Hypertensiology: Your specialist for high blood pressure in Düsseldorf

Hypertensiology is the specialized branch of internal medicine dedicated to the comprehensive diagnosis, treatment and prevention of high blood pressure (arterial hypertension) and its secondary diseases. As a certified hypertensiologist DHL®, Dr. Raphael Bruno offers you care at the highest scientific level in his cardiology practice in Düsseldorf. We understand that treating high blood pressure is much more than just prescribing tablets. It is an individual and long-term management based on precise diagnostics and a partnership between doctor and patient.

High blood pressure - the silent killer: why hypertensiology is so important

Arterial hypertension is one of the most common and most dangerous widespread diseases. The tricky thing is that high blood pressure does not cause any pain or clear symptoms for a long time, which is why it often remains undetected and untreated. In the meantime, however, the constantly elevated pressure gradually damages the blood vessels throughout the body and the organs that are supplied by them. The Hypertensiology aims to detect this „silent killer“ at an early stage and to treat it consistently in order to prevent serious secondary diseases.

Untreated high blood pressure is the main risk factor for:

• Heart attack: The heart must constantly pump against a high resistance, which damages the heart muscle.
• Stroke: The vessels in the brain are damaged and can rupture (cerebral hemorrhage) or become blocked by clots.
• Heart failure (cardiac insufficiency): The constant overload leads to thickening and slackening of the heart muscle.
• Renal failure: The fine filter cells of the kidneys are destroyed by the high pressure.
• Visual disturbances: The sensitive vessels of the retina can be damaged.
• Dementia: The chronic reduced blood supply to the brain can impair mental performance.

Blood pressure classification (according to ESC/ESH)

The following table, based on the European guidelines, serves to classify your values.

Hypertensiology diagnostics: more than just measuring blood pressure

A single blood pressure measurement taken in the excitement of the doctor's office is often not meaningful. The specialized hypertensiology Diagnostics therefore goes a decisive step further to obtain a real picture of your blood pressure and to identify possible causes or damage that has already occurred.

Our diagnostic pillars:

1. Standardized practice measurement: We carry out the measurement correctly under standardized resting conditions in order to minimize the so-called „white coat effect“.
2. Long-term blood pressure measurement (ABDM): This is the gold standard. You wear a small, automatic measuring device for 24 hours, which records your blood pressure in normal everyday life and also during sleep. This is the only way we can assess your actual blood pressure profile, especially the important nocturnal drop.
3. Search for organ damage: Using ECG, cardiac ultrasound, ultrasound of the kidneys and carotid arteries and laboratory tests (blood, urine), we look specifically for the first signs of damage to the target organs.
4. Root cause analysis: We initiate targeted diagnostics, particularly in young patients or patients with difficult-to-control high blood pressure, in order to rule out a treatable secondary cause.

Therapeutic approaches in hypertensiology: an individualized plan

The treatment of high blood pressure is not a rigid scheme, but is individually tailored to you, your concomitant illnesses and your life circumstances. The aim is not just to lower your blood pressure, but to achieve a comprehensive reduction in your overall cardiovascular risk. Before that, we look for the causes.

Therapy in hypertensiology consists of two pillars:

• 1. lifestyle changes (basic therapy): These measures are fundamental and can significantly lower blood pressure. These include a low-salt, balanced diet, regular endurance exercise, weight reduction, stress management and a reduction in alcohol consumption.
• 2. drug therapy: If lifestyle changes are not enough, drug treatment is essential. Today we have modern, well-tolerated drugs at our disposal. Often a combination of two or three active substances in low doses is more effective and has fewer side effects than a single high-dose medication. Adjustment requires patience and close cooperation between you and your doctor.

What does „Hypertensiologist DHL®“ mean? Your quality feature

The designation „Hypertensiologist DHL®“ is a protected title awarded by the German Hypertension League e.V. (DHL) to doctors who have completed special further training and have demonstrated their particular expertise in the field of hypertension. Hypertensiology have proven.

When you are treated by a DHL® hypertensiologist like Dr. Raphael Bruno, you can be sure that:

• He has in-depth and always up-to-date knowledge in the diagnosis and treatment of high blood pressure.
• He regularly undergoes further training in this area.
• He is also a competent partner for complex and difficult-to-control forms of hypertension.
• Treatment is carried out in accordance with the latest scientific guidelines of national and international specialist societies.

