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Review ariticle | DOI: https://doi.org/10.31579/2690-1897/193
1Bachelor's degree, attending physician, Dingnan Nanfang Integrated Traditional Chinese and Western Medicine Hospital, Ganzhou City, Jiangxi Province, No.3 Industrial Avenue, Lishi Town, Dingnan County.
2Associate degree, Shanglin People's Hospital, No. 2 Yanxi Street, Dafeng Town, Shanglin County, Nanning City, Guangxi Zhuang Autonomous Region.
3Associate degree, Shenzhen Bolin Ophthalmology Hongli Clinic, Bolin Ophthalmology, Lihu Huayuan, Yuanling Street, Futian District, Shenzhen.
*Corresponding Author: Chunli Hu, undergraduate degree, Shanglin People's Hospital, No. 2 Yanxi Street, Dafeng Town, Shanglin County, Nanning City, Guangxi Zhuang Autonomous Region.
Citation: Kui Wang, Xiuping Chen, Zhongfa Wang, Jianhua Zhong, Chunli Hu, (2024), Traditional Chinese and Western Medicine Strategies for the Prevention and Treatment of Hypertension Combined with Coronary Heart Disease Based on the Principle of Targeted Therapy, J, Surgical Case Reports and Images, 7(4); DOI:10.31579/2690-1897/193
Copyright: © 2024, Chunli Hu. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 29 April 2024 | Accepted: 07 May 2024 | Published: 15 May 2024
Keywords: hypertension; coronary heart disease; integrated traditional Chinese and Western medicine; tuned shooting
Hypertension concomitant with coronary heart disease, as a prevalent cardiovascular ailment in clinical practice, has long garnered considerable attention in its treatment. In recent years, an integrative approach combining both traditional Chinese and Western medicine, guided by the principle of personalized targeting, has exhibited notable advantages and potential in preventing and treating hypertension complicated by coronary heart disease. This discourse explores the application of integrative Chinese and Western medical strategies guided by the principle of personalized targeting in the prevention and treatment of hypertension concomitant with coronary heart disease. The principle of personalized targeting represents a burgeoning therapeutic paradigm, meticulously targeting the specific aetiology or mechanisms of the disease, precisely selecting therapeutic targets, choosing therapeutic targets, and dynamically adjusting treatment regimens throughout treatment to achieve optimal therapeutic outcomes. In the treatment of hypertension complicated by coronary heart disease, the principle of personalized targeting holds significant applicability. The integrative approach of Chinese and Western medicine guided by the principle of personalized targeting offers a fresh perspective and methodology for preventing and treating hypertension concomitant with coronary heart disease. It represents a feasible, effective therapeutic model poised to deliver enhanced clinical efficacy and quality of life for many patients.
Hypertension concomitant with coronary heart disease represents a grave cardiovascular condition, with its global incidence influenced by various factors, including region, age, gender, and lifestyle [1]. According to data from the World Health Organization (WHO), the incidence of hypertension concomitant with coronary heart disease has been on the rise globally. In developed nations, the ageing population and lifestyle changes have contributed to a sustained increase in the incidence of hypertension concomitant with coronary heart disease. Simultaneously, in developing countries, factors such as rapid urbanization, industrialization, unhealthy dietary habits, and lack of physical activity have led to a rapid surge in the incidence of hypertension concomitant with coronary heart disease [2]. It is estimated that millions of individuals worldwide succumb to complications such as myocardial infarction, angina, and heart failure caused by hypertension concomitant with coronary heart disease annually. Particularly in developing countries, where medical resources are limited and socioeconomic levels are insufficient, the impact of hypertension concomitant with coronary heart disease on public health is even more severe [3-4]. Additionally, the disease burden of hypertensive coronary heart disease cannot be overlooked. Coronary heart disease is one of the leading causes of cardiovascular mortality globally, with hypertension being a significant contributor to its occurrence, severely affecting the quality of life and health prognosis of affected individuals [5-6]. Furthermore, hypertensive coronary heart disease imposes a substantial burden on healthcare systems, including the consumption of medical resources, increased treatment costs, and the need for long-term patient care [7]. In addition to traditional epidemiological factors, changes in modern lifestyles have also significantly impacted the prevalence of hypertensive coronary