High blood pressure (hypertension)

High blood pressure (hypertension)

High blood pressure, technically known as hypertension, affects around 20 to 30 million people in Germany. The insidious thing about high blood pressure: When the diagnosis is made, the disease has usually caused unnoticed damage to various organs for years. High blood pressure cannot be cured in most cases, but high blood pressure can be lowered. Here, you can discover what causes hypertension, what signs you can use to recognize the disease, and what therapy and behaviour can help fight high blood pressure.

What is hypertension? Definition of high blood pressure

The term hypertension refers to a pathological increase in pressure in the body, which can affect not only blood pressure. This increase in pressure can occur, for example, in the muscles and brain, but also in the superficial veins (venous hypertension) or the pulmonary circulation (pulmonary hypertension). As a rule, however, the generic term hypertension means arterial hypertension, i.e. high blood pressure in the arteries.

Blood pressure itself is a natural tool of the body. It occurs when the heart constantly pumps oxygen-rich blood from the lungs through the arteries to the entire body. The blood travels a long distance. To cope with this, the heart builds up pressure to propel the blood forward. This pressure is also transferred to the vessel walls. If it is too high, it can damage them.


Blood pressure readings: what do you need to know?

Blood pressure fluctuates between two values ​​that depend on the contraction and relaxation of the heart:

  • The pressure wave created by the contraction of the left ventricle as blood is expelled from the heart into the aorta is called systolic blood pressure.
  • The pressure in the arteries that remains when the heart is just refilling with blood (mainly due to the elasticity of the arteries) is called diastolic blood pressure. It is below the systolic blood pressure.

Systolic and diastolic blood pressure values are measured with special devices and expressed as the pressure of a mercury column (mmHg stands for millimetres/column of mercury). Specific average values ​​are defined. If one or both values ​​are higher when measured several times at rest, this is high blood pressure.

In healthy people, resting blood pressure values ​​are permanently below 140/90 mmHg, with values ​​below 100/60 mmHg in women and values ​​below 110/60 mmHg in men being considered low blood pressure. If the values ​​are above 140/90 mmHg on several days, this is defined as high blood pressure (overt hypertension).

Usually, blood pressure fluctuates during the day: it is highest in the morning and late afternoon and falls again in the evening (around 6 p.m.).

Causes and risk factors of high blood pressure

Various risk factors can ensure that the blood pressure generated by the body is permanently too high. The following causes can promote the development of hypertension:

  • Older age (elasticity of the vessels decreases)
  • genetic factors (familial accumulation of high blood pressure)
  • Smoking
  • Overweight ( BMI at least 25)
  • muscular, nervous strains, such as chronic stress
  • lack of exercise
  • increased alcohol consumption
  • a high-salt diet

If these triggers are responsible for developing high blood pressure and no organic cause can be found for the high blood pressure, this is referred to as primary hypertension (essential hypertension). “benign essential hypertension” (benign = benign) describes high blood pressure without extreme blood pressure spikes. However, the term “benign” is now considered misleading and is generally only rarely used in medical terminology.


Causes of secondary hypertension

Secondary hypertension occurs as a result of another underlying disease. These include anomalies in the cardiovascular system (e.g. congenital heart defects such as aortic isthmus stenosis). These kidney diseases lead to reduced blood flow and hormone system disorders ( e.g., hyperthyroidism, hormone-producing tumours). Another common cause is obstructive sleep apnea.

Drug-induced hypertension is also a secondary form. High blood pressure is triggered by taking certain medicines. These include, for example, immunosuppressants, glucocorticoids and non-steroidal anti-inflammatory drugs (NSAIDs).

Secondary hypertension is significantly less common than primary hypertension. It occurs in only about 15 per cent of those affected.

Menopause as a cause of hypertension in women

High blood pressure occurs more frequently in women after the onset of menopause. This is because the production of the female sex hormone estrogen decreases during this time. This regulates blood pressure and protects blood vessels.

In addition, high blood pressure often goes unnoticed in women going through menopause since some symptoms, such as increased sweating or inner restlessness, can also be typical menopausal symptoms.

Particular case: high blood pressure during pregnancy

A unique form is high blood pressure during pregnancy. On the one hand, existing high blood pressure can worsen in pregnant women. On the other hand, the pregnancy itself can trigger hypertension. This happens when the placenta has too few blood vessels, or they are narrowed. To prevent the child from being undersupplied with oxygen, the blood pressure increases so the blood can flow better through the placenta.

