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Hypertension – Here are the guidelines for hypertension
In Germany alone, about 20 to 30 million people suffer from hypertension. High blood pressure can lead to many other health problems, ranging in the worst case to a heart attack or stroke. But when is the blood pressure too high?
In the United States last year, the recommendations for hypertension were adjusted. For example, since this adjustment, values in patients aged 140/90 are more likely to be tolerated in the United States, and in others, drug treatment is already starting at very normal levels of 130-85. The limit values in Europe remain different from those in the United States, with essentially 140/90 mmHg. This corresponds to the previous recommendations. However, older patients sometimes accept higher thresholds, up to 160 mmHg, "to avoid the undesirable side effects of excessive drug treatment," said Andrea Podczeck-Schweighofer, president of the Austrian Society of Cardiology (ÖKG).
In some cases, the drugs must already be administered within a normal normal blood pressure range (130-139 / 85-89 mmHg). "Namely, there is a particularly high cardiovascular risk due to cardiovascular disease," said Podczeck-Schweighofer.
The therapeutic goal of a therapy is always a reduction below 140/90 mmHg. In case of well-tolerated treatment, a systolic value of 130 mmHg should be sought and, in patients under 65, 120-129 mmHg. Target values below 120 mmHg are counterproductive for all patient groups because the risks outweigh the potential benefits.
Europe vs. USA
High blood pressure of 130/80 mmHg has been reported in the United States since last year. However, the new US guidelines only allow drugs to be taken if their risk factors are greater than 130/80 mmHg. Other patients should be treated with general measures. "Nevertheless, according to new US guidelines, about four million people also need drug treatment, which would not represent a threshold of 140/90 mmHg," said Podczeck-Schweighofer.
A treatment recommendation at the start of treatment is a novelty of the published European guideline for blood pressure. As a result, the majority of patients under high pressure in the future should start treatment with two different active substances from the beginning. Until now, it was recommended to start with a drug and use only a second or third drug if necessary. "In this context, the new directive states that combined preparations containing the substances contained in a tablet should increase adherence to treatment," said the ECOC president.
Less salt, more exercise
If hypertension can not be adequately controlled by a combination of three antihypertensives, a diuretic should also be added, as recommended. "Lifestyle changes are also recommended in the new ESC directive for all patients under high pressure," adds Podczeck-Schweighofer. These include a reduction in salt intake, a healthy diet, regular exercise, nicotine abstinence and the search for a normal weight. At the recent recommendation to consume only moderately alcohol, it is now clearly stated that what is called coma or excessive drinking is an absolute taboo.
With regard to hypertension and cancer, it is noted that a temporary interruption of cancer treatment may be considered when very high blood pressure levels are not controllable with an badociation treatment only.
Another novelty: a recommendation on hypertension and physical exertion in high mountains. Patients with high blood pressure should be advised to make excursions up to 4000 meters altitude. without.
Finally, attention is drawn to the risks of hypertension for health. This is, for example, a major risk factor for stroke. It also increases the risk of heart failure, atrial fibrillation, kidney failure, peripheral obstructive disease or dementia such as Alzheimer's disease. (Sb)
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