120 to 80, that’s about where everyone wants to go. But for many, blood pressure rushes up at some point, often without them noticing. In the long run, this can be life-threatening. dr Anne Fleck, an expert in preventive medicine, knows how to take countermeasures.
I’m skinny, so am I safe?
Unfortunately not, slim people are also affected. The reasons: too little exercise, alcohol, too much salt, magnesium deficiency, stress. “But there are also secondary factors, such as calcification of the renal artery, hyperthyroidism, rheumatic diseases such as lupus or vascular inflammation,” says Anne Fleck. In addition to intoxicants such as cannabis, medication can also increase blood pressure. “If you take cortisone or nonsteroidal anti-inflammatory drugs very regularly – such as ibuprofen or diclofenac – this can also increase blood pressure.” There is often a combination of several factors behind the increased values, which makes it difficult to find out the cause.
What makes the pressure go through the roof?
for dr Anne Fleck says “overweight is a huge factor. But the nice thing is that you can influence this by losing weight in a targeted manner. Blood pressure can be significantly reduced even by losing ten kilos.”
Half of all strokes and heart attacks could be avoided if something were done to treat high blood pressure in good time, says Anne Fleck.
Because the change usually creeps into life without warning and puts a strain on the vessels, often undetected for years. Around a third of all Germans suffer from it, and younger people and even young people are becoming increasingly common.
What symptoms should I look out for?
“A typical sign of high blood pressure is that you just feel a bit ‘out of it’,” says Anne Fleck. Morning headaches are also classic – especially headaches in the neck, which get significantly better when you sit up. Other symptoms can include dizziness, mild nausea, ringing in the ears, tinnitus, tiredness, insomnia or severe and frequent nosebleeds. “Severe nosebleeds are a classic in the emergency room during a high blood pressure crisis,” explains the doctor. “Likewise visual disturbances or angina pectoris, i.e. a narrow chest.”
What are the limits for hypertension (high blood pressure)?
“You have to look at it individually,” says the specialist in internal medicine. “Every one of us has high blood pressure when we are physically or mentally exhausted. It only becomes a problem when it is permanently in the excessive reference values.” Even if everyone is different: 140 to 90 is already too high.
And now – swallow pills forever?
Not if you ask Doc Fleck. “In the beginning, pills are often necessary,” she says. In many cases, however, it is often possible to completely reduce them through individual lifestyle changes – unfortunately, patients today are rarely given detailed and qualitatively good advice on this. “Nobody leaves my practice without specific recommendations, only with a blood pressure tablet. Because even with normal-weight patients, it is advisable to change the diet appropriately.
Specifically: more vegetables, herbs, low-sugar fruit, fatty fish and/or high-quality omega-3 fats from algae oil. But moderate carbohydrates, little alcohol and preferably no nicotine. Whole blood is a great way to measure whether magnesium and potassium are sufficient. In the case of a magnesium deficiency, as with all dietary supplements, you should substitute pure substances, then your blood pressure will often improve. And very important of course: exercise! All of this is not magic, but possible within the framework of innovative preventive medicine, and I would like to encourage people to do this.”
I’ve been taking antihypertensives lately, but to be honest: little is happening…
Don’t let it fool you! Patience is unfortunately of the essence when it comes to such a vital bodily function. “A blood pressure setting usually takes several weeks to figure out which drug and which dosage are suitable for the individual,” says Anne Fleck. “The drugs need time to adapt to the structure of the body – there can be strong fluctuations at the beginning. The only important thing is that this is closely monitored.”
High blood pressure: These are the official recommendations
Of course, the current guideline “Management of arterial hypertension” also advises more exercise, less salt and alcohol, losing weight until the stomach is gone, and not smoking. Because these lifestyle changes have been proven to have a blood pressure-lowering effect. But that’s not always enough, and the values remain at 140 to 90 mmHg (millimetres of mercury column) – i.e. where hypertension begins – or above. Anyone who has already changed the fine vessels in their kidneys or eyes due to high blood pressure should take medication anyway, just like those who are particularly at risk of cardiovascular damage because of diabetes, for example.
But which drugs and how high a dose?
In addition, the current guideline (published in 2018) brought two clear changes to its predecessor, which unfortunately still have not gotten around everywhere: On the one hand, the blood pressure value to which the tablets should lead has been significantly reduced. The target value is now 120 to 130 mmHg for the upper (systolic) value and 70 to 80 mmHg for the lower (diastolic) value. The decisive factor for the correction was the so-called SPRINT study from 2015. It compared the then standard high blood pressure treatment (target value: 135 mmHg) with one that aimed for 120 mmHg. The patients with the lower target value showed such a significantly reduced risk (by 43 percent!) of dying from a cardiovascular event such as a heart attack or stroke that the study was stopped prematurely. So it really pays to keep your blood pressure under control!
In addition, there was the realization that one shouldn’t go too deep either: The risks increase again if the blood pressure falls below 120 or 70 mmHg due to medication. That is why the target values for systole and diastole are now given as a window and no longer as a maximum value.
The second major change is the recommendation to be treated with more than one drug in the first place, with a combination of an ACE inhibitor (these are the drugs ending in -pril) or ACE receptor blockers (they end in -sartan) in combination with a calcium channel blocker (such as verapamil or diltiazem) OR a water pill or diuretic (such as chlortalidone or indapamide) – depending on what other medical conditions the patient has. These combos are meant to be given compressed into just one tablet. Because patients take one pill more reliably than several.
If the values are still unsatisfactory after three months and with higher dosages, a third substance is added, i.e. the ACE inhibitor or ACE receptor antagonist from above, plus calcium channel blockers AND diuretics. If blood pressure cannot be controlled even with such a three-ingredient tablet, this is referred to as therapy-resistant hypertension. Then there is usually spironolactone, a so-called aldosterone antagonist, and also a diuretic. The practice lags behind the recommendations. Because the convenient combi-agents are often significantly more expensive than the individual substances.