High Blood Pressure: Symptoms, Causes, Therapy

Brief overview

  • Symptoms: Headache (especially in the morning), nosebleeds, dizziness, easy fatigue, reddened face, shortness of breath, sleep disturbances, tinnitus, etc.; possibly symptoms of secondary diseases such as chest tightness, water retention in the tissues (edema) or visual disturbances
  • Causes and risk factors: unhealthy lifestyle (e.g. smoking, high-calorie diet, lack of exercise), stress, age, family predisposition, menopause and pregnancy, other diseases (e.g. metabolic disorders such as diabetes, organ damage such as kidney disease, cardiovascular disease), medications
  • Examinations and diagnosis: Physical examinations as well as blood pressure measurements (usually long-term blood pressure over 24 hours), blood and urine tests, kidney ultrasound, echocardiography
  • Treatment: Lifestyle changes (plenty of exercise and sport, losing weight, healthy diet, smoking cessation, etc.), possibly antihypertensive medication; treatment of the underlying disease in the case of secondary hypertension.
  • Prevention: Healthy lifestyle or diet, sufficient exercise, avoid or minimize stress, relaxation exercises, limit or stop smoking.

What is high blood pressure? When is blood pressure too high?

In high blood pressure (hypertension), blood pressure levels are permanently too high. Strictly speaking, high blood pressure is not a disease, but rather a risk factor for other, often chronic diseases.

Blood pressure levels are caused by the heart pumping blood into the blood vessels with every heartbeat, with the blood exerting pressure on the vessel wall from the inside. Depending on the heart’s action, physicians distinguish between two blood pressure values – a high and a low:

  • Diastolic blood pressure(lower value): In diastole, the heart muscle expands to allow the heart chambers to fill with blood again. There is still pressure in the vessels, but it is lower than the systolic blood pressure.

In every person, blood pressure is subject to certain fluctuations. For example, excitement and physical exertion cause blood pressure to rise, while it is significantly lower at rest or during sleep. These blood pressure fluctuations are normal and serve the physical adaptation to the respective situation. In healthy individuals, blood pressure values always settle back into the normal range. Only when blood pressure is permanently too high is treatment often necessary.

Blood pressure values

The unit of measurement for blood pressure is mmHg (millimeters of mercury). For example, a reading of 126/79 mmHg (read: 126 to 79) means that the systolic blood pressure is 126 and the diastolic is 79 mmHg. Physicians describe values of less than 120 mmHg systolic and less than 80 mmHg diastolic as optimal blood pressure. In addition, the following reference ranges for blood pressure apply:

Grade classification

Systolic

Diastolic

Normal

120-129 mmHg

80-84 mmHg

High-normal

130-139 mmHg

85-89 mmHg

Hypertension grade 1

(mild hypertension)

140-159 mmHg

90-99 mmHg

Hypertension grade 2

(moderately severe hypertension)

160-179 mmHg

100-109 mmHg

Hypertension grade 3

(severe hypertension)

≥ 180 mmHg

≥ 110 mmHg

Isolated systolic hypertension

≥ 140 mmHg

< 90 mmHg

High blood pressure in children and adolescents

High blood pressure affects not only adults, but also children and adolescents, especially during puberty. More and more young people have high blood pressure, which is why the European Society of Hypertension (ESH) recommends that blood pressure measurements should already be taken regularly with preventive checkups from the age of three.

Blood pressure levels in children and adolescents are usually lower than in adults. Because their bodies are still developing, it is not possible to set reference values like those for adults. The limits are based on the child’s sex, age and height. As with weight and height, there are so-called percentile curves that define the normal range of blood pressure in children. Thus, all values below the 95th percentile are unremarkable.

What are symptoms of hypertension?

Most patients show hardly any clear hypertension symptoms, so that the increased vascular pressure often goes unnoticed for a long time. High blood pressure is therefore a “silent” danger. However, early treatment is very important to prevent secondary damage. These occur even without preceding symptoms of high blood pressure. Therefore, it is important to take possible signs of high blood pressure seriously. These include:

  • Dizziness
  • Headaches, especially in the morning
  • Sleep disturbances
  • Nervousness
  • Ringing in the ears (tinnitus)
  • Tiredness/light fatigability
  • Nosebleeds
  • shortness of breath
  • reddened face
  • Nausea

A slightly reddened face – sometimes with visible red veins (couperose) – is also a possible sign of high blood pressure.

High blood pressure also often manifests itself in nervousness and shortness of breath. Middle-aged women often misinterpret these hypertension symptoms, mistaking them for menopausal symptoms or stress symptoms in general. The symptoms of hypertension often resemble menopausal symptoms. For example, women over 50 with high blood pressure are more likely to experience mood swings or hot flashes with increased sweating. If in doubt, it is always advisable to have high blood pressure clarified if there are any conspicuous signs.

