Arterial Hypertension

Abstract

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.

Figure 1

The prevalence of arterial hypertension in five geographic regions of Germany. In the German Health Interview and Examination Survey for Adults (Studie zur Gesundheit Erwachsener in Deutschland, DEGS1), the prevalence of arterial hypertension—defined as either documented high blood pressure values or the taking of medication to treat known hypertension—was determined in the male (♂) and female (♀) population in the period 2008–2011. The figure in parentheses is the percentage of hypertensive persons whose blood pressure was controlled with treatment [modified from [7])

Figure 2

The pathophysiology of essential arterial hypertension. Multiple hemodynamic, neural, humoral, and renal mechanisms lead to increased cardiac output and/or peripheral vascular resistance. The product of these two hemodynamic variables determines the blood pressure. ANP, atrial natriuertic peptide; BNP, B-type natriuretic peptide; RAAS, renin-angiotensin-aldosterone system

Figure 3

Current classifications of high blood pressure

Figure 4

Recommendations for the initiation of antihypertensive drug therapy depending on the initial blood pressure measured in the doctor’s office (after [8]). BP, blood pressure; CAD, coronary artery disease; CVD, cardiovascular disease

Figure 5

Recommendations for drug treatment of arterial hypertension with additional indications for first-line treatment because of further underlying diseases. ACE inhibitor, angiotensin-converting enzyme inhibitor; ARB, angiotensin-receptor blocker; EF, left ventricular ejection fraction. *¹ in combination with a potassium-sparing diuretic, as indicated *² symptomatic treatment for angina pectoris