If the blood pressure is below 150/100 mmHg, the blood pressure is usually not lowered with medication. If it is higher than this, therapy should be started to avoid health risks for mother and child. In general, the health of the mother and the fetus should be checked regularly in the case of high blood pressure because high blood pressure can be a symptom of other diseases such as preeclampsia or HELLP syndrome. After childbirth, high blood pressure usually goes away on its own.


Symptoms of high blood pressure

What are the signs of high blood pressure? Hypertension has almost always existed for some time without causing any symptoms. Since high blood pressure can cause damage to small blood vessels at this point, regular blood pressure checks are essential for early detection. Only then can targeted action be taken against hypertension.

Signs of the disease usually only appear after the high blood pressure has already affected the organs. The brain, eyes, heart, and kidneys are damaged early on. Depending on the affected region, the symptoms are quite different, often non-specific.

Symptoms of hypertension can include:

  • dizziness and ringing in the ears
  • sweats
  • nosebleeds
  • visual disturbances
  • headache (especially in the morning at the back of the head)
  • Nervousness, irritability, difficulty concentrating
  • sleep disorders

High blood pressure can cause other symptoms. In men, this can be erectile dysfunctionNausea and vomiting, tremors, cardiac arrhythmia, shortness of breath, pain, and a feeling of tightness in the chest are also possible with significantly elevated blood pressure.

If you notice these signs in yourself, you should urgently seek medical advice – also to have an illness caused by high blood pressure, such as a heart attack, treated as quickly as possible. In case of doubt, the emergency number should be notified.

Hypertension: Complications

Although – or maybe because – almost every third of adults in Germany suffer from high blood pressure, the danger of hypertension is often underestimated. This is mainly because it usually does not cause any symptoms initially.

High blood pressure can affect almost every organ. The increased blood pressure inside the vessels permanently damages the arteries, supplying the whole body with blood. Complications in the brain, eyes, heart and kidneys are prevalent.

If nothing is done about high blood pressure for years, the result is irreparable damage to the vessels. This, in turn, leads to severe diseases of various organs:

  • Heart:  High blood pressure constantly strains the left ventricle in particular. This can result in heart muscle weakness ( heart failure ). In addition, arteriosclerosis of the coronary arteries is promoted, which in turn can lead to circulatory disorders in the heart ( coronary heart disease, abbreviated as CHD) and a heart attack.
  • Brain: Damage to the vessels in the brain often causes a stroke.
  • Kidneys: The kidney function decreases due to changes in the kidney vessels ( kidney insufficiency ), which can result in kidney failure.
  • Eyes: Damage to the vessels in the back of the eye can lead to impaired vision and, in extreme cases, to blindness.
  • Limbs:  Rarely, high blood pressure causes circulatory disorders, especially in the legs (peripheral arterial occlusive disease ).

When is high blood pressure deadly?

Poorly controlled or untreated high blood pressure can be fatal because damage to blood vessels and the heart increases the risk of potentially life-threatening complications such as a stroke or heart attack.

There is also an acute danger to life in what is known as a hypersensitive emergency. The systolic blood pressure rises to over 180 mmHg, and the diastolic blood pressure to at least 110 mmHg. At the same time, acute organ damage occurs, for example, pulmonary oedema, aortic dissection or acute heart failure. A hypersensitive crisis can be triggered by severe mental stress or the sudden discontinuation of antihypertensive drugs. Diseases of the kidneys or organs that produce hormones (e.g. the thyroid gland) can also cause a sharp rise in blood pressure.

To avoid a hypersensitive emergency, blood pressure should be checked regularly. This way, you can notice an unusual increase before organ damage occurs. Rising blood pressure values ​​are noticeable, for example, through restlessness, panic, tremors, shortness of breath or a feeling of tightness in the chest.


Hypertension Diagnosis

Since there are often no or only unspecific symptoms, especially in the early stages of the disease, it is difficult to detect high blood pressure without a measuring device. Therefore, the diagnosis is often made by accident or as part of a preventive medical check-up. If there are already symptoms, these can also provide the first indications of high blood pressure.

