high blood pressure

Synonyms in the broader sense

Essential hypertension, hypertension, chronic arterial blood pressure increase, hypertensive crisis

  • Arterial hypertension
  • Medical: arterial hypertension

    What is hypertension?

    The first value of the blood pressure stands for the systolic, the second for the diastolic blood pressure. Here, the systolic value refers to the pressure in the vascular system during contracting ( contraction ) of the heart and the diastolic value thereof during the subsequent relaxation ( dilation ) of the heart.
    Hypertension (arterial hypertension) occurs when the heart has an increased pumping workload and delivers more blood into the body than normal per heartbeat (increased cardiac output = volume hypertension) or when the resistance of the vascular system to the heart is elevated ( increased peripheral resistance = resistance high pressure) or when these two factors are present simultaneously.

    The increased resistance in the vascular system is by far the more common cause of a chronic arterial blood pressure increase.

    The blood pressure value is calculated according to the following equation: Blood pressure (RR) = cardiac output (CO) * Vessel resistance (TPR = total peripheral resistance).
    Read also our topic artery

    Definition of hypertension

    The condition hypertension (arterial hypertension) is present, if with repeated, independent measurements at different times values ​​above 140/90 mmHg (spoken: 140 to 90 millimeters of mercury) occur. This definition comes from the current guidelines of the World Health Organization (WHO).

    Frequency (epidemiology)

    Occurrence in the population
    About 25% of the population in the western industrial nations have high blood pressure. In the over-50s of this population, this value rises to 50%.
    The incidence of high blood pressure increases with age, ie older people have a blood pressure increase more often than younger people.

    Stages of high blood pressure by values


    • Optimal:
      • systolic: <120 mmHg
      • diastolic: <80 mmHg
    • Normal:
      • systolic: <130 mmHg
      • diastolic: <85 mmHg
    • High normal:
      • systolic: 130-139 mmHg
      • Diastolic: 85-89 mmHg

    High blood pressure:

    • Stage 1 (mild hypertension):
      • systolic: 140-159 mmHg
      • Diastolic: 90-99 mmHg
    • Stage 2 (moderate hypertension):
      • systolic: 160-179 mmHg
      • diastolic: 100-109 mmHg
    • Stage 3 (severe hypertension):
      • systolic: 180-209 mmHg
      • Diastolic: 110-119 mmHg
    • Stage 4 (very severe hypertension):
      • systolic: 210 mmHg
      • diastolic: 120 mmHg
    • Isolated systolic hypertension:
      • systolic: 140 mmHg
      • diastolic: <90 mmHg

    (JNC / NIH, USA 1997)

    Classification of hypertension

    The increase in blood pressure is divided into different forms:

    1. labile and exercise-related high blood pressure, which does not occur permanently or only with physical exertion

    2. permanent hypertension (stable hypertension)

    3. Critical increase in blood pressure to values ​​above 230/130 mmHg without organ damage (hypertensive crisis)

    4. emergency blood pressure increase, which is defined as a blood pressure increase above 230/130 mmHg with organ damage that is life-threatening.


    Causes / Genesis / Risk factors

    While the causes of secondary hypertension are known, the development of primary hypertension is unclear.


    Furthermore, a distinction is made between 2 types of hypertension. Which type of hypertension is present in the patient is determined by the cause of the blood pressure increase.

