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[HTN inventory] Pay attention to heart failure! With blood pressure in this range, patients with hea

Issuing time:2020-10-24 10:49


Heart failure is abbreviated as heart failure. It is generally understood that the heart used for pumping blood is not good, and the tissues and organs of the whole body cannot get sufficient blood and nutrient supply, and it will soon lead to necrosis due to ischemia and hypoxia.


Literally we can see


The relationship between it and high blood pressure,


Hypertension is a cardiovascular disease,


It will affect the human heart to a certain extent.



When the blood pressure rises, when the heart wants to pump out the same amount of blood in normal times, the pressure and resistance it receives will inevitably increase. The heart has to work under high load. Long-term high load work will cause the heart to experience various problems. The disease eventually leads to heart failure.


Controlling blood pressure is necessary for the prevention and treatment of heart failure


According to the results of a large domestic sample meta-analysis, for every 10 mmHg reduction in SBP, the risk of heart failure is significantly reduced by 28%. Recent studies have confirmed that compared with standard antihypertensive therapy (SBP <140 mmHg), enhanced blood pressure (SBP <120) mmHg) can significantly reduce the incidence of heart failure in hypertensive patients by 38% and significantly reduce cardiovascular death by 43%.


As can be seen,


Patients with higher blood pressure


The higher the risk of heart failure.


Therefore, control blood pressure


It is necessary to prevent and treat heart failure.



For patients with hypertension and heart failure, the recommended blood pressure reduction target is 130/80 mmHg or less. For patients with hypertension and left ventricular hypertrophy but not yet heart failure, blood pressure can be reduced to 140/90 mmHg or less. It is well tolerated and can be further reduced to below 130/80 mmHg, which is beneficial to prevent heart failure.



The treatment strategy of hypertension complicated with heart failure


There are many classification standards for heart failure, which can be divided into acute heart failure and chronic heart failure according to its development process; according to the left ventricular ejection fraction LVEF value, heart failure can be divided into reduced ejection fraction heart failure (HFrEF), ejection fraction Threshold heart failure (HFmrEF) and ejection fraction retention heart failure (HFpEF). Different treatment strategies should be adopted for different patients with heart failure and hypertension.



1. Hypertension combined with chronic heart failure


Heart failure caused by long-term and persistent hypertension ultimately includes HFpEF and HFrEF.


(1) Hypertension combined with chronic HFrEF: ACEI (ARB can be used for those who cannot tolerate it), β-receptor blockers and aldosterone receptor antagonists are preferred. The combined use of the three drugs can reduce the mortality of patients and improve the prognosis. They all have a good effect on reducing blood pressure. If hypertension still cannot be controlled, amlodipine and felodipine are recommended.


(2) Hypertension combined with HFpEF: The above three drugs cannot reduce the mortality and improve the prognosis of such patients, but they are still recommended for antihypertensive therapy and are safe. If hypertension still cannot be controlled, amlodipine and felodipine are recommended.


It is not recommended to use alpha blockers and central hypotensive drugs. CCB with negative inotropic effects such as diltiazem and verapamil cannot be used for HFrEF, but it may still be safe for patients with HFpEF.


2. Hypertension combined with acute heart failure


Such patients need to actively lower blood pressure while controlling heart failure. The main intravenous administration of loop diuretics and vasodilators, including nitroglycerin, sodium nitroprusside or urapidil.




If the disease is mild, the blood pressure can be gradually reduced within 24 to 48 hours; in patients with severe disease and acute pulmonary edema, the reduction in mean arterial pressure in the initial 1 hour does not exceed 25% of the level before treatment, within 2 to 6 hours It drops to 160/100~110 mmHg, and the blood pressure gradually drops to normal within 24 to 48 hours.


Tips

Early detection, early intervention, and early treatment are necessary, with prevention as the main focus, regular inspections, and maintaining a healthy life schedule, not to make up for it after the disease occurs, and to get twice the result with half the effort.




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