high blood pressure

and Martina Feichter, medical editor and biologist

Martina Feichter studied biology with an elective subject pharmacy in Innsbruck and also immersed herself in the world of medicinal plants. From there it was not far to other medical topics that still captivate her to this day. She trained as a journalist at the Axel Springer Academy in Hamburg and has been working for since 2007 - first as an editor and since 2012 as a freelance writer.

More about the experts All content is checked by medical journalists.

High blood pressure (hypertension) is a common disease. Many millions of people in Europe suffer from it.In the long run, high blood pressure damages the blood vessels and thus contributes to the development of secondary diseases such as heart attacks and strokes. Here you can read everything you need to know about the causes, symptoms, dangers and treatment of hypertension!

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. O14I10I11O13I15I13

High blood pressure: quick reference

Definition of high blood pressure: blood pressure> 140/90 mmHg
Possible consequences: coronary heart disease, heart failure, heart attack, stroke, PAOD, retinal damage, kidney damage, etc.
Frequent symptoms: headache (especially in the morning), dizziness, easy fatigue, reddened face etc .; possibly also symptoms of secondary diseases such as chest tightness (angina pectoris), water retention in the tissue or visual disturbances
Treatment: change of lifestyle (lots of exercise and sport, weight loss, healthy diet, quitting smoking, etc.), possibly antihypertensive medication; Treatment of the underlying disease in secondary hypertension
Attention: In the event of a sudden, massive increase in blood pressure with signs of organ damage (hypertensive emergency), alert the emergency doctor immediately (emergency number: 112)!

Hypertension: definition

In the case of high blood pressure (hypertension), the blood pressure values are permanently too high. The blood pressure values are generated by the fact that blood is pumped from the heart into the blood vessels with each heartbeat. The blood exerts pressure on the vessel wall from the inside. Depending on the heart's action, a distinction is made between two blood pressure values:

Systolic blood pressure: It arises in the phase in which the heart contracts (systole). Blood is pumped from the heart into the main artery (aorta). The resulting pressure wave continues over the vessel walls of the arteries. This means that a pulse wave can also be measured in more distant body regions (such as arms and legs).
Diastolic blood pressure: During diastole, the heart muscle expands to fill up with blood again. There is still a pressure in the vessels, but it is lower than the systolic blood pressure.

The blood pressure of every person is subject to certain fluctuations. For example, excitement and physical exertion cause blood pressure to rise, while it can be significantly lower at rest or while sleeping. These blood pressure fluctuations are normal and are used for physical adaptation to the respective situation. In healthy people, the blood pressure values level off again and again in the normal range. Only if the blood pressure is permanently too high does it need treatment.

By the way: The term high blood pressure is mostly used in the sense of arterial high blood pressure (arterial hypertension), i.e. increased blood pressure values in the body circulation as described here. But there are other forms of hypertension, such as high blood pressure in the pulmonary circulation (pulmonary hypertension, pulmonary hypertension). This text here only deals with arterial hypertension.

High blood pressure values

The unit of measurement for blood pressure is mmHg (millimeters of mercury). For example, a reading of 126/79 mmHg (read: 126 to 79) means that the systolic blood pressure is 126 and the diastolic pressure is 79 mmHg. Doctors describe values of less than 120 mmHg systolic and less than 80 mmHg diastolic as optimal blood pressure. In addition, the following reference ranges apply for blood pressure:

Degree classification	Systolic	Diastolic
normal	120-129 mmHg	80-84 mmHg
High-normal	130-139 mmHg	85-89 mmHg
Grade I hypertension (mild high blood pressure)	140-159 mmHg	90-99 mmHg
Grade II hypertension (moderate high blood pressure)	160-179 mmHg	100-109 mmHg
Grade III hypertension (severe high blood pressure)	≥ 180 mmHg	≥ 110 mmHg
Isolated systolic hypertension	≥ 140 mmHg	<90 mmHg

The isolated systolic hypertension is a purely systolic high blood pressure. The diastolic blood pressure, on the other hand, is lowered. The cause is, for example, a malfunction of the aortic valve (one of the heart valves).

Hypertension: Dangers

In the long term, high blood pressure damages important organs such as the heart and its supplying vessels (coronary arteries), the other blood vessels, the brain and the kidneys. This can cause life-threatening illnesses.

