Internal Medicine

High blood pressure therapy

Synonyms in a broader sense

Essential hypertension, hypertension, chronic arterial hypertension, hypertensive crisis

English: arterial hypertension
Medical: Arterial hypertension

diagnosis

The doctor first asks the patient's medical history (anamnesis).
Here, special attention is paid to previous illnesses, such as a Diabetes (Diabetes mellitus), a restricted Kidney function (Renal failure) or one Hardening of the arteries (Arteriosclerosis). These diseases mean an increased risk of organ damage if blood pressure values are also increased.

The duration and maximum values of known elevated blood pressure values are also of interest. The doctor also asks about medication the patient is taking that may have an antihypertensive effect, such as Birth control (contraceptive) or Cortisone.
Since high blood pressure can occur more often in families, the doctor also inquires about possible diseases such as heart attack / myocardial infarction, high blood pressure, kidney diseases or strokes in the patient's family.
Information on the patient's eating habits, height and weight as well as physical activity complete the medical history.

The most important physical exam to determine if you have high blood pressure is Blood pressure measurement to Riva Rocci with an upper arm blood pressure cuff, which is performed on both arms in a sitting or lying position after at least five minutes of rest. The arm must be positioned at heart level for this. In the course of the clinical examination, the pulses on the arms and legs are also felt to detect a change in the blood vessels Main artery (aorta) to be excluded.

When measuring blood pressure, increased values must be determined at least twice, according to the following scheme:

Practice measurement: 140/90 mmHg
Self measurement: 135/85 mmHg
24-hour measurement: Daily profile 135/85 mmHg
Stress measurement (ergometry): 200/100 mmHg at 100 watts

The patient is also examined for the presence of consequential damage, i. the function of heart, eye and kidney will be clarified. A 24-hour blood pressure measurement (ambulatory blood pressureMonitoring), a blood test will be done Ultrasonic of the kidneys, the Fundus (Retina) examined (Eye background examination) and a urine status are recorded.

Therapy and recommendation

The aim of high blood pressure therapy is to normalize blood pressure, i.e. on values below 140/90 to lower mmHg, and that with the least side effects. For patients with Diabetes mellitus and or Kidney disease the therapy goal is defined below 130/80 mmHg.
The patient should regularly check his blood pressure values in independent blood pressure measurements. The best time for this is between
6 a.m. - 9 a.m. and 6 p.m. - 9 p.m. in front eating and taking medication. A close-meshed self-measurement is important to control the success of the therapy. Devices for measuring the upper arm provide more precise values than those for the wrist.
When measuring the upper arm, it must be noted that the cuff size affects the blood pressure values: If the cuff width is chosen too small, the measured values are too high; if the cuff is too wide, the values are correspondingly too low.

General measures to lower the high blood pressure should be carried out by every hypertensive patient in order to achieve lower, ideally normal blood pressure and thus avoid consequential damage to internal organs. This includes informing the patient about the disease and its possible consequences as well as motivating the patient to consistently carry out antihypertensive therapy against the increased blood pressure.
It is also important to normalize body weight and, in terms of diet, to keep it low in salt diet With a maximum of 6 grams of table salt per day and the consumption of a Mediterranean diet (i.e. the use of olive oil in cooking, the consumption of mainly fruit, vegetables, fish and salad, but little animal fat).

Quitting smoking, giving up caffeine and reducing alcohol consumption are also beneficial for lowering blood pressure. The reduction of stress is also very important.

Endurance sports how Nordic walking or jogging (at least 1 hour per week) is a very effective way to lower blood pressure.

These general measures to lower blood pressure apply particularly to patients with essential hypertension. In the case of secondary forms of hypertension, the cause of the increase in blood pressure, which the doctor can diagnose and name, must be eliminated.
The example of renal artery stenosis (constricted artery of the kidney) as the reason for an increase in blood pressure makes this clear: the patient is treated with medication and / or an artery widening is performed using a catheterpercutaneous transluminal artery dialatation). Since the narrowness of the artery, which is the cause of hypertension, is eliminated, the blood pressure drops.

Drug therapy, both for the primary and the secondary form of increased blood pressure, has to be individually adjusted to each patient and includes a wide range of drug groups. The correct medication is selected depending on the patient's condition.

