High blood pressure

High blood pressure itself usually goes unnoticed. Only if it is extremely high can it sometimes cause symptoms like dizziness or trouble seeing. If that happens, it may be a medical emergency.

But blood pressure that remains high for years at a time can result in other conditions that cause noticeable symptoms. For instance, heart failure can lead to shortness of breath and fluid retention in the legs. Heart rhythm disorders (arrhythmias) can cause a rapid heart rate (palpitations). Coronary artery disease (the hardening of the important arteries near the heart) can cause noticeable chest pain during physical activity (like climbing stairs).

The heart supplies the organs and tissues of the body with blood. With every beat, it pumps blood into the bloodstream. When this happens, the blood pushes against the walls of the blood vessels, which is our blood pressure.

Our bodies are able to regulate blood pressure as needed. Your blood pressure is typically at its lowest point when you are relaxing or sleeping. It increases when we do hard physical work and our muscles need more blood. Stress or fear can also cause your blood pressure to go up. It usually naturally increases a bit with age in most people as well.

So it’s normal for blood pressure readings to vary; that's just a sign of an active life. But the blood pressure levels in many people are constantly too high. Often, no exact cause is found. Then doctors call it “essential” or “primary” hypertension.

A cause of the high blood pressure is found in about 5 out of 100 people who have it. Possible causes include an overactive thyroid gland (hyperthyroidism) or a narrowed kidney artery. When the cause is known, doctors refer to it as “secondary” hypertension.

Sometimes medications can also increase blood pressure somewhat. Those medications include the following:

• Some medicines used to treat psychological illnesses
• Anti-inflammatory painkillers like diclofenac or ibuprofen
• Decongestant nasal sprays or drops
• Hormonal contraceptives that contain estrogens, like many birth control pills

Your lifestyle has a lot to do with how high your blood pressure is. The most important risk factors for high blood pressure include:

• Being overweight
• Eating too much salt
• Drinking too much alcohol
• Smoking
• Not getting enough exercise

But slim, athletic people who watch what they eat can also develop high blood pressure – for example, because it runs in their family.

Environmental factors like air pollution from vehicle traffic can increase blood pressure, too.

In Germany, about 50% of men and 40% of women have high blood pressure. These numbers increase with age. About 15% of adults with high blood pressure don't know that they have it.

Long-term high blood pressure increases the risk of cardiovascular disease and can cause damage to various organs. Constant high levels of pressure in the arteries causes them to become stiffer. As a result, the heart always has to work harder to pump enough blood around your body.

The possible long-term effects of high blood pressure include the following:

• Poor blood circulation in the legs
• Heart failure
• Coronary artery disease
• Heart attack
• Heart rhythm disorders such as atrial fibrillation
• Strokes
• Damage to the kidneys

But high blood pressure is only one of many risk factors for these kinds of complications. Other factors include family history, poor cholesterol levels, diabetes, being overweight and smoking. The risk increases more with age.

Taking all of the factors together, it’s possible to statistically estimate how likely different complications are for an individual person. Family doctors can use a risk calculator to help find the specific risk.

The risk of complications can be lowered by changing your lifestyle and taking antihypertensives.

There are a number of different devices that can more blood pressure either at the doctor's or at home. Your blood pressure varies naturally, so it is measured on several days to get a more reliable result than a single reading can offer.

Blood pressure is measured in units of “millimeters of mercury,” (mmHg). Blood pressure readings have two values that are always listed together: 128/85 mmHg, for example. The first number represents the pressure in the blood vessels when the heart muscles squeeze (systolic blood pressure). The second represents the pressure in the blood vessels when the heart muscles relax (diastolic blood pressure).

An adult’s blood pressure is considered to be normal if it is less than 140 over 90 (140/90). High blood pressure is diagnosed if

• the systolic reading is greater than 140 mmHg,
• the diastolic reading is greater than 90 mmHg, or
• both readings are greater than these values.

If your doctor measures one high blood pressure reading, then your blood pressure is measured again to confirm the diagnosis. Measuring blood pressure over a 24-hour period (ambulatory blood pressure monitoring) is usually recommended because that gives you the most reliable results. That involves carrying a portable instrument with you that measures your blood pressure with a cuff. Alternatively, you can measure your blood pressure at home several times or have it checked again at the doctor's four weeks later.

To detect any complications or other problems that might be related to the high blood pressure, your doctor will also ask about the following:

• Problems like palpitations, shortness of breath or chest pain, and erection problems in men
• Physical abnormalities like an elevated pulse, fluid retention, nervous disorders or unexpected changes in weight
• Other health conditions that you or your close family have
• Any medications that you use
• Your lifestyle, for instance whether you smoke
• For women: whether you are pregnant

Blood and urine testing can be used to check how your kidneys are functioning, among other things. An ECG can show whether you might have a heart rhythm problem.

Which other tests might be helpful will depend on your age and your individual risk factors.

There are a number of things you can do on your own to lower high blood pressure. Some people manage to keep their blood pressure under control by doing the following:

• Losing a little weight (with support from a nutrition specialist, for example)
• Eating less salt
• Drinking less alcohol or none at all
• Quitting smoking
• Getting more exercise

You can also use medication to lower your blood pressure – either in addition to these things or instead. That is an option if you can’t or don’t want to change your lifestyle, or if that doesn't make enough of a difference.

What you want to do about high blood pressure is a personal decision. High blood pressure that is just a little too high can often be lowered to a normal level just by changing your lifestyle. Medication is usually needed for very high blood pressure. Medications have side effects, though – and their benefits are not the same for everyone. That depends on your individual risk of complications.

When people are ill or need medical advice, they usually go to see their family doctor first. Information about health care in Germany can help you to navigate the German health care system and find a suitable doctor. You can use this list of questions to prepare for your appointment.