The most essential tool for diagnosing hypertension is the blood pressure monitor. If multiple measurements at rest are unclear, a 24-hour measurement can be carried out, and the blood pressure values ​​can be related to the activities that took place at the respective time. This is also useful to exclude the so-called “white coat hypertension” as a cause of short-term high blood pressure. This occurs when the person concerned is nervous during the examination, and the blood pressure rises.

During the initial diagnosis, whether secondary hypertension is present should also be clarified. This could be cured by eliminating the causes.

If high blood pressure has been diagnosed, regular medical examinations should follow. Particular attention should be paid to the organ systems often damaged by high blood pressure.

Hypertension: what do grades 1, 2 and 3 mean?

If high blood pressure has been diagnosed, it can be further subdivided into three degrees of severity. The following table shows the classification according to the guidelines of the German Society of Cardiology:

The higher applies if systolic and diastolic blood pressure fall into different categories. The information typically only applies under resting conditions since physical exertion also increases blood pressure in healthy people. If the blood pressure rises disproportionately only under stress, i.e. beyond the normal adaptation reaction, this is referred to as stress hypertension.

What helps against high blood pressure?

Treating high blood pressure means permanently lowering blood pressure to normal levels to avoid consequential damage. The earlier and more consistent the treatment, the better it will be.

General measures come first in the treatment of primary hypertension. Sometimes, a lifestyle change is enough to eliminate individual risk factors and get blood pressure under control. Therefore, if you have hypertension, you should:

  • Reach and maintain your average weight.
  • Ensure you eat a healthy mixed diet low in meat and fat (low in salt and little alcohol).
  • Engage in physical activity regularly.
  • Do endurance sports (e.g. swimming or jogging)
  • Give up smoking
  • Reduce stress (e.g. with autogenic training or yoga )

It is also important to treat existing diabetes or a lipid metabolism disorder appropriately, as these increase the risk of consequential vessel damage.

Medication can also lower blood pressure, which can be used when general measures are insufficient. Secondary hypertension is addressed by eliminating the cause. If this is not enough, medication is also used for treatment.


Drugs used to treat high blood pressure

Medication is used if the treatment measures mentioned do not help or are insufficient.

The following drugs are taken as tablets for high blood pressure:

  • Diuretics stimulate the kidneys to excrete water and salts.
  • Calcium antagonists expand the vessels so that the blood can flow better.
  • Beta-blockers block the effects of the stress hormones adrenaline and noradrenaline, which increase blood pressure.
  • ACE inhibitors inhibit the angiotensin-converting enzyme (ACE), which causes blood vessels to narrow and, thus, blood pressure to rise.
  • Sartans, also known as angiotensin antagonists, reduce the activity of the blood pressure-increasing hormone angiotensin.

The treatment is individually tailored to each person. For example, age and previous illnesses are essential. Usually, one starts with one preparation; only if this (or an alternative) does not help is it combined with another active ingredient. The medication for high blood pressure must be taken regularly and, in most cases, for life, even if there are no symptoms.

Like other medications, high blood pressure medications can have side effects. Depending on the active ingredient, these include headaches, fatigue, gastrointestinal complaints or a dry cough. The tablets should never be discontinued in the event of severe or persistent side effects. Instead, it should be discussed with the doctor, which means it is possible as an alternative.

living with high blood pressure

If high blood pressure is diagnosed, regular blood pressure checks are essential. In most cases, those affected can also do this themselves at home after medical instructions, enabling good documentation over a more extended period. This checks whether the measures taken to combat high blood pressure are working.

In addition, the fundus and organ systems are regularly checked for consequential damage.

If medication has been prescribed, it is essential to take it regularly as directed by your doctor. Primary high blood pressure is a chronic condition, and there is no cure – even though it can often be controlled well with the help of medication and, above all, through lifestyle changes.

A normal blood pressure without symptoms is the goal of treatment and a sign that the medication is well controlled – but not a reason to stop therapy.

Prevent high blood pressure.

The same general measures are recommended to prevent high blood pressure when it has already set in. These include, for example, a healthy diet and reducing stress.

In principle, prevention is optimal; Early detection and countermeasures are critical. Even if there are no symptoms, regular blood pressure measurements should be taken as part of the check-ups in the doctor’s office. During the general examination of the state of health (check-up) from age 35, further tests (blood sugar control, urine test, cholesterol level ) are also carried out, with which other risk factors for high blood pressure can be determined.

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