Hypertension

Introduction

High blood pressure - also known as arterial hypertension or hypertension - is a widespread disease in industrialised nations: according to estimates, one in four people in Switzerland suffers from high blood pressure. One in two people over the age of 60 has high blood pressure. Those affected often do not realise that they have high blood pressure, as high blood pressure does not cause any symptoms, at least initially. In the long term, however, high blood pressure can damage the heart, blood vessels, brain, eyes and kidneys. In addition to chronic organ damage, it also favours serious acute illnesses such as heart attacks and strokes. Blood pressure is considered elevated if the values are 140/90 mmHg or higher. However, those affected can do a lot to counteract high blood pressure: a healthy lifestyle helps to lower blood pressure and prevent secondary diseases. However, some patients also need additional medication to normalise their blood pressure.

Symptoms

In many cases, sufferers do not realise that they have hypertension, as high blood pressure does not cause any symptoms or pain - at least not at the beginning of the disease. It often takes years or decades before the first symptoms appear, either due to acutely high blood pressure or permanent organ damage. Possible symptoms can include headaches, heart palpitations, shortness of breath, dizziness, impaired vision or erectile dysfunction.

In a so-called "hypertensive emergency", the blood pressure is severely elevated - symptoms such as headaches, nosebleeds, visual disturbances or even serious complications such as stroke and heart failure occur. Those affected must be hospitalised immediately.

Progression

Hypertension usually progresses for years or even decades without any symptoms. However, if high blood pressure remains untreated, various organs are damaged in the long term and can cause the following symptoms:

• Heart: shortness of breath, chest pain, palpitations, water retention
• Brain: headaches, dizziness, sensory disturbances, paralysis, attention deficit disorder, dementia
• Eyes: visual disturbances
• Leg arteries: Pain when walking ("intermittent claudication")
• Kidneys: frequent and nocturnal urination

The risk of suffering a heart attack or stroke is twice to ten times higher in people with high blood pressure compared to healthy people.

Causes

In most cases, doctors are unable to identify a direct cause in patients with high blood pressure - in these cases, specialists refer to it as primary hypertension. Several factors favour the development of high blood pressure: hereditary predisposition, obesity, lack of exercise, stress, excessive salt and alcohol consumption, and smoking. In general, the incidence increases with age - while five to ten per cent of 30 to 39-year-olds are affected by high blood pressure, this figure rises to more than half for the over-60s.

In rarer cases (around ten per cent), illnesses such as kidney disease, sleep apnoea and hormonal disorders are the cause of high blood pressure. This is known as secondary hypertension. Medication (e.g. hormone preparations such as contraceptives, corticosteroids or anti-rheumatic drugs) or drugs can also be responsible for high blood pressure.

Diagnosis

Diagnosis
Several measurements are necessary to reliably diagnose high blood pressure, as blood pressure fluctuates throughout the day (for example after sporting activities). Some people are nervous when a doctor measures their blood pressure, which can lead to elevated blood pressure - also known as "white coat syndrome". Several measurements should therefore be taken on different days to make a diagnosis. Even more reliable is a 24-hour outpatient measurement, in which a blood pressure profile can be created over 24 hours under normal everyday conditions. Regular self-measurements including documentation at home are also a good method. It is also important for the specialist to know the exact living conditions and habits of the person concerned.
Two values are determined during a blood pressure measurement:

• The upper or systolic blood pressure value occurs when the pressure in the blood vessels is at its highest.
• The lower or diastolic blood pressure value is obtained when the heart relaxes and the pressure in the blood vessels is at its lowest.

The values are measured in millimetres of mercury (mmHg) and divided into the following categories:

• Optimal, no treatment: < 120 mmHg systolic, < 80 mmHg diastolic
• Normal, no treatment: 120-129 mmHg systolic, 80-84 mmHg diastolic
• High-normal, regular measurement and monitoring of values: 130-139 mmHg systolic, 85-89 mmHg diastolic
• Mild high pressure (level 1), medical treatment: 140-159 mmHg systolic, 90-99 mmHg diastolic
• Moderate high pressure (stage 2), medical treatment: 160-179 mmHg systolic, 100-109 mmHg diastolic
• Severe hypertension (stage 3), urgent medical treatment: > 180 mmHg systolic, > 110 mmHg diastolic
• Isolated systolic high blood pressure (only the first, upper value is too high), medical treatment: > 140 mmHg systolic, < 90 mmHg diastolic

Hypertension also exists if only one of the two values is above the defined limit. All patients with hypertension should measure their blood pressure twice a day at rest. The optimum time is between 6 and 9 a.m. and between 6 and 9 p.m.

Treatment

Treatment is generally necessary if the values reach 140/90 mmHg. If those affected only have mild to moderate hypertension, their blood pressure can be reduced to normal and healthy levels within a year by changing their lifestyle. Medication is not always necessary. Changing your lifestyle means reducing the risk factors for high blood pressure. The following measures support a reduction in blood pressure:

• Reducing excess weight
• A balanced diet (increased consumption of vegetables, fruit and fish)
• Limiting the intake of salt
• Regular exercise (at least 30 minutes five to seven days a week)
• Avoid smoking, drink little alcohol
• Avoiding contraception with hormone preparations if necessary

However, many patients require medication in addition to lifestyle improvements. Numerous medications are available for this purpose. Important substances include ACE inhibitors, angiotensin receptor blockers, diuretics, beta-blockers and calcium antagonists.

Despite taking antihypertensive medication, an unhealthy lifestyle should be changed, as medication could otherwise lose its effect. A healthy lifestyle, on the other hand, supports the effect of medication against high blood pressure. Many sufferers can take lower doses as the disease progresses or even stop taking medication altogether if they also adapt their lifestyle. Medication significantly reduces the risk of death and the number of heart attacks and strokes.

Prevention

A healthy lifestyle is not only recommended if you already have high blood pressure but can also help to prevent high blood pressure from developing in the first place. A healthy lifestyle also helps to avoid other risk factors such as high cholesterol or blood sugar levels.