Hypertension (high blood pressure) is a common disease- According to estimates, every fourth Swiss has an increased value - often, without knowing it: Because high blood pressure makes at the beginning usually no complaints. However, high blood pressure levels will damage the body. The good news: Everyone can do a lot to lower their blood pressure and prevent illness!
In hypertension, the pressure in the arteries - the blood vessels that carry the blood away from the heart - is significantly increased. This pressure, generated by the heartbeat and the vessel walls, is given in millimeters of mercury (mmHg) based on two values in the unit of measure . High blood pressure exists when values of at least 140 to 90 mmHg are present.
In 9 out of 10 people with high blood pressure, the doctor can find no cause : Then there is a so-called primary or essential hypertension . In the remaining cases, high blood pressure develops as a result of another illness (e.g. the kidneys or the hormone system) or by medication: a so-called high blood pressure also means secondary hypertension .
High blood pressure usually does not trigger symptoms for years to decades . This can lead to undetected hypertension and no therapy. During this time, the high blood pressure in the body often causes damage.
The possibilities of treating high blood pressure are manifold and depend on the individual case. A healthy lifestyle is particularly important and the indispensable basis for the treatment of hypertension. For example, those who pay attention to a low-salt diet, move a lot and lose weight can permanently lower their blood pressure. It is also advisable in high blood pressure to drink little or no alcohol and to give up smoking or at least reduce it and reduce stress. In addition, different medications help to normalize levels in hypertension. Examples are diuretics, beta blockers, ACE inhibitors and calcium channel blockers.
Persistently high blood pressure can damage the heart, blood vessels, brain, eyes and kidneys. These damages, in turn, can lead to secondary illnesses such as heart attacks or strokes . Therefore, it is particularly important to treat high blood pressure in a timely manner.
Anyone who manages to lower his blood pressure to normal levels promotes good health.
2. Definition
The term hypertension (high blood pressure) by definition refers to the pressure in the arteries when it exceeds a certain limit . Arteries are blood vessels that carry the blood away from the heart. The exact medical term for high pressure in the arteries is arterial hypertension . The blood pressure generated by the heartbeat and the tension of the vessel walls is given in the unit of measure of millimeters of mercury (mmHg) and is described on the basis of two values.
Hypertension, by definition, is when the values are at least 140 to 90 mmHg .
The first, upper (higher) value is the systolic blood pressure . It corresponds to the pressure that arises when the heart contracts and pumps the blood into the arteries. Then the heart relaxes again - the resulting lower pressure is the diastolic blood pressure (back value). Both values are always given in pairs. Depending on how high the values are, one can divide the blood pressure into classes (fall the two blood pressure values thereby into two different classes, the higher class is crucial).
Forms of hypertension
There are two types of high blood pressure (hypertension): primary and secondary hypertension.
- The secondary hypertension can on the one hand caused by certain medications (hormone preparations such as birth control pills). On the other hand, another condition can lead to increased blood pressure. This can be the case, for example, with a kidney disease or a metabolic disorder such as the so-called Cushing's syndrome .
- The primary or essential hypertension is a diagnosis of exclusion: The doctor comes only from that form if he finds no direct cause of hypertension. The primary hypertension arises without an externally recognizable cause.
Another common high blood pressure variant is isolated clinical hypertension (or Weisskittel hypertension ). The blood pressure values measured by the doctor are higher than those measured by the patient at home. The reason for this may be the tension that is sometimes felt when you enter a doctor's office and in conversation with the doctor or surgery staff and that increases your blood pressure.
frequency
Since high blood pressure (high blood pressure, hypertension) in the industrialized nations is one of the diseases with the greatest frequency, it is also called a widespread disease . Nearly every fourth Swiss has high blood pressure, from the age of 50 even more.
In about 90 percent of people with high blood pressure, the cause is unknown. There is a so-called primary hypertension, which means that the hypertension is not the result of certain medications or diseases. The number of people affected increases with age. But many young people also have hypertension - often without knowing it.
