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Arterial Hypertension
Jens Jordan1, Christine Kurschat, Hannes Reuter
1Institute of Aerospace Medicine (DLR) and Chair of Clinical Aerospace Medicine, University of Cologne, Germany; Department II of Internal Medicine, Divisions of Nephrology, Rheumatology, Diabetes and General Internal Medicine, University Hospital of Cologne, Germany; Department of Internal Medicine and Cardiology, Evangelisches Klinikum Köln Weyertal, Cologne; Department III of Internal Medicine, Cardiac Center, University Hospital of Cologne, Germany; University Hypertension Center, University of Cologne, Germany.
Insights
Essential arterial hypertension, a major cardiovascular risk factor, affects many adults. Effective management involves lifestyle changes and first-line medications to control blood pressure and reduce risk.
Area of Science:
- Cardiology
- Hypertension Management
Background:
- Essential arterial hypertension is a primary, treatable cardiovascular risk factor.
- In Germany, a significant percentage of men (18%) and women (13%) have uncontrolled high blood pressure (≥ 140/90 mmHg).
Purpose of the Study:
- To review current guidelines and evidence for diagnosing and managing arterial hypertension.
- To outline recommended treatment strategies, including lifestyle modifications and pharmacological interventions.
Main Methods:
- Selective literature search in PubMed for pertinent publications.
- Review of current European guidelines on hypertension management.
Main Results:
- Diagnosis of arterial hypertension requires repeated measurements (≥ 140/90 mmHg), confirmed by ambulatory or home monitoring.
- Target blood pressure for all patients, including those with diabetes or renal failure, is <140/90 mmHg.
- First-line treatments include lifestyle changes (diet, exercise, weight loss, smoking cessation) and medications (calcium channel blockers, ACE inhibitors/ARBs, thiazide-like diuretics). Mineralocorticoid-receptor blockers are options for resistant hypertension.
Conclusions:
- Most patients with essential hypertension can achieve well-controlled blood pressure and reduced cardiovascular risk.
- A combination of lifestyle interventions and first-line antihypertensive drugs is effective for managing hypertension.
Background:
Essential arterial hypertension is one of the main treatable cardiovascular risk factors. In Germany, approximately 13% of women and 18% of men have uncontrolled high blood pressure (≥ 140/90 mmHg).
Methods:
This review is based on pertinent publications retrieved by a selective literature search in PubMed.
Results:
Arterial hypertension is diagnosed when repeated measurements in a doctor's office yield values of 140/90 mmHg or higher. The diagnosis should be confirmed by 24-hour ambulatory blood pressure monitoring or by home measurement. Further risk factors and end-organ damage should be considered as well. According to the current European guidelines, the target blood pressure for all patients, including those with diabetes mellitus or renal failure, is <140/90 mmHg. If the treatment is well tolerated, further lowering of blood pressure, with a defined lower limit, is recommended for most patients. The main non-pharmacological measures against high blood pressure are reduction of salt in the diet, avoidance of excessive alcohol consumption, smoking cessation, a balanced diet, physical exercise, and weight loss. The first-line drugs for arterial hypertension include long-acting dihydropyridine calcium channel blockers, angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers, and thiazide-like diuretics. Mineralocorticoid-receptor blockers are effective in patients whose blood pressure cannot be brought into acceptable range with first-line drugs.
Conclusion:
In most patients with essential hypertension, the blood pressure can be well controlled and the cardiovascular risk reduced through a combination of lifestyle interventions and first-line antihypertensive drugs.
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