High blood pressure

1. High blood pressure: what is it?

High blood pressure, also known as arterial hypertension, is one of the major widespread diseases. Almost every third adult in Europe is affected, but not all of them are adequately treated. High blood pressure is a disease that is usually easy to treat and can have serious consequences if left untreated.

Blood pressure is influenced by a number of different factors, such as the blood flow caused by the pumping work of the heart and the vascular resistance. The heart is a muscle that alternately contracts and then relaxes again. The function is comparable to a pressure-suction pump, because the heart “sucks” or fills with blood when it relaxes and pumps blood into the vessels when it contracts. The vessels can be thought of as a garden hose and the heart as a pump or water tap. The more the tap is opened, therefore the stronger the heart beats and the more blood is pumped through the vessels with each heartbeat, the higher the pressure there. Similar to the garden hose to water, the blood vessels offer a certain resistance to the inflowing blood, which mainly depends on the elasticity and the diameter. The vascular damage (atherosclerosis) in the course of life make them stiffer and, through deposits, narrower, so that the resistance and thus the pressure in the vessels increases. In addition, certain hormones cause the blood vessels to constrict, which in turn increases the pressure as soon as the body releases these hormones.

The body can change the blood pressure, i.e. the pressure in the blood vessels, as required. For example, blood pressure is usually lower during sleep, but elevated during exercise. Short-term changes in blood pressure are therefore normal and important so that the organs are sufficiently supplied with blood at all times. However, if the pressure in the vessels is permanently elevated, they can be damaged.

2. Risk Factors and Lifestyle

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, increased salt consumption, alcohol and stress can all contribute to the development of high blood pressure.

A balanced diet and sufficient exercise are therefore extremely important for an healthy blood pressure. For example, the so-called Mediterranean diet with olive oil, fish and lots of fresh fruit, vegetables and salads and as little meat and animal fats as possible is recommended. In hypertension therapy, weight loss through exercise and a healthy diet can reduce the amount of medication required or, in mild cases, even make drug therapy unnecessary. Even moderate endurance training such as swimming, cycling, walking or jogging can have positive effects. It is important to do it regularly, preferably at least three times a week for at least 30 minutes. It can also be effective to reduce the daily salt consumption, for example, by adding less salt to dishes or by taking a critical look at the ingredients of ready meals. Salt is hidden in almost all foods, including bread, cheese and sweets, for example.

3. Symptoms

High blood pressure is a serious disease. However, many people underestimate it because high blood pressure does not cause them any symptoms. Unfortunately, that doesn’t make the disease any less dangerous. The damage caused by the long-term elevated blood pressure is often only noticed when serious secondary diseases, such as a heart attack, have occurred.

Other high blood pressure patients, on the other hand, have symptoms due to their illness, but do not associate them with it. This is because most of the symptoms are very non-specific. For example, dizziness, headaches, sleep disorders or nervousness can be associated with high blood pressure, but they can also have completely different causes.

In rare cases it is also possible that blood pressure suddenly strongly increases to values above 180/120 mmHg (further information on blood pressure values in the chapter “Blood pressure measurement and normal values”). The doctor calls this a hypertensive crisis or hypertensive emergency. Those affected often feel severe headaches, dizziness, nausea or even shortness of breath or chest pain. In these cases, it may be an emergency situation and a doctor should be contacted immediately.

4. Secondary illnesses

Stiffening and narrowing of the blood vessels due to vascular damage (atherosclerosis) promotes the occurrence of high blood pressure and high blood pressure increases vascular damage. A vicious circle develops, which can lead to a multitude of different consequential damages in the body.

1. Vascular damage:

The narrowing of the blood vessels can even result in the fact that highly affected areas of the body can no longer be adequately supplied with blood. This is particularly common on feet and legs. At first, for example, those affected notice that they often have cold, white and sometimes aching feet. In the further course there may be pain in the legs when walking, which will subside when stopping. This is known as peripheral arterial disease (PAD) or intermittent claudication.

The kidneys also usually suffer greatly from reduced blood flow. The kidneys are one of the organs in our body with the highest blood flow. High blood pressure therefore also often damages the vessels in the kidneys, which in the long term can lead to kidney failure.

The small vessels in the eyes can also be damaged by increased pressure. Bleeding and vision impairment may occur.

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.