3. Causes
Hypertension (hypertension) can have many different causes. If there are no direct causes of hypertension - and this is usually the case - there is a so-called primary hypertension . There are probably several factors involved in their formation.
Hereditary (genetic) factors
There are several indications that hereditary factors (genetic) play a role in the causes responsible for high blood pressure: Children are twice or threefold more likely to develop hypertension if one or both parents are already hypertensive.
Twin studies also show that the development of high blood pressure has its causes among other things in a genetic component. In very rare cases, high blood pressure is due to a specific injury to a carrier of the genetic make-up (a so-called gene). More likely, however, is that multiple such genetic defects in combination with external factors trigger hypertension.
Salt consumption
One of the possible causes of hypertension (high blood pressure, hypertension) is saline consumption : in about every third case of high blood pressure, the levels increase as soon as the affected person ingests too much sodium chloride.
With salt withdrawal the blood pressure sinks however clearly. The blood pressure of these people is sensitive to salt intake. The relationship between saline consumption and hypertension is not uncontroversial. It is clear that almost all people with high blood pressure benefit from limiting their salt intake, no matter what causes behind it. Professionals recommend not taking more than 6 grams of table salt per day with food.
stress
Possible causes of high blood pressure (high blood pressure, hypertension) may also include stress: stress hormones, so-called catecholamines , cause the blood vessels to contract. As a result, the vascular resistance increases - and the blood pressure rises. People with high blood pressure (hypertensives) are also likely to be particularly sensitive to these stress hormones.
There is no sufficient evidence that mental stress can be considered to be the cause of persistent (chronic) hypertension. However, about every second employee in the workplace has elevated blood pressure, which may be due to stress at work.
overweight
Obesity can also play a role in high blood pressure. High blood pressure is common in overweight people. By losing weight , however, the blood pressure back to normal: Pro lost kilograms blood pressure falls by an average of two millimeters of mercury (mmHg). Above all, the obesity plays a role as a possible trigger for the development of hypertension. In men, the waist circumference should therefore be less than 102 centimeters, in women less than 88 centimeters.
Alcohol and nicotine
In high blood pressure (high blood pressure, hypertension), alcohol and nicotine may play a role as causes . Even small amounts of alcohol cause the blood pressure to rise: Alcohol activates the autonomic nervous system, the heart beats faster and pumps more blood from the left ventricle into the arteries. Chronic alcohol abuse causes chronic high blood pressure in many cases.
Although alcohol abuse is ruled out for high blood pressure as a cause, those affected can lower their blood pressure by drinking less or no alcohol . Considered largely uncritical in terms of hypertension is an amount of about 20 grams of alcohol per day. This is equivalent to about 0.5 liters of beer with 5% alcohol by volume or 200 milliliters of wine with 12% alcohol by volume. But: Daily consumption of alcohol is to be advised against in any case, in order not to risk dependency.
Although smoking is not one of the direct causes of high blood pressure. However , nicotine significantly increases the risk of complications that can lead to high blood pressure - such as a heart attack or a stroke . Anyone who quits smoking will significantly reduce their risk of cardiovascular disease and a range of respiratory and cancers - not just in hypertension, but for all.
Secondary hypertension
Rarely high blood pressure (high blood pressure, hypertension) has its causes in other diseases or the use of certain medications: Then there is a so-called secondary hypertension .
The drugs that may be considered as causes for high blood pressure include hormone preparations such as contraceptives (estrogen pill), so-called corticosteroids and agents for the treatment of rheumatic diseases (anti-inflammatory drugs). The diseases in which high blood pressure can be caused include certain kidney, vascular or metabolic diseases. Secondary hypertension can be caused, for example, by:
- Vascular changes ( arteriosclerosis ) of the renal vessels
- Narrowing of the main artery (aortic isthmus stenosis)
- Hyperthyroidism (hyperthyroidism)
- Adrenal tumors that produce excessive levels of hormones such as epinephrine and norepinephrine (pheochromocytoma)
- Cushing syndrome (increased cortisol levels in the blood)
Often, asthmatics have elevated blood pressure levels. With them, the hypertension presumably arises through the treatment with certain medications (corticosteroids and beta-sympathomimetics).
