Hypertension (hypertension) is a common disease. In Germany, 20 to 30 million people suffer from it. In the long run, high blood pressure damages the blood vessels and thus contributes to the development of secondary diseases such as heart attacks and strokes. Here you read everything important to causes, symptoms, dangers and treatment of hypertension!
Hypertension: Short overview
- Definition of hypertension: Blood pressure> 140/90 mmHg
- Possible consequences: Coronary heart disease, heart failure, heart attack, stroke, PAOD, retinal damage, kidney damage, etc.
- Common symptoms: Headache (especially in the morning), dizziness, easy fatigability, flushed face etc .; possibly also symptoms of secondary diseases such as chest tightness (angina pectoris), water retention in the tissue or blurred vision
- Treatment: Lifestyle change (lots of exercise and exercise, weight loss, healthy eating, smoking cessation, etc.), possibly antihypertensive drugs; Treatment of the underlying disease in secondary hypertension
- Watch out: In the event of a sudden, massive rise in blood pressure with signs of organ damage (hypertensive emergency), call the emergency physician immediately (emergency number: 112)!
Hypertension: definition
In high blood pressure (hypertension), the blood pressure levels are permanently too high. The blood pressure results from the fact that at each heartbeat blood is pumped from the heart into the blood vessels. The blood exerts pressure on the vessel wall from the inside. Depending on the heart action, one differentiates between two blood pressure values:
- Systolic blood pressure: It arises in the phase in which the heart contracts (systole). Blood is pumped from the heart into the main artery (aorta). The resulting pressure wave continues on through the arterial walls of the arteries. As a result, even in more distant body regions (such as the arms and legs) a pulse wave can be measured.
- Diastolic blood pressure: In diastole, the heart muscle expands to replenish itself with blood. There is still pressure in the vessels, but it is lower than the systolic blood pressure.
In every person, blood pressure is subject to fluctuations. For example, excitement and physical exertion raise blood pressure, while at rest or while sleeping it can be significantly lower. These blood pressure fluctuations are normal and are used to adapt to the particular situation. In healthy people, the blood pressure levels fluctuate again and again in the normal range. Only if the blood pressure is permanently too high, it must be treated.
By the way: The term hypertension is usually used in the sense of arterial hypertension (arterial hypertension), ie elevated blood pressure values in the systemic circulation as described here. But there are other forms of hypertension, such as high blood pressure in the pulmonary circulation (pulmonary hypertension, pulmonary hypertension). This text here deals only with arterial hypertension.
High blood pressure values
The measurement unit for blood pressure is mmHg (millimeters of mercury). For example, a reading of 126/79 mmHg (126 to 79) means that the systolic blood pressure is 126 and the diastolic pressure is 79 mmHg. When optimal blood pressure Doctors refer to values of less than 120 mmHg systolic and less than 80 mmHg diastolic. In addition, the following blood pressure reference ranges apply:
Degree division |
systolic |
diastolic |
normal |
120-129 mmHg |
80-84 mmHg |
High-Normal |
130-139 mmHg |
85-89 mmHg |
Hypertension grade I (mild hypertension) |
140-159 mmHg |
90-99 mmHg |
Hypertension grade II (moderate high blood pressure) |
160-179 mmHg |
100-109 mmHg |
Hypertension grade III (severe hypertension) |
≥ 180 mmHg |
≥ 110 mmHg |
Isolated systolic hypertension |
≥ 140 mmHg |
<90 mmHg |
The isolated systolic hypertension is a purely systolic hypertension. Diastolic blood pressure, on the other hand, is lowered. The cause is, for example, a dysfunction of the aortic valve (one of the heart valves).
Hypertension: Dangers
High blood pressure permanently damages important organs such as the heart and its supplying vessels (coronary vessels), the other blood vessels, the brain and the kidneys. This can cause life-threatening illnesses.
In the heart, high blood pressure can promote arteriosclerosis (vascular calcification) of the coronary arteries. These Coronary heart disease (CHD) can become one Heart failure (heart failure) or to Arrhythmia to lead. Also a Heart attack is possible.
In the brain of hypertensive patients, it is more common than in healthy people to one stroke, The circulatory disorders caused by high blood pressure can affect even the smallest vessels of the brain (microangiopathy). This results in a chronic lack of supply of the brain tissue with oxygen and nutrients. It impairs brain performance and promotes early intellectual decline (vascular dementia).
Vascular damage caused by high blood pressure also affects the kidneys and their function over time: possible consequence is chronic kidney weakness (chronic renal insufficiency) up to kidney failure.
The circulatory disorders, which develop as high blood pressure consequences, have a negative effect on other body regions. So, for example, in the legs peripheral arterial disease (PAD) develop. In the eyes, the retina is damaged, which affects the eyesight. Doctors speak of this hypertensive retinopathy.
