High blood pressure (hypertension)

What is blood pressure actually?

It sounds strange at first, but blood is a liquid organ in the human body. Among other things, it can transport essential substances such as oxygen or nutrients through the body. For this purpose, it should be constantly in motion and move in orderly paths.

Since the blood in the body constantly circulates in the same blood vessels, it is also referred to as “blood circulation”. The drive for this is provided by the heart, whose function can be compared to that of a suction pump.

In order to fulfill their tasks throughout life, the blood vessels must be optimally adapted: they must be robust enough to transport the blood without loss, then branch out and become permeable sufficient to enable the exchange of substances and then the oxygen and transport nutrient-poor blood back again.

The fact that the heart beats about 60 times per minute and thus drives the blood forward creates a natural pressure in the vessels. This differs depending on which part of the cycle you are looking at.

In the arteries leading away from the heart, the pressure in a healthy adult is about 120 mmHg. As the process progresses, the pressure drops until it is only around 60 mmHg at times in the capillaries (small, heavily branched vessels where the exchange of substances takes place).

There is hardly any pressure left in the veins that bring the blood back to the heart. When one speaks of blood pressure in general usage, arterial blood pressure is meant.

What causes high blood pressure?

There are many reasons for high blood pressure. Sport, mental exertion, or nervousness can push it up in the short term. That’s a good thing because in stressful situations more oxygen gets into the muscles or the brain to cover the increased need. However, permanently elevated blood pressure is not desirable.

In about 10 percent of those affected, high blood pressure is triggered by other diseases. In this case, one speaks of “secondary hypertension”. The causative problem can be, for example, a disease of the kidneys, such as renal insufficiency or renal artery stenosis. However, a disruption in the hormonal balance, as is the case with Conn’s disease (also called Conn’s syndrome or primary hyperaldosteronism) or an overactive thyroid gland can cause hypertension.

Possible consequences of increased blood pressure

If the blood pressure is permanently too high, this can lead to a variety of secondary diseases. Because the walls, especially the small blood vessels, change due to the constantly increasing mechanical load. This change can lead to problems in various organs.

These include, for example:

• Heart and vessels
• Kidneys
• Brain
• Eyes

Diseases of the heart

In hypertension, the heart has to constantly pump against a higher pressure. Over time, this condition can “exhaust” the heart, resulting in heart failure. The vessels that supply the heart with blood itself (coronaries or coronary arteries) can also be damaged. In the worst case, this can promote a heart attack.

Vascular diseases

Apart from the organs, the vessels themselves can also become a problem, for example, due to a narrowing of the carotid artery (carotid stenosis) or an aortic aneurysm.

Diseases of the kidneys

The work of the kidneys is closely linked to blood flow. The proper functioning of the kidneys depends on the blood flowing through them at the right rate and at a constant rate. Long-term elevated blood pressure can lead to kidney failure.

Conversely, high blood pressure can also be the result of renal insufficiency.

Diseases of the brain

In the brain, high blood pressure can trigger strokes or dementia (ischemic or vascular dementia). Strokes can occur, for example, due to ruptured blood vessels as a result of high blood pressure.

Consequences for the eyes

A change in the vessels in the eyes can also have drastic consequences since the retina is a complex and sensitive part of the body. Constantly or extremely high blood pressure can lead to what is known as hypertensive retinopathy. This damage to the retina can lead to loss of vision over time.

How is high blood pressure diagnosed?

Since you do not feel the high blood pressure yourself and often there are no symptoms at first, you should have your blood pressure checked or checked at regular intervals by measuring both arms.

If direct symptoms occur as a result of high blood pressure, these are usually so unspecific that doctors or patients often cannot find the cause without further ado.

Insomnia, inner restlessness, and a “redhead with red cheeks” can also be indications of high blood pressure. It is important to note that many symptoms (such as headaches) could be both the cause and the result of hypertension.

The simplest method of diagnosis is blood pressure measurement on the arm, which can also be carried out for 24 hours at a time for a more precise diagnosis.

The next step should be further tests to find out whether the high blood pressure is primary or secondary (caused by another condition such as kidney failure).

Treatment options for high blood pressure

Especially in the early stages, it is not always necessary to treat high blood pressure with medication. A reduction in risk factors, such as being overweight or nicotine and alcohol consumption can already help to lower blood pressure again in the long term.

Lifestyle changes – treatment without drugs

The best thing you can do for your body is to lead a healthy lifestyle. This also applies to high blood pressure, which can possibly be regulated without medication by making lifestyle changes. This also helps to prevent many other diseases, such as diabetes mellitus.

There are a number of effective “lifestyle changes” that counteract high blood pressure. These include losing weight, exercising more, drinking less alcohol, and quitting smoking. A Mediterranean diet and reduced salt intake are also recommended. Those affected should therefore avoid cured and finished products.

There are numerous services, such as nutritional or addiction counseling, that can help you make changes to a healthier lifestyle. Talk to your family doctor about it.

Medication

If the blood pressure has reached a certain value, it should be treated with medication for high blood pressure. This is also referred to as “adjustment” with medication since the doctor and patient regularly check the tolerability and effectiveness of the therapy and adjust it to other risk factors if necessary. In principle, there are five groups of drugs that are used for high blood pressure:

At the beginning of the therapy, a so-called dual therapy usually takes place. That is, two of these drug groups are taken together. It is recommended to start with an ACE inhibitor or a sartan (AT1 receptor blocker) plus a thiazide diuretic or a calcium channel blocker.

Due to the possible side effects, beta-blockers should only be taken at the beginning of certain other symptoms such as angina pectoris (“chest tightness”) or heart failure is present.

It is usually started with a low dose, which is then increased until the desired blood pressure is reached. If the dual therapy is not sufficient even after a large increase in the dose, it is possible to switch to a triple therapy (e.g. diuretic + calcium antagonist + ACE inhibitor or sartan).

If the triple therapy does not have the desired effect either, the doctor treating you can also use an aldosterone antagonist such as spironolactone. In addition, potassium-sparing diuretics, peripheral alpha-1 blockers, central antisympathetic tonics, vasodilators, or renin inhibitors can be considered supplements to therapy.

Reference

https://www.nhs.uk/conditions/high-blood-pressure-hypertension