Organ damage in high blood pressure

In the long run, high blood pressure can damage various organs and have life-threatening consequences. The heart and coronary arteries, the brain, the eyes and the kidneys are most commonly affected.

In the area of the heart, high blood pressure can promote arteriosclerosis (calcification of the blood vessels) of the coronary arteries. This coronary heart disease (CHD) can lead to cardiac insufficiency or cardiac arrhythmias. A heart attack is also possible.

Strokes are more common in the brain of high blood pressure patients than in healthy people. The circulatory disorders caused by high blood pressure can also affect the smallest vessels in the brain (microangiopathy). This results in a chronic under-supply of the brain tissue with oxygen and nutrients. It impairs brain performance and promotes early mental degradation (vascular dementia).

The vascular damage caused by high blood pressure also affects the kidneys and their function over time: The possible consequence is chronic kidney weakness (chronic kidney failure) or even kidney failure.

The circulatory disorders that develop as a consequence of high blood pressure also have a negative effect on other parts of the body. For example, peripheral arterial occlusive disease (PAD) can develop in the legs. In the eyes, the retina is damaged, which affects vision. Doctors speak of hypertensive retinopathy here.

The constant pressure load in the vessels can lead to the formation of bulges in the vessel wall (aneurysms). They can burst, causing life-threatening internal bleeding. Aneurysms in the area of the main artery (aortic aneurysm) and in the brain pose a particular risk (a bursting brain aneurysm causes a hemorrhagic stroke).

Benign and malignant hypertension

It used to be referred to as "benign (essential) hypertension" if there was no critical deterioration in blood pressure (exacerbations) in the course of the disease. Many experts now reject this term because "benign" (= benign) hypertension is very dangerous and has an increased mortality rate.

As a counterpart to benign hypertension, the term "malignant" (malignant) hypertension was coined. It is defined by constant massive high blood pressure (diastolic usually> 120 mmHg), which, if left untreated, leads to death in 95 percent of those affected within five years.

Hypertensive crisis

In a hypertensive crisis (high pressure crisis), the blood pressure suddenly skyrockets to values above 230 mmHg (systolic) and / or 130 mmHg (diastolic). This can cause headaches, dizziness, nausea and vomiting, for example. If signs of organ damage due to the massive rise in blood pressure are added (such as angina pectoris), one speaks of a hypertensive emergency. Then there is danger to life and the emergency doctor must be alerted immediately (emergency number: 112)!

A hypertensive crisis is usually seen in patients with chronic high blood pressure. It rarely occurs in people whose blood pressure levels are otherwise normal. The trigger can then be, for example, acute inflammation of the kidney corpuscles (acute glomerulonephritis).

You can read more about the development, symptoms and treatment of the hypertensive crisis in the article Hypertensive Crisis.

High blood pressure: symptoms

Most patients show hardly any clear symptoms of hypertension, so that the increased vascular pressure often goes unnoticed for a long time. So high blood pressure is a "silent" danger. Early therapy is very important in order to prevent consequential damage. These can occur even without any previous symptoms of high blood pressure. This is why it is important to take the possible signs of high blood pressure seriously:

Dizziness
Headache, especially in the morning
sleep disorders
nervousness
tinnitus
Fatigue / easy fatigue
Nosebleeds
shortness of breath
flushed face
nausea

Headaches that tend to sit in the back of the head and mainly occur shortly after waking up are typical for high blood pressure. This is a consequence of nocturnal hypertension; normally blood pressure drops during sleep. If this is not the case, it can also lead to problems falling asleep and staying asleep. Above all, people who also suffer from sleep apnea often feel unrested and "worn out" the next day. A slightly reddened face - sometimes with visible red veins (couperose) - is also a possible sign of high blood pressure.

In addition, high blood pressure often manifests itself in nervousness and shortness of breath. Middle-aged women often misinterpret these symptoms of hypertension: they mistake them for menopausal symptoms or symptoms of stress in general. If in doubt, it is definitely advisable to have high blood pressure clarified as a possible trigger if there are any conspicuous signs.

This also applies if someone feels dizzy for no apparent reason, as dizziness is also a common symptom of high blood pressure. In some people, the signs of high blood pressure increase during the cold season.

"Only measurement brings certainty with high blood pressure"

Three questions for

Prof. Dr. med. Christoph Bamberger,
Internist and endocrinologist
1
Why is high blood pressure so often overlooked?