The constant pressure load in the vessels can lead to the formation of sloughs on the vessel wall (aneurysms). They can burst, causing life-threatening internal bleeding. A particular danger is caused by aneurysms in the area of the aorta (aortic aneurysm) and in the brain (a bursting brain aneurysm causes a haemorrhagic stroke).
Benign and malignant hypertension
It used to be called “benign (essential) hypertension” if there is no crisis in blood pressure (exacerbations) during the course of the disease. Many experts reject this term meanwhile, because even a “benign” (= benign) hypertension is very dangerous and has an increased mortality rate.
As a counterpart to benign hypertension, the term “malignant” (malignant) hypertension was coined. It is defined by a constant massive high blood pressure (diastolic mostly> 120 mmHg), which leads untreated within five years in 95 percent of those affected to death.
Hypertensive crisis
At a hypertensive crisis (high pressure crisis) The blood pressure suddenly jumps dramatically up to levels above 230 mmHg (systolic) and / or 130 mmHg (diastolic). This can cause, for example, headache, dizziness, nausea and vomiting. If there are signs of organ damage due to massive increases in blood pressure (such as angina pectoris), this is called hypertensive emergency, Then there is mortal danger, and it must immediately Emergency doctor alerted be (emergency number: 112)!
A hypertensive crisis is usually seen in patients with chronic hypertension. It rarely occurs in people whose blood pressure levels are otherwise normal. The trigger can then be, for example, an acute renal corollary inflammation (acute glomerulonephritis).
Read more about the development, symptoms and treatment of the high-pressure crisis in the article Hypertensive Crisis.
Hypertension: symptoms
Most patients show few obvious hypertension symptoms, so the increased vascular pressure often goes unnoticed for a long time. Hypertension is therefore a “silent” danger. An early therapy is very important to prevent consequential damage. These can also occur without previous high blood pressure symptoms. That’s why it’s important to take serious signs of hypertension seriously:
- giddiness
- Headache, especially in the morning
- sleep disorders
- nervousness
- tinnitus
- Fatigue / easy fatigue
- nosebleeds
- shortness of breath
- reddened face
- nausea
Typical of high blood pressure a headachewho tend to sit in the back of the head and especially in the time shortly after waking up. This is a consequence of nocturnal hypertension; usually the blood pressure drops during sleep. If not, it may too Sleep-in and sleep-through disorders come. Especially people who in addition to sleep apnea suffer, then often feel the next day unausgeruht and like “blundered”. One slightly reddened face – sometimes with visible red veins (rosacea) – is also a possible high blood pressure indication.
Hypertension is not uncommon in nervousness and shortness of breath, Middle-aged women often misinterpret hypertension symptoms, such as menopausal symptoms or stress symptoms in general. If in doubt, it is definitely advisable to clarify high blood pressure as a possible trigger in case of conspicuous signs.
This is also true if someone is often dizzy for no apparent reason, as in hypertension dizziness also among the common symptoms counts. In some people, the signs of hypertension increase in the cold season.
Hypertension: Symptoms of sequelae
High blood pressure can – in the long term – as mentioned above – damage organs. Then, people with hypertension have warning signs emanating from these organs. These can be, for example:
- Chest tightness and heartache (angina pectoris) in coronary heart disease (CHD)
- reduced efficiency and water retention (edema) in heart failure (heart failure)
- Pain in the legs in peripheral arterial disease (PAD)
- decreasing visual acuity and visual field defects in hypertensive retinopathy
Sometimes hypertension is first diagnosed by a heart attack, stroke or other serious complication. Therefore, it is particularly important not to overlook high blood pressure symptoms and to take regular checkups. This prevents such serious consequential damage.
Hypertension: causes and risk factors
Doctors distinguish between two basic forms of hypertension regarding cause:
- Primary hypertension: There is no underlying disease that can be detected as a cause of high blood pressure. This essential hypertension accounts for approximately 90 percent of all high blood pressure cases.
- Secondary hypertension: Here, the hypertension is based on another disease as a trigger. These can be, for example, kidney disease, thyroid dysfunction or other metabolic diseases.
Primary hypertension: causes
What exactly causes the primary hypertension is not yet known. However, several factors are known which favor the development of this form of high blood pressure:
- familial tendency to high blood pressure
- Overweight (body mass index = BMI> 25)
- lack of exercise
- high salt consumption
- high alcohol consumption
- low potassium intake (a lot of potassium is in fresh fruits and vegetables, dried fruit or nuts)
- Smoke
- older age (men ≥ 55 years, women ≥ 65 years)
Apparently there is also a connection between hypertension and menopause in women: High blood pressure occurs more frequently in women after the end of the fertile years.
