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High Blood Pressure: When should you worry?

Arterial hypertension is one of the most common internal diseases. According to the World Health Organization (WHO), between 35% and 40% of all people worldwide are affected. While there are many different underlying causes for the development of hypertension, the most common form is the idiopathic form, whose cause is still unknown. Apart from an unhealthy lifestyle, the main risk factor is age.

Although hypertension is a widespread affliction, many cases remain undetected for a long time, mostly because many people lack proper health care and the disease lacks obvious symptoms during its initial stages. Still, a permanently elevated blood pressure can be quite dangerous. In the long term, it damages the cardiovascular system and increases the risk of suffering from heart attacks, strokes, kidney and retinal damage. The definition of arterial hypertension is subject to constant change. Previously the rule of "100 + your age" was used as the upper limit for systolic blood pressure, but it is now regarded as harmful and outdated. According to the current definition, hypertension starts at a systolic level of more than 140 mmHg, and a diastolic blood pressure starts at a level of more than 90 mmHg. Contrary to those levels, a reading ​​below 120/80 mmHg is considered optimal.

But the discourse on what constitutes high blood pressure levels, as well as treatment methods, regularly changes due to constant new data as well as lacking evidence in certain fields of hypertension therapy. A US guideline, published in 2013, recommends raising the threshold level to 150/90 mmHg in people aged 60 years or older. However, another large-scale study has shown that a group of probands benefitted significantly from a lower systolic blood pressure of around 120 mmHg - although a combination of different drugs was necessary.

Although certain groups of patients might benefit from significantly lowering their blood pressure, leading associations and organizations still adhere to levels of < 140/90 mmHg, even at an older age. In elderly patients, doctors aim to keep their blood pressure between 150 and 140 mmHg while also taking into account their physical and mental constitution. According to current research, significantly lowering a patient's blood pressure levels appear to not be particularly beneficial to them in terms of morbidity and mortality, especially in elderly patients. In addition, blood pressure that's too low can negatively affect them.

Due to a lack of early symptoms, patients should take their blood pressure regularly, as  hypertension can occur in both young and middle aged people. If the measured values ​​are above 140/90 mmHg, it's important to get properly checked and to take action early on.

In the case of an existing hypertension, the patient should consider changing their lifestyle before starting drug therapy. Regardless of guidelines, the therapy and targeted levels ​​should be tailored to the patient's constitution, lifestyle and age in order for them to find the best possible compromise between medical necessity and individual needs.