High Blood Pressure (Hypertension)

High blood pressure causes no pain, and often no other symptoms for a long time. As a result, raised blood pressure frequently goes unnoticed by those affected, or is recognised only very late. Late detection carries serious risks, as persistent high blood pressure has a negative impact on the heart and blood vessels. It is therefore very important that hypertension is detected early by one of our avi Medical GPs and treated as effectively as possible. Only in this way can we improve and enhance your life expectancy and quality of life.

Throughout your entire hypertension treatment, our doctors will be your constant companion and always there for you.

Blood pressure indicates the pressure at which blood is pumped from the heart through the body down to the smallest capillary vessels. This pumping action occurs as the heart contracts. At maximum contraction of the heart, the highest blood pressure value is reached. This (upper) value is called systolic blood pressure. The heart then relaxes and no longer pumps blood into the arteries. As a result, blood pressure falls back to its lowest value. This (lower) value is called diastolic blood pressure. Blood pressure is measured in mmHg (millimetres of mercury). Two values are therefore always given when measuring blood pressure — for example: 120/80 mmHg.

120 mmHg = systolic blood pressure = upper value

80 mmHg = diastolic blood pressure = lower value

The optimal value for healthy blood pressure is 120/80 mmHg — expressed as: 120 over 80. Fluctuations throughout the day are natural and serve to adjust the body to the current situation. Acute stress or exertion causes blood pressure to rise sharply, while relaxation or sleep brings it back down.

In healthy individuals, blood pressure values consistently return to the normal range. Only when blood pressure remains consistently elevated over a prolonged period of measurement is this referred to as hypertension. This is the case at values of 140/90 mmHg or above.

The causes of high blood pressure are subject to multiple interactions between genes, environment, and lifestyle. The more risk factors are present simultaneously, the higher the probability of developing hypertension. Two types of high blood pressure are distinguished according to their origin: primary and secondary hypertension.

Primary hypertension is the most common form of high blood pressure and is referred to as essential hypertension. Approximately 90% of hypertension patients have this form. Essential hypertension occurs without an identifiable underlying cause. Predisposing factors in hypertension include: increasing age (men from 55+ and women from 65+), physical inactivity, obesity, family history, smoking, high alcohol consumption, and the menopause.

Secondary hypertension arises as a result of another condition. Approximately 10% of hypertension patients are affected by secondary hypertension. Causative conditions may include: metabolic diseases, renal diseases, thyroid dysfunction, vascular diseases, hormonal imbalances, or medications.

The signs of high blood pressure are difficult to attribute conclusively, as the condition often progresses for a long time undetected. However, the following symptoms occur more frequently: headaches, dizziness, palpitations, nervousness, shortness of breath on exertion, and sleep disturbances. In many cases, however, there are no symptoms at all.

To check whether you have high blood pressure and whether blood pressure treatment is necessary, it is important to first arrange a consultation at one of our avi GP practices.

As part of the examination, the first step is a thorough assessment of your medical history, current medications, and any symptoms you may have. Following this detailed discussion with your avi doctor and on the basis of these findings, your blood pressure will be measured at the practice. Blood pressure can sometimes fluctuate, which means it may be worthwhile carrying out 24-hour blood pressure monitoring (ambulatory blood pressure monitoring). This is ideally suited to determining your actual blood pressure and has the advantage of also capturing your nocturnal blood pressure readings. You can take the 24-hour blood pressure monitor home with you for a few days — your avi doctor will then receive the readings directly from the device and will discuss them with you afterwards. Depending on your medical history, the next step will involve laboratory investigations at one of our avi practices to assess the risks and consequences of high blood pressure. These may include, for example, kidney function values, minerals such as sodium, potassium, and calcium, cholesterol, blood glucose, thyroid values, and where applicable, adrenal cortex hormones. Where necessary, we can use an ECG and exercise ECG to determine whether your heart rhythm is abnormally altered at rest or under exertion.

Based on the results of your investigations, our doctors will then discuss your individual treatment plan with you. In order to treat high blood pressure effectively, both the level of blood pressure and the individual risk of secondary conditions — heart attack, stroke — are decisive factors. This means that not only high blood pressure itself needs to be treated, but above all the risk factors that cause it, such as elevated blood lipid levels. It is therefore important that you are also prepared to engage in self-management. This means adopting a healthy diet, taking sufficient exercise, and stopping smoking and drinking alcohol. Based on the results of your investigations, medication may be the optimal complement to self-management in order to reduce blood pressure. Sometimes it is sufficient to prescribe a single medication, but a combination of several blood-pressure-lowering agents is often necessary. The following drug classes are recommended as first-line medications by the German Hypertension League (Deutsche Hochdruckliga):****

• Diuretics have a dehydrating effect. Water and salt are excreted via the kidneys, which reduces the release of renin (a blood-pressure-raising hormone produced by the kidneys). The reduction in fluid volume thereby lowers blood pressure. Beta-blockers inhibit the effect of stress hormones such as adrenaline, which raise blood pressure and pulse rate. Beta-blockers prevent this by blocking the beta receptors. This reduces the load on the heart, which then beats more quietly.
• ACE inhibitors and angiotensin receptor blockers inhibit a hormone that causes vasoconstriction. They therefore act indirectly as vasodilators and reduce the burden on the heart. ACE inhibitors block the protein ACE, which promotes the conversion of angiotensin I to angiotensin II, which in turn causes the blood vessels to narrow and blood pressure to rise. By blocking ACE, the increased load in the blood vessels is reduced and blood pressure falls. The conversion of angiotensin I to angiotensin II is blocked, as is the breakdown of the peptide hormone bradykinin. As a result, a dry, irritating cough can occur. Angiotensin receptor blockers are a further development of ACE inhibitors. Rather than blocking the protein itself, they block the receptors to which the protein would bind. The vasoconstrictive and therefore blood-pressure-raising effect of angiotensin II is thereby reduced. Bradykinin is broken down unimpeded, so a dry, irritating cough occurs far less frequently than with ACE inhibitors.
• Calcium antagonists reduce tension in the vessel walls. An elevated calcium content in muscle cells causes contraction, leading to narrowing of the vessels and higher blood pressure. Calcium antagonists relax the musculature within the vessels, thereby lowering blood pressure and reducing the workload on the heart. They also reduce the heart's oxygen requirements.

Your avi doctor will determine which drug class best suits your treatment and will discuss this with you.

Regular measurement and monitoring of blood pressure is a preventive measure to detect long-term changes. For this reason, it is important that you attend one of our avi practices for regular check-ups. Only in this way can we work together to bring your high blood pressure under control and enable you to live a carefree, healthy life.