There is also another, often underestimated factor in hypertension: stress, Although he is not considered the sole cause of high blood pressure. However, in people with a tendency to hypertension, stress is almost always negative.
Above average frequency of primary hypertension occurs together with other diseases. These include:
- overweight
- Type 2 diabetes
- elevated blood lipid levels
If these three factors occur simultaneously with high blood pressure, doctors speak of Metabolic syndrome.
Secondary hypertension: causes
In secondary hypertension, high blood pressure causes are found in another condition. These are usually kidney diseases, metabolic disorders (for example Cushing’s syndrome) or vascular diseases.
So can Narrowing of the renal arteries (Renal artery stenosis) as well chronic kidney disease (e.g., chronic glomerulonephritis, cystic kidney) may be causes of hypertension. The same is true for a congenital Narrowing of the main artery (Aortic stenosis).
Also triggers the secondary hypertension can Sleep Apnea Syndrome be. This is a breathing disorder while sleeping.
Also drugs come as high blood pressure causes in question. These include, for example, hormones (such as the “anti-baby pill”) and rheumatism. Last but not least, certain drugs such as cocaine and amphetamines cause abnormal blood pressure.
Rarely come Disorders of hormone balance as high blood pressure cause. These include:
- Cushing’s syndrome: In this hormonal disorder, the body produces too much cortisol. This hormone affects many metabolic processes and is released during stress, among other things.
- Primary hyperaldosteronism (Conn syndrome): Overproduction of the hormone aldosterone due to a disorder in the adrenal cortex (such as a tumor).
- pheochromocytoma: This is a mostly benign adrenal tumor that produces stress hormones (catecholamines such as norepinephrine, epinephrine). This hormone overproduction leads to hypertensive episodes of headache, dizziness and palpitations.
- acromegaly: Here produces a (usually benign) tumor in the anterior lobe of the pituitary gland unchecked growth hormones. This enlarges certain parts of the body such as hands, feet, lower jaw, chin, nose and eyebrow ridges.
- Androgenital syndrome: The inherited metabolic disease leads to a disturbed production of the hormones aldosterone and cortisol in the adrenal gland. The cause of the disease is a genetic defect that is untreatable.
- Thyroid dysfunction: Hypertension also occurs more frequently in connection with hyperthyroidism (hyperthyroidism).
Hypertension and sports
The physical stress of sports raises the blood pressure. This is usually not a problem for people with healthy blood pressure. In hypertensive patients, on the other hand, levels may rapidly increase to a dangerous level. Especially in sports such as strength training with heavy weights sometimes threatening blood pressure peaks occur. This is especially the case when weight-lifting is associated with pressure-breathing.
Nevertheless, sports with high blood pressure is recommended in many cases – in the form of the right sport and in an individually suitable training intensity. For example, many hypertensive patients benefit from regular moderate endurance training. In the best case, the high blood pressure can be lowered even a bit by sport.
Hypertension in pregnancy
High blood pressure in pregnancy may have been triggered by the pregnancy itself. Such a Pregnancy-related high blood pressure develops after the 20th week of pregnancy (SSW). If, on the other hand, hypertension existed before pregnancy or develops until the 20th week of gestation, it is considered pregnancy-independent.
Pregnancy-related hypertension is often uncomplicated and usually disappears by itself within six weeks after birth. It may also be the starting point for hypertensive pregnancy disorders such as pre-eclampsia, eclampsia and HELLP syndrome. These diseases can develop rapidly and become a danger to both mother and child. Therefore, the doctor checks the blood pressure of pregnant women regularly as part of the check-ups.
pre-eclampsia
If pregnant women suffer from hypertension and increased protein excretion via the urine (proteinuria) after the 20th week of pregnancy, preeclampsia is present. The affected women also have mostly water retention in the tissue (edema).
Pre-eclampsia is one of the so-called pregnancy poisoning (gestosis). Failure to receive medical treatment can lead to life-threatening seizures (eclampsia).
Read more about this pregnancy-related form of high blood pressure disorder in the article Preeclampsia.
Hypertension: examinations and diagnosis
Many sufferers live for years with high blood pressure (hypertension), without noticing. They feel good because excessive blood pressure often causes no long-term discomfort. Everyone should therefore know their blood pressure values, check them regularly and have them checked by the doctor.
Measure blood pressure
The most important test to detect hypertension is blood pressure measurement. However, the one-time measurement does not say anything about whether the blood pressure is in need of treatment or not. The blood pressure fluctuates during the day and is about increased after exercise or coffee enjoyment. Some patients are nervous when doctor measures blood pressure, which can temporarily increase blood pressure. This phenomenon is also called “white-collar syndrome”.
Overall, therefore: To obtain meaningful blood pressure values are repeated measurements (for example, at three different times). Also Long-term measurements (over 24 hours) are useful for the diagnosis of hypertension. Through them, the doctor can observe daily fluctuations.
