Introduction
Within the framework of our heart action, we distinguish between two phases: systole and diastole. During systole, also known as the tension phase, the heart pumps blood into the circulation and in diastole it fills up again. Both phases of the heart produce different pressure values: systolic or diastolic pressure.
Ideally, the systolic blood pressure of an adult is between 100 and 140 mmHg (“first value”) and the diastolic blood pressure between 60 and 90 mmHg (“second value”). Blood pressure values of > 140 mmHg systolic are referred to as high blood pressure. In Europe alone, approximately 30-45% of the population suffers from high blood pressure. Short- and long-term consequences can be stroke, heart attack, kidney disease and many other serious diseases.
Treatment of systolic hypertension
Nowadays, the indication, i.e. the necessity of a therapy, is not only determined by the level of blood pressure, but rather by the overall risk of cardiovascular disease (heart attack, stroke, heart failure, etc.). This risk is particularly high, for example, in the presence of very high blood pressure values (>180/110mmHg) and/or already existing clinical pictures of the cardiovascular system. In these cases, drug therapy is therefore absolutely necessary to lower the blood pressure or systole.
1. weight normalization Overweight patients should strive to reduce their weight. The “body mass index” (BMI) can serve as a rough guide for this. It is calculated using the formula BMI = body weight (kg)(height [m])2 and should be approx.
25 kg/m2. If you suffer from high blood pressure and want to reduce your diastole, you should avoid high-salt foods and do not add salt to foods. Instead, it is recommended to use special dietary salt.
A lot of fruit, vegetables, salad, nuts and as little animal fat as possible also have a beneficial effect on diastole. 3. lifestyle change Smoking and excessive alcohol consumption promote the development of high blood pressure. You should therefore stop smoking and consume as little alcohol as possible.
Coffee consumption can also have negative effects on diastolic blood pressure. Relaxation training and stress avoidance are also helpful. 4. sport Regular endurance training (5-7/week for at least 30 minutes) such as swimming, walking or running reduces the risk of heart attack considerably and can have a decisive effect on reducing diastole.
In principle, slightly elevated blood pressure values (especially diastole) can be lowered in about 25% of cases by taking full advantage of the above measures. However, in most cases, pure behavioral changes do not replace drug-based blood pressure therapy, which is also absolutely necessary in the case of high blood pressure values. There are numerous possibilities for the treatment of hypertension.
The body can effectively increase blood pressure by mainly two substances: Noradrenalin/Adrenalin and Angiotensin. By suppressing the effect of these two messenger substances, hypertension can be brought under control. In principle, one can distinguish between a so-called “monotherapy” and a “combination therapy”.
While the former uses only one drug, the combination therapy uses two or more drugs in parallel. A total of five different substance classes are available. In the case of systolic high blood pressure alone, all of these drugs can ultimately be used.
Nevertheless, in practice a combination of thiazides and calcium antagonists is most popular.
- Thiazides: These are diuretic drugs and act in the kidney. Thus thiazides indirectly lower blood pressure.
Known active ingredients are hydrochlorothiazide (HCT) or xipamide. Since the electrolytes (“salts”) in our body, especially potassium, can become imbalanced during therapy, regular blood checks must be carried out during therapy.
- ACE inhibitors and angiotensin receptor blockers: Substances ending in -pril such as enalapril or ramipril belong to the group of ACE inhibitors, substances ending in -sartan such as valsartan or candesartan belong to the group of angiotensin receptor blockers. Both classes lower blood pressure by interfering with the important renin-angiotensin-aldosterone system (RAAS), which regulates blood pressure through complex control loops.
Crucial organs for this are the heart, lungs and kidneys. In particular, ACE inhibitors are the drugs of choice today, as current research shows that they have the best effect in most patients.
- Calcium antagonists: They block calcium channels in the walls of arterial blood vessels, causing them to dilate or expand. Active ingredients such as amlodipine thus lower blood pressure.
- Beta-blockers: For a long time, beta-blockers (metoprolol, bisoprolol, etc.)
were considered the treatment of choice for high blood pressure. Recent studies show, however, that other drugs, such as ACE inhibitors, have an advantage and protect patients better against secondary diseases. Nevertheless, beta blockers are still indispensable in certain cases of high blood pressure.
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