The goal of any high-pressure therapy is to reduce the risk of complications. Therefore, blood pressure normalization below 140/90 mmHg is usually targeted, in patients with type 2 diabetes below 140/85 mmHg and in kidney disease with proteinuria below 125/75 mmHg. The treatment takes place independently of palpable ailments, because the high pressure first of all makes no symptoms. In addition to the level of the blood pressure values, the medical treatment decisions also take into account the overall risk profile, ie the sum of the individual risk factors of the patient for cardiovascular diseases (eg obesity , smoking, alcohol consumption, diabetes, elevated cholesterol values, events such as heart attack , stroke) in the medical history).
GENERAL MEASURES
To lower the blood pressure, it makes sense in any case that the patient:
- adjusts its nutrition (balanced / full - ie a lot of vegetables, fruits, fiber eg whole grains, low animal fats), ie reduces existing overweight; low in salt (below 6 grams per day).
- does not smoke and low in alcohol (less than 20-30 g / day for men or less than 10-20 g / day for women; (30 g = 2.5 glasses of wine à 0.125 l, 20 g = approx. 0.5 l of beer )).
- regularly - on 5-7 days per week for at least 30 minutes - physically burdened and moved. Especially endurance training (swimming, hiking, cycling, Nordic walking, cross-country skiing, golf) has a favorable effect on blood pressure.
- Relieves stress. Sufficient sleep, short breaks during the day, assigning tasks and responsibility, as well as sports and a relaxing hobby help to reduce a constant inner tension.
With mild hypertension (about 140/90 mmHg), these measures are often sufficient to restore normal blood pressure . In any case, a healthy, active lifestyle basically supports the effectiveness of a drug treatment.
MEDICAL THERAPY
If it is also necessary to take medication, this should be done consistently and regularly. The following drugs / substance classes (antihypertensives) for hypertension treatment are available, all of which are equally suitable for therapy at the beginning and in the long run, be it as monotherapy or combination therapy:
- ACE inhibitors and AT-1 receptor antagonists : preparations of these classes of drugs act as vasodilators through several different pathways. Essentially, they inhibit the formation of the blood pressure-enhancing hormone angiotensin II. They sustainably lower blood pressure and prevent end organ damage. Contraindicated in: pregnancy, hyperkalemia, angioedema.
- Diuretics (diuretic, diuretic) : These kidney drugs include thiazides and loop diuretics (especially in renal impairment) and potassium-sparing diuretics. They increase the excretion of saline and water through the kidneys and increase their effect in combination with other antihypertensive drugs. In the longer term, diuretics lower blood pressure by reducing responsiveness to vasoconstrictor stimuli. Since minerals such as potassium are excreted at higher doses, the diet should be rich in potassium (eg bananas, dried fruit, potatoes) or the mineral be supplied in tablet form when taking diuretics. In gouty patients with high blood pressure, diuretics to lower blood pressure is rather to be discouraged.
- Beta-blockers : Beta-blockers are drugs that block the so-called ß-receptors in the body. This inhibits the effect of certain stress hormones. These stress hormones (norepinephrine, epinephrine) usually have a stimulating effect on various organs (including the heart). If they are blocked, heart rate and blood pressure will drop. So the heart beats a bit slower and is relieved. Contraindicated in: asthma, atrio-ventricular block
- Calcium antagonists or calcium channel blockers : Calcium antagonists block the calcium channels in the cardiac and vascular muscle cells. They reduce the calcium influx into the cells, thereby lowering the vascular tension and thus the blood pressure. Verapamil and diltiazem are contraindicated in: atrio-ventricular block, severe heart failure.
Drugs of this class of drugs can be prescribed individually (monotherapy) or together (combination therapy) - taking into account possible underlying or comorbidities. If the initial therapy fails, the drug or combination can be changed until the blood pressure is effectively lowered.
Treatment with blood pressure medication is sometimes experienced by patients as a burden, since the lowering of blood pressure can initially make tired and knocked off. The body has to change first and get used to the lower blood pressure. The drugs should therefore be given at the beginning creeping, ie low dose at the beginning, which is gradually increased. So the organism has time to adapt slowly. The conversion can take up to a month.
CONSEQUENCE IS IMPORTANT
Remember, even if you have no symptoms, untreated high blood pressure can eventually lead to more or less dangerous damage to your body. If you feel the consequences, this damage is usually irreversible. Taken in time, you can manage the risk associated with hypertension. For this it is usually necessary to carry out the therapy for life. If necessary, your motivation (compliance) can be improved through individual and group discussions as well as doctor-patient seminars. The success of the treatment, ie the reduction in blood pressure, must be checked regularly by the doctor and the medication possibly adapted. By maintaining a healthy lifestyle, you can keep the dosage of the active ingredients as low as possible.
In addition to the regular measurement of the blood pressure by the doctor, self-monitoring and 24-hour blood pressure measurements under home conditions, during the activities of the day and at night sleep have become an important complementary measurement method for therapy control. Patients who measure their own blood pressure should receive detailed training in metrology, preferably as part of a structured hypertension training program.