This also applies if someone often feels dizzy for no apparent reason, as dizziness is also a common symptom of hypertension. For some people, signs of hypertension increase during the cold season.

Warning signs of secondary diseases

  • Chest tightness and heart pain (angina pectoris) in coronary artery disease (CAD)
  • Reduced performance and water retention (edema) in heart failure (cardiac insufficiency)
  • Pain in the legs in peripheral arterial disease (pAVK)
  • Decreasing visual acuity and visual field defects in hypertensive retinopathy

Sometimes doctors don’t diagnose hypertension until a heart attack, stroke or other serious complication occurs. Therefore, it is especially important not to overlook hypertension symptoms and to attend regular check-ups. In this way, such serious consequential damage can be prevented.

Does high blood pressure manifest itself differently in women than in men?

Most symptoms are comparable in women and men. However, there have been few gender-specific analyses to date, so it is not yet possible to make any comprehensive statements.

Furthermore, there are initial findings on gender differences in the mechanism underlying the development of hypertension. However, they are not yet sufficient to draw clear conclusions for a more targeted therapy.

What are the causes?

Physicians distinguish between two basic forms of hypertension in terms of cause:

  • Primary hypertension: In this case, there is no underlying disease that can be proven to be the cause of the high blood pressure. This essential hypertension accounts for about 90 percent of all cases of high blood pressure.
  • Secondary hypertension: In this case, the high blood pressure is triggered by another disease. These include kidney disease, thyroid dysfunction or other metabolic disorders.

Primary hypertension: Causes

Exactly what causes primary hypertension is not yet clearly understood. However, several factors are known to promote the development of this form of hypertension:

  • Overweight (body mass index = BMI > 25)
  • Lack of exercise
  • High salt consumption
  • High alcohol consumption
  • Low potassium intake (a lot of potassium can be found in fresh fruits and vegetables, dried fruits or nuts)
  • Smoking
  • Older age (men ≥ 55 years, women ≥ 65 years).

There also appears to be a link between hypertension and menopause in women: Hypertension occurs more frequently in women after the end of their fertile years. From the age of 75 years, on average, more women are affected by hypertension than men.

Other influencing factors

Primary hypertension occurs more often than average together with other diseases. These include:

  • Overweight or obesity (adiposity)
  • Type 2 diabetes
  • Elevated blood lipid levels

If these three factors occur at the same time as high blood pressure, doctors call it metabolic syndrome.

However, if you are overweight, starvation is not the appropriate solution to lower blood pressure. How to lower high blood pressure in a healthy way, read here.

Secondary hypertension: causes

In secondary hypertension, the causes of high blood pressure are found in another disease. In most cases, these are kidney diseases, metabolic disorders (for example, Cushing’s syndrome) or vascular diseases.

Sleep apnea syndrome is also considered a possible trigger of secondary hypertension. This is a breathing disorder during sleep.

Medications are also possible causes of high blood pressure. Examples include hormones (such as the birth control pill) and rheumatism medications. Last but not least, certain drugs such as cocaine and amphetamines usually increase blood pressure pathologically.

Less frequently, hormonal imbalances are considered to be the cause of high blood pressure. These include:

  • Cushing’s syndrome: In this hormone disorder, the body produces too much cortisol. This hormone influences numerous metabolic processes. Among other things, the body secretes more of it during stress.
  • Primary hyperaldosteronism (Conn syndrome): Overproduction of the hormone aldosterone due to a disorder in the adrenal cortex (such as a tumor).
  • Acromegaly: Here, a (usually benign) tumor in the anterior lobe of the pituitary gland produces uncontrolled growth hormones. This causes certain parts of the body to enlarge, such as the hands, feet, lower jaw, chin, nose and eyebrow ridges.
  • Androgenital syndrome: This inherited metabolic disorder results in impaired production of the hormones aldosterone and cortisol in the adrenal gland. The cause of the disease is a genetic defect that is not treatable.
  • Thyroid dysfunction: hypertension often occurs in association with hyperthyroidism.

This is where control centers for the circulatory system and also blood pressure are located, which fail when damaged. Constant tension in the spinal muscles due to a blockage in the upper back and neck further intensifies the negative effect on blood pressure.

Caution with certain foods

Coffee has often been said to promote high blood pressure when consumed in excess because of the caffeine it contains. However, experts disagree on this. Some studies show that moderate and especially regular coffee consumption does not have a negative effect. Experts even say that such regular consumption (one to three cups per day) has a positive effect on the mortality rate in hypertensive patients. Coffee has a negative effect on blood pressure especially when it is consumed only occasionally.

