If heart failure worsens during the course of taking β-blockers, the dosage of diuretics can be increased to eliminate water and sodium retention; the increasing dose can also be suspended or the interval between increasing doses can be suspended, or the previous dose can be returned. Try not to stop the drug and maintain β-blocker therapy. If the heart rate is less than 55 beats/min, accompanied by obvious dizziness and fatigue, or atrioventricular block of more than second degree, the dose should be reduced or the drug should be discontinued.
3. To avoid the deterioration of renal function
for the use of ACEI, ARB and diuretics, serum creatinine and serum potassium levels should be monitored. Patients with renal insufficiency and those with blood potassium levels >5.5 mmol/L should not use aldosterone receptor antagonists.