Even snoring and prolonged breathing pauses during the night followed by daytime sleepiness (sleep apnea) may be responsible for secondary hypertension.
4. symptoms
It can take some time for high blood pressure (high blood pressure, hypertension) to trigger symptoms: It often takes years or decades for the first signs of hypertension to appear. Therefore, many sufferers do not know that their blood pressure is too high.
However, this carries risks, because: High blood pressure without symptoms permanently harms the body. High blood pressure can lead to long-term damage to the organs, which can be prevented by early hypertension therapy. Therefore, it is important to pay attention to possible warning signs - so too high blood pressure can cause the following symptoms:
- a headache
- dizziness
- nosebleeds
- tinnitus
When the high blood pressure affects organs, the symptoms can be very different. Possible signs of organ damage due to hypertension include:
- shortness of breath
- shortness of breath
- Chest pain (angina pectoris)
- Impaired vision or sensibility disorders
- Heart attack and stroke
High blood pressure symptoms that are similar to stroke (i.e. dizziness, blurred vision, paralysis , impaired consciousness) may indicate a hypertension-induced emergency that can damage organs such as the brain, eyes, or heart: a so-called hypertensive emergency . The blood pressure values are greatly increased, usually over 230 to 130 millimeters of mercury (mmHg).
If high blood pressure causes symptoms of hypertensive emergency, it is necessary to seek medical attention immediately and then bring it to hospital, as the high pressure in the vessels can be dangerous in the short term. There are medicines available that can quickly lower blood pressure in such a situation - for example, the active ingredients nitroglycerin, urapidil and nifedipine. It is also important to calm the person concerned and avert further stress from him.
Doctors speak of a hypertensive crisis when there is severe hypertension but there is no acute risk of organ damage. A hypertensive crisis, unlike a hypertensive emergency, does not require immediate lowering of blood pressure with medication.
5. Diagnosis
In high blood pressure, the diagnosis is often late , because: High blood pressure levels occur mostly without apparent cause - and this so-called primary hypertension often runs for years or decades symptom-free, so that it goes unnoticed.
To diagnose hypertension (high blood pressure, hypertension), it is first necessary to measure blood pressure, which will help the doctor determine if hypertension is present and, in conjunction with other findings, assess which treatment is appropriate. Hypertension is considered confirmed if at least two measurements on two separate days show elevated blood pressure values (higher than 140/90 mmHg).
In order to avoid a false high blood pressure diagnosis, it is important to rest for at least five minutes before measuring the values , for example in a chair or on a treatment table. It is advisable to take the first blood pressure measurement on both arms and legs to exclude changes to the vessels (such as a narrowing of the main artery).
In addition, it is crucial for high blood pressure diagnosis to inform the doctor about the medical history and the exact circumstances and habits of life . For example, the doctor will want to know if there are any pre-existing conditions that may be related to high blood pressure or increase the risk of subsequent damage to organs such as the eyes or kidneys. This can be, for example, diabetes mellitus , cardiovascular disease or kidney disease. But also information on body weight, exercise, eating and drinking habits and taking medications can help diagnose hypertension.
In addition, it is possible to check the blood pressure via an ambulatory 24-hour measurement , a load measurement (ergometry) and the self -measurement for high blood pressure diagnosis .
Blood pressure self-measurement
In hypertension (high blood pressure, hypertension) plays in the diagnosis as well as in the subsequent therapy, the blood pressure self-measurement an important role: Recommended devices are those with whom the blood pressure measured on the upper arm. Care must be taken that the device complies with the official accuracy criteria. The size of the blood pressure cuff should be based on the circumference of the upper arm. If you choose a too small cuff for thicker arms, the actual blood pressure may be lower than the measured one.
All people with high blood pressure should measure their blood pressure twice a day, even at rest, and enter it into a blood pressure pass. The optimal time for this blood pressure self-measurement is between 6:00 and 9:00 in the morning and between 18:00 and 21:00 in the evening, before eating and taking medication.
