High Blood Pressure

High blood pressure is a very common problem in all developed countries in the world. High blood pressure damages walls of arteries and accelerates the process of atherosclerosis. The WHO indicated hypertension as repeatedly measured blood pressure higher than 140/90 mm Hg.


Note: The values of blood pressure is, as you surely know, given in the form of two numbers divided by “/”. The first number gives the value of pressure in the peripheral arteries during cardiac systole (systolic pressure) when the heart ejects blood into the arteries. This is also the reason why this number is higher. The second number indicates the amount of blood pressure in peripheral arteries during cardiac relaxation when the heart fills with blood (diastolic pressure). This pressure is lower than the systolic one.


In the majority of people (90-95%), the reason of high blood pressure is unknown and it is probably due to combination of more factors such as obesity, high salt intake, genetic predisposition, psychical stress, smoking, etc.


In the rest, (i.e. 5-10% patients), the high blood pressure is caused by another specific disorder such as the narrowing of the renal artery, kidney diseases, sleep apnea, hormonal disorders (Cushing's syndrome, Conn's syndrome), some rare tumors (pheochromocytoma), pregnancy and others. In the second half of the pregnancy, high blood pressure may be related to a dangerous condition known as preeclampsia.


Many patients are influenced by anxiety from the presence of a doctor and this situation is referred to as the “white coat syndrome”. That means they have high blood pressure when they are checked by a doctor, but much lower values of blood pressure at home.


The problem is that the high blood pressure usually has no symptoms, only some people may feel uncertain symptoms such as fatigue, malaise, dizziness and recurring headache. However, long-lasting high blood pressure may cause serious complications due to progression of atherosclerosis. These complications include for example heart attack, stroke, peripheral vascular disease and one (or more) of these conditions may be even the first manifestation of the previously asymptomatic high blood pressure.


High blood pressure can also mechanically disrupt small blood vessels causing chronic renal failure (kidney vessels), macular degeneration (eye vessels), nosebleed, etc.


Heart is also affected, because it must pump against high blood pressure in peripheral arteries and this leads to overload of the left ventricle. Exhaustion of the heart may lead to symptoms of heart failure. High blood pressure is very dangerous in diabetics as all the above-mentioned complications are much more probable. The combination of high blood pressure and untreated diabetes is particularly devastating to the eyes and kidneys.


High blood pressure is in the vast majority of cases detected incidentally during preventive examination by a general practitioner. The blood pressure is measured by manometers (either mercury-based or digital). Modern digital pressure gauges work for themselves after being attached to the arm, but many doctors still prefer the good old mercury manometers for their accuracy and reliability. The diagnosis of high blood pressure should be stated after repeated confirmation of high values of the pressure. When the blood pressure is abnormally high in a young person or when it does not respond well to the therapy, it is advisable to rule out the secondary hypertension (see Causes).


People should in the first place change their lifestyle including healthy diet, weight loss, reduced salting and plenty of physical exercise. Smoking is generally not recommended. The lifestyle changes are usually combined with antihypertensives. When the pharmacotherapy is started or when we change the dosage of the drugs, it is advisable to check the patient after some time as the antihypertensives may easily cause symptomatic low blood pressure.


It is important to realize that the medical treatment is in most cases lifelong. The patient should not have the idea that it is going to take a month or two of using pills and the pressure will be cured forever.


Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Contact: jiri.stefanek@seznam.cz
 Sources: basic text sources