    1. Hypertension whose causes are unknown (primary or essential hypertension).
      In 90-95% of hypertension, no organic cause for the elevated blood pressure can be found.
      Factors such as diet, stress, smoking, physical condition, and hormones are believed to influence the development of high blood pressure.
      It is regularly and very controversially discussed whether or not an increased salt intake can lead to the development of high blood pressure. It seems to be related, so a saline restriction (5mg saline / day) is often recommended. A scientifically proven statement, but so far can not be made on this topic.
      Obesity and high-fat diet increase the high blood pressure. Smoking causes vasoconstriction through nicotine, causing blood pressure to rise. Stress activates the sympathetic, ie the stress-mediated nervous system, which results in an increase in blood pressure. Alcohol causes an increase in the heart rate, which can be accompanied by a significant increase in blood pressure.
    2. Secondary hypertension, whose causes are known and can be named, ie the hypertension is based on a sometimes recoverable underlying disease of an internal organ. 10-15% of patients with hypertension suffer from organic-induced hypertension.
      Here are a narrowing of the renal artery (renal artery stenosis), a kidney tumor or changes in the kidney tissue (renoparenchymatöse hypertension) as a cause. Since the kidney is affected, it is called a "renal hypertension".
      Other diseases that may be associated with blood pressure elevation include aortic stenosis (aortic ismus stenosis), valvular heart disease, and hormonal causes, such as adrenaline and norepinephrine over-adrenal (pheochromocytoma) or increased cortisone (Cushing's disease) caused increase in blood pressure is called "endocrine hypertension".

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    This topic may also interest you: Conn syndrome


    Most of the time, the increased blood pressure does not manifest itself through symptoms, leaving it undetected for a long time. Often, the diagnosis is a random finding during a routine check. Nevertheless, early therapy is needed to avoid later consequences of increased blood pressure.

    Symptoms can include hypertension, dizziness, headache, sleep disturbances, tinnitus, nosebleeds (nosebleeds with headache), blurred vision or a flushed face. Probably the most common symptom is the headache, which usually lies in the back of the head and appears after waking up. High blood pressure can also manifest itself through increased nervousness and shortness of breath. If the above symptoms appear, it is advisable to have them examined by a physician, as increased blood pressure can lead to harmful consequences in the long term.

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    The strength of the symptoms does not necessarily indicate the level of blood pressure, even with mild symptoms may be an increased blood pressure. If you experience more headaches, blurred vision, dizziness or a feeling of pressure in the chest, you should have this clarified by the family doctor. Especially in pregnancy, you should see the doctor immediately, as it can lead to life-threatening seizures in high blood pressure in pregnancy.

    More about this topic can be found at: Pregnancy Hypertension - Dangerous?

    Symptoms of high blood pressure

    Headache as a common cause of hypertension

    High blood pressure ( arterial hypertension ), both the essential and the secondary form, remains unnoticed by many patients for a long time, as it is possible that there will be no symptoms for years to decades. This is particularly treacherous for the patient, since a constantly elevated blood pressure, despite subjective well-being, can already cause severe damage to the vascular system. However, if the increase in blood pressure becomes symptomatic, many patients complain of noticeable palpitations, dizziness, ear noises, shortness of breath during physical exertion and headaches in the morning after getting up as well as nosebleeds.
    It is important that the increased blood pressure ( arterial hypertension ) is treated by a doctor to prevent vascular and organ damage.
    If there is already a vascular and organ involvement, symptoms such as chest pain (angina pectoris) as part of a coronary heart constriction (coronary heart disease (CHD)) to heart attack (myocardial infarction) and stroke (apoplexy) often occur.
    If the latter symptoms occur, it may be a hypertensive emergency in which the blood pressure is increased to more than 230/130 mmHg. In this case, the patient must be treated promptly.

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    Headache from high blood pressure

    Headache is a common warning sign of high blood pressure. Especially if the headache occurs in the morning, this speaks for a headache, caused by a high blood pressure. Most of the headaches sit in the back of the head. The headache is caused by a lack of blood pressure at night. If the blood pressure is normal, it lowers during the night. Often the headache is accompanied by blurred vision at the same time. Patients also often complain that they do not sleep through the night and often wake up in the second half of the night.

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    What to do in hypertension?

    If the physician detects an elevated blood pressure, it is usually advisable to first change one's personal lifestyle in order to achieve a natural blood pressure reduction and to reduce risk factors. These measures include increased exercise, weight reduction in case of overweight, moderate consumption of alcohol, and a low-salt diet.


    Next step after the so-called lifestyle modification, is then a medical lowering of blood pressure. It is first tried to reduce the blood pressure using a drug, but often two or three drugs with different modes of action are needed. But also in parallel to drug therapy, measures should be taken to reduce factors that increase blood pressure, so that the dose of the medication can be reduced or even stopped altogether.

