High Blood Pressure: What is Arterial Hypertension?

Arterial hypertension is often silent, unnoticed, insidious and yet it affects vessels and organs throughout the body and increases the risk of heart attack and stroke up to ten times.

The Definition of Arterial Hypertension

Arterial hypertension, sometimes shortened to "hypertension" or "hypertonus", colloquially simply high blood pressure, is an abnormally high pressure in the arteries.

According to the WHO, this means a blood pressure of 140 systolic to 90 millimetres diastolic mercury column (mmHg for short) in practice measurements, 130/80 mmHg in 24-hour outpatient measurements and an average of 135/85 mmHg in home measurements. Systolic means the pressure in the vessels during the tension phase of the heart, when blood is pumped to the organs, and diastolic, when the heart muscle relaxes.

Although this is hardly noticeable, narrowing of the vessels (arteriosclerosis) and fatal heart disease can be the result. More than 20% of Central Europeans have high blood pressure, and only one in four people over 60 has normal blood pressure. Because the symptoms are often not noticeable at first, only a small proportion of those affected are treated in time.

Medicine distinguishes between primary (also essential) and secondary hypertension.

Secondary hypertension refers to an increase in blood pressure that is caused by another disease or an external influence, e.g. medication, hormone imbalances, hyperthyroidism, kidney problems, malformations of the aorta or drugs. Treatment of the causative disease is important in this case in order to lower the high blood pressure again.

For example, contraception with a hormone-containing preparation or hormone treatment during the menopause can influence blood pressure. Similarly, the menopause can promote high blood pressure because during this time a woman's oestrogen levels drop, which has a blood pressure-lowering effect.

Primary hypertension has no recognisable physical causes, is multifactorial and has not been conclusively scientifically clarified. However, its risk factors are known. If the primary hypertension is very difficult to control with medication, the presence of secondary hypertension must be considered. Sometimes primary hypertension can only be treated by reducing the risk factors.

The WHO also divides stages of hypertension according to the degree of damage: Hypertension grade 1 means hypertension without damage to the end organs. Hypertension grade 2 is used for mild damage and hypertension grade 3 for severe organ damage and secondary diseases.

High blood pressure is considered one of the four major risk factors for cardiovascular disease, along with diabetes mellitus, smoking and elevated cholesterol (hypercholesterolaemia).

The Symptoms and Consequences of High Blood Pressure

Arterial hypertension is often asymptomatic for a long time. The first symptoms may be a headache in the morning, insomnia, nausea, nosebleeds, fatigue, a red head, mental tensions and dizziness. In the course of time, shortness of breath, changes in the feeling of thirst and visual disturbances may occur.

Over time, high blood pressure hardens the blood vessels and promotes fatty deposits that impede blood circulation (constriction, arteriosclerosis). The list of possible consequences is then unfortunately long:

• renal insufficiency and failure (hypertensive nephropathy)
• heart attack
• stroke
• angina pectoris
• heart failure (or hypertensive heart disease HHK with heart failure)
• atrial fibrillation
• eye damage (hypertensive retinopathy)
• dementia 

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Risk Factors for High Blood Pressure

Promoting risk factors are accordingly the same as for other heart diseases: Smoking, obesity, excessive alcohol and drug consumption, too much salt and unhealthy fat in the diet, too little exercise,  nocturnal pauses in breathing, old age, heredity.

Psychosomatic factors have also been recognised for years as favouring factors, such as stress due to work situations, stressful family situations or anxiety.

Diagnosis and Therapy of Arterial Hypertension

In order to diagnose arterial hypertension, blood pressure must be measured. 140/90 mmHg in a single measurement is not sufficient for a diagnosis. Only when elevated values are measured in at least three measurements within a few weeks can we be sure that there is elevated blood pressure. However, it is not always trivial to make the diagnosis, as some patients' blood pressure is only too high or fluctuates greatly under certain circumstances. In such situations, it is best to invest more time in clarification. An example of this is the so-called "practice or white coat hypertension". Some patients are nervous during a doctor's visit, which can manifest itself in short-term high blood pressure.  In order to detect this temporary increase, patients can measure their blood pressure themselves at home or a long-term blood pressure measurement can be arranged.

The basis of the therapy is a change in lifestyle: heart-healthy diet, sufficient exercise, adequate sleep, weight reduction, smoking cessation, minimising the consumption of alcohol, sugar, salt, saturated fats and stress reduction.

Drug therapy is usually used for severely elevated blood pressure. There are many different active substances available, which are often combined with each other. If patients have side effects from the medication, it is almost always possible to find an active substance that is well tolerated.

One of the most common secondary diseases of untreated high blood pressure is heart failure or arteriosclerosis. This is when additional outpatient and inpatient therapies come into play to widen constricted vessels. (coronary angioplasty).

Below you will find an overview, recommendations and further reading on the subject of high blood pressure. Are you interested in an expert clarification of your symptoms or a cardiological check-up? We are happy to be at your disposal at our Heart Centre in Zurich.