On the occasion of the recent publication (June 2023) of the new European guidelines for hypertension, it is an opportunity to summarize some useful, simple information and practical advice on this very common problem.

When our doctor, in repeated measurements, finds our Systolic Blood Pressure (the big pressure, as we usually say) >140 mmHg and/or Diastolic (the small one or the heart) >90 mmHg then we have Hypertension.
There is a proven relationship between Hypertension and the risk of cardiovascular diseases (stroke, coronary heart disease and heart failure), as well as the establishment and progression of chronic kidney failure, which is why we are so concerned about the regulation of blood pressure.

The above value ranges correspond to the pressure level at which the benefits of intervention (lifestyle change or medication) exceed those of no action, as demonstrated by the results of randomized trials.

There are a total of eight categories of blood pressure (5 stages of Hypertension):

• Optimal SBP <120 and DBP <80mmHg
• Normal SBP 120-129 and DBP 80-84mmHg
• High normal SBP 130-139 and/or DBP 85-90mmHg
• Stage 1 SBP 141-159 and/or DBP 91-99mmHg
• Stage 2 SBP 160-179 and/or DBP 100-109mmHg
• Stage 3 SBP >180 and/or SBP >110mmHg
• Isolated Systolic Hypertension ≥ 140 and <90mmHg
• Isolated Diastolic Hypertension <140 and ≥90mmHg How is blood pressure measured correctly?

Correct measurement of blood pressure is of paramount importance. The preferred method is automated with an electronic sphygmomanometer cuff. Random screening for hypertension is recommended in all adults (persons ≥18 years). Regular blood pressure measurements are important from age 40 and in adults at increased risk for hypertension, special ethnic groups such as blacks, people with high blood pressure and people who are overweight or obese, women in menopause, as well as women who have had hypertension in pregnancy or preeclampsia.

Blood pressure measurement should always be part of every medical visit even in people younger than 18 years old. Because of the variability of blood pressure, an elevated value in the office should be confirmed in at least two to three visits, unless the blood pressure values ​​recorded during the first visit are significantly elevated, i.e. above 180 mmHg, or the cardiovascular risk is large. Values ​​to start treatment are SBP >140 mm Hg or DBP >90 mm Hg.

In patients who have values ​​close to the diagnosis limit and have a low cardiovascular risk because they have no history from parents or other health problems, only lifestyle changes can be suggested to them initially.

Good blood pressure regulation is a bet for longevity and a better life. A healthy lifestyle is therefore recommended:

• Reducing body weight (as well as reducing the cycles of weight loss and regaining) and if this is not possible with diet and exercise alone, the use of anti-obesity drugs and in obese people and bariatric operations is enhanced. Obesity is a major trigger of hypertension, so trying to lose weight is strongly recommended. In fact, it has been shown that losing 10 kg leads to a reduction in blood pressure by 20 mmHG.
• It is recommended to limit sodium intake and increase potassium intake.
• We reduce the addition of salt to the food and add lemon or other herbs to the food to preserve its taste. It is useful to look at the labels of the products we buy to indicate less salt content.
• Increase potassium intake. A satisfactory amount is more than 3.5 grams per day. Foods rich in potassium are bananas, avocados, potatoes, sweet potatoes, beets, fruits.
• It is also advisable to reduce the intake of fats and increase the consumption of fruits and vegetables.
• We increase physical activity by adding regular exercise (150 minutes per week) to our lives.
• We limit the consumption of alcohol, after all, it is also extra unnecessary calories. The maximum permitted daily consumption limit is 30ml (2 drinks) for men and 15ml (1 drink) for women.
• Quitting smoking is necessary. In fact, to combine with the above, it has been found that exercise significantly reduces the desire for nicotine. There are smoking cessation clinics for those struggling on their own.
• Better stress management, avoiding exposure to noise and air pollution are included in measures to regulate blood pressure.

When is medication required?

If the healthy dietary advice does not work and with this approach the regulation is not achieved after two to three months, then medication is in order. Importance is given to the reduction of blood pressure and not to the drug that will be chosen.

It is recommended that all antihypertensive pills be administered together in the morning for better compliance, i.e. so that they are not forgotten. Good blood pressure control in middle-aged and older people minimizes the future risk of cognitive decline and dementia.

For older people (aged 80 or older), initiation of medication when SBP is 160 mm Hg is recommended, although initiation at lower values ​​of 140 – 160 mm Hg may be individually considered. The initiation threshold for very susceptible patients must be individualized.

To younger people and in better physical condition patients the lower the better, but not below 120 mm Hg.