High Blood Pressure (Arterial Hypertension): Therapy

High-normal blood pressure levels (130 to 139 mmHg systolic and or 85 to 89 mmHg diastolic) should be lowered primarily by diet (see under General Measures and Nutritional Medicine) and lifestyle modification (see under Exercise and Psychotherapy). If there is a slightly increased cardiovascular risk, these measures should precede drug therapy for a period of up to six months. In the event of hypertensive derailment (“hypertensive urgency”), although inpatient treatment is not mandatory, it is advisable for blood pressure > 210/110 mmHg.

General Measures

  • Nicotine restriction (abstaining from tobacco use)Notice: After an initial small study in a direct comparison of e-cigarette and conventional cigarette showed that the increase in blood pressure for both products is comparable (pulse wave velocity as an indirect measure of vascular stiffness ↑).
  • Limited alcohol consumption (men: max. 25 g alcohol per day; women: max. 12 g alcohol per day).
  • Limited caffeine consumption (max 240 mg of caffeine per day; equivalent to 2 to 3 cups of coffee or 4 to 6 cups of green/black tea).
  • Aim for normal weight!Determination of BMI (body mass index, body mass index) or body composition using electrical impedance analysis and, if necessary, participation in a medically supervised weight loss program. Goal: Weight reduction to a BMI of 25 kg/m2 and a waist circumference of < 102 cm in men and < 88 cm in women, if there are no contraindications (contraindications).By a weight loss of 10 kg, the systolic blood pressure is reduced by 15 mmHg, the distolic by 8 to 10 mmHg.
  • Daily blood pressure control during periods of heat; already temperatures above 25 ° C stress especially people with hypertension: at high temperatures, blood pressure drops because of vasodilation (vasodilatation). If patients take antihypertensive (blood pressure-lowering) medication, this effect can be intensified. The consequences are dizziness, attacks of weakness and, in the worst case, circulatory collapse.Caution! With systolic blood pressure values (the top value) below 110 mmHg, an immediate visit to the doctor is required.
  • Review of permanent medication due topossible effect on the existing disease or secondary diseases:
  • Avoidance of psychosocial stress:
    • Bullying
    • Mental conflicts
    • Stress – Stress on the psyche is also stress on the blood vessels.
  • Sufficient sleep and rest periods help to reduce stress. The ideal length of sleep depends on age. Adults should sleep between 7 and 9 hours.
  • “30-minute nap” – leads to a significant decrease in 24-hour blood pressure.

Vaccinations

The following vaccinations are advised, as infection can often lead to worsening of the present disease:

  • Pneumococcal vaccination
  • Flu vaccination

Regular checkups

  • Regular medical checkups

Nutritional medicine

  • Nutritional counseling based on nutritional analysis
  • Observance of the following specific nutritional medical recommendations:
    • Dietary salt restriction (i.e., low-salt diet < 6 g of table salt per day) – effect of salt reduction is greater the higher the baseline blood pressure value.
    • Low-fat diet (reduce animal fats!)
    • Avoiding the consumption of red meat
    • Diet rich in:
  • See also under “Therapy with micronutrients (vital substances)” – if necessary, taking a suitable dietary supplement.
  • Detailed information on nutritional medicine you will receive from us.

Sports Medicine

  • Endurance training (cardio training) and strength training.
    • Endurance training
      • 30 min moderate activity 5 times per week
      • 50 min 3 times/week or a total of 75 minutes weekly of more vigorous physical activity.
    • Strength training: strength endurance only; indication: mild to moderate hypertension): 5-25 repetitions at submaximal intensity for various exercises, at least 3 times per week (ESC: Class IA recommendation) [guidelines: ESC], without press breathing.
      • High-intensity strength training is discouraged for [guidelines: ESC]
        • High cardiovascular risk (eg, impaired renal function, documented atherosclerotic disease, SCORE ≥ 5%) and/or in the presence of end-organ damage (class III C),
        • Uncontrolled blood pressure (systolic >160 mmHg) until blood pressure is under control (Class III C).
  • High-intensity interval training (HIT) with short repetitions of 1-4 minutes duration at about 95% to 100% of maximum heart rate or maximum oxygen uptake also has beneficial effects on blood pressure.
  • Before starting exercise required examinations are stress ECG and echocardiography (heart ultrasound).
  • Treadmill test as an indicator of whether a patient with endurance running training can permanently reduce blood pressure: If after short-term load on the treadmill an acute low blood pressure occurs, the chances are good that the blood pressure also falls permanently during endurance training.
  • Regular endurance training (three to four times a week aerobic exercise for 40 minutes each) with dynamic sports not only mitigates existing hypertension, but reduces the risk of coronary heart disease (CHD) with the resulting secondary diseases such as myocardial infarction (heart attack). Furthermore, depending on the training intensity and duration, the HDL cholesterol (HDL: “high density lipoprotein”) is increased and the LDL cholesterol (LDL: “low density lipoprotein”), triglycerides and uric acid lowered.
  • By endurance training falls on average systolic blood pressure by 4 mmHg and diastolic by 3 mmHg; in patients with arterial hypertension, an even greater blood pressure reduction of 8 mmHg systolic and 5 mmHg diastolic was documented.
  • Preparation of a fitness or training plan with appropriate sports disciplines based on a medical check (health check or athlete check).
  • Detailed information on sports medicine you will receive from us.

Physical therapy (including physiotherapy)

  • Saunas improve hemodynamics (blood flow in blood vessels) and lower blood pressure in hypertensive patients. A Finnish study demonstrated that the more frequently subjects used the sauna, the lower their risk of sudden cardiac death, death from coronary heart disease (CHD) or cardiovascular disease, and death from any cause.The German Hypertension League advises hypertension patients to avoid the cooling bath after the sauna because radical cooling has a vasoconstrictor and pressure-increasing effect. Instead of the cooling bath, it is better to take your time cooling down and take a lukewarm shower, he said.

Psychotherapy

Complementary treatment methods

  • Meditation (mindfulness meditation) – a mindfulness-based stress reduction, a Western variant of Buddhist meditation; here.eight weekly group sessions of two and a half hours duration and a final “exercise day in silence” + in addition to the group sessions to meditate privately six times a week for at least 45 minutesResult: participants with stage 2 hypertension improved their blood pressure values significantly: they thus reached the same pressure as patients whose blood pressure values were only slightly elevated at the beginning of the study; even after 6 months and after 12 months, the blood pressure values were further about 15.1 mg below the initial values before the start of the study.