Hypertension – These are the guidelines for hypertension
In Germany alone, about 20 to 30 million people suffer from hypertension. Hypertension increases the risk of numerous other diseases. In the US, hypertension guidelines were adjusted last year. For example, since this adjustment, values in patients older than 140/90 are more likely to be tolerated in the US, and in others, drug treatment is already starting at very normal levels of 130-85. We explain the specific guideline in this article.
The limits in Europe remain different from the US, where 130-80 apply, with basically 140/90 mmHg. This corresponds to the previous recommendations. However, elderly patients sometimes accept higher thresholds up to 160 mmHg, "to avoid undesirable side effects of over-intensive drug therapy," said Andrea Podczeck-Schweighofer, president of the Austrian Society of Cardiology (ÖKG).
In certain cases, the medication should be administered within a normal blood pressure range (130-139 / 85-89 mmHg). "That is, if there is a particularly high cardiovascular risk due to cardiovascular disease," said Podczeck-Schweighofer.
The goal of treatment for a therapy is still a reduction below 140/90 mmHg. In case of well-tolerated therapy, 130 mmHg should be obtained as systolic value and, in patients less than 65 years, 120 to 129 mmHg. Target values below 120 mmHg are counterproductive for all patient groups because the risks outweigh the potential benefits.
Europe vs. USA
Hypertension of 130/80 mmHg has been reported in the US since last year. However, patients who require blood pressure above 130/80 mmHg in the new US guidelines are considered to need medication only if they have other risk factors. Other patients should be treated with general measures. "But even so, according to the new US guidelines only in the United States, about four million people additionally need drug treatment, which would not be a limit of 140/90 mmHg," says Podczeck-Schweighofer.
New in published European blood pressure guideline is a recommendation of treatment at the beginning of therapy. Thus, most high-pressure patients in the future should undertake a treatment with two different action substances from the start. So far, it has been recommended to start with a drug first and only if necessary to use a second or third drug. "In this context, the new guideline notes that the combined preparations containing the substances in a tablet should increase adherence," said the ECOC president.
Less salt, more exercise
If hypertension can not be adequately controlled with a combination of three antihypertensive agents, a diuretic should also be added as recommended. "Lifestyle modifications are also recommended in the new ESC guideline for all high-pressure patients," adds Podczeck-Schweighofer. These include a reduction in salt intake, a healthy diet, regular exercise, nicotine withdrawal and struggling for normal weight. For the recent recommendation to consume alcohol only moderately, now comes the explicit indication that the so-called coma or binge drinking is an absolute taboo.
With regard to hypertension and cancer, it should be noted that a temporary withdrawal of cancer treatment can be considered when very high blood pressure levels are not controllable only with combination therapy.
Another novelty is a recommendation on hypertension and physical exertion in the high mountains. Patients with high blood pressure should be advised to make excursions up to 4,000 meters above sea level. without.
Last but not least, attention is drawn to the health risks of hypertension. This is, for example, a significant risk factor for stroke. It also increases the risk of heart failure, atrial fibrillation, renal failure, peripheral obstructive disease or dementias such as Alzheimer's disease. (Sb)