This certificate is an important and reliable seal of quality for you as a patient.

Hypertensiology and secondary hypertension: the search for the cause

In around 90% of patients, there is no single, clear cause for the high blood pressure; this is referred to as „essential“ or „primary“ hypertension. In the remaining 10%, however, the high blood pressure is the result of another, treatable underlying disease. This is referred to as „secondary hypertension“. An important part of the specialized hypertensiologic Clarification is the targeted search for such causes, especially in the case of:

• Young patients (< 40 years) with high blood pressure.
• Sudden onset or very difficult to control high blood pressure.

Possible causes include kidney disease, narrowing of the renal arteries, hormonal disorders (e.g. of the thyroid gland or adrenal glands) or sleep apnea syndrome. Detecting and treating such a cause can cure high blood pressure or make treatment considerably easier.

Frequently asked questions in hypertensiology

Here we answer common questions that patients have about high blood pressure.

Do I have to take pills all my life if I have high blood pressure?

In most cases, yes. Essential hypertension is a chronic disease that requires long-term treatment. The medication does not cure high blood pressure, but controls it. Stopping the medication would usually lead to a renewed rise in blood pressure.

What is the difference between systolic and diastolic blood pressure?

The systolic (upper) value measures the pressure in the blood vessels when the heart contracts and ejects blood. The diastolic (lower) value measures the pressure when the heart muscle relaxes and refills with blood. Both values are important for the Hypertensiology The systolic value becomes more important with age.

Can I cure high blood pressure through exercise and diet?

In the case of slightly elevated blood pressure (grade 1) and otherwise low risk, a consistent lifestyle change can sometimes be sufficient to normalize the values. In most cases, however, it is an extremely important supplement to drug therapy, allowing the dose of medication to be kept as low as possible.

What is „white coat hypertension“?

This describes the phenomenon that the blood pressure rises simply due to the excitement in the doctor's office, while at home it is within the normal range. In order to distinguish this reliably from genuine high blood pressure, long-term blood pressure measurement over 24 hours is the decisive examination in the Hypertensiology.

My blood pressure fluctuates throughout the day. Is that normal?

Yes, certain fluctuations are completely normal. Physical activity, stress or even pain can cause a short-term rise in blood pressure. The average blood pressure value over a longer period of time is important for the diagnosis. Extreme fluctuations or a lack of drop in blood pressure during the night are pathological.

I can't feel my high blood pressure. Why should I take tablets anyway?

This is precisely the danger. The absence of symptoms does not mean that the high pressure does not cause damage. Drug therapy is a preventive measure that protects you from serious late effects such as heart attacks and strokes.

When is blood pressure too low?

In contrast to high blood pressure, low blood pressure (hypotension) is usually medically harmless and is even associated with a longer life expectancy. It only requires treatment if it leads to symptoms such as constant dizziness, tiredness or a tendency to faint.

Is there a special „blood pressure diet“?

The DASH diet (Dietary Approaches to Stop Hypertension) has proven to be very effective. It is based on a low-salt, high-fiber diet with lots of fruit, vegetables, wholegrain products and low-fat dairy products as well as little red meat and sweets. We will be happy to advise you on this.

I have side effects from my blood pressure medication. What should I do?

Under no circumstances should you stop taking the medication without authorization. Please contact us immediately. There are many different classes of active ingredients available today. An experienced Hypertensiologist will almost always find an alternative medication that is well tolerated by you.

My blood pressure is too high despite taking three tablets. What should I do now?

If the blood pressure cannot be lowered to the target range with three or more different medications, this is referred to as „therapy-resistant hypertension“. This is a clear indication for consultation with a specialist. As Hypertensiologists DHL®, we specialize in the diagnosis and treatment of such complex cases.

Your blood pressure in experienced hands

Adjusting high blood pressure is one of the most important measures to protect your health in the long term. Entrust this responsible task to a proven expert. As a certified Hypertensiologist DHL® in Düsseldorf, Dr. Raphael Bruno offers you comprehensive and guideline-based care. Make an appointment to have your blood pressure optimally adjusted.