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    From a borderline body weight one speaks from a BMI (body mass index) of 25. The BMI is calculated from the body weight by the body size to the square. A normal weight correspond to values ​​between 18.5 and 24.9. Also, more frequent stress drives up the blood pressure, therefore, mechanisms should be developed to reduce this. For example, some people help with autogenic training or other relaxation procedures. Some herbal ingredients are also said to have a hypotensive effect. These include garlic (Allium sativum), hawthorn (Crataegus), mistletoe (Viscum album) and anthracnose (Rauwolfia serpentina). These are available without prescription in the pharmacy, but should also be consulted with the attending physician when taking herbal antihypertensives.

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    People with high blood pressure should pay attention to low-salt diet, a lot of fruits and vegetables as well as vegetable fats.

    The first step in the treatment of a hypertensive patient is the so-called lifestyle modification, which includes above all a healthy diet and regular exercise. In particular, the combination of elevated blood lipid levels, obesity and high blood pressure can be dangerous for the cardiovascular system, for example in the context of infarctions.

    Recommended is a Mediterranean diet, with plenty of fruit, vegetables and healthy fats. It should be particularly resorted to vegetable fats. Animal fats, as found in butter, cream and meat, are best kept to a minimum. Also, a fiber-rich food should be taken, for example, by grain products.

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    A high-salt diet should definitely be avoided, as a high salt intake leads to an increase in blood pressure. Especially fast food dishes have a high salt content. Therefore, it is recommended to cook yourself, so you can determine the amount of salt itself. The increased salt concentration in the body ensures that the body excretes less fluid in the balance and more fluid flows into the vessels to compensate for the high salt content there, so that the blood pressure increases.

    Overall, a daily salt intake of up to 6 grams per day is recommended for high blood pressure patients, while normal salt intake is usually between 12 and 15 g per day. If the salt intake is lowered sufficiently, a blood pressure reduction of between 10 and 15 mmHg can be achieved.


    Hypertension and sports

    Regular exercise can lower blood pressure by between 5 and 10 mmHg. Furthermore, regular exercise contributes to the reduction of body weight, which also has a protective effect. Especially endurance sports such as jogging, cross-country skiing, cycling, swimming, hiking or Nordic walking are recommended.

    Sports with extreme stress should be avoided as it will drive blood pressure unhealthily high again.

    In addition to endurance sports, a moderate strength training is also helpful because the muscle metabolism optimizes the metabolism. However, a strong strength training should be avoided, as it often comes to a compressed breathing, which leads to harmful high blood pressure peaks.


    The sports units should be held three to five times a week for at least 30 minutes. If no sport has been run for several years, the units should be increased slowly. Even with lack of time, it is extremely important to carry out the training sessions, because exercise in general has a positive effect on the cardiovascular system. Recommended are also special sports groups, for people with cardiovascular diseases.

    Medicines for hypertension

    If the blood pressure is permanently increased and can not be reduced by the reduction of risk factors, a drug therapy must be resorted to. This is especially important to protect the body from complications such as a heart attack or stroke.

    Lowering the blood pressure to values ​​below 140 / 90mmHg means a significant increase in life. There are several ways to lower the blood pressure by medication. Among the most commonly prescribed medications are the so-called ACE inhibitors, beta-blockers, diuretics, calcium antagonists and angiotensin antagonists.


    ACE inhibitors cause the inhibition of an enzyme (angiotensin converting enzyme, ACE), which forms the hormone angiotensin. If the effect of the enzyme disappears, the formation and action of angiotensin, which normally increases blood pressure, is eliminated. It is important that the ACE inhibitor should not be used during pregnancy. Common side effect of this class of medication is a dry, irritating cough.

    Beta-Blockers reduce the heart rate and make stress hormones, such as adrenaline and norepinephrine, which normally increase blood pressure, have less effect on the heart. In beta-blockers should be taken to ensure that they do not suddenly stop, but the dose slowly creeps out, otherwise there may be high blood pressure crises. For example, beta-blockers are contraindicated in asthmatics because they can narrow the muscles within the bronchi and cause shortness of breath.

