Continuous operation in high temperatures, with blood pressure fluctuating as the weather gets hot? Some patients feel that their blood pressure has suddenly increased recently. In fact, heat and high blood pressure are not necessarily related. On the contrary, in summer, the temperature is higher, and blood vessels around the body dilate. Therefore, the patient's blood pressure may be lower than in winter. Some patients also believe that their blood pressure suddenly "returns to normal" and voluntarily reduce or stop taking medication, which is also unacceptable! Some people wake up in the early morning of summer and suddenly realize that their hands and feet are not working properly. When they go to the emergency room, they find that they have already suffered a stroke... poor blood pressure control, or a series of adverse events that are harmful to their health. The "Report on Cardiovascular Disease in China" shows that the crude incidence of hypertension among residents aged 18 and above in China is 27.9%, and the number of patients has increased from less than 30 million in 1958 to nearly 300 million, with younger onset of disease. On the contrary, the awareness rate, treatment rate, and control rate of hypertension are still at a relatively low level, at 51.6%, 45.8%, and 16.8%, respectively. In short, many people are unaware that they have high blood pressure, let alone reasonable stress control. It is urgent to recognize and manage hypertension and reduce the malignant cardiovascular events caused by hypertension. Question 1: Is blood pressure prone to fluctuations during high temperature days? Generally speaking, human blood pressure shows a seasonal pattern of "high in autumn and winter, low in spring and summer". Prospective research data on chronic diseases in China shows that the average difference in systolic blood pressure between summer and winter is 10mmHg. Under high temperature conditions, peripheral blood vessels in the human body dilate to increase heat dissipation, reducing vascular resistance and lowering blood pressure. Due to vasodilation and reduced cardiac load, cardiac output decreases and blood pressure further drops. In addition, during hot weather, the human body is prone to excessive sweating, leading to increased dehydration through the skin and a decrease in blood volume. When the temperature rises, the activity of the sympathetic system decreases, leading to a slower heart rate and lower blood pressure; Low temperature can activate the sympathetic nervous system and renin-angiotensin system in the human body, leading to increased heart rate, vasoconstriction, and thus hypertension. Researchers also observed that although the average blood pressure in summer is lower than in other seasons, nighttime systolic blood pressure increases and non -/rebound type blood pressure is more common in summer. In addition, "migratory bird style" health preservation is more common in China, and some elderly people choose to spend the winter in the warm south and escape the heat in the cold north. Significant changes in environmental temperature in a short period of time can also cause fluctuations in blood pressure. Question 2: What should be paid attention to when controlling pressure in summer? Some hypertensive patients with good blood pressure control in winter may experience hypotension in summer, manifested as fatigue, dizziness, and blackness. In order to reduce the occurrence of hypotensive events, doctors usually tend to reduce the types or doses of antihypertensive drugs for patients in summer. However, the decision to adjust antihypertensive drugs is based on the blood pressure in the consultation room or the patient's complaint of having low blood pressure during the face-to-face consultation. One blood pressure measurement is occasional and does not represent the true, all day blood pressure of hypertensive patients. It is precisely this type of medication reduction that increases the risk of nocturnal hypertension in patients during summer. Therefore, it is recommended that hypertensive patients undergo 24-hour dynamic blood pressure monitoring before adjusting their antihypertensive treatment plan to understand their blood pressure situation within a day. If the blood pressure is lower than the recommended target value and it is clear that it is due to seasonal fluctuations in blood pressure, they should carefully reduce medication or dosage under the guidance of a doctor's full evaluation. Secondly, patients can measure their home blood pressure values on their own every day, at multiple time points in the morning, morning, afternoon, evening, and before bedtime. They need to rest for more than 30 minutes before measuring blood pressure, and record the indoor and outdoor temperatures during blood pressure measurement, paying attention to the regularity of their blood pressure changes with temperature. During the visit, the doctor can adjust the antihypertensive medication based on the patient's home blood pressure monitoring results. In summer, some hypertensive patients may find that their blood pressure is normal or even low, so they stop taking antihypertensive drugs on their own. They will frequently monitor their blood pressure in the days before stopping the medication, and gradually relax after finding that