High blood pressure is one of the most common diseases worldwide and is one of the most important risk factors for cardiovascular diseases and strokes along with obesity, smoking and the existence of diabetes mellitus. Because of its initial asymptomatic nature, high blood pressure is a creeping and dangerous disease that affects older people in particular. The most important measure to reduce high blood pressure in the long term and above all without medication would be a change in lifestyle. For this purpose, a healthy diet, exercise, weight loss and abstention from nicotine and alcohol would be of utmost importance. If these conservative measures are not sufficient, medication can be used to try to reduce high blood pressure.
Definition of high blood pressure
Normal blood pressure is defined as systolic values of 120mmHg and diastolic values of 80mmHg. Blood pressure values up to 139mmHg systolic and 89mmHg diastolic (139/89mmHG) are considered “still normal”. From blood pressure values of 140/90mmHg one speaks of high blood pressure, which can be divided into 3 degrees of severity. From values of 230/120mmHg one speaks of a high blood pressure crisis or also called hypertensive crisis. These are associated with a very high risk of acute cerebral haemorrhages, strokes, heart attacks and kidney damage.
Causes of high blood pressure
There are many different causes of high blood pressure. Doctors differentiate between primary hypertension, which is not based on a causal disease, and secondary hypertension. Typical causes of primary hypertension include smoking, obesity, high alcohol and salt intake, old age, diabetes, and a family history of hypertension. In less than 10% of all cases, high blood pressure is caused by a disease, it is secondary, so to speak. Typical diseases for secondary high blood pressure would be a pheochromocytoma, hyperaldosteronism (called Conn’s disease), hyperthyroidism or kidney disease.
Symptoms of high blood pressure
In most cases, high blood pressure remains assymptomatic and only becomes noticeable from values >230/120mmHg. Typical symptoms are dizziness, ringing in the ears, headaches, nosebleeds and palpitations.
Therapy with the help of medication
High blood pressure can be treated conservatively or with medication. From blood pressure values of 160mmHg, high blood pressure must be treated and reduced. Whether medication or a lifestyle change is used depends on the level of blood pressure and existing risk factors.
A 3-step scheme is followed with medication, starting with monotherapy (individual therapy) and increasing to a triple combination. Most doctors initially try to reduce high blood pressure with the help of ACE inhibitors (e.g. ramipril), diuretics (e.g.
thiazides) or a beta-blocker (e.g. metoprolol). ACE inhibitors should always be the therapy of choice because of their kidney and heart protecting effects. ACE inhibitors are particularly suitable for diabetics.
Diuretics are particularly suitable for patients who also suffer from heart failure or pulmonary oedema. If a single drug is not sufficient to lower blood pressure adequately, stage 2 of high blood pressure therapy is chosen. This is a combination of 2 drugs of different drug classes.
For example, a diuretic should be combined with either an ACE inhibitor, a Sartan, a beta blocker or a calcium antagonist. Another possibility would be to combine a calcium antagonist with a beta-blocker or an ACE inhibitor. Since each patient responds better or worse to a particular medication, there are many different combination options that should be explored before combining three or four drugs.
If a two-part combination of antihypertensive drugs is still not enough, a triple combination therapy can be considered. This involves combining a diuretic with two other drugs (e.g. an ACE inhibitor + a calcium antagonist). However, the triple combination should always be the therapy of last choice and should only be used after the double combination therapy has been exhausted.
