Hypertension: Symptoms, Causes, and Development of High Blood Pressure

High blood pressure is a vascular disease.

With every heartbeat, the heart pumps blood through the body. To do this, it builds up pressure that pushes the blood from the heart into the blood vessels. If this pressure is elevated or even too high, it is referred to as high blood pressure or hypertension. Excessive pressure in the blood vessels can damage them and lead to other health problems.

When measuring blood pressure, two values are determined: the systolic value describes the pressure during the heart’s contraction phase, and the diastolic value describes the pressure during the relaxation phase.

The systolic and diastolic values are expressed in mmHg.

Optimal blood pressure readings are around 120/80 mmHg. Readings up to 139/89 mmHg are considered high-normal. 

If these thresholds are consistently exceeded, high blood pressure is present. Since the condition often causes no symptoms, it frequently goes undiagnosed for a long time. This is precisely why high blood pressure is dangerous. Over the course of years, elevated blood pressure can damage blood vessels and other organs without those affected even noticing.

Blood pressure can be measured using an inflatable arm cuff © interstid | AdobeStock

The causes of high blood pressure are varied. In most cases, no clear cause can be identified. Doctors refer to this as primary hypertension. This form accounts for the majority of all cases of high blood pressure.

In addition, there is secondary hypertension, in which another medical condition causes the high blood pressure. Kidney disease, hormonal disorders, or certain medications can be particular triggers. In these cases, the condition is also referred to as secondary high blood pressure.

Nevertheless, there are factors that can influence the development of high blood pressure. Being overweight is at the very top of the list. For many patients with high blood pressure, weight loss can lead to significantly lower blood pressure readings. However, other risk factors can also influence blood pressure levels, including:

• genetic predisposition and heredity,
• kidney damage,
• lack of physical activity,
• metabolic disorders, such as diabetes mellitus,
• tobacco or alcohol use, and
• emotional stress.

The personal risk of high blood pressure increases with age. In addition, unhealthy eating habits, lack of physical activity, and being overweight have a negative impact on blood pressure regulation.

Men are affected slightly more often at a younger age, while the prevalence between the sexes becomes more similar in older age.

A typical characteristic of high blood pressure is that the condition causes no symptoms for a long time. That is why it is often referred to as the “silent killer.” Many people with high blood pressure do not notice any clear symptoms at first. When symptoms do occur, they often manifest as headaches, dizziness, sleep disturbances, ringing in the ears, or nervousness.

Some people also report heart palpitations or reduced stamina. However, no single symptom is specific to high blood pressure, which is why the condition is often first detected during a routine checkup.

Symptoms can be more pronounced, especially in cases of high blood pressure. In such cases, the risk of acute complications increases significantly.

High blood pressure can cause a number of life-threatening complications. Patients with chronic high blood pressure are at risk of suffering a stroke. The risk of a heart attack or heart failure also increases if high blood pressure is left untreated. Other complications include damage to the kidneys and eyes.

Many patients are also advised to see an ophthalmologist after being diagnosed with high blood pressure. The reason for this is that the blood vessels in the retina can be directly examined. This allows the ophthalmologist to draw conclusions about the condition of the entire body.

If changes have already occurred, they may also have taken place in other parts of the body. While a visit to an ophthalmologist may initially sound far-fetched to many patients, it is highly recommended for those with high blood pressure.

The affected blood vessels lose their elasticity and become more susceptible to deposits and narrowing. With high blood pressure, the heart must constantly work against increased resistance, causing the heart muscle—especially the left ventricle—to thicken. Over the long term, this additional strain can lead to heart failure.

The following conditions can result from high blood pressure:

• Heart attack
• Heart failure
• Kidney damage
• Stroke
• Eye damage or impaired vision

The diagnosis of high blood pressure begins with a thorough review of the patient’s medical history and repeated blood pressure measurements. A single elevated reading is generally not sufficient to confirm the diagnosis. Measurements are usually taken using an upper-arm cuff.

In addition, a 24-hour ambulatory blood pressure monitoring test may be performed. This records both systolic and diastolic readings during daily activities. The severity of the condition can be determined based on the measured values. This includes, among other things, classification into stage 1 hypertension and other severity levels.