heart disease. Adverse dietary habits, lack of exercise, and chronic stress, among other factors, are closely associated with the occurrence of hypertensive coronary heart disease [8-9]. Therefore, the prevention and control of hypertensive coronary heart disease require a comprehensive consideration of biomedical, psychosocial, and environmental factors, along with the adoption of multi-layered and multi-faceted intervention measures [10]. Hypertension concomitant with coronary heart disease presents itself as a common cardiovascular malady, posing a serious threat to human health. However, its pathogenesis is intricate, and treating it is a formidable challenge [11]. By amalgamating traditional Chinese medicine with modern Western medicine, we can harness the strengths of both modalities to enhance treatment efficacy, ultimately improving clinical outcomes and quality of life for patients. Traditional Chinese medicine focuses on addressing the fundamental causes of ailments, employing differential diagnosis and treatment to harmonize the body's yin-yang balance, regulate the circulation of qi and blood, and ameliorate the functional state of the heart and blood vessels, thereby mitigating the occurrence and progression of cardiovascular diseases [12-13]. On the other hand, Western medicine emphasizes symptom relief and control, utilizing pharmaceuticals, surgical interventions, and other technical means to treat illnesses. Integrative treatment combining Chinese and Western medicine can fully leverage the role of traditional Chinese medicine in regulating overall qi and blood circulation, promoting blood circulation, and eliminating blood stasis while integrating Western medicine's focus on symptom control. This dual approach targets both the root cause and symptoms of the disease, rendering treatment more comprehensive and effective [14-15]. Integrative treatment can use a variety of therapeutic methods, combining traditional Chinese medicine treatments such as herbal medicine, acupuncture, and massage with Western medical approaches like medication therapy and interventional treatment, thereby forming a comprehensive treatment system. Chinese herbal medicine acts by promoting blood circulation and resolving blood stasis, acupuncture adjusts the function of the neuroendocrine system and autonomic nervous system, while medications lower blood pressure and dilate blood vessels, all contributing to the therapeutic goals [16-17]. Given the diversity in the conditions and constitutions of hypertensive coronary heart disease patients, personalized treatment plans are imperative. Integrative treatment can tailor treatment plans according to individual differences such as age, gender, disease severity, and physical condition, ensuring treatments are more targeted and effective [18-20]. Integrative treatment plays a crucial role in promoting the recovery of patients with hypertension concomitant with coronary heart disease. Traditional Chinese medicine can regulate the body's yin-yang balance, promote smooth circulation of qi and blood, and enhance the body's self-repair capabilities, while Western medical techniques can swiftly alleviate symptoms, control disease progression, and when used in conjunction, expedite patient recovery and improve quality of life. Chinese medicine emphasizes "preventing illness before it occurs," focusing on preventative and healthcare measures [21-22]. Integrative treatment not only addresses existing cardiovascular diseases but also, by regulating the body's yin-yang balance and promoting smooth circulation of qi and blood, enhances constitution and boosts immunity, fundamentally preventing the occurrence and progression of cardiovascular diseases. Integrative treatment capitalizes on the strengths of both Chinese and Western medicine, creating a complementary and integrated treatment system. Traditional Chinese medicine emphasizes a holistic approach and differential diagnosis and treatment, which can fundamentally regulate the body. Western medicine focuses on the rapid relief and control of symptoms, possessing the advantage of swift efficacy. By combining the two, we can fully leverage their respective strengths and enhance treatment efficacy. Integrative treatment can tailor personalized treatment plans according to individual differences among patients, taking into account factors such as age, gender, disease severity, and physical condition, thus making treatment more targeted and effective. Chinese medicine emphasizes prevention and healthcare. Integrative treatment not only addresses existing cardiovascular diseases but also, by regulating the body's yin-yang balance and promoting smooth circulation of qi and blood, enhancing constitution, and boosting immunity, fundamentally preventing the occurrence and development of cardiovascular diseases [23-25].
