Did you know: High blood pressure

There are various factors which contribute to the development of high blood pressure. In general, it is more common with advancing age and in individuals with a family history. Beyond that, the main risk factors include overweight, diabetes, and smoking, but as lack of physical activity, high salt intake, alcohol, and stress can also contribute to the development of high blood pressure.

A healthy diet and regular physical activity are therefore extremely important for maintaining healthy blood pressure. For example, the Mediterranean diet, rich in olive oil, fish, and plenty of fresh fruits, vegetables, and salads, while as low as possible in meat and animal fats is recommended. In the treatment of high blood pressure, weight loss through exercise and a healthy diet can reduce the amount of medication required. A healthy lifestyle should always be a key part of hypertension treatment, alongside medication. Even moderate endurance training, such as swimming, cycling, walking, or jogging, can have positive effects. It is important to exercise regularly, ideally three to seven times a week for at least 30 minutes. It can also be helpful to reduce daily salt intake, for example by salting food less or checking labels on ready meals. Salt is hidden in almost all foods, including bread, cheese, or sweets.

High blood pressure is a serious condition. However, many people underestimate it because their high blood pressure does not cause them any symptoms. But that does not make it less dangerous. The damage caused by prolonged elevated blood pressure is often only noticed after major complications, like a heart attack, have already occurred.

Some patients with high blood pressure do experience symptoms related to their condition, but they may not be able to associate them with it. That is because most symptoms are very unspecific. For example, dizziness, headaches, sleep disorders, or nervousness can result from high blood pressure but may also have completely different causes.

In rare cases, blood pressure can suddenly spike to over 180/110 mmHg (for more information, see the chapter on “Examinations and Normal Ranges”). Doctors refer to this as a hypertensive urgency. If additional symptoms appear due to organ damage, e.g., involving the heart, brain, or kidneys, it is referred to as a hypertensive emergency. The people affected often experience severe headaches, dizziness, nausea, shortness of breath, or chest pain. These cases are considered a medical emergency, and a doctor should be contacted immediately.

Stiffening and narrowing of the arteries due to the buildup of cholesterol, fat, and other substances (atherosclerosis) contribute to high blood pressure, which in turn increases the damages to the vessels. This creates a vicious cycle that can lead to a variety of different complications in the body.

Vascular Damage

The narrowing of the arteries can be so severe that certain areas of the body are no longer supplied with sufficient blood. This often affects the feet and legs, resulting in peripheral artery disease (PAD). Initially, there may be no symptoms or only mild discomfort. As the condition progresses, walking may cause pain that subsides when stopping. This is known as window shopping disease or, medically, as claudicatio intermittens. If the disease continues to progress, pain may occur even at rest, along with cold or pale skin on the legs or feet.

The kidneys also tend to suffer a lot from reduced blood flow. They are among the most highly perfused organs in the body. Therefore, vascular damage due to high blood pressure particularly affects the kidneys and their function, which can lead to kidney failure in the long term.

The small blood vessels in the eyes can also be damaged by high blood pressure. This can potentially impair vision and even causing blindness.

Stroke

Patients with high blood pressure have a significantly higher risk of suffering a stroke. In a stroke, a part of the brain does not receive enough blood and is damaged as a result. The most common cause is the blockage of one of the blood vessels that supply the brain. High blood pressure contributes to both general narrowing of the vessels and the formation of blood clots that can then completely block a vessel. If this occurs in the brain, it results in a stroke. Depending on which part of the brain is affected and how large the damaged area is, a stroke can result in various impairments or, in the worst case, it can be fatal.

Heart Attack

A heart attack occurs when part of the heart is not sufficiently supplied with blood due to a blockage in one or more blood vessels. If a portion of the heart muscle does not receive enough blood and therefore sufficient oxygen, it begins to die. Depending on the size of the affected area, the heart’s pumping ability may be moderately to completely impaired. In the worst case, if a large area of the heart muscle is no longer supplied with blood, death is the result of a heart attack.

When measuring blood pressure, a distinction is made between two values: the higher systolic value, which is listed first, and the second lower value, known as diastolic value. The systolic value reflects the pressure exerted by the blood on the vessel walls during the heart’s pumping phase. The diastolic value, on the other hand, shows the pressure during the heart’s relaxation phase. As a rule, both values are elevated in patients with high blood pressure. The first value is usually the more important one, but there are also some conditions in which the second value in particular is elevated.

High blood pressure is diagnosed by measuring blood pressure, but a single occasional measurement of elevated blood pressure does not necessarily indicate arterial hypertension. As a rule, doctors will perform repeated measurements or a 24-hour blood pressure monitoring. If elevated values are found in this case, the diagnosis of arterial hypertension is confirmed. Once high blood pressure has been diagnosed, further testing may follow. These tests assess, among other things, whether the high blood pressure has already caused consequential damage, e.g., to the blood vessels, heart, or kidneys.

High blood pressure is defined as a reading of 140/90 mmHg or higher. These values refer to blood pressure measurements taken in a doctor’s office. For blood measurements taken independently at home, values above 135/85 mmHg are already considered high blood pressure.