In addition, the doctor examines whether any complications have already developed or whether another condition is causing the high blood pressure. Blood and urine tests, ultrasound examinations, as well as heart and eye examinations can provide important clues.

Before starting treatment, the cause of the high blood pressure must be identified. An important part of treating high blood pressure is managing the underlying condition and eliminating risk factors for cardiovascular disease.

Overweight patients should therefore lose weight and adjust their diet accordingly. In particular, excessive salt intake is problematic in cases of high blood pressure.

If the condition is caused by underlying organ problems, these must also be treated. In addition, those affected should

• reduce stress,
• quit smoking if necessary, and
• avoid alcohol.

Relaxation exercises are often dismissed as silly. However, they can have a positive effect on stress reduction and, consequently, on blood pressure.

Many patients receive medication to lower their blood pressure long-term. The range of such medications is very broad. ACE inhibitors, sartans, beta-blockers, calcium channel blockers, and diuretics are frequently used.

Which treatment is appropriate depends on the individual circumstances of the patient. The goal of medication is to permanently lower blood pressure and prevent complications.

The excretion of water further reduces blood pressure. Competitive athletes must report the use of such medications to the National Anti-Doping Agency (NADA). A doctor’s note is also recommended. This must be carried during competitions. Diuretics are on the list of prohibited substances and can therefore lead to the athlete’s exclusion from competitions or the annulment of results.

Possible treatment options for high blood pressure:

• Weight loss
• Dietary changes
• Stress reduction
• Avoiding nicotine and alcohol
• Adopting a generally healthier lifestyle
• Taking blood pressure-lowering medications

Generally, primary care physicians can diagnose and treat high blood pressure. In some cases, they may refer you to a specialist, such as a physician specializing in internal medicine.

Modern blood pressure-lowering medications have significantly improved the prognosis for people with high blood pressure. Many patients benefit from a personalized combination of several measures.

If high blood pressure is detected early and treated consistently, the prognosis is favorable in most cases. Many people with high blood pressure can achieve and maintain normal blood pressure levels through a combination of a healthy lifestyle and medication.

If the condition remains untreated, however, the risk of damage to blood vessels and organs increases continuously. Especially with persistently elevated blood pressure, the strain on the heart, brain, and kidneys increases.

Regular checkups and consistent adherence to treatment are therefore crucial for long-term treatment success.

High blood pressure is usually managed by

• primary care physicians,
• internists,
• cardiologists (heart specialists), and
• nephrologists (kidney specialists)

. However, these physicians are generally not specialists exclusively in high blood pressure.

A few years ago, the German Hypertension League (DHL) introduced the additional qualification of “hypertensiologist.” Physicians with this additional qualification have completed advanced training in hypertensiology and are therefore recognized specialists in high blood pressure.

The ESH (European Society of Hypertension) awards specialists the title “Hypertension Specialist of ESH.”

Hypertension specialists have a wealth of experience with patients who have high blood pressure. This is particularly helpful in cases of difficult diagnoses or previously undiagnosed causes.

If blood pressure suddenly rises to levels above 180/120 mmHg, it may be a medical emergency. If additional symptoms such as chest pain, shortness of breath, vision problems, or signs of a stroke occur, call emergency services immediately.

If there are no acute symptoms, it is recommended to measure your blood pressure again after resting for a few minutes and to seek medical advice as soon as possible.

When is blood pressure considered high?

High blood pressure is diagnosed when measured readings are consistently above the recommended thresholds, i.e., above 140/90 mmHg.

What blood pressure readings are considered normal?

Normal blood pressure readings are around 120/80 mmHg. However, slight variations are possible on an individual basis.

Is high blood pressure curable?

The underlying cause cannot always be eliminated, but with consistent treatment, high blood pressure can usually be controlled very well.

What are the potential consequences of untreated high blood pressure?

Untreated high blood pressure significantly increases the risk of heart attack, stroke, heart failure, and kidney damage.

Can high blood pressure be prevented?

People who exercise regularly, maintain a healthy weight, don’t smoke, and eat a balanced diet can prevent high blood pressure and protect their cardiovascular system in the long term.

How common is high blood pressure in Germany?

High blood pressure is one of the most common chronic conditions in Germany and affects several million people.