Did you know: High blood pressure

There are several factors that facilitate the development of high blood pressure. In general, high blood pressure occurs more often in older people and people with family history of hypertension. Apart from that, obesity, diabetes and smoking are risk factors, but lack of exercise, high salt consumption, alcohol and stress can all contribute to the development of high blood pressure.

A healthy diet and regular physical activity are 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 low in meat and animal fats is often recommended. Weight loss through exercise and a healthy diet can reduce the need for medication in blood pressure therapy. 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. The key is consistency: ideally three to seven times a week for at least 30 minutes. It is also helpful to reduce daily salt intake by salting food less or checking labels on processed foods. Salt is hidden in many foods, even in bread, cheese, or sweets.

High blood pressure is a serious condition. However, many people underestimate it because they do not feel any symptoms. But that does not make it less dangerous. The damage caused by elevated blood pressure often becomes apparent only after major complications like a heart attack.

Some people with high blood pressure do have symptoms, but they may not associate them with the condition. hat is because the symptoms are often nonspecific, such as dizziness, headaches, sleep disorders or nervourness. These can result from high blood pressure but may also have other 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”). This is called 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. Symptoms may include severe headaches, dizziness, nausea, shortness of breath, or chest pain. This is 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 accelerates vessel damage. This creates a vicious cycle that can lead to various complications in the body.

1. Vascular damage:

Severe narrowing of the arteries can lead to reduced blood flow in certain areas of the body. 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. In advanced stages, pain may occur even at rest, along with cold or pale skin on the legs or feet.

The kidneys are particularly sensitive to reduced blood flow. Since they are among the most well-perfused organs in the body, vascular damage due to high blood pressure can impair kidney function and eventually lead to kidney failure. 

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

2. Stroke:

High blood pressure patients have a significantly higher risk of suffering a stroke. In the event of a stroke, part of the brain is supplied with too little blood and is damaged as a result. The most common reason for this is the occlusion of one of the blood vessels that supply the brain. High blood pressure contributes both to the general narrowing of the vessels and to the formation of blood clots, which can then completely occlude a vessel. If this happens in the brain, it leads to a stroke. Depending on which part of the brain is affected and how large the damaged area is, various impairments or, in the worst case, death can be the result of a stroke.

3. Heart attack:

A heart attack is the loss of blood supply to parts of the heart muscle due to the occlusion of one or more blood vessels. If part of the heart muscle is no longer supplied with enough blood and therefore insufficiently oxygenated, it dies. Depending on how large the damaged part is, the heart can be moderately to completely disturbed in its pumping work. In the worst case, when a large part 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 so-called systolic value, which is indicated first, and the second lower value, the so-called diastolic value. The systolic value shows the pressure that the blood exerts on the vessel walls during the pumping phase of the heart. The diastolic value, on the other hand, shows the pressure in the relaxation phase of the heart. Usually, both values are increased in high blood pressure patients. The first value is usually the more important one, but there are also diseases in which the second value in particular is elevated.

High blood pressure is diagnosed by measuring blood pressure, but a single elevated reading does not necessarily indicate arterial hypertension. Doctors usually perform repeated measurements or a 24-hour blood pressure monitoring. If consistently elevated values are found, the diagnosis is confirmed. Further testing may follow to assess whether any organ damage has occurred, such as to the blood vessels, heart, or kidneys.

In a clinical setting, high blood pressure is defined as a reading of 140/90 mmHg or higher. For home measurements, the threshold is 135/85 mmHg. The goal of treatment is to reduce blood pressure to 120–129 mmHg systolic and 70–79 mmHg diastolic, as long as the patient tolerates it well. If not, the blood pressure should be lowered as much as possible within the patient’s comfort. Well-controlled blood pressure is essential for reducing cardiovascular risk and preventing complications. Regardless of this general recommendation, however, treatment goals should always be discussed with your doctor, as individual factors such as comorbidities or age also play a role.

Successful treatment also involves regular monitoring of blood pressure. This can be done by a primary care doctor or at a pharmacy. Many patients also monitor their blood pressure at home and keep a (digital) log. It is important to sit comfortably in a quiet setting, with your back supported and arm rested. Before measuring, rest for five minutes and avoid smoking, caffeine, or exercise for 30 minutes. Repeat the measurement after 1–2 minutes and record both readings. 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. You can also ask your doctor for advice on when and how often to measure your blood pressure.

In most cases, high blood pressure cannot be cured. It is a chronic condition that often lasts a lifetime. While it is highly treatable, effective management requires long-term medication use and lifestyle changes, as this is the only way to ensure that it is effective and protects against further damage. The main goal of treatment is to reduce the risk of serious cardiovascular events.

The main goal of treatment is to reduce the risk of serious cardiovascular events. By changing your lifestyle, such as eating a healthy diet and exercising regularly, you can lower your blood pressure and thus reduce your cardiovascular risk. See section 2 “Risk Factors and Lifestyle” for details.

In some cases, lifestyle changes alone may normalize blood pressure. However, most patients will also require medication.

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

Most of these medications have few or mild side effects. Still, some patients struggle with long-term, regular use, partly because they feel that the medication causes them more discomfort than not taking it. , sometimes because they feel that the medication causes them more discomfort than not taking it. This is often because high blood pressure causes no symptoms before treatment, and it can take time for the body to adjust to lower pressure. This does not make the disease 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 therapy. These initial side effects are usually a sign the medication is working and often subside with time or disappear completely.

Not all medications work equally well or are equally tolerated by all patients, and the tolerability of a drug can also vary greatly. So if a medication is not working well, the doctor can try increasing the dose or adding another medication to support it. If this does not improve the situation or if the patient experiences side effects from the medication that they cannot tolerate, the medication can be discontinued and one or more other medications prescribed instead. Often, one medication is not enough to reach target values, so many patients require two or more drugs. Combining several medications at lower doses is generally more effective and better tolerated than using a single drug at a higher dose to achieve a better reduction in blood pressure. Combining several medications interferes with various regulatory cycles in our body that control blood pressure. This can add up the positive effects of the individual medications, but not the side effects. Combination therapy is therefore generally better tolerated than therapy with a single medication in a higher dosage.  

Important: Never make changes to your medication without consulting your doctor! Even if you feel that a drug is not working or is causing side effects, always discuss it with a doctor.

There are many different medications used to lower blood pressure. Below are five major drug classes commonly prescribed:

1. ACE inhibitors (e.g. Ramipril)

ACE inhibitors reduce the effects of a hormone that causes blood vessels to constrict. As a result, the vessels remain dilated and the blood pressure decreases. A common side effect of this drug is dry cough.

2. Angiotensin-2 antagonists (e.g. Candesartan)

Like ACE inhibitors, these block the effect of a hormone that constricts blood vessels, but they act at a different point in the regulatory pathway. They tend to cause fewer side effects.

3. Diuretics (e.g. Hydrochlorothiazide or HCT)

These increase the excretion of fluid through the kidneys, reducing blood volume and lowering blood pressure. A common side effect is increased urination. Diuretics can also alter blood electrolytes, particularly by lowering potassium levels.

4. Calcium channel blockers (e.g. Amlodipine)

These relax the small muscles in vessel walls, allowing the vessels to widen. Common side effects include headaches and ankle swelling (edema).

5. Beta blockers (e.g. Metoprolol)

These reduce the effects of stress hormones like adrenaline, which cause the heart to beat faster and more forcefully. By blocking these effects, beta blockers help the heart beat more slowly and reduce blood pressure. Common side effects include fatigue and a feeling of weakness.