High Blood Pressure & Cholesterol Management

Hypertension and dyslipidaemia are treatable. We combine medication with concrete recommendations on exercise, nutrition and weight management, and we measure success by numbers: systolic and diastolic blood pressure, LDL cholesterol, HDL, triglycerides, HbA1c. The target values are based on your personal risk profile and your comorbidities, not on standard thresholds.

So that at every check you know exactly where you stand and what the next step is.

High blood pressure and elevated cholesterol often develop silently and over years. You notice no symptoms, but your arteries narrow, plaque builds up on the vessel walls, and your heart works against a higher resistance. You should arrange an appointment if you have been diagnosed with high blood pressure or high cholesterol and need specialist long-term care.

Likewise if there have been heart attacks, strokes or sudden cardiac events in your family, because a family history is one of the strongest risk factors, especially with familial hypercholesterolaemia. Symptoms such as recurrent headaches, dizziness, visual disturbances, chest complaints or unexplained fatigue can point to hypertension, even though they are often attributed to other causes. Diabetes, excess weight and smoking further increase your cardiovascular risk and make a cardiological assessment particularly worthwhile.

If a recent blood test or a blood pressure measurement at your GP showed abnormal values, the further diagnostics and treatment planning belong in the hands of a cardiologist. And if you want your current medication reviewed or optimised, for example because you notice side effects or the values are not within the target range despite treatment, you are in the right place. Early management of these risk factors is among the most effective measures to prevent serious heart disease, stroke and kidney failure.

We begin with a thorough conversation about your blood pressure and cholesterol values, your lifestyle, your family history and existing conditions such as diabetes, kidney disease or sleep apnoea. A focused cardiovascular examination follows, to assess your current status and to identify risk factors. The diagnostics begin with a blood pressure measurement at rest in both arms, because a difference of more than 15 mmHg between the two can point to peripheral arterial disease.

If white-coat hypertension or masked hypertension is suspected, in other words high blood pressure that occurs only outside the practice, we prescribe 24-hour ambulatory blood pressure monitoring (ABPM). The device records your blood pressure automatically every 15 to 30 minutes throughout the day and night and makes daily fluctuations and the nocturnal dipping behaviour visible. An absent nocturnal fall in blood pressure (non-dipping) is an independent risk factor for cardiovascular events.

The lipid profile from the fasting blood sample measures total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides and, where needed, lipoprotein(a), a genetically determined risk factor. In addition we determine blood sugar, HbA1c, kidney function tests (creatinine, eGFR), potassium, liver values and inflammatory markers such as high-sensitivity CRP, to build a complete cardiovascular risk profile. A resting ECG records the electrical activity of your heart and detects arrhythmias and signs of left ventricular hypertrophy, which is common with long-standing hypertension.

Where needed, we add an echocardiography to establish whether high blood pressure has already led to a thickening of the heart wall or a diastolic dysfunction. On this basis we calculate your individual 10-year cardiovascular risk according to the SCORE2 model and set your personal target values.

Not every elevated value requires medication straight away. With moderate risk and no organ damage we begin with lifestyle change: more exercise, a reduced-salt diet, weight management and stress reduction. If the values do not fall sufficiently after three months, or your risk is high from the outset, for example with existing coronary heart disease, diabetes or a 10-year risk above 10 percent, we start medication.

For hypertension we use, depending on the profile, ACE inhibitors, sartans (angiotensin II receptor blockers), calcium antagonists, beta-blockers or diuretics. Often we combine two substances at low dose, which is more effective and causes fewer side effects than a single substance at high dose. The ESC guidelines recommend this combination therapy as standard for most patients with grade 2 hypertension or higher risk.

For dyslipidaemia, statins are the first choice to lower LDL cholesterol. If statins alone are not enough, or you cannot tolerate them because of muscle pain (myalgia), we add ezetimibe or try a different statin at a lower dose. In cases of very high risk, for example after a heart attack, with diabetes and end-organ damage, or with familial hypercholesterolaemia, PCSK9 inhibitors come into consideration.

