High blood pressure

What is hypertension?

Arterial hypertension, or just hypertension, is a common blood vessel disorder. Our heart pumps blood into our vascular system with every beat, which results in pressure onto the blood vessel walls. A chronically elevated arterial blood pressure, that means constant values above 140/90 mmHg, is referred to as arterial hypertension. To really be able to recognize the disease, long-term surveillance is necessary, as our blood pressure changes due to factors such as time of the day or physical activities.

What makes hypertension so dangerous is its subtle progression until it eventually results in serious conditions such as stroke, heart attackor kidney failure. According to the severity of the disease, the treatment may be carried out by a family physician or a cardiologist.

Causes: How does hypertension develop?

Two types of arterial hypertension are distinguished.

Primary hypertension

If no obvious underlying disease causing the hypertension can be identified, it is termed primary hypertension. In other words, the hypertension is there just like that. Even though primary hypertension can have various triggers, the exact cause remains unknown.

Risk factors that are thought to play a role in the development of primary hypertension are family history, obesity, alcohol consumption, low degree of physical activity, smoking, age, potassium deficiency and high salt intake. Women have a greater risk for hypertension once they reach menopause.

If a patient has hypertension and simultaneously suffers fromType 2 diabetes, abdominal obesity and increased blood cholesterol, the disease is termed metabolic syndrome. It is associated with a significantly increased risk for stroke.

Secondary hypertension

Secondary hypertension always results from an underlying disease. Such diseases can be for example diseases of kidneys, blood vesselsor metabolic disorders. Medications including birth control pills and antirheumatic drugs can also cause hypertension.

Symptoms of hypertension

Hypertension is frequently named the “silent killer”, as it may remain undiscovered for a long time and doesn’t induce explicit symptoms. Yet early diagnosis and therapy are essential, because severe diseases and organ damage can be the result.

Typical complaints for hypertension are headaches especially in the back of the head, dizziness, nausea and red discoloration of the face. Sleep disorders and anxiety can also be experienced and while women often blame it on menopause, it may truly be a hidden danger. In men, arterial hypertension can lead to erectile dysfunction.

Diagnosis: How is hypertension recognized?

As hypertension often progresses without symptoms, early recognition plays a central role. Self-monitoring is recommended from the age of 34.

If hypertension is suspected, blood pressure measurement by a specialist is the most important examination. One single measurement of blood pressure is not sufficient, however. As blood pressure in healthy individuals is subject to change throughout the day and depends on numerous factors such as time of the day, physical activity, coffee or alcohol consumption, it needs to be measured for at least 24 hours.

If multiple measurements at different times show values above 140/90 or patients complain about headache and nausea, a thorough basic examination is necessary.

This examination is performed by a specialists and includes a detailed patient history, physical examination including blood pressure measurement, laboratory tests of blood and urine, electrocardiogram (ECG) and long-term blood pressure measurement.

If secondary hypertension is suspected, an array of further tests aimed to discover the potential underlying disease must be carried out.

How is arterial hypertension treated?

If hypertension is identified early on and the patient hasn’t yet been afflicted by secondary organ damage, the major recommendation are lifestyle changes. Healthy diet, weight reduction along with more physical activity, avoidance of stress and abstinence from nicotine and alcohol usually go a long way.

If these lifestyle changes fail to achieve a decrease in blood pressure or the disease is already in more advanced stages, blood pressure drugs are indicated. Each patient requires an individual set of blood pressure medication and should be chosen carefully by the doctor with regards to possible side effects of the drugs.

The following drugs can be prescribed solitary or in combination and are among the standard medications for hypertension:

• Diuretics lead to blood vessel dilation. They reduce the fluid volume by increasing salt excretion. They are frequently combined with other medications for synergistic effect.
• Betablockers inhibit receptors fort he stress hormones adrenaline and noradrenaline and thus inhibit the sympathetic system (part of the autonomous nervous system responsible for “fight or flight”).
• Calcium channel blockers relax the musculature of blood vessels and improve their elasticity, causing a drop in pressure exerted against vessel walls.
• ACE-inhibitors intervene in the Renin-Angiotensin-Aldosterone-System.

What are prognosis and course of disease like in hypertension?

Prognosis for the progression of hypertension can differ from patient to patient quite sigificantly. The measured blood pressure values and possible additional diseases are essential.

Generally, the earlier hypertension is detected, the lower the risk to develop organ damage or other diseases from it and the easier hypertension becomes to manage.

Without treatment, hypertension can cause atherosclerosis, myocardial infarction, stroke, eye and kidney diseases. Therefore, regular checkups after the age of 35 are important.

Patients can change a great deal themselves. By living heathy and avoiding risk factors, the prognosis of further progression of their hypertension can be positively influenced.

Hypertension during summer time

During the summer months temperatures of more than 30 degree celsius may be encountered. Already 25 degrees celsius are associated with a significant burden for patients with high blood pressure or other cardiovascular illnesses. Thus, the risk for heart attacks increases during the summer months. Especially abrupt fluctuations in temperature are dangerous as they may produce heart rhythm disorders.

High temperature also causes blood vessels to dilate, which causes a drop in blood pressure in addition to blood pressure medication. Therefore, medication dosage must be adapted appropriately to such changes, otherwise dizziness or even cardiovascular collapse can be the result.

For all of the mentioned reasons, it is recommended that patients with hypertension have their blood pressure checked daily during the summer months. Also patients should consult their general practitioner to have their medication dosage adjusted to meet their individual needs.