If the blood pressure has stabilized or normalized through therapy, more rare measurements are sufficient (e.g. two measurements in the evening and two in the morning once a week). Self-measured blood pressure values should not exceed 135 to 85 millimeters of mercury (mmHg).
Complementary examinations
In addition to blood pressure measurements for hypertension (high blood pressure, hypertension) are used for the diagnosis of complementary investigations, because: Modern high blood pressure diagnostics is - as the therapy - not only on the blood pressure values. It also considers the risk factors for cardiovascular diseases, already existing organ damage and concomitant diseases. The risk factors include above all:
- Smoke
- overweight
- lack of exercise
- Diabetes mellitus
- elevated blood lipid levels
In the basic examination, the doctor determines therefore fats (lipids) and sugar (glucose) in the blood, also minerals such as potassium and the kidney values (creatinine). Since high blood pressure can damage the kidney or it may even be impaired in its function in concomitant diabetes mellitus , it is advisable to also examine the urine.
The following methods can be used to help you diagnose high blood pressure, such as blood testing and urinalysis, to identify any organ changes that have already occurred and to identify causes of secondary hypertension:
- Examination of the ocular fundus
- Electrocardiogram (ECG)
- Ultrasound (sonography) of heart (echocardiography) and kidneys
- X-ray of the ribcage
- Hormone analyzes (e.g. catecholamines or thyroid hormones)
6. Therapy
When high blood pressure (high blood pressure, hypertension), the therapy should start early to prevent later organ damage and sequelae such as heart attack and stroke . Anyone who lowers his blood pressure and long term, promotes his health and actively protects his cardiovascular system.
For high blood pressure, the goal of the treatment is always to lower the resting blood pressure below values of 140 to 90 millimeters of mercury (mmHg). Other recommendations apply to persons who also have other illnesses. So apply for diabetics Values below 140 to 85 as desirable, those who ever had a stroke should lower their blood pressure to below 130 to 80th
The hypertension therapy is individual . The treatment relies heavily on general measures to lower blood pressure. These include stress reduction or a change in lifestyle and in many cases also antihypertensive drugs.
Since the secondary hypertension arises as a result of certain underlying diseases or drugs, in this form of hypertension, the treatment is based on the respective cause of high blood pressure. In addition, specific recommendations for the treatment of hypertension apply to the following groups of people:
- Children and adolescents
- older people
- pregnant woman
- People with coronary heart disease (CHD) or heart failure (heart failure)
- People with kidney disease
- People with atrial fibrillation, a cardiac arrhythmia
General measures
In high blood pressure (high blood pressure, hypertension) anyone can influence the effect of the drugs by various general measures in addition to improve and lower blood pressure. Those who change their lifestyle can sometimes lower their blood pressure without medication. At least it is often possible to reduce the dose of the drugs, which in turn means that fewer side effects occur and the person tolerates the drugs better. Sometimes these measures lead to success even without additional medication. If high blood pressure is common in your family, having a healthy lifestyle can lower your blood pressure and / or delay the onset of high blood pressure.
For the treatment of high blood pressure, general and specific dietary measures are recommended: In the case of high blood pressure, attention should be paid to the intake of saline. Most people consume too much table salt every day.
Who limited his salt intake to a maximum of 4 to 6 grams per day, can affect his high blood pressure positive and of course lower.
A low-salt diet leads to a slight blood pressure reduction of about 10 to 15 millimeters of mercury (mmHg) in every second person with high blood pressure. These people are considered "salt-sensitive". Reducing the amount of saline even further - to about 3 grams of saline per day - even leads to a marked reduction in blood pressure. We recommend fresh, low-salt and individually prepared food. Finished products and many sausage and cheese products are often more salted and therefore better to avoid when the blood pressure is too high.
As a general measure for hypertension therapy, it is advisable to change your diet: Anyone who takes high fruit and vegetables for high blood pressure can also lower his blood pressure significantly. Cholesterol is one of the major risk factors for cardiovascular disease. Polyunsaturated fatty acids in fish and vegetable oils can lower cholesterol and blood pressure levels.
