High blood pressure: Prevent, recognize, treat

1. What is high blood pressure?
2. What are the consequences of high blood pressure?
3. What increases the risk of high blood pressure?
4. How can high blood pressure be prevented?
5. How are high blood pressure, diabetes and obesity related?
6. What are the disorders (symptoms) in case of high blood pressure?
7. How is high blood pressure diagnosed?
8. How is high blood pressure treated?

High blood pressure is divided into different degrees of severity. These degrees have an influence on the therapy. There are a total of 3 degrees of severity. They are defined as follows:
 

Low blood pressure below 120/70 mmHg should also be avoided, as it can increase the risk of circulatory disorders.

More than a third of all Germans have high blood pressure (hypertension). Men are affected slightly more often than women. Especially in old age, the risk of high blood pressure increases significantly. When they are older than 65, more than 60 out of 100 people in Germany have hypertension.

Permanently elevated blood pressure can have serious consequences. It damages the small and large blood vessels and thus promotes calcification of the arteries (arteriosclerosis). These vessels can then no longer adequately perform their task of maintaining the blood flow to the organs. As potentially less blood reaches the organs, they are less well supplied with oxygen and nutrients and can be damaged.

Possible consequences of high blood pressure are:

• Heart attack
• Stroke
• Coronary heart disease (CHD)
• Heart failure (cardiac insufficiency)
• Renal insufficiency
• Circulatory disorders in the legs
• Damage to the eyes

People with high blood pressure also have an increased mortality risk.

There are various factors that can increase the risk of developing high blood pressure. Many of these are related to lifestyle and can be influenced. There are other causes of high blood pressure that cannot be changed.

The most important controllable risk factors for high blood pressure include:

• Severe overweight (obesity)
• Smoking
• High alcohol consumption
• Elevated blood sugar levels
• Elevated blood lipids
• Lack of physical activity
• Stress
• Kidney disease

Risk factors for high blood pressure that cannot be influenced are:

• Age: High blood pressure occurs more frequently with increasing age.
• Gender: Men fall ill more often than women.
• Hereditary (familial) factors: If close relatives (grandparents, parents) have high blood pressure, the likelihood of also developing high blood pressure is greater.

If high blood pressure is suspected because there are symptoms or risk factors for high blood pressure, your general practitioner will carry out a blood pressure measurement. This can be a 24-hour blood pressure measurement, requiring that you wear a blood pressure cuff and a measuring device on your body for 24 hours. Another option is to measure your blood pressure daily with a home blood pressure monitor over 7 days – twice in the morning and twice in the evening, each time 1 to 2 minutes apart. Your blood pressure is considered high if the daily average value (with 24-hour measurement) or the average value of all measurements in a week is 135/85 mmHg or higher.

For the direct diagnosis of high blood pressure in the doctor's office, 3 blood pressure measurements are taken at 2-minute intervals. An average value is calculated from the 2nd and 3rd measurements. A value of 140/90 mmHg or higher indicates high blood pressure.

High blood pressure can be treated with or without medication. In most cases, however, non-pharmacological measures, in particular lifestyle changes, are combined with the use of medication. Your attending physician will set individual target values for treating your high blood pressure.

Lifestyle changes that can lower blood pressure are:

• Nutrition: You should include plenty of fruit, vegetables, pulses, whole-grain products and low-fat milk and dairy products in your diet. Fish and nuts are also recommended, as well as lean meat if any. Try to avoid sugar or use it as sparingly as possible.
• Salt: If possible, eat no more than 6 grams of salt per day. This corresponds to about one teaspoon. Please note that many ready-made products contain a high amount of salt.
• Overweight: Try to reduce existing excess weight through a balanced diet with reduced calorie content and sufficient physical activity.
• Physical activity: Exercise regularly. Moderate-intensity activities are recommended, for example cycling or brisk walking, for a total of at least 2 hours per week. Clarify with your doctor in advance what needs particular attention during your physical activity and how strenuous the training should be.
• Stop smoking: Give up smoking and avoid passive smoking.
• Alcohol: Avoid alcohol or try to reduce your alcohol consumption as much as possible. Excessive alcohol consumption can increase blood pressure. According to current scientific knowledge, even small amounts of alcohol can be harmful.
• Relaxation: Learn relaxation techniques to reduce stress (e.g. yoga) and incorporate them regularly into your everyday life.

If lifestyle changes are not enough to lower blood pressure (sufficiently), there are various medications in tablet form that can be prescribed by a doctor. Which medication is most suitable for you depends on

• the severity of the high blood pressure,
• concomitant diseases, if any,
• your general state of health.

If you have diabetes in addition to high blood pressure, you may need a different antihypertensive agent than someone who has already had a stroke. Those with grade 3 hypertension (180/110 mmHg or higher) can benefit from a combination of 2 or more different antihypertensive drugs.