Coffee causes blood pressure to rise for a short time. Therefore, if possible, do not drink coffee shortly before a blood pressure measurement.

Sodium bicarbonate, also called sodium hydrogen carbonate, is believed to have a negative effect on blood pressure when consumed regularly. It has a similar effect to salt and binds a lot of water in the body, which causes blood pressure to rise. This is particularly problematic in the treatment of chronic kidney disease, where sodium bicarbonate is included in standard therapy. However, many people also use sodium bicarbonate to treat heartburn. Occasional use is apparently unproblematic. Check with your doctor about possible risks should you use it more frequently.

High blood pressure and sports

Nevertheless, sport is recommended in many cases of hypertension – with the right type of sport and at an individually suitable training intensity. Many hypertension patients benefit from regular moderate endurance training. In the best case, sport can even reduce high blood pressure.

Read more about how to lower high blood pressure with the help of exercise here.

High blood pressure after vaccination

Vaccinations are well tolerated by most people and are not dangerous. The vaccines used – both live and dead vaccines, as well as mRNA-based vaccines – affect the body in specific ways, specifically stimulating the immune system but not harming the body itself. Nevertheless, side effects or complications do occur in some cases.

High blood pressure during pregnancy

Pregnancy-related hypertension, i.e. high blood pressure triggered by the pregnancy itself, usually develops after the 20th week of pregnancy (SSW). On the other hand, if hypertension existed before pregnancy or develops by the 20th week of gestation, it is considered pregnancy-independent.

Pregnancy-related hypertension is often uncomplicated and usually disappears on its own within six weeks after birth. Sometimes, however, it is the starting point of hypertensive pregnancy diseases such as preeclampsia, eclampsia, and HELLP syndrome. These diseases sometimes develop quickly and pose a risk to both mother and child. For this reason, doctors regularly check the blood pressure of pregnant women as part of their preventive examinations.

Preeclampsia

Pre-eclampsia is one of the so-called pregnancy poisonings (gestoses). If it is not treated by a doctor, it can lead to life-threatening seizures (eclampsia) in the worst case.

You can read more about this pregnancy-related form of hypertension in the article Pre-eclampsia.

How can high blood pressure be detected?

Many people live with high blood pressure (hypertension) for years without realizing it. They feel healthy because high blood pressure often causes no symptoms for a long time. It is therefore good to know your blood pressure values precisely by checking them regularly yourself and having them checked by your doctor.

Measure blood pressure

Overall, therefore, the following applies: To obtain meaningful blood pressure values, multiple measurements (for example, at three different times) are helpful and necessary. Long-term measurements (over 24 hours) are also useful for diagnosing high blood pressure. Through them, the physician accurately observes diurnal fluctuations.

Without a suitable blood pressure monitor, blood pressure cannot be determined accurately. How to measure blood pressure correctly, read here!

Further diagnostic steps

The doctor usually asks the patient about existing pre-existing conditions that could be the cause of secondary hypertension. These are, for example, kidney or thyroid diseases.

A physical examination is also part of the clarification of high blood pressure. It helps to assess the individual cardiovascular risk and to detect possible signs of blood pressure-related organ damage. High blood pressure is often only detected when it has already damaged the blood vessels (for example, arteriosclerosis). The vessels of the heart, brain, kidneys and eyes are particularly affected. In the long term, the heart muscle is also damaged, and heart failure is the result. Further examinations of the eyes, heart and kidneys, for example, are necessary for a more precise examination of possible secondary diseases.

Therapy of high blood pressure

For most hypertensive patients, the European guideline recommends lowering blood pressure to below 140/90 mmHg. If the patient tolerates the treatment, a target value of less than 130/80 mmHg is aimed for. However, it is important not to fall below the target value of 120/70 mmHg. Depending on the patient group, however, there are also different recommendations:

  • In “frail” elderly patients and patients over 65 years of age, physicians aim for a systolic blood pressure between 130 and 139 mmHg.
  • In patients with kidney disease (nephropathy) and concomitant proteinuria, a systolic blood pressure value of less than 125/75 mmHg is usually reasonable.
  • In diabetic patients and all other hypertensive individuals, a diastolic blood pressure value below 80 mmHg is recommended.

The doctor also adapts the recommendations on target blood pressure values individually.

Lowering blood pressure: What you can do yourself

It is also highly advisable to give up smoking if you suffer from hypertension, so as not to exacerbate the cardiovascular risk. Doctors also recommend reducing stress, if necessary with the help of relaxation techniques such as autogenic training or yoga.

In addition, many patients try to reduce elevated blood pressure levels to a healthier level with home remedies or alternative healing methods such as homeopathy.

Read more about what you can do yourself for high blood pressure in the article Lowering Blood Pressure.

