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Care for patients with difficult to adjust high blood pressure
According to health experts, around 30 percent of the adult population in the western world suffers from high blood pressure. Many sufferers take medication to lower blood pressure. But in some cases, these have little effect. Caring for patients with hypertension that is difficult to adjust is a major challenge for medical professionals.
Number one risk factor for cardiovascular diseases
The German High Pressure League e. V. DHL® reports that around 30 percent of adults worldwide have high blood pressure. Untreated hypertension is the number one risk factor for cardiovascular diseases and is therefore responsible for many deaths from heart attacks or strokes. But even with medical treatment, some patients do not achieve good values. According to estimates, up to 20 percent are so-called difficult to adjust hypertensives. Their care is a major challenge for medical professionals.
How high the blood pressure can be
Hypertension is not felt by patients for a long time and often only becomes noticeable when it has caused organ damage. He is therefore - like other diseases - referred to as a "silent killer".
But how high can the blood pressure actually be? Hypertension is defined by a systolic blood pressure of over 140 mmHg and a diastolic blood pressure of more 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 advocate moderate target values.
Simple means are not enough for some patients
Since, in addition to being overweight or obese, too little exercise, an unhealthy, overly salty diet, tobacco and increased alcohol consumption and stress are considered risk factors, those affected are generally advised to minimize these risks in order to lower their blood pressure.
If a healthier lifestyle is not enough, doctors prescribe medications to lower the patient's blood pressure. But even with these, good values are not achieved in some cases.
"Doctors speak of difficult-to-adjust or therapy-resistant hypertension if patients do not achieve good blood pressure values, despite changes in their lifestyle and therapy with three blood pressure lowerers of different substance classes," explains the DHL® in a message.
Hypertension patients difficult to adjust
The reasons for this can be very different:
"The 10 to 20 percent difficult to adjust hypertension patients from which we have to start represent a relevant problem in general and internistic practice," says Professor Dr. med. Walter Zidek, clinical director at the Charité University Medicine Berlin.
"The reasons why hypertension patients are difficult to adjust vary widely and are not always easy to diagnose," says the doctor.
"Without a clear concept for diagnostics and care, over-treatment or incorrect treatment can occur, which ties up enormous resources without leading to a solution," explains Zidek.
New diagnostic or therapeutic approaches
If difficulties arise in high-pressure treatment, new diagnostic or therapeutic approaches are sometimes required instead of switching or adding additional blood pressure medication.
"A systematic and rational search for the causes is important here," said the expert. A large number of the difficult to adjust patients have problems with adherence, i.e. with the loyalty to the prescription of the prescribed medication.
"In practice it is often not easy to identify these patients and it is not easy to change their attitude towards medication," explains Professor Zidek. Another cause can be insufficient medical treatment.
"In practice, one of the most frequent deficits in the treatment of patients who are difficult to adjust is to underestimate the role of saline elimination through appropriate diuretic, ie dehydrating therapy," explains the specialist.
In addition, kidney disease or endocrinological disease can also be the basis for hypertension that is difficult to adjust.
Concomitant diseases such as renal insufficiency, the metabolic syndrome or obstructive sleep apnea also complicate treatment.
At a joint conference of the DHL® and the German Diabetes Society on November 10th and 11th in Mannheim, discussions will be held on how to deal with these difficult-to-treat patients. (ad)