    Diuretics are used to increase the excretion of water, so that less blood circulates in the circulation and the pressure is lower. With the diuretics care should be taken that not too much water is excreted and it comes to a dehydration of the body. Especially on hot days and after physical activity should be paid attention to a sufficient hydration. Especially old people are at risk. Signs of dehydration or imminent dehydration are: dry mouth, muscle weakness and increasing confusion.

    Calcium's antagonists, the calcium antagonists, cause the vessels to dilate, while calcium normally narrows the vessels. Side effects of calcium antagonists include facial flushing, rashes and palpitations.

    The so-called sartans or angiotensin antagonists inhibit the action of the hormone angiotensin, which serves to increase blood pressure. Accordingly, they have a similar effect as the ACE inhibitors.

    All in all, when treating high blood pressure, there is a feeling of drowsiness and fatigue in the initial stages of therapy, as the body first has to get used to the lower blood pressure after it has been permanently increased for some time. To reduce the side effects of medication, it may be helpful to start with a low dose of the drug to get the body used to it and then increase the dose later.

    In many patients, a single medication to adjust the blood pressure is not enough, so that a second and partly third must be resorted to. In some cases, it is advisable to take one of the medications in the evening, since in some patients, the blood pressure as usual in healthy, in the evening does not decrease, but then increased at night.

    In ten percent of cases, hypertension becomes secondary, such as renal artery constriction or kidney hormone overproduction (hyperaldosteronism). In these cases, the underlying disease must be treated, because the usual antihypertensive drugs do not work in this type of high blood pressure.

    Since this topic can only be touched on here you will learn much more under the page: medicines for hypertension

    Hypertension due to coffee

    The study of coffee consumption in combination with high blood pressure is ambiguous. Some studies even claim that coffee has a positive effect on blood pressure, although it is certain that coffee, like other caffeinated drinks, will increase blood pressure for a short time after consumption.

    The increase in blood pressure after drinking coffee is between 10 and 20 mmHg and lasts for about 20 to 30 minutes. After a cup of coffee no blood pressure measurement should take place, since the values ​​are then increased by the caffeine and have no explanatory power. It is recommended to stay with a maximum of three cups of coffee a day, so that the blood pressure is not driven up several times a day.

    Hypertension due to alcohol

    In severe hypertension should be dispensed with alcohol, as it can increase the release of hormones in addition to the blood pressure.

    Alcohol is also a risk factor for high blood pressure. On the one hand, alcohol also has an antihypertensive effect, as alcohol leads to a widening of the skin vessels, which causes the characteristic reddish facial flushing (flushing) when consuming alcohol. On the other hand, there is an activation of the sympathetic, which leads to a release of blood pressure increasing hormones. Alcohol increases blood pressure, especially in stress situations or with simultaneous nicotine consumption.


    Men should not consume more than 20 g per day, which is equivalent to about half a liter of beer or a quarter of a liter of wine. For women, about half of the crowd is valid. So equivalent to 10g per day, which corresponds to a wine volume of 125ml. Because in men, the blood pressure increases in a quantity of 30g alcohol and in women from 20g.

    Although red wine is also considered to have a beneficial, protective effect on the cardiovascular system, it is only consumed in moderation. Scientific studies have shown that drinking more than 30g per day of alcohol leads to a double risk of high blood pressure. Patients with particularly high blood pressure should abstain as much as possible from alcohol consumption. Blood pressure increases by about 7 mmHg when alcohol is consumed above the limit of 30g alcohol. Especially in men it comes through the use of alcohol to a rise in blood pressure. Smokers are also stronger than non-smokers.


    Hypertension due to smoking

    Smoking, like many other illnesses, is also a risk factor in high blood pressure. Smoking causes the blood vessels to contract, increasing the pressure inside the vessels, which means blood pressure. Smoking also increases the risk of arteriosclerosis, which causes deposits within the vessels, which also increases blood pressure. Because of these mechanisms, abstinence from smoking is one of the most important measures to lower blood pressure.

    High Blood Pressure | Hypertension | Nucleus Health (February 2020).

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