Blood pressure What measures help against difficult to set high blood pressure?

Care of patients with difficult to adjust high blood pressure

According to health experts, about 30 percent of the adult population in the Western world suffer from high blood pressure. Many sufferers take medicines to lower blood pressure. But in some cases, these hardly show any effect. The care of patients with difficult-to-adjust hypertension is a major challenge for physicians.

Risk factor number one for cardiovascular diseases

The German high pressure league e. According to DHL®, around 30 percent of adults worldwide suffer from high blood pressure. Untreated hypertension is the number one risk factor for cardiovascular disease and therefore responsible for many deaths from myocardial infarction or stroke. But even with medical treatment, some patients do not achieve good scores. According to estimates, up to 20 percent are among the so-called hard to adjust hypertensives. Their care is a great challenge for physicians.

About 30 percent of adults in the Western world suffer from high blood pressure. Up to 20 percent are among the so-called difficult-to-adjust hypertensives. These patients represent a major challenge for physicians. (Image: Photographee.eu/fotolia.com)

How high the blood pressure may be

High blood pressure is not felt by the patients for a long time and often only occurs when it causes organ damage. He is therefore - as well as other diseases - referred to as a "silent killer".

But how high is the blood pressure? Hypertension is defined by a systolic blood pressure greater than 140 mmHg and a diastolic blood pressure greater than 90 mmHg.

Some experts meanwhile mean that 120 instead of 140 should be the new blood pressure target, but the high-pressure league continues to argue for moderate targets.

In some patients simple means are not enough

Since overweight and obesity are not considered exercise, unhealthy, too-salty, tobacco, and increased alcohol and stress are risk factors, sufferers are usually advised to minimize these risks to lower blood pressure.

If a healthier lifestyle is not enough, doctors prescribe antihypertensive drugs to the patient. But even with these, good values ​​are sometimes not achieved.

"Physicians who talk about poorly adjustable or refractory hypertension speak for themselves when patients do not achieve good blood pressure levels, despite changes in their lifestyle and therapy with three antihypertensive drugs of various substance classes," explains DHL® in a statement.

Hard to adjust hypertension patients

The reasons can be very different:

"The 10 to 20 percent hard-to-adjust hypertension patients we have to assume are a relevant problem in general and internist practice," says Professor Dr. med. med. Walter Zidek, Clinic Director at the Charité-Universitätsmedizin Berlin.

"The reasons that high blood pressure patients are difficult to adjust are very different and not always easy to diagnose," said the doctor.

"Without a clear approach to diagnostics and care, there can be over- or under-treatment that binds enormous resources without leading to a solution," explains Zidek.

New diagnostic or therapeutic approaches

Difficulties in high pressure treatment sometimes require new diagnostic or therapeutic approaches instead of switching or adding more blood pressure medicines.

"Here is a systematic and rational search for the causes important," said the expert. A large proportion of difficult-to-adjust patients have adherence problems, that is, adherence to the prescribed medication.

"Often it is not easy to discern these patients in practice and it is not easy to change their attitude towards medication," explains Professor Zidek. Another cause may be inadequate medical treatment.

"In practice, one of the most common shortcomings in the treatment of difficult-to-adjust patients is to underestimate the role of saline elimination through appropriate diuretic, ie dehydrating therapy," explains the practitioner.

In addition, kidney disease or endocrine disease may also be the result of difficult-to-adjust high blood pressure.

An accompanying disease such as renal insufficiency, the metabolic syndrome or obstructive sleep apnea complicate the treatment.

At a joint meeting of the DHL® and the German Diabetes Association on 10 and 11 November in Mannheim, there will be a debate, among other things, about how to deal with these difficult-to-treat patients. (Ad)