Hypertension with coronary heart disease (CHD) refers to coronary atherosclerotic heart disease caused by long-term hypertension, which is a common type of coronary heart disease. Its pathological and physiological characteristics mainly include the following aspects (see Figure 1): 1. Atherosclerosis and plaque formation: Long-term hypertension will damage coronary artery endothelial cells, make the vascular wall inflammatory reaction, and promote the formation of atherosclerosis. In patients with hypertensive coronary heart disease, the endothelial cells of the arterial wall are damaged, and cholesterol and lipoproteins are easy to deposit, forming atherosclerotic plaque, leading to coronary artery lumen stenosis [26-27]. 2. Insufficient coronary artery blood supply: Due to arteriosclerosis and plaque formation, the coronary artery lumen narrows and blood flow is obstructed, resulting in insufficient myocardial blood supply. When the oxygen consumption of the heart muscle increases (such as emotional excitement, exercise, etc.), symptoms of angina may occur [28-29]. 3. Myocardial ischemia and myocardial injury: Insufficient coronary artery blood supply can lead to myocardial ischemia, and in severe cases, it can cause myocardial infarction. Hypertensive patients have reduced myocardial tolerance to ischemia, which can lead to myocardial injury and seriously affect cardiac function [30-31]. This overload can lead to left ventricular hypertrophy and dilation, known as hypertensive heart disease. Left ventricular hypertrophy reduces the heart's filling during diastole, reduces the diastolic function of the heart, increases the burden on the heart, and further exacerbates the development of coronary heart disease [32-33]. There is a close correlation between hypertension and coronary heart disease, and their pathological and physiological mechanisms interact with each other, jointly promoting the development and progression of cardiovascular disease [34-35]. Therefore, for patients with hypertension, timely and effective control of blood pressure and prevention and treatment of coronary heart disease are key measures to reduce the risk of cardiovascular events.
Figure 1: Pathological and physiological characteristics of hypertension combined with coronary heart disease
3.1 Overview of the Treatment Principles of Traditional Chinese Medicine's "Adjusting State"
Western medicine believes that hypertension combined with coronary heart disease is a disease characterized by persistent elevated arterial blood pressure, while coronary heart disease is mainly due to coronary atherosclerosis, leading to insufficient blood supply to the myocardium. From the perspective of traditional Chinese medicine, hypertension belongs to the category of "headache", "dizziness" and other diseases. Its essence is qi and blood imbalance, while coronary heart disease is related to "chest obstruction", often caused by emotional discomfort and improper diet leading to heart meridian stasis [38-39]. Balancing the functions of the five viscera (heart, liver, spleen, lungs, and kidneys) is considered foundational in traditional Chinese medicine for maintaining health. In treating hypertension and coronary heart disease, adherence to the principle of harmonizing the five viscera and restoring their normal physiological functions is essential. Heart: As the "monarch organ," maintaining balance in the heart is crucial for regulating emotions. Through acupuncture, herbal medicine, and psychological counseling,
emotional distress can be alleviated, promoting the stability of cardiac function. Liver: The liver stores blood and regulates the free flow of emotions. By adjusting the liver's function of regulating emotions, the impact of emotional fluctuations on blood pressure can be reduced, thus maintaining stability in blood pressure. Spleen: The spleen governs transportation and transformation. By tonifying the spleen and replenishing qi, digestion and absorption can be improved, providing ample nutritional support to the heart while avoiding damage to the blood vessels caused by internal dampness and heat due to poor digestion. In summary, harmonizing the functions of the five viscera is essential in traditional Chinese medicine for maintaining health. Treatment strategies for hypertension and coronary heart disease should focus on restoring the balance of the five viscera and promoting their normal physiological functions. The treatment of hypertension combined with coronary heart disease is not only about simply controlling blood pressure or improving heart blood supply, but more importantly, through the combination of traditional Chinese and Western medicine, achieving a balanced state of the five organs, striking the target of blood stasis and heat, and fundamentally restoring the natural balance and healthy state of the human body. This comprehensive and in-depth treatment method not only effectively controls the condition, but also improves the patient's quality of life and promotes physical and mental health (see Figure 2).
Figure 2: Principles of targeted therapy for the prevention and treatment of hypertension combined with coronary heart disease using a combination of traditional Chinese and Western medicine
The mechanism of action and efficacy evaluation of the combination of Chinese and Western medicine in the treatment of hypertension combined with coronary heart disease is a treatment model that comprehensively utilizes the diagnostic methods, treatment methods, and drug therapies of traditional Chinese medicine and Western medicine to achieve better therapeutic effects. Mechanism of action: 1. Comprehensive regulation of cardiovascular function: Traditional Chinese medicine comprehensively regulates the cardiovascular system by regulating the balance of qi and blood, yin and yang, and tonifying the organs. Western medicine drugs mainly target pathological and physiological processes such as hypertension, angina, and myocardial ischemia, and improve cardiovascular system function through antihypertensive, vasodilator, and antithrombotic effects. 2. Reduce cardiac load: Combination therapy can regulate cardiovascular system function through traditional Chinese medicine, improve myocardial blood supply, reduce cardiac load, reduce cardiac load and oxygen consumption, alleviate angina symptoms, protect myocardium, and reduce myocardial damage [40].