We dose step by step, check liver values and creatine kinase regularly and speak openly about side effects and alternatives. The goal is a medication that lowers your LDL to the individual target value and that you can carry in everyday life for the long term.

Every three to six months you come in for a check, depending on the stability of your values and your risk profile. We measure your blood pressure at rest, check your current lipid profile, kidney values, electrolytes and liver function, and adjust the therapy. If your blood pressure is difficult to control despite medication, we use 24-hour blood pressure monitoring again to check whether the therapy works throughout the day and at night.

Persistent nocturnal hypertension often requires an adjustment of the timing of intake or of the choice of substance. If a secondary hypertension is suspected, in other words high blood pressure caused by an underlying condition such as renal artery stenosis, primary hyperaldosteronism or sleep apnoea, we initiate further diagnostics and work interdisciplinarily. We watch the connection between hypertension, cholesterol and diabetes closely, because these risk factors reinforce one another.

If your HbA1c rises or your fasting blood sugar is borderline, we work with Sofia Jurgeleit to ensure coordinated treatment that addresses all risk factors at once. Your cardiologist remains your dependable point of contact and knows your entire history. Every check ends with a clear summary: where your values stand, what changes in the therapy, when the next appointment is.

The goal is a stable regimen that you can maintain without major restrictions in everyday life and that lowers your risk of heart attack and stroke in the long run.

Medication alone is often not enough, and sometimes it is not the first step at all. Regular exercise, 150 minutes of moderate endurance activity per week such as brisk walking, swimming or cycling, can lower systolic blood pressure by 5 to 8 mmHg while improving HDL cholesterol. Reducing salt to under 5 grams a day acts like half a blood pressure tablet.

Weight loss of 5 to 10 percent improves both blood pressure and cholesterol values and reduces insulin resistance. We do not give generic advice. We discuss with you concretely which changes are realistic in your everyday life, and we help you set achievable intermediate goals.

Stopping smoking is the single most effective measure for reducing cardiovascular risk, because smoking affects both blood pressure and LDL cholesterol negatively and damages the vessel walls directly. If you smoke and want to stop, we support you with a clear strategy. Moderate alcohol consumption and stress management also play a role, for example through regular exercise, sufficient sleep or targeted relaxation techniques.

In many cases, consistent lifestyle changes allow medication doses to be reduced or, in mild cases, medication to be avoided altogether. That is not a promise but a goal we pursue together and in measurable steps.

Why are high values dangerous even though I feel nothing?

High blood pressure and a high cholesterol level usually cause no complaints for years. But they strain your vessels and your heart every day and silently raise the risk of heart attack and stroke. This is exactly why we speak of a silent risk: the first noticeable sign is often the event itself, the one we want to prevent.

Do I need medication straight away?

Not necessarily. With slightly elevated values and a low overall risk, we often begin with targeted adjustments in everyday life and monitor closely. If the values are markedly elevated or your cardiovascular risk is high, medication makes sense. We make this decision together, based on your individual overall risk.

How often should I have my values checked?

That depends on your starting values and your risk profile. If blood pressure and cholesterol are stably controlled, checks every few months up to once a year usually suffice. In the adjustment phase or when changing the therapy we check more frequently. You can measure blood pressure well yourself at home between appointments.

Can I lower my values without medication?

In many cases yes, at least partly. Regular exercise, a balanced diet, less salt and alcohol, stopping smoking and a healthy weight have a measurable effect on blood pressure and cholesterol. For some people these measures are enough; for others they complement medication and improve its effect.

Which target values apply to me?

That is individual and is based on your overall risk, not on a single number alone. For healthy adults, a blood pressure below 120 mmHg systolic is normal; according to the newer, stricter guidelines, values above 120 mmHg already count as elevated blood pressure and higher values as high blood pressure. For LDL cholesterol, the target values are lower the higher your cardiovascular risk is. We set your personal target value together in the consultation.

What happens at the first assessment?

We record your values, your history and your risk factors, put the result in context for you and discuss the next steps. So that after the appointment you know where you stand and what makes sense.

Do I need a referral?

No. You can contact us directly at the Utoquai, without a referral. You will usually have an appointment within 48 hours.