1. Can the occurrence of high blood pressure be prevented when it is already present in the family?

Modern medicine worldwide has focused the mitigation of risk factors and their impact on development of hypertension. High rates of hypertension patients, not only in our country, but globally, are the main reason for such a prominent place given to prevention of this diseases.

Prevention of this disease comprises all activities implemented in order to:

  • Prevent the occurrence of the disease,
  • Diagnose it early,
  • Administer proper treatment promptly.

What are the prevention measures?

  • Regular exercise

Moderate and regular exercise is extremely important, since this has beneficial effect on the risk factors (blood pressure, obesity and blood fats)

  • Quitting smoking

Tobacco smoke has adverse effect on the whole body.

  • Loosing body weight – Slimming diet

It is necessary that measures you implement in order to lose weight are supervised by an expert, instead of resorting to random diets or using unsafe drugs. Healthy diet long-term, even lifelong, should only be prescribed by a nutritionist.

  • Healthy diet

In cases of hypertension healthy diet is extremely important as well as sticking to it consistently:

  • Less salt intake,
  • Low intake of carbohydrates,
  • Low intake of fatty foods,
  • Regular meals should not be skipped,
  • Moderate alcohol intake,
  • No energy drinks whatsoever.

Stress as one of the risk factors should not be overlooked. It is necessary to reduce stress, which is easier said than done.

It is important to have at least an hour for yourself and indulge in what relaxes you and makes you feel good – walk, massage, chat with a friend, doing the crossword puzzles, … something to make you forget your problems.

2. How is the diagnosis established – does every spike of blood pressure over 140, once or twice, automatically implies hypertension and what requirements have to be fulfilled to establish this diagnosis?

Hypertension is a disease diagnosed in a simple manner, by blood pressure measurement – using a manometric or electronic device.  The diagnosis is most commonly established by a doctor  who measures the blood pressure in his/her office, and sometimes patients register values they measure at home, which needs to be double-checked.

In addition to individual measurement, ambulatory i.e. 24hrs arterial blood pressure monitoring is also required (the device measures your pressure during common daytime and nighttime activities).  Only a doctor can indicate this type of examination.

Basic blood chemistry and microalbuminuria (urine proteins) tests have to be done for each patient with hypertension. If we suspect secondary hypertension (accounting for only 5% of all cases of hypertension), additional tests and investigations have to be conducted:

  • Nephrological examination (24h proteinuria – patients collect 24hrs urine, urea and creatinine clearances are determined),
  • Doppler imaging of renal blood vessels and echosonography of the kidneys,
  • Endocrinological investigations (catecholamine determination, which requires discontinuation of some medicines beforehand),
  • Polysomnographic recording, if sleep apnea is suspected,
  • Echosonography of the heart and cervical vessels.


All of the above examinations are performed if a cardiologist or hypertensiologist indicate them.

3. How is blood pressure measured properly in home setting and how frequently patients with hypertension should take these blood pressure measurements?

Blood pressure can be measured at home, using a conventional device with manometer or automated devices; only the so-called wrist-band i.e. bracelet devices should not be used.

How to take blood pressure measurement properly:

  • It is important that the patient is relaxed before the measurement, resting for 30 minutes
  • The pressure should be taken every day at the same time, before or after treatment, to be able to compare the obtained values (2-3 times a week, unless your doctor tells you otherwise),
  • No coffee half an hour before pressure taking,
  • Wrist-band (“bracelet” devices) should not be used,
  • Use appropriate, properly gauged devices with adequate cuff (has to cover 80% of the upper arm circumference),
  • Patients are advices to take the pressure three times in 3-5 min intervals and register the mean values.


Circadian blood pressure rhythm

Blood pressure is a variable parameter and does not carry the same value at each time of the day. These are normal physiological oscillations both in persons with normal and in those with elevated blood pressure.  