The goal of treatment is to reduce blood pressure to systolic values of 120–129 mmHg and diastolic values of 70–79 mmHg, as long as the patient tolerates it well. If these target values are not tolerated, systolic blood pressure should be lowered as much as possible, because only well-controlled blood pressure values can reduce the overall cardiovascular risk and thus prevent secondary diseases. Regardless of this very general recommendation, however, treatment goals should always be discussed with your doctor, as other factors such as comorbidities or the patient’s age must also be taken into account in the therapy.

Successful treatment of high blood pressure also involves regular monitoring of blood pressure readings. These can be measured regularly by your family doctor or at a pharmacy, for example. Many patients also feel confident enough to monitor their blood pressure themselves at home and enter it in a (digital) diary. To do this, you should sit comfortably in a quiet setting, lean back, and rest your arm. Before taking the measurement, you should rest for about five minutes and refrain from smoking, drinking coffee, or exercising for 30 minutes beforehand. The measurement should be repeated after 1 to 2 minutes and both results should be noted. It is recommended to take measurements in the morning and evening over seven consecutive days once a month, or seven days before your next doctor’s visit. In addition, you can ask your doctor for advice on when and how often you should measure your blood pressure.

Unfortunately, high blood pressure is incurable in most cases. It is a chronic condition that will accompany those affected for the rest of their lives. Although it can be treated very effectively, it is necessary for those affected to adjust their lifestyle and take medication regularly and continuously, as this is the only way to ensure that it is effective and protects against further damage. The main goal of high blood pressure therapy is to reduce the risk of serious cardiovascular disease.

The main components of treating high blood pressure are medication and lifestyle changes. Lifestyle changes alone, such as a healthy diet and regular physical activity, can lower blood pressure and thus reduce cardiovascular risk. For more details on a healthy lifestyle, please see section 2. Risk Factors and Lifestyle.

In some cases, lifestyle changes alone may be sufficient to normalize blood pressure. However, in most cases, additional drug therapy is necessary.

Just like our bodies, blood pressure medications can lower blood pressure in very different ways. They act on various regulatory mechanisms in our bodies that serve to adjust blood pressure to current needs, such as increasing pressure during exercise.

In most cases, blood pressure medications have very few or mild side effects. Nevertheless, some people find it difficult to take their blood pressure medications regularly and consistently. This may be because they feel that the medications cause them more discomfort than not taking them. This is because many people had little or no discomfort before treatment, despite their high blood pressure. This does not make the condition any less dangerous or taking medication any less important. Since the body usually takes time to adjust to lower blood pressure after starting treatment, some people may experience fatigue and dizziness at the beginning of their treatment. In most cases, however, this is a sign that the treatment is working. The symptoms often subside or disappear completely over time.

Not all medications work equally well or quickly for everyone, and tolerance to a medication can also vary greatly. If a drug is not effective, doctors may attempt to increase the dose or add another medication to support it. If this does not result in improvement or if the patient experiences side effects that they cannot tolerate, the medication may be discontinued and one or more other medications may be prescribed instead.

Often, a single medication is not enough to lower blood pressure to the desired target values, so many patients have to take two or more drugs. Combining several medications at lower doses can usually achieve a better reduction in blood pressure than increasing the dose of a single medication. The combination of several medications interferes with various regulatory cycles in our body that control blood pressure. This allows the positive effects of the individual medications to add up, but not the side effects. Combination therapy is therefore generally better tolerated than therapy with a single medication in a higher dosage.

It is important to note that changes to medication should never be made without consulting the treating physician! Even if you feel that a medication is not being tolerated or is not having the desired effect, you should discuss this with a doctor.

There are many different medications used to lower blood pressure. The following describes five of the major groups that are particularly commonly used in the treatment of high blood pressure.

ACE inhibitors (e.g., Ramipril)

ACE inhibitors reduce the effect of a hormone that causes blood vessels to constrict. This keeps them dilated and lowers blood pressure. A common side effect of this medication is a dry cough.

Angiotensin II receptor blockers (ARBs) (e.g., Candesartan)

Like ACE inhibitors, these suppress the effect of a hormone that constricts blood vessels. The difference between the two groups of active substances is the location at which the drug interferes with the hormone’s regulatory cycle. This group of active substances has particularly few side effects.

Diuretics (e.g., Hydrochlorothiazide or HCT)

Diuretics are medications that increase urine output. They cause the body to excrete more fluid through the kidneys, thus reducing blood volume and lowering the pressure in the blood vessels. A common consequence is an increased urge to urinate. Another side effect of these medications is a change in blood salt levels, particularly a reduction in blood potassium levels.

Calcium channel blockers (e.g., Amlodipine)

Calcium antagonists cause the small muscles in the walls of the blood vessels to relax, allowing the vessels to widen. Common side effects include headaches and ankle edema(fluid accumulation in the ankle).

Beta blockers (e.g., Metoprolol)

Beta blockers reduce the effects of stress hormones. Stress hormones, like adrenaline, cause the heart to beat faster and more strongly, among other things. If stress hormones are suppressed by medication, the heart can beat more calmly and blood pressure drops. Common side effects of this medication include fatigue and a feeling of weakness.