High Blood Pressure (Arterial Hypertension)

From hypertension – colloquially called high blood pressure – (synonyms: Arterial hypertension; arterial hypertension; hypertension; hypertensive disease; hypertension – arterial; hypertension; essential hypertension; ICD-10-GM I10.-: Essential (primary) hypertension) is when blood pressure is permanently elevated to values greater than 140 mmHg systolic and/or greater than 90 mmHg diastolic. One can only speak of “hypertension” when pathological (pathological) values are measured after blood pressure has been measured at least three times at different points in time. For the different definitions of hypertension, see Classification. Arterial hypertension can be divided into the following forms:

  • Primary (essential or idiopathic) hypertension – in this form, the cause is unknown; up to 95% of hypertensions are counted in this group
  • Secondary hypertension – in this form of hypertension, there are very many possible causes; however, usually then there is a disorder of hormone secretion or kidney damage (5% of cases).
  • Hypertensive crisis (malignant hypertension, hypertensive emergency) – increase in blood pressure to values of > 230/120 mmHg; with a short duration, no organ damage occurs; with a longer duration, organ damage (high pressure encephalopathy with visual disturbances, changes in consciousness, neurological deficits and convulsions/muscle cramps; intracranial hemorrhage (bleeding within the skull; parenchymal, subarachnoid, sub- and epidural, and supra- and infratentorial hemorrhages)/intracerebral hemorrhage (ICB; cerebral hemorrhage), vertigo (dizziness) or Consciousness disorder, papilledema papilledema (congestion papilla usually bilateral) at the back of the eye, pulmonary edema (water retention in the lungs), unstable angina pectoris (“chest tightness” with inconstant symptoms), myocardial infarction (heart attack) and descending aortic aneurysm / vascular outpouching) to expect.
  • Isolated systolic hypertension (ISH) – in this form, the systolic blood pressure value is > 140 mmHg, while the diastolic blood pressure value is in the normal range; the main feature of elevated isolated systolic blood pressure is arterial stiffness; low diastolic blood pressure is considered an indicator of increased cardiovascular risk in patients with ISH
  • Isolated diastolic hypertension (IDH) – in this form, the systolic blood pressure value is < 140 mmHg and the diastolic value is > 90 mmHg

Another special form of hypertension is the “masked hypertension” (Engl. masked hypertension). This is the phenomenon of normal blood pressure values in practice and elevated values in everyday life, especially at work. Approximately 50% of hypertensive patients are unaware of their condition, and the rest receive insufficient or no treatment. Frequency peak: Systolic blood pressure correlates with age. Diastolic blood pressure reaches its maximum at about age 60 in men and about age 70 in women. Thereafter, diastolic blood pressure decreases again. The prevalence (disease frequency) is 50-60% in older people (in Germany). In people over 75 years of age, up to 70 % suffer from hypertension. In western Germany, the prevalence is 24%, and in eastern Germany, it is 30%. The prevalence for secondary hypertension is about 5%. In Europe, the prevalence for hypertension is about 50%. About 25% of men and about 15% of women do not know they have hypertension. Also, only about 25% of male and about 40% of female hypertensive patients in the studies had satisfactory treatment with blood pressure values of less than 160/95 mmHg, that is, had reached the state of “controlled” hypertension. The large remainder of patients undergoing treatment had received inadequate treatment. Hypertension in childhood, adolescence, and adolescence is reported to be 2-12%. In contrast to older hypertensive patients, in 50-60% of younger patients the elevation of blood pressure is of secondary nature, so that in this group of patients further diagnostics are always necessary to detect primary diseases. Course and prognosis: Pharmacotherapy (drug treatment) plays the most important role in the treatment of primary hypertension. Furthermore, lifestyle changes have to be considered (giving up smoking, reducing alcohol consumption, weight reduction, starting/increasing sports activity, etc.).Untreated or poorly controlled blood pressure is a risk factor for diseases of the cerebral vascular system (vascular system of the brain) and the cardiovascular system (affecting the heart and vascular system). Likely sequelae include atherosclerosis (hardening of the arteries), apoplexy (stroke), myocardial infarction (heart attack), kidney damage (renal insufficiency), and damage to the eyes (retinopathy – changes in the retina leading to visual impairment). About 5-15% of all patients with hypertension have refractory arterial hypertension (unresponsive to therapy). The mortality risk (risk of death) depending on the time of diagnosis: The probability of mortality in hypertensive patients with a diagnosis age of less than 45 years was increased by 2.59 times compared to normotensives (patients with normal blood pressure) during the observation period of 6.5 years on average. Those diagnosed after age 65 still had a 29% increased risk of mortality compared with normotensives of the same age. Patients diagnosed with hypertension before age 45 had a 5.85-fold increased risk of hemorrhagic infarction (stroke due to spontaneous rupture/tear of a blood vessel). Caution. Diastolic blood pressure increases in younger patients are a serious risk factor and indicate increased mortality (number of deaths in a given period, relative to the number in the population in question).