Hypertension: when should we take treatment? Dr Gérald Kierzek responds

Hypertension: when should we take treatment? Dr Gérald Kierzek responds
We talk about hypertension a lot, but at what threshold do we speak of danger and when should it be treated with medication? The very precise response from Dr Kierzek, medical director of True Medical.

It is the most common cardiovascular disease in France, and affects one in 3 adults, and 65% of French people over the age of 65. High blood pressure linked to abnormally high blood pressure in the blood vessels can put you in danger: it increases the work of the heart which is exhausted (heart failure) and constitutes an important cardiovascular risk factor. But when should we worry about it and especially when should we be “treated”? The answer in numbers…

What is normal blood pressure?

Two numbers are taken into account to define blood pressure: the higher number reflects the blood pressure when the heart empties (systolic pressure) and the lower number the blood pressure when their heart relaxes to fill (diastolic pressure). There
normal value of the

blood pressure is 120/80 mm of mercury (unit of measurement of blood pressure). The limit value beyond which we speak of high blood pressure is 140/901 when the measurement is made in the doctor’s office and 135/851 during a self-measurement. The higher the blood pressure, the greater the risk of cardiovascular disease.

When should we consider treatment?

“Knowing whether it is time to start drug treatment depends on several factors”announces Dr Gérald Kierzek, medical director of True Medical.

First of all the blood pressure level

According to the recommendations (ESH/ESC 2023, HAS 2020), the level indicates the procedure to follow.

  • Blood pressure ≥ 140/90 mmHg : If the cardiovascular risk is low or moderate, hygienic and dietary measures are first recommended for 3 to 6 months. “If blood pressure remains ≥ 140/90 mmHg after this period, drug treatment is initiated”;
  • Blood pressure ≥ 160/100 mmHg : drug treatment is started immediately, even in the absence of risk factors;
  • Blood pressure ≥ 180/110 mmHg : this is severe hypertension requiring immediate treatment and rapid assessment.

Overall cardiovascular risk

Treatment is started earlier in the event of:

  • Diabetes (objective < 130/80 mmHg if tolerated);

  • Chronic kidney disease;

  • Cardiovascular history (stroke, heart attack, etc.);
  • High risk score (age, smoking, dyslipidemia, etc.).

Detection of target organ damage

In this case, a cardiometabolic assessment must be carried out with additional examinations. But treatment is put in place in the event of

  • Left ventricular hypertrophy (echocardiography);

  • Microalbuminuria;

  • Arteriosclerosis (arterial stiffness).

In summary:

PA ≥ 140/90 + low risk → Hygiene-dietary measures first.

PA ≥ 140/90 + high risk → Treat immediately.

PA ≥ 160/100 → Immediate treatment.