What is hypertension?
Blood pressure is determined by the amount of blood pumped out by the heart and the resistance counteracting blood flow. If left untreated, hypertension can lead to complications such as myocardial infarction and stroke.
Hypertension develops over years and affects many people; it can be easily recognized and treated accordingly in cooperation between the patient and the physician.
Most people suffering from hypertension experience no symptoms that are suggestive of hypertension; on the contrary, many of them feel very well despite elevated blood pressure values.
A small number of patients reports of headaches, vertigo and nasal bleeding in early stages of the disease. However, these symptoms often do not appear until the disease progresses to reach a life-threatening stage.
There are many risk factors for developing hypertension:
Age: The risk of developing hypertension increases with age.
Family predisposition: Hypertension can be hereditary.
Overweight and lack of physical exercise: The higher the body weight, the more blood is required to supply the body with oxygen; as a result, the blood volume in the body, and consequently also the pressure on the vessel walls, increases.
Nicotine: Smoking leads to an immediate increase in blood pressure; in addition, the toxic substances contained in cigarettes cause damage to the vessel walls, resulting in vasoconstriction and elevated blood pressure.
Excessive salt intake: Excessive salt intake results in the body retaining a correspondingly high amount of liquid.
Excessive consumption of alcohol: Long-term alcohol consumption causes damage to the heart and increases the blood pressure.
Chronic diseases such as high cholesterol levels, diabetes mellitus and sleep apnea can also increase the risk of developing hypertension. Hypertension may occasionally occur during pregnancy.
During the last few years, hypertension has also been increasingly observed in adolescents, which is usually associated with overweight, lack of physical exercise and unbalanced nutrition.
Hypertension causes damage to the vessel walls and thus to the corresponding organs of the body; the higher the blood pressure and the longer it is left untreated, the greater the damage.
If left untreated, hypertension can cause:
Myocardial infarction or stroke: Hypertension leads to vascular calcification (referred to as arteriosclerosis), which may cause myocardial infarction, stroke or similar complications.
Dilated vessel walls (aneurysm): Hypertension may lead to weakness and leakage of vessel walls, the consequence being that the vessel “bursts”, involving the risk of exsanguination.
Cardiac failure: In order to enable the heart to continue pumping despite elevated blood pressure, the cardiac muscle’s wall thickens, which is no longer sufficient over the course of time if hypertension is not treated effectively. This results in the enlargement of the heart’s cavities. Such a heart is no longer capable of supplying the body with a sufficient amount of blood, resulting in cardiac failure.
Kidney failure: Over the course of time, weakness of vessel walls and narrowed renal blood vessels cause renal insufficiency, which may necessitate blood lavage.
Blindness: Thickened, narrowed or torn vessels in the eyes may ultimately lead to blindness.
Weakness of memory: Untreated hypertension may affect the ability to think, remember and learn.
What to do if hypertension is suspected
If you think you may be suffering from hypertension, visit your general practitioner and have your blood pressure measured. This requires no special provisions. You should avoid caffeinated beverages. Take all your prescription and OTC drugs with you to the appointment, as some of these drugs may have a substantial influence on your blood pressure. Please do not stop taking prescription drugs without consulting your physician.
Blood pressure measurement and diagnosis
The blood pressure is ascertained using an inflatable cuff and a measuring device, and is indicated in millimetres of mercury (mmHg.). The reading consists of two components: the first one, also referred to as the upper reading, indicates the blood pressure at the time the blood is pumped out of the heart (systolic value). The second one, also referred to as the lower reading, indicates the blood pressure during two heartbeats (diastolic value).
The blood pressure measurement can yield the following results:
Normal blood pressure: A blood pressure below 129/85 mmHg is considered to be normal.
Pre-hypertension: The preliminary stage of hypertension. The upper, systolic value is between 130 and 139 mmHg; the lower, diastolic value is between 85 and 89 mmHg. In most patients, this develops into hypertension.
Stage 1 hypertension: The upper, systolic value is between 140 and 159 mmHg; the lower, diastolic value is between 90 and 99 mmHg.
Stage 2 hypertension: This is the case if the systolic value is above 160 mmHg or the diastolic value above 100 mmHg.
Both components of the blood pressure reading are important. The systolic value gains in significance on reaching the age of 50. Isolated systolic hypertension, which means that the diastolic value is within the normal range, is the most common form of hypertension.
Before the diagnosis of hypertension is made, your physician will measure your blood pressure several times, if necessary, at different points in time. Your physician may ask you to measure your blood pressure at home in order to rule out that your blood pressure values are only elevated when you see a doctor (referred to as white coat hypertension). During the last few years, ambulatory blood pressure monitoring has established itself, making it possible to ascertain in your familiar environment whether you suffer from hypertension on the basis of several measurements within 24 hours.
Blood pressure self-measurement
For patients already diagnosed with hypertension, it is very important that they measure their blood pressure at home on a daily basis and note down the readings in a log. This is the only way for your attending physician to reliably assess whether the medication you are taking is sufficient.
Outpatient treatment options
Hypertension can be treated in various ways. In some cases, a change in lifestyle and eating habits (exercise, loss of weight and giving up smoking) can be sufficient to reach the target blood pressure.
In many cases, however, these measures do not suffice, which is why your attending physician will prescribe you medication to help you reach the target blood pressure after evaluating the blood test and ECG results. At this point, it should be emphasized that we are not yet able to cure hypertension; this means that you will have to take this medication on a regular, long-term basis, even if you measure blood pressure values within the target range. Occasional omission of the prescribed medication may lead to fluctuations in blood pressure, sometimes entailing hospitalization which could otherwise be avoided.
This is understood to be hypertension that is still above the target range despite taking three different antihypertensives on a regular basis. This group also comprises patients who do not reach the target blood pressure until taking four different medicines. The reasons for this can vary greatly; good collaboration with your attending physician can often help find a way out. This also means that you have to inform your physician about all medicines, vitamin preparations as well as your eating and drinking habits. You should also honestly report any side effects of your existing medication. Any change in medication and dosage should be discussed with your attending physician.
If your blood pressure continues to be outside the target range, two main treatment methods to still reach the target blood pressure have been in place for several years.
Renal sympathetic denervation involves the use of electric current to ablate nerve fibers that surround the renal artery for blood pressure regulation. For this purpose, a catheter is advanced up to the renal artery via a puncture in the inguinal region, soon also in the carpal region, and the treatment is performed using an ablation catheter.
Baroreceptor stimulation therapy (referred to as high-pressure pacemaker) involves the treatment of special cells on the carotid artery with electrical impulses via a thin wire; these impulses signal the brain to reduce the blood pressure. Similarly to a cardiac pacemaker, the probe is connected to a battery implanted subcutaneously beneath the clavicle.
Whether you are eligible for one of these treatment methods can only be ascertained after several examinations and in close collaboration with your attending physician.