Hypertension (high blood pressure)

What is it?

When our heart contracts, it pushes blood through the arteries and is, as such, responsible for the blood pressure. The blood pressure is highest when the heart contracts. This is the top number or systolic blood pressure. When the heart relaxes, the blood pressure falls. This is the bottom number or diastolic blood pressure.

Blood pressure is too high when a physician or nurse records numbers greater than 140/90 mmHg, even after repeated measurements. Since the blood vessels lose elasticity with the ageing process, blood pressure increases with age. That is why the top number in persons older than 80 years old can go as high as 150-160 mmHg.

As blood pressure can also rise as a result of the stress of a doctor's visit ('white coat hypertension'), it may be appropriate to measure your blood pressure at home with an automatic blood pressure monitor. These blood pressure measurements should be less than 135/90 mmHg.

In 90-95% of the cases, there is no clear cause for high blood pressure.

Symptoms

Having high blood pressure does not cause any pain or immediate symptoms. However, if left untreated, high blood pressure can lead to major cardiovascular disease or other organ abnormalities. Hypertension can be at the root of a heart attack, heart failure, reduced kidney function, stroke and eye abnormalities.

High blood pressure can damage blood vessel walls. This damage causes atherosclerosis and increases the risk of cardiovascular diseases.

How is the diagnosis made?

Blood pressure is not a static measurement, but fluctuates constantly throughout the day. Physical exertion, emotions - they all can increase blood pressure. Therefore, it is necessary to have multiple measurements taken throughout the day. There are also day-night variations.

A 24-hour blood pressure measurement gives you a good picture of blood pressure during daily activities, during day and at night.

Once diagnosed, your physician will examine whether there is damage already to the various organs. For this purpose, additional examinations may be carried out, such as:

• Blood test
• Urinalysis
• Electrocardiogram (ECG)
• Echocardiography through the chest (transthoracic echocardiography)
• Eye examination

Other risk factors will also be considered and will be treated appropriately. Finally, we will check for any secondary arterial hypertension. Your sleep pattern will also be analysed if you have high blood pressure that is difficult to treat in order to see if you have sleep apnoea syndrome.

Treatment

Lifestyle recommendations are absolutely necessary:

• Weight loss in case of obesity or overweight
• Dietary changes
• Less salt
• More vegetables and fruit
• Limit alcohol
• Exercise
• Smoking cessation

If health and dietary measures are not sufficient, medication treatment will be suggested. There are currently some major classes of medication for this purpose:

• Diuretics
• Beta blockers
• Calcium blockers
• Inhibitors of the renin-angiotensin system
• Centrally working antihypertensives
• Alpha blockers

Latest publication date: 15/05/2024
Supervising author: Dr Provenier Frank