• Jens Jordan, Christine Kurschat, and Hannes Reuter.
• Institute of Aerospace Medicine (DLR) and Chair of Clinical Aerospace Medicine, University of Cologne, Germany; Department II of Internal Medicine, Divisions of Nephrology, Rheumatology, Diabetes and General Internal Medicine, University Hospital of Cologne, Germany; Department of Internal Medicine and Cardiology, Evangelisches Klinikum Köln Weyertal, Cologne; Department III of Internal Medicine, Cardiac Center, University Hospital of Cologne, Germany; University Hypertension Center, University of Cologne, Germany.
• Dtsch Arztebl Int. 2018 Aug 20; 115 (33-34): 557568557-568.

BackgroundEssential 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).MethodsThis review is based on pertinent publications retrieved by a selective literature search in PubMed.ResultsArterial 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.ConclusionIn 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.

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