High blood pressure - Arterial hypertension

Our arteries and veins supply the entire body with oxygen and nutrients through the blood. They also carry away toxic waste products. Arterial hypertension (high blood pressure) is promoted by many factors and can significantly weaken the cardiovascular system and the organs. Because it causes no symptoms for a long time, arterial hypertension is insidious. High blood pressure can also develop as a side effect of other illnesses, but it can just as well appear without any identifiable cause. In very many cases, arterial hypertension is the result of an unhealthy lifestyle. That also means it can be brought under control by changing your lifestyle.

Because it often goes unnoticed for a long time, high blood pressure is commonly called "the silent killer." But excessively high blood pressure can lead to serious complications-for example, cardiovascular diseases such as heart attack, stroke, or kidney failure. The insidious thing is that the disease remains symptom-free for so long. In fact, research by the Robert Koch Institute found that one in two adults between the ages of 18 and 79 is affected. Arterial hypertension is therefore usually discovered incidentally during other routine examinations. Optimal values are between 105-119 mmHg systolic and 65-79 mmHg diastolic. Values between 120-129 mmHg systolic and 80-84 mmHg diastolic are considered normal. When blood pressure is within these ranges, all organs receive enough oxygen. To allow the blood to continue flowing evenly, our blood vessels are designed to stretch elastically under pressure. With high blood pressure, they become stiff and thicken. A person with persistently high blood pressure has a life expectancy that is about 15 years shorter. If the upper blood pressure value (systolic value) is persistently above 140 mmHg and the lower value (diastolic value) is above 90 mmHg, this is called arterial hypertension. Please also note that, according to the Hypertension League's guidelines, a home blood pressure measurement of >=135 and/or >=85 mmHg is considered high blood pressure. Persistently high blood pressure in the arteries damages the blood vessels and the heart. The vessel walls become stiffer, harden, and narrow. There is a greater tendency toward atherosclerosis because more fats and calcium build up at critical points. In the long term, the fine blood vessels in the brain are also affected, and the risk of stroke increases. The eyes can be damaged as well.

Essential, also called primary, hypertension occurs in the vast majority of hypertension cases. It is a diagnosis of exclusion, which means no direct cause can be found.
Secondary hypertension is caused by another underlying disease, such as metabolic disorders or impaired kidney function. Vascular diseases can also lead to arterial hypertension, for example vascular inflammation and pathological changes in the coronary arteries. Atherosclerosis is a particularly strong risk factor for arterial high blood pressure. High blood pressure in pregnancy is also classified as secondary hypertension. High blood pressure caused by certain medications is likewise called secondary hypertension. When high blood pressure is diagnosed in connection with another disease, treating the underlying condition must take priority alongside medication for the blood pressure.

To get meaningful readings, blood pressure must be measured several times a day at regular intervals for at least three consecutive days. This can help rule out so-called "white coat hypertension" - also called isolated office hypertension. In that case, the patient only shows elevated readings at the doctor's office. At home, the blood pressure is normal. There is also isolated ambulatory hypertension. This so-called masked hypertension shows normal readings in the doctor's office. It often occurs in younger men who drink alcohol, smoke and are prone to stress.

Risk factors for developing arterial hypertension

High blood pressure can be genetic. However, there are a number of risk factors that make developing hypertension more likely.
Excess weight in particular is increasingly recognized as important in the development of high blood pressure, because blood volume, stroke volume and cardiac output are directly related to body mass. With long-term overweight, arterial resistance in the vessels increases.
In addition to smoking, alcohol consumption and lack of physical activity, stress and a high intake of table salt are further risk factors for developing hypertension.
In cases of increased stress, it is particularly the hormone adrenaline that can raise blood pressure. This is a natural and useful process: adrenaline causes the small blood vessels to constrict so that more blood is available to the large muscle groups the body needs for flight or fight. However, if a person is under chronic stress, the stress hormones can cause a chronic narrowing of the vessels, which can lead to persistently high blood pressure (hypertension). Causes of chronic stress are varied - for example severe psychological stress, excessive workload, or bullying.

As already described, symptoms often do not appear for a long time. Symptoms only become noticeable at a late stage. During physical exertion, blood pressure rises excessively. The higher the blood pressure, the more pronounced symptoms such as morning nausea and dizziness are. Circulatory problems can also occur in the extremities, manifesting as tingling and numbness.

Typical symptoms of high blood pressure include

• Dizziness
• Headache in the early morning
• Nosebleeds
• Ringing in the ears
• Palpitations
• unspecified heart-related complaints

Lifestyle changes are very important and highly promising for arterial hypertension. Except for people with organic underlying diseases, blood pressure can often be lowered relatively quickly this way. Even people with the less common secondary hypertension benefit from lower cholesterol levels through healthy food and more physical activity. Endurance sports help lower blood pressure in the long term. If you swim, cycle, do Nordic walking, jog or do something similar for at least 30 minutes three times a week, you can immediately counteract arterial hypertension. Strength training can also help, but blood pressure spikes must be avoided; isometric exercises can also be useful. Smokers should urgently quit smoking. It is a major risk factor for stroke and heart attack. People who are overweight should reduce their weight. If you drink alcohol, you should significantly cut back. A healthy diet includes plenty of fruit, fresh vegetables and low-fat foods. People at risk should also reduce the amount of animal protein, as it can negatively affect blood pressure and raise cholesterol levels. Ideally, those affected should also regularly check their blood pressure at home.

In many cases, medication is still necessary. The dose and type of drugs depend on the severity of the arterial hypertension. The aim is to normalize levels to below 140/90 mmHg and, for patients with kidney disease, to below 125/75 mmHg. Common blood-pressure-lowering medications are ACE inhibitors and AT1 receptor antagonists. On one hand they widen the blood vessels and on the other they inhibit production of a hormone that raises blood pressure. Patients with kidney dysfunction are given diuretics. These also achieve good long-term results.

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