Further diagnostic steps
In most cases, the doctor also asks the patient about existing pre-existing conditions that may be the cause of secondary hypertension. These can be, for example, kidney or thyroid disorders.
Maybe they are too Blood and urine tests or one Ultrasound examination of the kidneys necessary. They help to distinguish a primary from secondary hypertension. In addition, they may indicate risk factors for cardiovascular disease (such as increased lipid levels) and possible organ damage (e.g., abnormal kidney values).
Also one physical examination belongs to the clarification of hypertension. It also helps to estimate the individual’s cardiovascular risk to detect possible signs of blood pressure-related organ damage. Often, the high blood pressure is not recognized until it has already damaged the blood vessels (for example arteriosclerosis). Above all, the vessels of the heart, brain, kidneys and eyes are affected. Over time, the heart muscle also takes damage, and heart failure (heart failure) is the result. For a more detailed investigation of possible sequelae can more Examinations of eyes, heart and kidneys be necessary.
Hypertension: treatment
How the therapy of hypertension should look in each case depends on various factors. The most important factors are the level of blood pressure and the individual risk of complications such as CHD (coronary heart disease), heart attack or stroke. In addition, the doctor takes into account the age of the patient and any existing underlying / comorbidities such as diabetes mellitus in the treatment planning.
The German high pressure league recommends to almost all Hypertonikern, the blood pressure on below 140/90 mmHg to lower. For certain groups of patients, however, they are easy different recommendations:
- In “frail” elderly patients and those over 80, hypertension therapy should target systolic blood pressures between 140 and 150 mmHg.
- In patients with kidney disease (nephropathy) and concomitant proteinuria, a systolic blood pressure of less than 130 mmHg may be useful.
- In diabetic patients, an attempt should be made to lower the diastolic blood pressure to 80-85 mmHg.
The doctor also adjusts the recommendations for the target values of the blood pressure individually.
Lowering blood pressure: What you can do yourself
The basis of hypertension therapy is a lifestyle change. This includes, for example, trying to reduce existing overweight. The right diet and regular exercise help. Both are also recommended for high blood pressure patients who do not put too many kilos on the scales.
It is also advisable to abstain from smoking in case of hypertension so as not to exacerbate the cardiovascular risk. Also recommended are stress relief and relaxation techniques such as autogenic training or yoga.
In addition, many patients are trying to reduce elevated blood pressure levels to a healthier level with home remedies or alternative healing methods such as homeopathy.
You can read more about what you can do even with high blood pressure in the article Reduce blood pressure.
Medicines for hypertension
If a lifestyle change is not enough to lower high blood pressure, the doctor prescribes additional antihypertensive drugs (antihypertensives). There are five main groups of drugs that are preferred for the treatment of high blood pressure. They reduce blood pressure reliably and are usually well tolerated. They include:
- ACE inhibitors
- AT1 antagonists (angiotensin receptor blockers, sartans)
- Beta blockers
- Diuretics (dehydrators, “water tablets”)
- Calcium antagonists
When which drugs are best suited depends on the individual case. In addition, sometimes taking a single drug is enough to lower the high blood pressure sufficiently (monotherapy). In other cases, a combination of different drugs is necessary (combination therapy), for example, an ACE inhibitor and a calcium antagonist.
at secondary hypertension It is not enough just to take antihypertensives. It must be treated the underlying disease. For example, narrowed renal arteries (renal artery stenosis) can be expanded in a surgical procedure. This can lower high blood pressure.
Hypertension: disease course and prognosis
The hypertension prognosis differs from patient to patient and can not be generally predicted. The course of the disease depends on several factors. These include, for example, the level of blood pressure and the presence of other comorbidities. Generally, the sooner high blood pressure is detected and treated, the lower the risk of complications such as heart attack or stroke. If hypertension is not treated, the risk of consequential damage increases.
In order to keep an eye on the blood pressure values and to recognize possible secondary diseases early, should high blood pressurePatients perform regular check-ups at the doctor.
Additional information
Book recommendations:
- Hypertension: Prevent, Detect, Treat (Anke Nolte, Stiftung Warentest, 2016)
- High blood pressure. Compact Guide: Effective Prevention and Self-Help with Increased Values (Dr. med. Eberhard J. Wormer, Mankau Verlag, 2017)
- The great cookbook for hypertension: All the important information for a blood pressure-lowering diet. 130 recipes for the whole family (Sven-David Müller, Schlütersche Verlag, 2015)
guidelines:
- ESC Pocket Guidelines “Guidelines for the management of arterial hypertension” of the German Cardiac Society – Cardiovascular Research and the German Hypertension League (2013)
Support Groups
German high-pressure league e.V. DHL
www.hochdruckliga.de