the measurement results are normal, evolving into not taking medication or monitoring blood pressure. Little did they know, a few days before stopping taking antihypertensive drugs, there was still a certain concentration of the drug in the patient's body, and blood pressure may still be able to maintain normal levels. After a long period of drug withdrawal, a small number of patients' blood pressure, especially at night, abnormally increased without realizing it. It was not until one morning when they woke up and found that their hands and feet were weak and they could not walk. After being urgently sent to the hospital, they discovered that they had suffered a stroke, but it was too late. In addition, some patients take antihypertensive drugs not only to lower blood pressure, but also widely used antihypertensive drugs recommended by international guidelines to improve ventricular remodeling and reduce the risk of death in heart failure patients. Therefore, the adjustment of antihypertensive drugs for hypertensive patients needs to be carried out under the guidance of a doctor and should not be made on their own. Question 3: There are many antihypertensive drugs, how to choose? With a deeper understanding of hypertension, the types of targeted antihypertensive drugs are also increasing. Research has confirmed that continuous use of ACEI/ARB antihypertensive drugs for 12 months can significantly improve seasonal blood pressure fluctuations in hypertensive patients. For elderly hypertensive patients, calcium antagonist antihypertensive drugs are often the first choice. Studies have also found that ACEI/ARB antihypertensive drugs combined with calcium antagonists can effectively reduce their blood pressure variability. For patients with nighttime hypertension, it is more recommended to use long-acting antihypertensive drugs. For patients with better blood pressure control in winter and lower blood pressure in summer, doctors often focus on reducing diuretics when reducing antihypertensive drugs. The most important thing in the selection and adjustment of antihypertensive drugs is to develop a final plan under the strict guidance of a doctor, based on individual basic conditions, combined with other comorbidities including liver and kidney function. Question 4: What should we pay attention to in our lifestyle? Abnormal fluctuations in blood pressure are a risk factor for cardiovascular disease, therefore maintaining stable blood pressure is crucial. In addition to regularly taking antihypertensive drugs, the impact of lifestyle changes on blood pressure should not be underestimated. The hypertension control diet recommended by many foreign doctors, especially the improved Mediterranean diet, can significantly reduce the systolic blood pressure (5.50-7.62mmHg) and the risk of all-cause mortality and cardiovascular mortality in hypertensive patients. The 2022 Chinese Heart Health (CHH) diet has also been shown to reduce systolic blood pressure by 10mmHg compared to the control population. Simply put, CHH diet means a 5% -8% reduction in the proportion of fat energy and a 3.5% -5.5% increase in the proportion of protein energy compared to a normal diet. In addition, too high salt intake will lead to water and sodium retention, increasing the risk of hypertension and other cardiovascular and renal diseases, so it is necessary to reduce salt in diet. The World Health Organization and multiple guidelines recommend that adults consume less than 5 grams of salt per day, equivalent to the amount of a beer cap, while increasing their intake of potassium rich foods such as spinach, bananas, oranges, etc. Research has shown that a low sodium and potassium rich diet can reduce systolic blood pressure by 7.1 mmHg in elderly people and significantly reduce the risk of cardiovascular and stroke. For hypertensive patients who smoke and drink every day, it is very important to quit smoking and drinking. Nicotine in tobacco can lead to faster heart rate, vasoconstriction, and accelerated atherosclerosis. Alcohol can cause sympathetic nerve excitement in the body and raise blood pressure. Moderate and heavy drinkers can significantly reduce blood pressure after restricting drinking. In addition, obesity and overweight are also contributing factors to hypertension. By engaging in moderate aerobic exercise daily, such as brisk walking, jogging, and skipping rope, efforts can be made to control BMI within the normal range, which is an effective way to lower blood pressure. It is recommended to exercise for 30 to 45 minutes each time, 3 to 5 days a week. For patients with unstable blood pressure, vigorous exercise should be avoided to prevent adverse events such as cerebral hemorrhage caused by sudden increase in blood pressure. In addition, maintaining mental health has a positive effect on lowering blood pressure in hypertensive patients, especially young hypertensive patients. For people with a "migratory bird" lifestyle, especially those with comorbidities of cardiovascular and cerebrovascular diseases, it is recommended to undergo a comprehensive physical examination and evaluation before departure to reduce the risk of sudden temperature changes causing blood pressure fluctuations and even triggering malignant events such as heart attacks and strokes. (New Society)