In summary, the combination of traditional Chinese and Western medicine in the treatment of hypertension combined with coronary heart disease plays a role in the mechanism of action through comprehensive regulation of cardiovascular function, reduction of cardiac load, adjustment of immune inflammatory response, and improvement of microcirculation. In terms of efficacy evaluation, the treatment effect is mainly comprehensively evaluated through assessment of antihypertensive effects, improvement of cardiac function, symptom relief, incidence of cardiovascular events, and quality of life, providing patients with more comprehensive and personalized treatment plans.
Typical case analysis and efficacy evaluation: Typical case analysis can more intuitively demonstrate the application effect of integrated traditional Chinese and Western medicine treatment in patients with hypertension and coronary heart disease. Case background: A multicenter, retrospective clinical study was conducted in the medical record management system of six hospitals in Tianjin. The research subjects are patients with coronary heart disease and angina pectoris aged 35-75. They were hospitalized in the cardiology department from September 1, 2014, to September 1, 2019, and underwent coronary angiography. We divided patients into 3 groups based on total cholesterol levels, evaluated the degree of CAS using the Gensini score, and further divided them into 6 subgroups based on the presence or absence of HTN. Clinical trial name: A randomized controlled study on combining traditional Chinese and Western medicine for the treatment of hypertension combined with coronary heart disease. Experimental design: Study subjects: hypertensive patients with coronary heart disease, N=200. Grouping: Randomly divided into a treatment group and a control group, with 100 people in each group.
1. Outlook: The combination of traditional Chinese and Western medicine treatment can fully utilize the advantages of traditional Chinese and Western medicine, comprehensively consider the overall situation of patients, develop personalized treatment plans, and improve the targeted and effective treatment. Traditional Chinese medicine emphasizes the overall concept, pays attention to regulating the balance of yin and yang, and recuperates human functions through acupuncture and moxibustion, herbal medicine and other methods; Western medicine, on the other hand, tends to focus on pathological and pharmacological treatments, with drugs and surgery as the primary approaches. Future development trends and directions: Strengthen clinical research: In the future, it is necessary to strengthen clinical research on combining traditional Chinese and Western medicine in the treatment of hypertension combined with coronary heart disease, especially long-term, large-scale randomized controlled trials. More clinical evidence is obtained through scientific research design and rigorous data analysis to verify the effectiveness and safety of integrated traditional Chinese and Western medicine treatment. Improve treatment standards: Develop unified treatment standards and guidelines for hypertension combined with coronary heart disease using traditional Chinese and Western medicine, and clarify the principles, methods, and technical specifications of treatment. Establish a multidisciplinary cooperation mechanism to promote the formulation and promotion of treatment standards, as well as improve the quality and level of clinical practice. Intensify talent cultivation efforts: Increase talent cultivation efforts for integrated traditional Chinese and Western medicine treatment, and cultivate doctors and researchers with theoretical and clinical skills in integrated traditional Chinese and Western medicine. By offering relevant professional courses and training programs, we aim to strengthen the training and education of doctors, nurses, and other medical personnel, as well as improve their ability and level of integrated Western medicine treatment. Strengthen scientific research: Strengthen basic research on the mechanism of integrated traditional Chinese and Western medicine treatment and explore the mechanism and influencing factors of integrated traditional Chinese and Western medicine treatment. Through in-depth experimental research and clinical observation, reveal the advantages and limitations of integrated traditional Chinese and Western medicine treatment and provide a scientific basis for its further development. In summary, the combination of traditional Chinese and Western medicine has broad prospects for treating hypertension combined with coronary heart disease, but it also faces some challenges. In the future, it is necessary to strengthen scientific research, improve treatment standards, increase talent cultivation efforts, promote medical system reform, promote the development and application of integrated traditional Chinese and Western medicine treatment, and make greater contributions to improving the quality of life and health level of patients.
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