Prof. Dr. med. Christoph Bamberger
High blood pressure is known as the "silent killer" because it is usually not felt. Symptoms, such as headaches, are only experienced at very high levels. But even slightly elevated values, i.e. anything above 140/95 mmHg, damage the arteries in the long term. The only way to diagnose high blood pressure is to take repeated or, best of all, a 24-hour blood pressure measurement. Those who do not take measurements (or have them measured) cannot know whether their blood pressure is too high!
2
I have high blood pressure but I don't feel sick - does it still need treatment?

Prof. Dr. med. Christoph Bamberger
Yes, in any case. Because it still gnaws at our blood vessels and clearly increases the risk of heart attacks and strokes. Losing excess weight and engaging in a regular exercise program can lower a slightly elevated blood pressure, but in most cases the use of antihypertensive medication is unavoidable. But do not worry: such drugs are very well tolerated today.
3
Can I also influence my high blood pressure myself?

Prof. Dr. med. Christoph Bamberger
Continuous stress is one of the most important influenceable risk factors for high blood pressure. So you can try to recognize constant stress and find ways to escape the hamster wheel.
Prof. Dr. med. Christoph Bamberger,
Internist and endocrinologist
In 2006, the hormone expert founded the Medical Prevention Center Hamburg (MPCH), now Conradia Medical Prevention, of which he is the director to this day.

High blood pressure: symptoms of secondary diseases

As mentioned above, high blood pressure can damage organs in the long term. Then people with high blood pressure have warning signals emanating from these organs. This can be, for example:

Chest tightness and heart pain (angina pectoris) in coronary heart disease (CHD)
reduced performance and water retention (edema) in heart failure (cardiac insufficiency)
Leg pain in peripheral arterial occlusive disease (PAD)
Decreased visual acuity and visual field failures in hypertensive retinopathy

Sometimes hypertension is first diagnosed after a heart attack, stroke, or other serious complication. It is therefore particularly important not to overlook symptoms of high blood pressure and to attend regular preventive examinations. This is how such serious consequential damage can be prevented.

High blood pressure: causes and risk factors

Doctors differentiate between two basic forms of high blood pressure in terms of cause:

Primary hypertension: There is no underlying disease that can be proven to be the cause of high blood pressure. This essential hypertension makes up about 90 percent of all high blood pressure cases.
Secondary hypertension: The high blood pressure is due to another disease as a trigger. These can be kidney diseases, thyroid dysfunction or other metabolic diseases, for example.

Primary hypertension: causes

It is not yet known exactly what causes primary hypertension. However, several factors are known that favor the development of this form of high blood pressure:

familial tendency to high blood pressure
Overweight (body mass index = BMI> 25)
Sedentary lifestyle
high salt consumption
high alcohol consumption
low potassium intake (there is a lot of potassium in fresh fruits and vegetables, dried fruits or nuts)
smoking
older age (men ≥ 55 years, women ≥ 65 years)

Apparently there is also a connection between hypertension and menopause in women: high blood pressure occurs more frequently in women after the end of the fertile years.

There is also another, often underestimated, factor in high blood pressure: stress. It is not considered the sole cause of high blood pressure. However, in people with a tendency to hypertension, frequent stress almost always has a negative impact.

Primary hypertension often occurs together with other diseases more than average. These include:

Obesity
Type 2 diabetes
increased fat levels in the blood

If these three factors occur at the same time as high blood pressure, doctors speak of the metabolic syndrome.

Secondary hypertension: causes

In secondary hypertension, the causes of high blood pressure are to be found in another disease. In most cases, these are kidney diseases, metabolic disorders (for example Cushing's syndrome) or vascular diseases.

Narrowing of the renal arteries (renal artery stenosis) and chronic kidney disease (e.g. chronic glomerulonephritis, cystic kidneys) can be causes of high blood pressure. The same applies to a congenital narrowing of the main artery (aortic stenosis).

Sleep apnea syndrome can also trigger secondary hypertension. This is a breathing disorder during sleep.

Medicines can also be used as causes of high blood pressure. Examples include hormones (such as the “anti-baby pill”) and anti-rheumatic drugs. Last but not least, certain drugs such as cocaine and amphetamines can pathologically increase blood pressure.

