High blood pressure:
How it develops and how it can be lowered

Most people who suffer from high blood pressure do not have any symptoms. As a result, it often remains undetected, which is problematic as secondary diseases may develop during this phase.

Possible signs of high blood pressure include:

• Dizziness
• Headache (predominantly in the morning)
• Fatigue/exhaustion
• Nervousness
• Sleep disorders
• Ringing in the ears
• Nosebleeds

At a later stage, when the organs are already damaged, further symptoms may develop:

• Shortness of breath
• Difficulty breathing
• Chest tightness, chest pain (angina pectoris)
• Visual and sensory disorders, visual field deficits

In most cases (about 90%), there is no cause or underlying disease behind high blood pressure. In the remaining cases, kidney disease, a thyroid disorder or other metabolic disorders may be the trigger for the sustained increase in blood pressure.

However, there are also some factors that promote high blood pressure:

• Genetic predisposition
• Being overweight (body mass index 25 and above) or obese
• Lack of exercise
• High alcohol consumption
• Smoking
• Age (between 55 and 65 years)
• Type 2 diabetes

Hormonal changes can also play a role in women, who are usually diagnosed with high blood pressure during or after the menopause. Psychological factors, such as constant stress, can have an effect as well.

High blood pressure can also occur during pregnancy – usually around the 20th week. This pregnancy-related hypertension usually disappears on its own a few weeks after birth.

Since many sufferers do not experience any symptoms at first, it makes sense to have regular blood pressure checks during visits to the doctor. However, one measurement alone is not enough to be able to make an exact diagnosis. Blood pressure fluctuates and many patients are nervous at the doctor’s, so the value may be increased and not representative.

Measurements must therefore be taken at least three times at different times of the day. Alternatively, a long-term measurement can be carried out. For this, the patient carries a device on their body for 24 hours that automatically takes blood pressure measurements.

In the subsequent medical history discussion, the doctor asks questions about possible pre-existing conditions, e.g. a thyroid disorder, as well as risk factors such as smoking, lack of exercise and being overweight. If there is evidence of cardiovascular disease, the doctor may also order an exercise test on an exercise machine.

Other diagnostics include:

• Blood tests
• Urine analysis
• Ultrasound of the heart (echocardiography) and kidneys
• Electrocardiogram (ECG)
• X-rays
• Examination of the eyes

Treatment for high blood pressure varies from person to person and depends primarily on how high the blood pressure is and the risk of coronary heart disease. Age and pre-existing illnesses also play a role.

The aim of all treatment is to lower blood pressure. Ideally, the value should be between 130/80 mmHg and 120/70 mmHg in patients without pre-existing conditions. In older patients, the systolic value may also be slightly higher.

For hypertension, the treating doctor usually prescribes medication in tablet form:

• Beta blockers
• ACE inhibitors
• AT1 antagonists (angiotensin receptor blockers, sartans)
• Calcium antagonists
• Diuretics (water tablets)

A combination of several drugs may also be used.

The longer the high blood pressure persists, the greater the risk of organ damage and secondary diseases. It is therefore important to detect and treat hypertension at an early stage. Otherwise, the following diseases may develop:

• Heart failure caused by constant pressure on the heart, which can enlarge the left ventricle. This increases the risk of heart attacks.
• Strokes: high blood pressure can lead to brain damage.
• Kidney damage: high blood pressure damages vessels in the kidney. As a result, renal tissue dies and the kidneys’ performance deteriorates.

Patients with high blood pressure do not have to resign themselves to the diagnosis. They can help to reduce their blood pressure themselves. Possible steps include maintaining an active lifestyle with plenty of exercise, eating a healthy diet and avoiding constant stress. Tobacco and alcohol consumption should also be reduced.

If you find it difficult to lose weight, join a self-help group. It can also help if patients involve their family in their new way of life, e.g. by engaging in sporting activities or preparing healthy meals together. In this way, those affected do not feel alone or excluded.