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Hypertension Aids What to do if you have difficult to control hypertension?
Hypertension is a folk disease that can cause many serious sequelae. When diagnosing hypertension urgent therapeutic countermeasures should therefore be initiated. However, the blood pressure in 65 percent of high-pressure patients is not sufficiently controlled, reports the German Society for Nephrology (DGfN) and appeal to current study data. What causes this can and what measures help with difficult to adjust high blood pressure, Professor Martin Hausberg has stated at the 9th Annual Meeting of the DGfN.
According to the expert, difficult to set high blood pressure can have different causes and not always put a "real" resistance to therapy behind it. First of all, the reasons for the problems should be identified in order to then initiate targeted countermeasures. If no reduction of the blood pressure values to the target area is possible with the usual methods, a referral to a nephrologist / hypertensiologist should be made, according to the DGfN.
Heavily adjustable hypertension requires special measures to ensure that the target values are achieved in the long term. (Image: Andrey Popov / fotolia.com) Hypertension is a significant risk factor
According to the German Society of Nephrology, hypertension is one of the major cardiovascular risk factors (arteriosclerosis) with potentially fatal consequences such as stroke or heart attack. In addition, the risk of blindness and kidney damage increases. Conversely, kidney disease in most cases associated with high blood pressure, so that kidney disease and hypertension cause each other and reinforce, the experts report. The underlying mechanisms are manifold and complex.
Connection between kidneys and high blood pressure
For example, the connection between hypertension and kidney is regulated by volume and electrolyte balance (excretion of salt and water), endocrine functions of the kidney (production of blood pressure-related hormones, renin-angiotensin-aldosterone system) and the direct interaction of the kidneys with the kidney sympathetic nervous system. For patients with chronic kidney disease (CKD), "lowering blood pressure or adjusting blood pressure is critical to slowing the disease process and prolonging dialysis-free lives," according to the DGfN.
Therapy-resistant hypertension
According to the DGfN, hypertension is considered to be resistant to therapy if it can not be reduced to the target range despite a triple combination antihypertensive (at maximum dosage according to guidelines including a diuretic). In such cases, first find out why hypertension is difficult to set. Sometimes it is not about a "real" resistance to therapy, but there could be other reasons, said Professor Martin Hausberg, Past President of the German Hypertension League and Congress President of the 9th Annual Meeting of the German Society of Nephrology (DGfN).
Whiskers hypertension a possible cause
For example, the expert mentions the so-called "white-coated hypertension" as a possible cause of the difficulty-setting blood pressure values. According to international studies, this is the cause of an apparent non-response of hypertensive therapy in 12 to 34 percent of those affected. With a 24-hour blood pressure measurement can be here make sure that it is not such a form of hypertension.
Adherence problems with far-reaching effects
According to Professor Hausberg, Adhärenzprobleme can also be present, which are sometimes difficult to determine. Poor patient adherence (implementation of the recommendations), for example, in the general measures (low-salt diet, diet change, weight loss, alcohol abstinence) and tablet intake could have far-reaching effects. A recent study found that "up to 80% of patients did not take their medication as prescribed."
Secondary hypertension results in other diseases
If other problems can be ruled out, according to the expert, it is also necessary to check whether there is a so-called secondary hypertension which, for example, can occur due to narrowing of the renal artery (renal artery stenosis, so-called renovascular hypertension). A sleep apnea syndrome is often associated with (especially nocturnal) blood pressure increases, as it comes to hypoxia to repeated sympathicotone wake-up reactions. In addition, there are medicines that can increase hypertension and whose use may need to be weighed (eg, estrogens, steroids, non-steroidal anti-inflammatory drugs / NSAIDs)..
Invasive procedures the last option
If there is a suspicion of therapy-resistant hypertension, according to the DGfN, referral to a nephrologist / hypertensiologist is generally recommended. For example, after exclusion of white-coat hypertension, adherence problems and secondary hypertension treatment with antihypertensive multiple combinations can be tried in which four, five or six antihypertensive drugs are used in parallel. If this drug therapy is not sufficiently effective, invasive procedures such as renal denervation or baroreflex stimulation may be used in treatment-resistant hypertension. (FP)