Synonyms in a broader sense
Essential hypertension, hypertension, chronic arterial hypertension, hypertensive crisis
- English: arterial hypertension
- Medical: Arterial hypertension
The doctor first asks for the patient’s medical history (anamnesis). Here, particular attention is paid to previous illnesses, such as diabetes mellitus, impaired kidney function (renal insufficiency) or arteriosclerosis. These diseases mean an increased risk of organ damage if blood pressure is also elevated.
The duration and maximum values of known elevated blood pressure values are also of interest. Furthermore, the doctor will ask about medications that the patient is taking and which may have a blood pressure-increasing effect, such as contraceptives or cortisone. Since high blood pressure is more common in families, the doctor will also ask about possible diseases such as heart attack/myocardial infarction, high blood pressure, kidney disease or strokes in the patient’s family.
Information on the patient’s eating habits, height and weight as well as sporting activities complete the medical history. The most important physical examination to determine high blood pressure is the blood pressure measurement according to Riva Rocci with an upper arm blood pressure cuff, which is carried out on both arms in a sitting or lying position after at least five minutes of rest. The arm must be positioned at heart level.
During the clinical examination, the pulses are also palpated on the arms and legs to rule out any vascular changes in the aorta. During the blood pressure measurement, elevated values must be determined at least twice according to the following scheme: The patient is also examined for the presence of secondary damage, i.e. the function of heart, eye and kidney is clarified. In this context, a 24-hour blood pressure measurement (outpatient blood pressure monitoring) can be carried out on apparatus-based examinations, a blood test can be performed, an ultrasound of the kidneys can be performed, the fundus of the eye (retina) can be examined (fundus examination) and a urine status can be determined.
- Practice measurement: 140/90 mmHg
- Self measurement: 135/85 mmHg
- 24-hour measurement: day profile 135/85 mmHg
- Load measurement (ergometry): 200/100 mmHg at 100 Watt
The aim of hypertension therapy is to normalize blood pressure, i.e. to reduce it to values below 140/90 mmHg, and this with the least side effects. For patients with diabetes mellitus and/or kidney disease, the therapy goal is defined as being below 130/80 mmHg. The patient should regularly check his or her blood pressure values in independent blood pressure measurements.
The best time for this is between 6. 00-9. 00 and 18.
00-21. 00, and this should be done before eating and taking medication. Close self-monitoring is important to control the success of the therapy.
Devices for measuring the upper arm provide more accurate values than those for the wrist. When measuring on the upper arm, it must be noted that the size of the cuff has an effect on the blood pressure values: If the cuff width is too small, the measured values are too high; if the cuff is too wide, the values are correspondingly too low. General measures to lower the elevated blood pressure should be carried out by every hypertensive patient in order to achieve lower, ideally normal blood pressure and thus also to avoid consequential damage to internal organs.
This includes informing the patient about the disease and its possible consequences as well as motivating the patient to consistently carry out antihypertensive therapy against high blood pressure. It is also important to normalise body weight and, with regard to nutrition, to follow a low-salt diet with a maximum of 6 grams of table salt per day and to eat a Mediterranean diet (i.e. using olive oil for cooking, eating mainly fruit, vegetables, fish and salad, but little animal fat). Also promoting the lowering of blood pressure are stopping smoking, avoiding caffeine and reducing alcohol consumption.
The reduction of stress is also of great importance. Endurance sports such as Nordic walking or jogging (at least 1 hour per week) is a very effective method for lowering blood pressure. These general measures to lower blood pressure are particularly applicable to patients with essential hypertension.
With secondary forms of hypertension, the cause of the blood pressure increase, which can be diagnosed and named by the doctor, must be eliminated. The example of renal artery stenosis (narrowed artery of the kidney) as the cause of an increase in blood pressure makes this clear: the patient is treated with medication and/or an arterial dilatation is carried out by means of a catheter (percutaneous transluminal arterial dialatation). As the narrowing of the artery, which is the cause of hypertension, is thus eliminated, the blood pressure drops.
Drug therapy, both for the primary and secondary form of high blood pressure, must be adjusted individually to each patient and includes a wide range of active ingredients. The right medication is selected depending on the patient’s condition. Substances of first choice, i.e. primarily used, are thiazides, beta blockers, ACE inhibitors and angiotensin receptor blockers.
The effects of the listed drug classes are briefly described below: As a rule, this therapy is a permanent therapy for years; often it is necessary to carry it out for life. Initially, a so-called monotherapy (therapy with only one drug) is started, i.e. the patient receives a single drug, which is selected according to the patient’s mode of action and concomitant diseases. If there is no significant reduction in blood pressure within approximately 3-4 months, a combination of two preparations can be prescribed.
A triple combination of drugs can also be prescribed by the doctor to lower blood pressure, even if the intake of two drugs is not sufficient. There are often side effects of medications such as fatigue and exhaustion, but these usually disappear again after normal blood pressure values have been reached. Of course, high blood pressure can also be treated with homeopathic medication.
- Thiazides: increase in the excretion of salt and water via the kidneys
- Beta-blockers: heart rate reduction, protection of the heart from catecholamine effects
- ACE inhibitors: reduction of peripheral vascular resistance; TPR with RR=TPR * HZV
- Angiotensin receptor antagonists: reduction of peripheral vascular resistance; see above
The vascular system can be damaged by the increase in blood pressure. This process remains unnoticed by the patient for a long time, as it does not cause any symptoms, but nevertheless progresses slowly and steadily. Many patients with high blood pressure (hypertension) suffer from early hardening of the arteries (arteriosclerosis).
The vessels are exposed to an increase in pressure due to high blood pressure and change their wall properties accordingly, whereby cholesterol and fat particles can more easily attach themselves to the vessel walls. As a result of these deposits, the vessels become narrower and smaller in diameter, and the pressure that the heart has to exert to pump blood through the body increases. The heart and blood vessels are therefore subject to increased pressure.
Muscular weakness of the left heart (heart failure) and a blockage of the coronary arteries (CHD) with a possible subsequent heart attack can also be complications. Due to the narrowed coronary arteries, the blood supply to the heart muscle is reduced, especially under stress, and a painful tightness in the chest (angina pectoris) may result. If the blood supply to the heart is completely interrupted, the patient suffers a life-threatening heart attack, the precursor of which is often the chest pain just described.
The small vessels of the kidney can be attacked by the pressure load, so that the filtering function of the kidneys is restricted and proteins that are not normally filtered into the urine can be detected in the urine (hypertensive nephropathy with microalbuminuria). This protein transfer into the urine indicates involvement of the kidneys, which should be eliminated by appropriate medication to lower blood pressure. Reduced blood flow to the brain can also be a consequence of high blood pressure.
About 15% of hypertensive patients suffer a fatal stroke (apoplexy). It is possible that the stroke occurs due to the narrowing of the blood vessels and the reduced blood flow or, due to the changes in the walls of the vessels, they tear and a cerebral haemorrhage occurs. Especially in diabetics with high blood pressure, regular examination of the back of the eye (fundoscopy) is important, since the vessels of the choroid that supply the retina of the eye are also subject to changes due to the increase in blood pressure (diabetic retinopathy).
The vessels can tear and bleed into the retina. A reduced blood supply to the retina and the optic nerve can also occur. Both complications lead to a deterioration of vision (reduction in visual acuity). Another dangerous complication of hypertension is the dilatation of the aorta (aortic aneurysm), as life-threatening bleeding with high blood loss can occur. It is therefore necessary to treat patients effectively to prevent the occurrence of complications.