Disorders of the hormonal balance are less common as a cause of high blood pressure. These include:

Cushing's Syndrome: In this hormonal disorder, the body makes too much cortisol. This hormone influences numerous metabolic processes and is released more frequently during stress, among other things.
Primary hyperaldosteronism (Conn syndrome): Overproduction of the hormone aldosterone due to a disorder in the adrenal cortex (such as a tumor).
Pheochromocytoma: This is a mostly benign tumor of the adrenal gland that produces stress hormones (catecholamines such as noradrenaline, adrenaline). This overproduction of hormones leads to high blood pressure episodes with headaches, dizziness and a racing heart.
Acromegaly: Here a (mostly benign) tumor in the anterior lobe of the pituitary gland produces uncontrolled growth hormones. This causes certain parts of the body to enlarge, such as the hands, feet, lower jaw, chin, nose, and eyebrow ridges.
Androgenital syndrome: The inherited metabolic disease leads to impaired production of the hormones aldosterone and cortisol in the adrenal gland. The cause of the disease is a genetic defect that cannot be treated.
Thyroid dysfunction: high blood pressure is also more common in connection with an overactive thyroid (hyperthyroidism).

High blood pressure and exercise

The physical exertion during sport causes blood pressure to rise. This is usually not a problem for people with healthy blood pressure levels. In high blood pressure patients, on the other hand, the values can quickly rise into a dangerous range. Especially in sports such as strength training with heavy weights, threatening blood pressure peaks sometimes occur. This is particularly the case when weight lifting is combined with press breathing.

Nevertheless, exercise is recommended in many cases with high blood pressure - in the form of the right type of sport and with an individually suitable training intensity. For example, many hypertensive patients benefit from regular moderate endurance training. In the best case scenario, exercise can even lower high blood pressure a little.

High blood pressure in pregnancy

High blood pressure during pregnancy can be triggered by the pregnancy itself. Such pregnancy-related high blood pressure develops after the 20th week of pregnancy (SSW). If, on the other hand, the high blood pressure existed before pregnancy or develops up to the 20th week of pregnancy, it is considered to be independent of pregnancy.

Pregnancy-related hypertension is often uncomplicated and usually disappears on its own within six weeks after the birth. However, it can also be the starting point for hypertensive pregnancy diseases such as preeclampsia, eclampsia and HELLP syndrome. These diseases can develop quickly and become dangerous for both mother and child.Therefore, the doctor regularly checks the blood pressure of pregnant women as part of the preventive check-ups.

pre-eclampsia

If pregnant women suffer from high blood pressure and increased protein excretion in the urine (proteinuria) after the 20th week of pregnancy, preeclampsia is present. The women affected also usually have water retention in the tissue (edema).

Preeclampsia is one of the so-called pregnancy poisoning (gestoses). If it is not treated by a doctor, life-threatening seizures (eclampsia) can occur.

You can read more about this pregnancy-related form of high blood pressure disease in the article Preeclampsia.

Hypertension: examinations and diagnosis

Many sufferers live with high blood pressure (hypertension) for years without realizing it. You feel good because high blood pressure often does not cause symptoms for a long time. Everyone should therefore know their blood pressure values, check them regularly and have them checked by a doctor.

Measure blood pressure

The most important test to determine if you have high blood pressure is to measure your blood pressure. The one-time measurement does not say anything about whether the blood pressure needs treatment or not. The blood pressure fluctuates during the day and is increased after exercise or coffee consumption. Some people feel nervous when their doctor measures their blood pressure, which can temporarily increase blood pressure. This phenomenon is also known as "white coat syndrome".

Overall, therefore, the following applies: In order to obtain meaningful blood pressure values, repeated measurements (e.g. at three different points in time) are helpful. Long-term measurements (over 24 hours) are also useful for diagnosing high blood pressure. The doctor can use them to precisely observe fluctuations in the time of day.

Further diagnostic steps

Usually the doctor also asks the patient about existing pre-existing conditions that could be the cause of secondary hypertension. These can be kidney or thyroid diseases, for example.

Blood and urine tests or an ultrasound scan of the kidneys may also be necessary. They help to differentiate between primary and secondary high blood pressure. They can also indicate risk factors for cardiovascular diseases (such as increased blood lipid levels) and possible organ damage (e.g. abnormal kidney values).

Ultrasound examination of the kidneys

A doctor should perform an ultrasound scan of the kidneys to differentiate between primary and secondary hypertension.

