High Blood Pressure (Hypertension) : Causes, Symptoms And Treatment

Blood pressure is considered elevated (hypertension) when multiple readings are 140/90 mmHg or higher. High blood pressure can hardly be recognized otherwise. It only very rarely triggers typical symptoms of its own, but gradually damages the heart, vessels and other organs. By the time symptoms of hypertension appear, it has usually already done significant, potentially serious damage. High blood pressure significantly increases the risk of heart attacks, strokes and other cardiovascular diseases.

Anyone who speaks of high blood pressure usually means arterial high blood pressure (arterial hypertension). There are other forms, such as high pressure in the pulmonary circulation, which are less common. Elevated arterial blood pressure is common. But many people do not know that they are affected because no symptoms can be felt. As a result, many who know their values take the condition lightly. High blood pressure is usually caused by an unhealthy lifestyle. Risk factors include lack of exercise, obesity, stress, plenty of alcohol and cigarettes.

High blood pressure (hypertension)

Causes and risk factor

In nine out of ten hypertensive patients, doctors cannot find a physical cause for high blood pressure (essential or primary hypertension). However, some risk factors - i.e. certain circumstances and behavior - are known to contribute significantly to the development of primary high blood pressure:

• Familial predisposition/genes: Scientists already know more than 15 different genes that are involved in the development of high blood pressure. Children are at two to three times the risk if both parents have high blood pressure.
• Obesity: More than half of all people who are overweight get high blood pressure.
• Lack of exercise: The blood vessels need training. Those who neglect it significantly increase their risk of cardiovascular diseases, including high blood pressure.
• Salt: High salt consumption (table salt) is associated with high blood pressure.
• Stress: In the long run, “stress hormones” not only increase blood pressure, but also blood sugar levels.
• Alcohol: Daily amounts of more than 30 grams of alcohol (equivalent to 0.75 liters of beer or 0.4 liters of wine) raise blood pressure.
• Smoking: One of the harmful effects of nicotine consumption is that blood pressure rises.
• Age: Blood pressure increases somewhat with age, and older people are therefore more likely to have hypertension.

Secondary hypertension or high blood pressure with a specific cause is only present in about one in twenty sufferers. In most cases, an illness has increased the blood pressure, such as kidney disease, narrowing of the renal arteries, certain sleep disorders with pauses in breathing/obstructive sleep apnea syndrome or hormonal disorders. But medication (e.g. certain hormonal contraceptives and anti-inflammatory painkillers, cortisone), dietary supplements (e.g. so-called fat burners) or drugs such as cocaine and amphetamines (stimulants) can also trigger high blood pressure.

Symptoms

Blood has to be under pressure, otherwise it wouldn't be able to flow up our veins against gravity. Blood pressure results from the pumping power of the heart and the resistance of the vessel walls. With each pump, the heart ejects a gush of blood, which can be felt as a pulse on the wrist. The surge briefly expands the elastic walls of the arteries before they contract again. The walls of the arteries also push the blood forward.

When blood pressure rises above the healthy level, you usually don't notice it for a long time. Hypertension is a creeping pest. In most cases, signs such as headaches, dizziness, tiredness, shortness of breath or visual disturbances only appear when blood pressure values are very high or organs have already suffered permanent damage from prolonged high pressure. But even imperceptible, low blood pressure increases the health risks in the long term. In the long run, on the one hand, the blood vessels in particular suffer, which can result in serious illnesses; on the other hand, the heart has to pump against the higher pressure. In the process, it changes morbidly. The following conditions are among the most common problems or complications that can lead to high blood pressure:

• Atherosclerosis (hardening of the blood vessels), heart attack, stroke and other cardiovascular diseases. Deposits (plaques) build up in the walls of the arteries. The walls curve inward, causing the arteries to narrow. The blood supply to the affected body parts or organs decreases. The consequences of arteriosclerosis are the most common causes of death in Switzerland and other industrialized nations. Where narrowed or blocked arteries cause problems depends on their location.
• In the brain, strokes or a decrease in mental abilities (dementia) can occur.
• Coronary heart disease, angina pectoris (heart narrowing) and, in the case of vascular occlusions, heart attacks can also occur in the heart.
• The function of the kidneys can decrease (kidney weakness, kidney insufficiency) or fail completely (kidney failure). In a roundabout way, narrowed renal arteries can aggravate high blood pressure or pathologically increase normal blood pressure.
• Pain during movement and later also at rest can be the result of constricted vessels in the pelvis, legs and arms ("intermittent claudication", peripheral arterial occlusive disease [PAOD]). It is also possible for tissue to die off due to constrictions at these points.
• Men with narrowed arteries in their abdomen can develop erectile dysfunction (erectile dysfunction).
• The heart has to pump harder because of the increased blood pressure. As a result, the heart muscle can change in such a way that the heart fills less and circulates less blood (cardiac insufficiency, cardiac insufficiency).
• Vascular changes in the retina can severely limit vision, but this is rare.

Treatment

In order to be able to reliably determine high blood pressure, several measurements are necessary. Blood pressure fluctuates throughout the day. It can also increase for a short time, for example due to mental stress. One speaks of the "white coat effect" when the blood pressure from excitement is excessive only in measurements at the doctor's. Therefore, at least three measurements should be taken on different days at different times for a diagnosis. In addition, many professionals advise 24-hour measurements or multiple measurements at home. It is sufficient for a diagnosis if only one of the two blood pressure values is constantly elevated.

In mild to moderate hypertension, positive lifestyle changes can often bring blood pressure back to normal within a year. Drugs are not absolutely necessary, but the committed participation of those affected is all the more important. Making sensible lifestyle changes means eliminating risk factors or at least significantly reducing their influence. In concrete terms, this means reducing excess weight, exercising more, avoiding or reducing stress, eating a balanced diet, consuming less salt, only drinking alcohol in moderation and, if necessary, quitting smoking. Women who use hormonal contraceptives or who are taking hormone replacement therapy during menopause should discuss with their doctors how these treatments affect their high blood pressure and whether there are alternatives.

Medicines for high blood pressure

A healthy lifestyle increases the effect of medication for high blood pressure (antihypertensives, antihypertensives): many of those affected then only have to take lower doses or, after a while, may be able to do without medication altogether. Conversely, their effect can be lost through unreasonable behavior. Blood pressure medication significantly reduces the risk of death and the number of heart attacks and strokes in hypertensive patients. To do this, they should be “optimally adjusted”: people with hypertension must be given the right medication, take the right dose and as prescribed. To guarantee this, blood pressure should be checked regularly. The values must not deviate beyond the satisfactory range. If it does, the doctors have to readjust the therapy or blood pressure with the patient. Drugs from the following groups are most commonly used to treat high blood pressure:

• Diuretics cause the kidneys to excrete more sodium and water. As a result, the amount of fluid in the blood vessels decreases and blood pressure decreases.
• Beta blockers slow the heart down so it circulates less blood. In addition, the drugs ensure that the kidneys release less of a certain hormone (renin), which narrows the blood vessels and increases blood pressure.
• Calcium antagonists (calcium channel blockers) prevent calcium from having an effect, which otherwise constricts blood vessels.
• ACE inhibitors make the body less efficient at converting the chemical precursor angiotensin I into the hormone angiotensin II, which causes the blood vessels to narrow.
• Sartans (also AT1 antagonists, angiotensin receptor blockers) block the binding sites through which angiotesin II constricts the vessels.

Which drugs are most suitable depends on the level of blood pressure, tolerability, age and general health of the patient. If substances from the families mentioned lead to undesired effects, some substances from other families can also be used (e.g. alpha-1 receptor blockers, alpha-2 agonists, renin inhibitors). They usually lower blood pressure just as well, but are sometimes less well tolerated or researched. Several groups of scientists are currently working on a vaccination against high blood pressure. It is not yet available for widespread use.