Substances of first choice, i.e. primarily used, are Thiazides, Beta blockers, ACE inhibitors and Angiotensin receptor blockers.

The effects of the listed drug classes are briefly described below:

Thiazides: Increase in salt and water excretion via the kidneys
Beta blockers: Heart rate lowering, protection of the heart from the effects of catecholamines
ACE inhibitors: Lowering of peripheral vascular resistance; TPR with RR = TPR * CO
Angiotensin receptor antagonists: Lowering of peripheral vascular resistance; so.

As a rule, this therapy is a long-term therapy for years; often it is necessary to do it for life.

First a so-called monotherapy (therapy with only one drug) is started, i.e. the patient receives a single preparation, which is selected according to the mode of action and the accompanying illnesses of the patient. If there is no significant decrease in blood pressure within 3-4 months, a combination of two preparations can be prescribed. The doctor can also order a combination of three drugs to lower blood pressure, even if taking two drugs is not enough.

Media knowledge side effects such as tiredness and exhaustion often occur, but these usually disappear again after normal blood pressure values have been reached.

Of course, high blood pressure can also be treated with homeopathic medicines. Please read on: Homeopathy for high blood pressure.

Complications high blood pressure

The vascular system can be damaged by the increase in blood pressure. This process goes unnoticed by the patient for a long time because it does not cause any symptoms, but nevertheless progresses slowly and steadily. Many patients with high blood pressure (hypertensive) suffer from premature hardening of the arteries (arteriosclerosis).
The vessels are exposed to an increase in pressure due to the high blood pressure and accordingly change their wall properties, whereby cholesterol and fat particles can more easily attach to the vessel walls. As a result of these deposits, the vessels narrow and their diameter becomes smaller, and the pressure that the heart has to exert to pump blood through the body increases. The heart and blood vessels are therefore exposed to increased pressure.
A muscle weakness of the left heart (Heart failure) and an occlusion of the coronary arteries (KHK) with a possibly following Heart attack can also occur as complications. The blood supply to the heart muscle is poor due to the narrowed coronary arteries, especially under stress, and a painful tightness in the chest (Angina pectoris) result. If the blood supply to the heart is completely interrupted, the patient suffers a life-threatening heart attack, the harbinger of which is often the chest pain just described.

The small vessels of the kidney can be attacked by the pressure load, so that the filter function of the kidneys is restricted and proteins that are normally not filtered out into the urine can be detected in the urine (hypertensive nephropathy with microalbuminuria). This transfer of protein into the urine indicates that the kidneys are involved, which should be switched off with appropriate medication to lower blood pressure.

A reduced blood supply to the brain can also be the result of high blood pressure. Approx. 15% of hypertensive patients suffer a fatal one Stroke (apoplexy). Here it is possible that the stroke occurs due to the narrowing of the blood vessels and the reduced blood flow or, because of the changes in the walls of the vessels, these tear and one Cerebral hemorrhage entry.

Regular examination of the fundus (fundoscopy) is particularly important for diabetics with high blood pressure, as the vessels of the Choroidthat supply the retina of the eye, due to which the increase in blood pressure is subject to changes (diabetic retinopathy). The vessels can tear and bleed into the retina. A reduced blood flow to the retina and the optic nerve can also occur. Both complications lead to a worsening of the Vision (decreased visual acuity).

Another dangerous complication of hypertension is the dilation of the main artery (Aortic aneurysm), as life-threatening bleeding with high blood loss can occur.

So, it is necessary to treat the patients effectively to prevent complications from occurring.

Course and prophylaxis

A blood pressure value below 120/80 mm Hg is an optimal value. Since the risk of cardiovascular diseases doubles with every increase of 20/10 mmHg compared to the optimal value, the hypertensive patient can use general measures and good blood pressure control Medication strongly recommended.

Through special training programs for patients with high blood pressure, they learn how to deal with their illness and receive instructions on how to include antihypertensive measures in everyday life. In order to avoid organ damage and complications as a result of high blood pressure, intensive care by the family doctor and the patient's motivation to follow the general measures and drug therapy (compliance) are necessary.