Risk reduction
In large placebo-controlled studies, a significant reduction in mortality from medication has been demonstrated. On average, the relative risk of mortality can be reduced by 12-15%. The result is independent of gender.
This significantly reduces the number of heart attacks and strokes. In everyday life, however, it has been proven that many patients do not receive sufficient medication. A study has shown that only every second patient in need of therapy was actually treated. Both general practitioners and cardiac specialists (cardiologists) overestimated the effectiveness of their therapy.
General measures to lower blood pressure
In addition to drug therapy, lifestyle changes are an important component in the successful therapy of high blood pressure to lower blood pressure. There are numerous factors that have been proven to reduce cardiovascular risk. Although giving up smoking does not directly lower blood pressure, it does greatly reduce the risk of complications.
For example, people who quit smoking in middle age have the same life expectancy as non-smokers. Nicotine also reduces the effectiveness of some antihypertensive drugs, such as beta blockers. High alcohol consumption significantly increases the risk of stroke and correlates positively with high blood pressure.
In addition, like nicotine, alcohol reduces the effectiveness of some drugs. For this reason, the maximum amount of alcohol per day should not exceed 30g for men and 20g for women. Weight reduction is one of the most important measures for lowering blood pressure.
This can lead to a reduction in blood pressure between 5-20mmHg per 10kg of weight loss. In addition, a change in lifestyle with more exercise and a healthy diet reduces the pre- and post-heart rate and thus the muscle mass of the left chamber (left ventricular hypertrophy). This significantly increases the ability to cope with stress and reduces stress-related shortness of breath (dyspnoea).
In addition, regular physical activity several times a week for at least 30 minutes can significantly reduce cardiovascular mortality. Sports such as swimming, running or hiking are suitable. Pure strength sports such as weight lifting are not suitable.
High blood pressure and strokes can be effectively and easily prevented by reducing the daily salt content and sufficient daily intake of potassium. Studies have shown that people who take less than 2.5g of table salt daily reduce their cardiovascular risk by a quarter. People who also eat more fruit and vegetables to increase their daily potassium intake can reduce this risk even further.
Overall, a healthy balanced diet with lots of fruit, vegetables and fish can reduce the cardiovascular risk. However, most of the above measures are only useful and effective in combination. Changing your diet alone without increased physical activity and continued consumption of alcohol and nicotine cannot reduce blood pressure and cardiovascular risk.
The therapy to lower blood pressure is initially carried out as monotherapy with only one drug (active ingredient). If this is not sufficient, it is possible to combine different drugs with different modes of action. First choice drugs are ACE inhibitors, AT1 antagonists, beta blockers, diuretics and calcium antagonists.
The choice of the appropriate drug depends on the patient’s age and concomitant diseases. The ACE inhibitors reduce the formation of the blood pressure-increasing angiotensin 2 and thus the activity of the renin-angiotensin-aldosterone system, which is activated by the kidney blood flow. The angiotensin-1 receptor antagonists act at a different site of the same system and prevent the effect of angiotensin II on its receptor.
Thus, the conversion to aldosterone can no longer take place and the blood pressure-increasing effect does not occur. It makes little sense to combine these two drugs because they act at a similar site. They are rather used as alternatives because the angiotensin-1 receptor antagonists are sometimes better tolerated than the ACE inhibitors.
The beta blockers act at the ß1- selective receptors, which are located at the heart. By inhibiting these receptors, the ejection rate of the heart is reduced and thus the blood pressure. Diuretics are substances that promote volume excretion in the kidney.
This reduces the volume in the vascular system and lowers blood pressure. The calcium antagonists, especially of the nifedipine type, reduce the vascular tone in the arteries and thus lower the pressure in the vascular system. All these groups of active substances are equivalent in terms of reducing the risk of mortality.
However, there is a clear discrepancy between the effects on organ complications in individual studies. For this reason, despite the good efficacy of the drugs, their use must be evaluated critically and risk assessment is always useful. You will find more detailed information under our topic: Medications for high blood pressureEven the therapy of high blood pressure offers many different approaches apart from drug treatment.
Supporting pillars in hypertension therapy are sport, optimized nutrition, sufficient sleep, not smoking and less alcohol. Positive effects on blood pressure have been proven and are not to be sneezed at through physical activity, especially in the area of endurance. In combination with a conscious diet, the associated weight reduction can also have an influence on blood pressure.
The topic of nutrition offers further possibilities to fight against high blood pressure and should therefore be integrated into the therapy in any case. In addition to a healthy and balanced diet in the form of a lot of vegetables, fruit and low-fat dairy products, you should make sure that you eat less salt and instead, for example, use other spices to enhance the taste of your food. Salt promotes high blood pressure values enormously and by consciously reducing the consumption of salt, the values can decrease up to 5mmHg.
Furthermore, alcohol should only be drunk in moderation. By the way, various types of tea are considered to be respected blood pressure-lowering agents and can demonstrably lead to an improvement in the blood pressure situation. Especially green tea, mistletoe, evergreen, hibiscus, hawthorn, olive leaf, garlic, valerian and heart tea are suitable for lowering blood pressure.
It is now generally agreed that blood pressure, blood fat values and magnesium balance are positively influenced by the consumption of nuts in moderation. As a natural drop in blood pressure occurs during the nightly resting phase, it is understandable that a regular lack of sleep has a negative effect on blood pressure and drives it up. This is often accompanied by the fact that those affected are very stressed and have little time for relaxation or compensation.
Therefore, autogenic training and consciously switching off from stressful situations are very important for the well-being of the body. Systolic blood pressure can be lowered by 8mmHg through active relaxation and stress reduction. In summary, one can say that there are enough starting points for therapy and that one does not have to think immediately about blood pressure lowering medication. Many of the above-mentioned aspects are logically also well suited as prophylaxis.
