Krystyna Knypl, M.D. Ph.D., a specialist in treating high blood pressure, talks to Barbara Deręgowska.

Why is high blood pressure dangerous?
In many cases people don't feel any symptoms of high blood pressure. In spite of this fact the disease develops, causing organ damage, and the person suffering from high blood pressure (hypertension) is not aware of this condition. It is often said that hypertension is a silent killer.

Which organs can be damaged by hypertension?
High blood pressure has a negative influence on the heart, the circulation system, brain and kidneys. Each year, 7.2 million people die of a heart attack and 5.5 million die of a stroke.

Is the lack of symptom awareness the main reason for complications?
There are several reasons-hypertension is hardly ever an isolated disease. In most cases it is accompanied by other disorders, such as high cholesterol level, excess weight, abnormal glucose level. Moreover many people smoke and have a sedentary lifestyle. All these factors combined intensify each other's negative influence. This is why it is essential to examine the patient carefully and analyze his lifestyle. In most cases there are two or three, and sometimes even more, concomitant risk factors. They should be identified correctly and it should be determined what their influence on the organism is.

How can you assess the risk to a person's health?
Nowadays, there are specially designed tables at a doctor's disposal. Using these tables the doctor can determine the global risk of heart attack or stroke. It is a modern, precise and comprehensive approach. We cannot address isolated test results-we need to treat the person as a whole. Hypertension should be treated by a general practitioner. If problems in blood pressure control occur, a Polish GP can consult a specialist in hypertension-in Poland there are over 90 doctors who have a diploma in this new specialty.

Is the order in which you determine the risk factors important?
The easiest step is to measure the blood pressure. If the result is over 130/80 it is advisable to check the blood pressure several times in the following days. If high results are persistent, it is a signal to check other risk factors.

What is the correct way to measure blood pressure?
I advise my patients to measure blood pressure in three different situations-in the morning after getting up, in the afternoon when they are back home after work and when they have a headache, chest pain or other health problems. It is crucial to measure blood pressure early in the morning because this is when the circulatory system functions differently from other parts of day. Early in the morning blood coagulation is higher, arrhythmia may occur, and blood pressure rises-it is called the morning surge in the circulatory system. Patients suffering from the morning surge have a significantly higher risk of heart attack and stroke.

What can be done to prevent this?
You should lead a healthy lifestyle and if it is needed, take medicine which will provide good blood pressure control during the day and night. You can achieve this by using medicine a couple of times a day or by choosing a long-acting medicine. Among medicines lowering high blood pressure, which are available now, angiotensin receptor II blocker (ARB) telmisartan has the longest effect. It is particularly recommended in hypertensive patients who suffer from the morning surge. The doctors are now waiting for the results of the ONTARGET clinical trial, sponsored by Boehringer Ingelheim, which investigates whether the combination of the ARB telmisartan and angiotensin converting enzyme (ACE) inhibitor ramipril provides superior cardiovascular protection.