A physical examination is also part of the work-up for high blood pressure. It also helps to assess the individual cardiovascular risk and to recognize possible signs of organ damage caused by blood pressure. High blood pressure is often only recognized when it has already damaged the blood vessels (e.g. atherosclerosis). The blood vessels of the heart, brain, kidneys and eyes are particularly affected. In the long run, the heart muscle is also damaged, and the result is cardiac insufficiency. Further examinations of the eyes, heart and kidneys, for example, may be necessary for a more detailed examination of possible secondary diseases.

High blood pressure: treatment

How the therapy for high blood pressure should look like in individual cases depends on various factors. The most important factors are the level of blood pressure and the individual risk of secondary diseases such as CHD (coronary artery disease), heart attack or stroke. In addition, the doctor takes into account the patient's age and any existing underlying / concomitant diseases such as diabetes mellitus when planning therapy.

The European guideline recommends lowering blood pressure below 140/90 mmHg for most hypertensive patients. If the treatment is tolerated, a target value of less than 130/80 mmHg should be aimed for. The target value of 120/70 mmHg should not be undercut. For certain patient groups, however, slightly different recommendations apply:

In "frail" elderly patients and patients over 65 years of age, the high blood pressure therapy should aim for a systolic blood pressure between 130 and 140 mmHg.
In patients with kidney disease (nephropathy) and accompanying proteinuria, a systolic blood pressure value below 125/75 mmHg can be useful.
In diabetic patients, an attempt should be made to reduce the diastolic blood pressure value below 80 mmHg.

The doctor also adjusts the recommendations for the target blood pressure values individually.

Lowering Blood Pressure: What You Can Do By Yourself

The basis of high blood pressure therapy is a lifestyle change. This includes, for example, trying to reduce excess weight. Proper nutrition and regular exercise help with this. Both are also recommended for high blood pressure patients who do not weigh too many pounds.

Refraining from smoking is also very advisable in the case of hypertension so as not to further exacerbate the cardiovascular risk. Stress relief and relaxation techniques such as autogenic training or yoga are also recommended.

In addition, many patients try to reduce high blood pressure levels to healthier levels with home remedies or alternative healing methods such as homeopathy.

Read more about what you can do yourself with high blood pressure in the article Lowering Blood Pressure.

Medicines for high blood pressure

If a change in lifestyle is not enough to reduce high blood pressure levels, the doctor will also prescribe antihypertensive drugs that lower blood pressure. There are five main groups of drugs that are preferred for treating high blood pressure. They reliably lower blood pressure and are usually well tolerated. It includes:

ACE inhibitors
AT1 antagonists (angiotensin receptor blockers, sartans)
Beta blockers
Diuretics (water tablets)
Calcium antagonists

When and which drugs are best suited depends on the individual case. In addition, the following applies: Sometimes taking a single drug is enough to reduce high blood pressure sufficiently (monotherapy). In other cases, a combination of different drugs is necessary (combination therapy), for example an ACE inhibitor and a calcium antagonist.

In secondary hypertension, it is not enough to simply take antihypertensive drugs. The underlying disease has to be treated. For example, narrowed renal arteries (renal artery stenosis) can be widened in a surgical procedure, for example. This can lower the high blood pressure levels.

Hypertension: disease course and prognosis

The prognosis for high blood pressure varies from patient to patient and cannot be generally predicted. The course of the disease depends on several factors. These include, for example, the level of blood pressure and the presence of other comorbidities. In general, the earlier high blood pressure is detected and treated, the lower the risk of secondary diseases such as heart attack or stroke. If the hypertension is not treated, however, the risk of consequential damage increases.

In order to keep an eye on the blood pressure values and to recognize possible secondary diseases at an early stage, high blood pressure patients should have regular check-ups with their doctor.

Additional information

Book recommendations:

High blood pressure: prevention, detection, treatment (Anke Nolte, Stiftung Warentest, 2016)
High blood pressure. Compact guide: Effective prevention and self-help in the case of high values (Dr. med.Eberhard J. Wormer, Mankau Verlag, 2017)
The big cookbook against high blood pressure: All the important information for a diet that lowers blood pressure. 130 recipes for the whole family (Sven-David Müller, Schlütersche Verlag, 2015)

Guidelines:

ESC Pocket Guidelines "Guidelines for the Management of Arterial Hypertension" of the German Society for Cardiology - Heart and Circulatory Research and the German Hypertension League
"Practice guidelines for office and out-of-office blood pressure measurement", the European Society of Hypertension