5. Blood pressure measurement and normal values

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.

Blood pressure is defined as values of 140/90 mmHg or higher. The aim of high blood pressure therapy is therefore to reduce blood pressure to at least values below 140/90 mmHg. Especially in young patients under 65 years of age, it is recommended to keep the blood pressure constant in a range of 120-129/80 mmHg. Regardless of this general recommendation, the individual target blood pressure should always be discussed with the treating doctor, because other factors such as concomitant diseases must also be included in the therapy.

Successful high blood pressure treatment also includes regular monitoring of blood pressure values. These can be measured regularly by the family doctor or in the pharmacy, for example. Many patients also measure their blood pressure independently at home and enter it in a (digital) diary. To do this, you should sit down comfortably and allow yourself a few minutes of rest before taking the measurement. Sometimes it can also be useful to repeat the measurement after 1-2 minutes. It is best to ask your doctor for advice on how and when to measure your blood pressure.

6. Medication

Unfortunately, in most cases there is no cure for high blood pressure. It is a chronic disease that will accompany those affected throughout their lives. Fortunately, however, it is very easy to treat and as long as it is treated well, it does not affect the quality of life or the lifespan. But for this it is necessary that those affected take their medication regularly and permanently, because only then they can work and protect against consequential damage. The most important goal of high blood pressure therapy is to lower the risk of serious cardiovascular disease.

Just like our body, blood pressure medication can lower blood pressure in a number of different ways. They intervene in various regulatory mechanisms in our body that serve to adapt blood pressure to current needs, such as increasing the pressure during exercise. The use of antihypertensive medication can cause a very natural response in the body. If the body is used to high blood pressure values, it sometimes reacts to antihypertensive drugs by activating another regulating mechanism (not influenced by the drug) to increase the blood pressure again. Although the drug works in the body, it has no external effect (on the blood pressure measured).

Therefore, most patients need to take two or more antihypertensive drugs to normalize blood pressure. In this way, different control mechanisms of the body are influenced and steered in the right direction without any other mechanism trying to regulate it.

In most cases, blood pressure medication has very few and mild side effects. Nevertheless, some people have difficulties taking their blood pressure medication regularly over a long time because they have the feeling that the medication causes them more symptoms than they had without, since many people had no or hardly any symptoms before treatment despite their high blood pressure. Unfortunately, this does not make the disease any less dangerous and the intake of medication any less important. Since the body can only slowly get used to the lower blood pressure after starting the therapy, some people feel tired and dizzy at the beginning of their therapy. In most cases, however, this is a sign that therapy is working and the symptoms often subside or go away over time.

Not all drugs work equally well or quickly in all people; and the tolerability of a drug can also be very different. So if a drug works poorly, an attempt can be made to increase the dose or to add another drug to support it. If the situation does not improve or the patient experiences side effects from the medication that he cannot tolerate, it can be stopped and one or more other drugs can be prescribed instead.

It is important that changes to the medication should never be made without consulting your doctor! If you have the feeling that you cannot tolerate a drug or you do not reach the effect desired, please speak to your doctor about it.

7. What blood pressure medication are there?

There are a number of different drugs that can lower blood pressure. In the following paragraphs, 5 of the main groups that are used frequently in the treatment of high blood pressure are described.

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)

Angiotensin-2 Antagonists, like ACE inhibitors, suppress the effect of a hormone that constricts the blood vessels. The difference between the two active ingredient groups is the place where the drug operates in the hormone’s control loop. This group is particularly low in side effects.

3. Beta blockers (e.g. Metoprolol)

Beta blockers reduce the effects of stress hormones. Stress hormones such as adrenaline cause our body, among other things, to make the heart beat faster and stronger. If the stress hormones are suppressed by a drug, the heart can beat slower and the blood pressure decreases. Common side effects of this drug may include tiredness and weakness.

4. Diuretics (e.g. Hydrochlorothiazide HCT)

Diuretics are so-called water tablets. They cause the body to excrete more fluid through the kidneys, which reduces the volume of blood and thus the pressure in the blood vessels. A common side effect of this drug may be an increased urge to urinate.

5. Calcium antagonists (e.g. Verapamil)

Calcium antagonists cause the small muscles in the walls of the blood vessels to relax and the vessels to widen. Common side effects can be headache and palpitations.