High blood pressure affects about 40% of adults in Romania. It is called “the silent killer” because for years it causes no symptoms, yet it damages the blood vessels, the heart, the kidneys and the brain. Here is how it is treated with medicines and which lifestyle changes really work.
Normal values vs hypertension
- Optimal: below 120/80 mmHg
- Normal: 120-129 / 80-84 mmHg
- High normal: 130-139 / 85-89 mmHg
- Grade 1 hypertension: 140-159 / 90-99 mmHg
- Grade 2 hypertension: 160-179 / 100-109 mmHg
- Grade 3 hypertension: above 180/110 mmHg (an emergency)
The diagnosis is confirmed after repeated measurements — at least 3 different occasions, or 24-hour ambulatory (Holter) monitoring.
The major classes of antihypertensive medicines
1. ACE inhibitors (angiotensin-converting enzyme)
The first choice for most patients. Examples: enalapril, ramipril, perindopril, lisinopril, zofenopril. They lower blood pressure by widening the blood vessels.
Benefits: they protect the kidneys in people with diabetes, reduce cardiac remodelling after a heart attack and help prevent heart failure.
Side effects: a persistent dry cough (10-20% of patients), hyperkalaemia, angioedema (rare).
2. Sartans (ARBs — angiotensin receptor blockers)
An alternative to ACE inhibitors if they cause a cough. Valsartan, losartan, irbesartan, candesartan, telmisartan, olmesartan.
Benefits: similar to ACE inhibitors, but without the cough. Better tolerated.
3. Diuretics
They reduce blood volume. Divided into thiazides (hydrochlorothiazide, indapamide), loop diuretics (furosemide, torasemide) and potassium-sparing diuretics (spironolactone, eplerenone).
Thiazides (indapamide in particular) are the first choice in older people and in people of African descent. Furosemide is reserved for oedema.
4. Beta-blockers
They lower the heart rate and the force of contraction. Bisoprolol, metoprolol, nebivolol, carvedilol, atenolol.
Preferred indications: associated coronary heart disease, arrhythmias, hyperthyroidism, after a heart attack. NOT the first choice for isolated hypertension without other conditions.
5. Calcium channel blockers
They widen the arteries. Amlodipine, lercanidipine, modified-release nifedipine (dihydropyridines); verapamil, diltiazem (non-dihydropyridines, which also affect the heart rate).
Very popular in Romania, often in fixed combinations.
Fixed combinations — the modern strategy
The 2024-2026 European guidelines recommend starting treatment directly with 2 molecules at a low dose. Advantages: faster blood pressure control, fewer side effects, better adherence. Common combinations:
- Perindopril + indapamide (Noliprel)
- Valsartan + amlodipine (Exforge)
- Ramipril + amlodipine (Triveram also adds atorvastatin)
- Bisoprolol + perindopril (Cosyrel)
See the current prices in HartaFarmacii — Blood pressure or search directly in search.
Lifestyle — a real, quantified effect
Lifestyle changes can lower blood pressure by a cumulative 10-20 mmHg — sometimes enough to remove the need for medication in mild stages.
- Salt below 5 g/day — effect: -5-7 mmHg systolic.
- Losing 5 kg — effect: -5 mmHg.
- Moderate exercise 150 min/week — effect: -5-8 mmHg.
- The DASH diet (plenty of vegetables, fruit, low-fat dairy) — effect: -5-11 mmHg.
- Alcohol at most 14 units/week (1 unit = 10 g of pure alcohol) — effect: -3-5 mmHg.
- Stopping smoking — it does not lower blood pressure directly, but it reduces cardiovascular risk by 30-50%.
Home monitoring
Measure your blood pressure twice a day, in the morning and in the evening, for 7 days before a consultation. The average of these measurements is more relevant than a single value at the surgery.
Recommended monitor: an upper-arm cuff model, clinically validated (look for ESH/BHS/AAMI certification). Popular brands: Omron, Microlife, Beurer. Prices in the HartaFarmacii search.
Hypertensive emergencies
If your reading is above 180/110 mmHg with symptoms (intense headache, blurred vision, chest pain, difficulty breathing) — go to the emergency department immediately or call 112. Do NOT try to bring your blood pressure down suddenly with lots of tablets — a rapid drop can cause an ischaemic stroke.
Common mistakes by patients with hypertension
- Stopping treatment when the readings are normal — the readings are normal BECAUSE of the treatment. Stopping = a rapid return.
- Taking the medication only in the morning — for most patients, evening dosing (chronotherapy) may be more effective — discuss this with your cardiologist.
- Using “natural” supplements instead of medication — garlic, hawthorn and green tea have very mild effects (-2-3 mmHg), not enough for real hypertension.
- Self-medicating with captopril 25 mg — many patients take captopril under the tongue at any reading. A rapid drop can cause an ischaemic stroke or a heart attack.
- Neglecting the blood pressure monitor — measure at least weekly and record the readings in an app or a diary. The monthly average is the basis for medical decisions.
Important interactions
- NSAIDs (ibuprofen, diclofenac) — reduce the antihypertensive effect and affect the kidneys. Use paracetamol for pain.
- Nasal decongestants (pseudoephedrine) — raise blood pressure. Avoid them.
- Systemic corticosteroids — raise blood pressure. With prolonged treatment, the antihypertensive needs adjusting.
- Liquorice (liquorice root) — a mineralocorticoid effect, raises blood pressure.
Conclusion
Hypertension is a chronic disease, but it is perfectly controllable with a combination of the right medication and lifestyle. Treatment is for life — stopping it brings the readings back within 1-2 weeks. Follow your regimen, measure regularly, go for annual check-ups and adjust it with your cardiologist. Compare prices for blood pressure monitors and antihypertensives on HartaFarmacii.
Frequently asked questions
- Can I take my blood pressure medication only when my readings are high?
- NO. The medication is continuous, for life. Stopping it brings the readings back within 1-2 weeks and increases the risk of complications (heart attack, stroke). Only the doctor can adjust or reduce the dose.
- When should I measure my blood pressure at home?
- Twice a day, in the morning (after waking up, before coffee and medication) and in the evening (before dinner). For 7 days before your check-up with the doctor. The average is more relevant than an isolated reading.
- Can diet alone control hypertension?
- In grade 1 hypertension (140-159/90-99), sometimes yes — with weight loss, less salt and exercise. The cumulative effect can reach 15-20 mmHg. In grades 2 and 3, medication is mandatory even with an optimal lifestyle.
- Can I take generic antihypertensives instead of brands?
- Yes, most antihypertensives have very good generics. Preconip, Terapia, Zentiva and Labormed produce enalapril, ramipril, amlodipine and valsartan identical to the original brands. Savings of 50-70%.
- What should I do if I have a cough from an ACE inhibitor?
- Talk to your doctor — it is switched to a sartan (valsartan, losartan, telmisartan), which has the same haemodynamic profile without the cough. The cough does not go away while you stay on the ACE inhibitor — only after switching.