The high-pressure (high blood pressure, hypertension) recommended for therapy general measures include the fight against obesity : who has a few pounds too much on the ribs and a little decrease, does his blood pressure a favor. Just five kilograms of body weight less is enough to lower the blood pressure by about ten millimeters of mercury (mmHg). Especially if high blood pressure occurs in your family, you should be careful to counter obesity in time. Children whose high blood pressure is associated with obesity often achieve more through regular exercise and healthy eating than through medication.
Furthermore, in the case of hypertension treatment, the correct handling of alcohol and smoking has a positive effect : If you have too high blood pressure, you severely limit your alcohol intake or you should abstain completely from alcohol . It is advisable to take no more than 20 grams of alcohol in one day. For comparison, a glass of twelve percent red wine contains about 12 grams of alcohol, a quarter of a liter of beer about 10 grams of alcohol. However, in general: abstain from daily consumption of alcohol in order to reduce the risk of dependency.
Stay alcohol free for at least two to three days a week!
In addition, in general and especially for high blood pressure: Who wants to prevent cardiovascular, respiratory and cancer diseases , should give up smoking - even if the cigarettes for many people to life belong.
stress reduction
In the case of hypertension stress reduction is also important in the context of the general therapy measures : Those who can handle stress professionally and privately, have a favorable influence on the course of hypertension. Relaxation techniques (such as progressive muscle relaxation, autogenic training or breathing exercises) can further lower your blood pressure - especially if high blood pressure is due in part to mental factors.
Physical activity
The general measures recommended for high blood pressure therapy include sufficient physical activity. Sport and exercise have several positive effects:
- Those who regularly work up a sweat can reduce stress more easily.
- Physical activity contributes to weight loss .
- The movement stimulates the metabolism, so you also burn more calories, for example.
- Sport has a favorable influence on blood lipid levels.
All people with high blood pressure benefit from a regular physical training , especially those who have previously not or only insufficiently exercised . A training frequency of about 30 minutes three days a week , you should at least comply to achieve a hypotensive effect. The load is individually different. Particularly suitable for high blood pressure treatment endurance sports such as:
- to jog
- Walking
- hike
- swim
- Ride a bike
Power and high performance sports are not recommended for hypertension.
Medical therapy
Hypertension (high blood pressure, hypertension) a helping therapy drugs further if general measures such as diet, weight loss, stress reduction and exercise alone does not bring adequate and lasting success. During the treatment of hypertension, it is necessary to have the blood pressure checked quarterly to every six months.
For hypertension treatment drugs from different classes of drugs are available. Everyone receives an individually fitting hypertension therapy. The challenge is to use the most effective yet tolerable antihypertensive agents , ideally suited for lifelong treatment. Among the standard medications include high blood pressure:
- Dehydrating medications ( diuretics ): Diuretics such as the active ingredient Hydrochlorothiazid ensure that you excrete more water and salts through the kidneys. The blood vessels are therefore less strongly filled with liquid - the pressure in the vessels decreases. The diuretics include so-called thiazide diuretics, loop diuretics, potassium-sparing diuretics and so-called aldosterone antagonists such as the active ingredient spironolactone.
- Drugs that Slow the Heartbeat ( Beta-blockers ): Beta-blockers such as Atenolol or Metoprolol cause a slower heart rate, causing blood pressure to drop. They also shield the heart against stress hormones. For asthma and a very slow heartbeat, you should only take beta-blockers after consulting with your doctor and taking a risk assessment.
- Drugs that Inhibit the Action of the Protein ACE ( ACE Inhibitors ): ACE is involved in the production of the hormone angiotensin II, which increases blood pressure. If ACE is blocked, the blood pressure drops as well. Examples are the active ingredients ramipril, enalapril and captopril.
- Medicines that reduce the effect of calcium ( calcium antagonists, calcium channel blockers ): calcium leads to increased tension of the blood vessels. If the calcium channel is blocked at the vessels, the blood vessels dilate again. Examples are the active substances verapamil, nifedipine and amlodipine.
