The treatment of high blood pressure is a great challenge, not only for the doctor but also for the patient. High blood pressure does not usually cause any symptoms, but it means a high risk of vascular diseases, especially heart attacks and strokes. Therefore, it is an important medical task to recognise high blood pressure, to determine causes if necessary and finally to initiate an effective and safe therapy. This must be controlled by the doctor and the patient through self-measurement during the course. The patient should be able to understand the procedure so that he or she can implement the suggested treatment measures, even if the high blood pressure does not cause him or her any symptoms. A good guideline for all these measures is contained in last year's guideline of the European Society of Cardiology in cooperation with the European Society of Hypertension.
Classification of blood pressure values
The diagnosis of high blood pressure is only made after several measurements in practice or by a 24-hour long-term blood pressure examination. The patient's own measurements are also helpful. The guideline contains a practical instruction for this purpose:
The measurements should preferably be taken for 1 week and recorded. Before each measurement, the patient should have sat for 5 minutes. Then he should take 2 measurements 1 minute apart on the arm where the higher blood pressure is usually present. The resulting mean value should be written down in a protocol. The measurements should be taken in the morning and in the evening, preferably at fixed times.
The doctor then first determines whether one of the rare diseases that can cause high blood pressure is present. In addition, he arranges for examinations to be carried out to determine possible consequential damage caused by high blood pressure.
Treatment is then given taking into account the overall risk profile for heart attack and stroke, which primarily includes smoking, a fat metabolism disorder and diabetes. This can initially include a change in lifestyle, such as the beginning of an athletic endurance training or a weight loss. At the same time, or possibly after a test phase of several months, the doctor will start a drug treatment to lower blood pressure. The guideline already recommends the combination of 2 antihypertensive agents at the beginning of the drug treatment.
First and foremost, 5 different types of medication are available:
- Angiotensin II receptor antagonists (so-called "Sartane")
- ACE inhibitors
- Ca antagonists
- Thiazides (so-called "dewatering agents")
- beta blocker
In cases of high blood pressure that is difficult to adjust, other drugs, including spironolactone, are used. Nifedipine is used as a chewable tablet or as a drop for the emergency lowering of blood pressure with systolic values above 180 mmHg. The aim of the treatment is to lower blood pressure below 140/90 mmHg. Values below 130/80 mmHg should be achieved in patients under 65 years of age. Values below 120/70 mmHg should be avoided due to the risk of undesirable drug effects. To monitor the therapy, repeat practice measurements, the patient's own measurements or another long-term blood pressure measurement should be performed.
