Symptoms
High blood pressure is often asymptomatic, meaning that no symptoms occur. Nonspecific symptoms such as headache, bleeding in the eye, nosebleeds, and dizziness are observed. In advanced disease, various organs such as the vessels, retina, heart, brain and kidney are affected. Hypertension is a known and important risk factor for atherosclerosis, dementia, cardiovascular diseases such as cerebral stroke, myocardial infarction, heart failure as well as renal failure. The risk is further increased if additional risk factors are present, such as dyslipidemia and diabetes mellitus.
Causes
In up to more than 90% of cases, the cause is unknown. High blood pressure is then referred to as primary idiopathic or essential. High blood pressure can also occur secondarily as a result of disease, physiologically, or after ingestion of drugs or intoxicants:
- Kidney disease
- Hormonal causes: e.g. hyperaldosteronism, phaechromocytoma, hyperthyroidism.
- Vascular diseases
- Medications: e.g. contraceptives, sympathomimetics, analgesics.
- Intoxicants: e.g. cocaine, amphetamines.
- Pregnancy
Risk factors
Known risk factors for developing hypertension include:
- Age
- Hereditary disposition
- Overweight
- Too little physical activity
- Smoking
- Too much salt, too little potassium
- Alcohol
- Stress, character
Diagnosis
It is recommended that those over 18 have their blood pressure checked at least once a year at a pharmacy or under medical care. Diagnosis is made in medical treatment with repeated blood pressure measurements, based on patient history and physical examination. Correct measurement is essential to obtain meaningful values. A difficulty is “white coat hypertension“, where elevated values are measured only in the presence of a medical professional or in medical facilities. Possible secondary causes must be identified. Values are defined as follows in adults (>18 years of age):
| Optimal | < 120 < 80 |
| Normal | 120 – 129 and/or 80 – 84 |
| High normal | 130 – 139 and/or 85 – 89 |
| Mild hypertension | 140 – 159 and/or 90 – 99 |
| Moderate hypertension | 160 – 179 and/or 100 – 109 |
| Severe hypertension | ≥ 180 and/or ≥ 110 |
Hypertension exists even if only one of the values is above the threshold, which is often observed in the elderly.
Nonpharmacologic treatment
The main goal of treatment is to lower blood pressure and prevent complications and death. The non-drug measures (lifestyle changes) should precede drug therapy:
- Eat enough fruits and vegetables, potassium, calcium and magnesium.
- Limit the consumption of alcohol
- Give up smoking
- More physical exercise
- Weight reduction in case of overweight
- Reduce saturated fats, use vegetable oils with unsaturated fatty acids
- Review medications
- Reduce stress, relaxation techniques
- Limit salt consumption
- Regular self-monitoring of blood pressure
Drug treatment
Antihypertensive agents (antihypertensives) are used for drug treatment:
- ACE inhibitors: e.g., enalapril, perindopril, lisinopril.
- Sartans: e.g., valsartan, irbesartan, candesartan.
- Renin inhibitors: Aliskiren
- Calcium channel blockers: e.g., amlodipine
- Beta blockers: e.g., metoprolol, bisoprolol, nebivolol
- Diuretics: e.g., torasemide, hydrochlorothiazide.
- Alpha blockers: e.g. doxazosin
- Central antihypertensives: e.g., methyldopa.
Combination drugs are often needed and especially in moderate to severe hypertension. Secondary hypertension can also be treated causally, depending on the cause.