- Drugs that block the receptors of the hypertensive hormone angiotensin II ( angiotensin II receptor blockers, AT1 antagonists or "sartans" ). Examples are the active ingredients valsartan, candesartan and losartan.
In addition, there are three therapy strategies available for medicinal hypertension treatment :
- Step therapy: You receive a high blood pressure first, a blood pressure-lowering drug, with insufficient effect, the doctor can give you another drug.
- Combination Therapy : From the start of treatment you will receive certain low-dose combination preparations.
- Sequential monotherapy: If a drug has not achieved the desired effect, the doctor exchanges this for another, until your blood pressure drops significantly.
A very high blood pressure, concomitant diseases or existing organ damage require a combination therapy. This is the case with the majority of hypertensives. Two drugs are used simultaneously against hypertension in the form of a prescribed combination preparation and in the lowest possible dosage. If the success achieved is permanently insufficient, it is possible to increase the dose or to use a triple combination (e.g. diuretic with ACE inhibitor and calcium antagonist). The drugs have their full effect within two to six weeks.
7. History
In high blood pressure (high blood pressure, hypertension) the course depends to a high degree on an early therapy. High blood pressure usually runs free of complaints for years to decades. The level of blood pressure also increases the likelihood of developing a sequelae disorder. If the high blood pressure continues untreated, it can damage the heart, blood vessels, brain, eyes and kidneys. However, with appropriate therapy and a change in lifestyle, blood pressure can be reduced to normal levels.
Crucial to the success of a treatment is that the affected people themselves contribute to changing their lifestyle and to take the medication regularly and in the long term. In special training programs, hypertensives can therefore find out about the handling of high blood pressure and treatment options.
When not treated in time high blood pressure, many sufferers from the complications of high blood pressure: about half of the consequences of coronary heart disease (heart attack), a third of circulatory disorders in the brain ( stroke ) and up to 15 percent of kidney failure .
complications
An untreated or inadequately treated high blood pressure (high blood pressure, hypertension) can cause various complications in the further course . Affected are primarily the heart and vascular system, the brain blood supply and the kidneys. Other diseases such as diabetes mellitus often occur in combination with high blood pressure.
The complications associated with hypertension (high blood pressure, hypertension) often affect the cardiovascular system: high blood pressure leads to constant pressure in the cardiovascular system. This enlarges the left ventricle, which can lead to heart failure (heart failure).
High blood pressure also promotes hardening of the arteries (atherosclerosis) in the coronary vessels and in other body regions. Symptoms like angina pectoris or a heart attack can be the result. High blood pressure is considered a risk factor for coronary heart disease , in which the coronary arteries are narrowed. Arteriosclerosis can lead to circulatory problems in the legs. Hypertensive agents also increase the risk that the aorta widens (aortic aneurysm), which can subsequently rupture and lead to life-threatening bleeding.
Among the parts of the body that are often affected by complications in high blood pressure (high blood pressure, hypertension) is the brain: High blood pressure is the biggest risk factor for a stroke . Up to 70 percent of all strokes in people over the age of 65 occur as a result of hypertension.
The complications that occur in the course of high blood pressure often affect the kidneys as well: kidney diseases (shrinking kidneys) or even kidney failure are possible; High blood pressure is the most common cause of progressive chronic kidney failure (renal insufficiency): the increased blood pressure damages the small vessels in the kidney and functional kidney areas die. The overall function of the kidney decreases - until acute renal failure. Kidney damage from high blood pressure is the third most common reason why people need to dialysis (blood wash).
8. Prevent
If you want to prevent hypertension (high blood pressure, hypertension) or delay the course, you can do a lot. Lifestyle changes can be instrumental in helping to lower high blood pressure levels - or prevent hypertension from occurring.
With regular exercise, healthy diet Stress reduction and a normal weight, you can do something good for the blood pressure and keep the values permanently in the normal range!If you are already taking medicines for high blood pressure, it is advisable to follow the individual therapy in order to achieve permanently stable blood pressure values.