Circadian blood pressure rhythm implies the so-called physiological oscillations of blood pressure values over a 24-hour period that are present in all persons (those with high, normal or low blood pressure):

  • The lowest blood pressure value is measured at 2 a.m. after which the pressure rises gradually – preparing us for awakening,
  • At about noon mild decline of blood pressure ensues
  • From 4 p.m. it begins to rise again to 11 p.m.
  • From 11 p.m. to 2 a.m. it declines again.   


Unfortunately, due to inadequate choice of antihypertensive medication or inappropriate dosing, major oscillations in pressure values may take place, which automatically increases the risk of heart attack or stroke.   

Advice for our patients in case they have major oscillations in blood pressure values: Consult your doctor to adjust your treatment, and never do that on your one!

Oscillations of blood pressure frequently result from incorrect dosage determined by patients themselves, which is wrong and carries risk for themselves. You should take the therapy prescribed by your doctor regularly, every single day.

4. How and why weather conditions affect patients with hypertension and what is advised to them during abrupt changes in atmospheric pressure?

In the period of major weather changes, larger amounts of positive ions accumulate in the atmosphere and our body reacts to them.

Biometerologists, people who study the impact of weather on human health, say that the hypothalamus and pituitary functions may change during major weather changes, i.e. may result in reduced adrenaline secretion. This phenomenon may cause depression and higher secretion of serotonin, which in turn cause headache and migraine.

Variable secretion of epithalamine and melatonin in the body causes insomnia.

With dusk or increased accumulation of clouds, melatonin is produced from serotonin in the epiphysis, and the hormone plays an important role in the regulation of daily alternation of the sleep-wake cycle.

Sudden change of weather, from bright and sunny to cloudy affects the melanin level in the body, making us sleepy, inert and depressed during the day (particularly on cloudy days).

All of this suggests that weather changes affect our bodies and we should not neglect their impact on our health.  

It goes without saying that this is more prominently manifested in susceptible persons, so that all chronic patients, including those suffering from cardiovascular, GIT, rheumatological, and in particular psychiatric diseases tolerate sudden weather changes with greater difficulties.

Pressure oscillations may also take place seasonally, being lower in the summer and higher in the winter.  Over the summer, due to increased vasodilatation (expansion of blood vessels), but also due to increased sweating, the pressure declines and your doctor may adjust your antihypertensive medication, if needed.  

In the summer physical exertion should be avoided during the hottest part of the day, while water intake should be increased and the diet should be based on more fruits and vegetables.  

Patients need to comply with prescribed treatment regularly, and in case of any worsening they should contact their attending physician, instead of adjusting the treatment themselves.


5. Do hypertension drugs have to be taken life-long?

Hypertension is a life-long disease, but an antihypertensive medication prescribed once need not necessarily be needed indefinitely.

The treatment is prescribed and adjusted by your doctor.

The treatment of arterial hypertension may be pharmacological and non- pharmacological.

Non- pharmacological measures should be implemented from an early age, particularly in families with history of hypertension.  First of all, food should be less salty (most of the salt we ingest comes from industrially processed food), drink alcohol only moderately, exercise moderately (30-60min walks), take regular meals to avoid obesity, and quit smoking. If these non- pharmacological measures are not sufficient, we have to include medicines, as well (pharmacological treatment).

6. Can treatment be adjusted after some time? How is it done and why patients should not do it on their own?

It should be pointed out that each patient has his/her own medicine or own combination of medicines. Individual approach is important in treatment of elevated blood pressure and there is no panacea for all.   

Appropriate medicine should be prescribed only by doctors, never by patients themselves. Treatment adjustment is also prescribed by doctors, not by patients, since this may put health at risk.

What are the consequences of inadequately treated hypertension?

Statistical data show the following consequences of inadequately treated hypertension:

  • Stroke in 61% of cases,
  • Ischemic heart disease in 47% of cases,
  • Atrial fibrillation (heart rhythm disorder) in 52% of cases,
  • In 26%, or even more, kidney dialysis becomes necessary,
  • Disability in 50% of cases.