Blood pressure medicine may cause palpitations

High blood pressure: treatment

The aim of every high-pressure therapy is to reduce the risk of secondary diseases. Therefore, normalization of blood pressure below 140/90 mmHg is generally aimed for, in patients with type 2 diabetes below 140/85 mmHg and in kidney diseases with proteinuria below 125/75 mmHg. The treatment takes place regardless of palpable symptoms, as the high pressure does not initially cause any symptoms. The medical therapy decisions take into account not only the level of the blood pressure values ​​but also the overall risk profile, i.e. the sum of the patient's individual risk factors for cardiovascular diseases (e.g. obesity, smoking, alcohol consumption, diabetes, high cholesterol values, events such as heart attack, stroke in the medical history).

General measures

To lower the blood pressure, it is always useful that the patient:

  • Adjusts his diet (balanced / wholesome - i.e. lots of vegetables, fruit, fiber e.g. whole grain products, little animal fats), i.e. reduces existing excess weight; consumes little salt (less than 6 grams per day).
  • no smoking and little alcohol (less than 20-30 g / day for men or less than 10-20 g / day for women; (30 g = 2.5 glasses of 0.125 l wine, 20 g = approx. 0.5 l beer )) consumed.
  • Exercise and exercise regularly - 5-7 days a week for at least 30 minutes. Endurance training in particular (swimming, hiking, cycling, Nordic walking, cross-country skiing, golf) has a positive effect on blood pressure.
  • Reduces stress. Sufficient sleep, short breaks during the day, distributing tasks and relinquishing responsibility as well as sport and a relaxing hobby help to reduce constant inner tension.

In the case of mild hypertension (around 140/90 mmHg), these measures alone are often sufficient to bring the blood pressure back to normal. In any case, a healthy, active lifestyle generally supports the effectiveness of drug treatment.

Medical therapy

If it is also necessary to take medication, this should be done consistently and regularly. The following drugs / substance classes (antihypertensive drugs) are available for the treatment of high blood pressure, all of which are equally suitable for beginning and long-term therapy, be it as monotherapy or combination therapy:

  • ACE inhibitors and AT-1 receptor antagonists: Preparations from these classes of active substances have a vasodilating effect through several different reaction pathways. Essentially, they inhibit the formation of the blood pressure-increasing hormone angiotensin II. They sustainably lower blood pressure and prevent end-organ damage. Contraindicated in: pregnancy, hyperkalemia, angioedema.
  • Diuretics (water tablets, water tablets): These kidney-acting drugs include thiazides and loop diuretics (especially for those with impaired kidney function) as well as potassium-sparing diuretics. They increase the excretion of table salt and water via the kidneys and, in combination with other antihypertensive drugs, increase their effectiveness. In the longer term, diuretics lower blood pressure by reducing responsiveness to vasoconstricting stimuli. Since minerals such as potassium are excreted at higher doses, the diet should be rich in potassium (e.g. bananas, dried fruit, potatoes) when taking diuretics or the mineral should be taken in tablet form. In gout patients with high blood pressure, diuretics to lower blood pressure are not recommended.
  • Beta blockers: Beta blockers are drugs that block what are known as ß-receptors in the body. This inhibits the effects of certain stress hormones. These stress hormones (noradrenaline, adrenaline) normally have a stimulating effect on various organs (including the heart). If they are blocked, the pulse and blood pressure drop, as does the heart's beating power. So the heart beats a little slower and is relieved. Contraindicated in: asthma, atrioventricular block
  • Calcium antagonists or calcium channel blockers: Calcium antagonists block the calcium channels in the heart and vascular muscle cells. They reduce the influx of calcium into the cells, thereby lowering the vascular tension and thus also the blood pressure. Verapamil and diltiazem are contraindicated in: atrioventricular block, severe heart failure

Medicines from these drug classes can be prescribed individually (monotherapy) or together (combination therapy) - taking into account possible underlying or concomitant diseases. If the initial therapy is unsuccessful, the preparation or the combination can be changed until the blood pressure is effectively reduced.

Treatment with blood pressure medication is sometimes experienced by patients as stressful, since lowering the blood pressure can initially make them tired and exhausted. The body first has to adapt and get used to the lower blood pressure. The medication should therefore be given gradually at the beginning, i.e. a low dose at the beginning, which is gradually increased. This gives the organism time to slowly adapt to it. The changeover can take up to a month.

Consistency is important

Remember, even if you don't have any symptoms, that untreated high blood pressure ultimately leads to more or less dangerous damage to your body. When you feel the consequences, the damage is mostly irreversible. Treated in good time you can get the risk associated with high blood pressure under control. For this it is usually necessary to carry out the therapy for life. If necessary, your motivation (compliance) can be improved through individual and group discussions as well as doctor-patient seminars. The success of the therapy, i.e. the lowering of blood pressure, must be checked regularly by the doctor and the medication may need to be adjusted. By adhering to a healthy lifestyle, you can keep the dosage of the active ingredients as low as possible.

In addition to the regular measurement of blood pressure by the doctor, self-measurements and 24-hour blood pressure measurements under home conditions, during daytime activities and while sleeping at night have become an important supplementary measurement method for therapy control. Patients who measure their blood pressure themselves should receive detailed instruction in the measurement technology, ideally as part of a structured hypertension training program.