Home remedies can at best supplement conventional medical treatment, but not replace it. If the symptoms persist for a long time, do not improve or even get worse, you should always consult a doctor.

Medicines against high blood pressure

  • ACE inhibitors
  • AT1 antagonists (angiotensin receptor blockers, sartans)
  • Beta-blockers
  • Diuretics (dehydrating agents, “water tablets”)
  • Calcium antagonists

When which medications are most appropriate depends on the individual case. In addition, sometimes taking a single medication is sufficient to lower high blood pressure sufficiently (monotherapy). In other cases, a combination of different drugs is necessary (combination therapy), for example an ACE inhibitor and a calcium antagonist.

Despite being well tolerated, blood pressure medications can sometimes cause side effects. For example, some beta-blockers cause circulatory disturbances, which are then accompanied by a general feeling of coldness and often cold hands and feet. Some patients report that they feel cold more often and tremble accordingly.

With secondary hypertension, it is not enough to simply take antihypertensives. Instead, the doctor will treat the underlying disease and thus the trigger of the high blood pressure. For example, narrowed renal arteries (renal artery stenosis) can be widened in a surgical procedure. In most cases, this lowers the high blood pressure levels.

Is high blood pressure dangerous?

The prognosis for high blood pressure varies from patient to patient and cannot be predicted in general terms. The course of the disease depends on several factors. These include, for example, the level of blood pressure and the presence of concomitant diseases. In general, the earlier high blood pressure is detected and treated, the lower the risk of secondary diseases such as heart attack or stroke. If, on the other hand, hypertension is not treated, the risk of secondary damage increases.

With consistent therapy, blood pressure can usually be adjusted and controlled very well. Also, the symptoms of high blood pressure alone are often not so severe, so that longer periods of illness and inability to work are generally not to be expected.

In the long term, high blood pressure damages important organs such as the heart and its supplying vessels (coronary vessels), the other blood vessels, the brain and the kidneys. In the worst case, this triggers life-threatening diseases and reduces life expectancy.

Benign and malignant hypertension

In the past, doctors spoke of “benign (essential) hypertension” if no crisis-like worsening of blood pressure (exacerbations) occurred in the course of the disease. Many experts now reject this term because “benign” (= benign) hypertension is also very dangerous and has an increased mortality rate.

Dangers

Particularly in older people, the previously ill or pregnant women, high blood pressure is often associated with a more severe course of infectious diseases. They are considered to be at increased risk, which is why doctors advise them to be vaccinated against SARS-CoV-2, for example.

In the area of the heart, high blood pressure promotes, for example, arteriosclerosis (hardening of the vessels) of the coronary arteries. This coronary heart disease (CHD) often leads to cardiac insufficiency or cardiac arrhythmias. A heart attack is also possible.

Over time, the vascular damage caused by high blood pressure also affects the kidneys and their function: a possible consequence is chronic kidney weakness (chronic renal insufficiency) or even kidney failure.

The circulatory disorders that develop as a result of high blood pressure also have a negative effect on other parts of the body. In the legs, for example, peripheral arterial occlusive disease (PAVD) often develops. In the eyes, they damage the retina, which impairs vision. Doctors refer to this as hypertensive retinopathy.

The constant pressure in the vessels leads to the formation of bulges in the vessel wall (aneurysms). When these burst, they cause life-threatening internal bleeding. A particular danger is posed by aneurysms in the area of the aorta (aortic aneurysm) and in the brain: A burst brain aneurysm causes a hemorrhagic stroke.

Hypertensive crisis

If there are also signs of organ damage due to the massive increase in blood pressure (such as angina pectoris), doctors call it a hypertensive emergency. Then there is a danger to life. In the worst case, a blood pressure increase of this magnitude is fatal for the person affected. In such a case, call the emergency doctor immediately!

A hypertensive crisis is usually seen in patients with chronic high blood pressure. Only rarely does it occur in people whose blood pressure values are otherwise normal. The trigger is then, for example, an acute inflammation of the renal corpuscles (acute glomerulonephritis).

You can read more about the development, symptoms and treatment of the hypertensive crisis in the article Hypertensive crisis.

Can high blood pressure be prevented?

If you smoke, it is advisable to stop smoking or at least keep it to a minimum.

If you are at increased risk because of other underlying diseases, it is advisable to have them treated as soon as possible. Also try to lose weight if you are overweight, and avoid excessive and prolonged stress.

Not only physical overload is harmful to health, but also psychological stress. Even if everything is fine from a purely physical point of view, permanent psychological stress sometimes translates into physical ailments. If, for example, you often have very stressful workdays, even small regular actions in your private everyday life can help to take your mind off your professional worries.