High Blood Pressure: Hypertension, Symptoms and Causes

Arterial hypertension, also called high blood pressure and hypertension, is the most common disease of the cardiovascular system (cardiovascular system). It is reported to affect up to 25% of the adult population worldwide.

The condition has also been likened to a non-infectious epidemic.

It has often been called a silent killer, mainly because people may, for a long time, not even suspect that there is a problem with high blood pressure.

It is precisely in the case of chronic persistence or non-treatment that it has a progressively negative impact across the entire human organism. It is the cause of various physical ailments, problems and new diseases.

High blood pressure does not hurt. It does not need to show any symptoms.

It happens that its complication, such as stroke, is the first manifestation of high blood pressure. Therefore, early detection and early treatment of hypertension is significant in limiting its risk factors and complications.

Alarmingly, up to 25% of deaths over the age of 40 are due to high blood pressure.

High blood pressure has been defined by the World Health Organization since 1993 as:

Hypertension in adulthood is:
a sustained increase in blood pressure to, or above, 140 / 90 mmHG.
This value was measured repeatedly in at least two cases out of three measurements.

Beware, however, high blood pressure does not only affect the adult population. The negatives of a sedentary lifestyle and excessive body weight are a risk for the development of high blood pressure even in childhood.

In addition to the division given in the table, we also know the classification of hypertension into primary and secondary.

What does that mean?

Primary hypertension has no known cause, or various risk factors are involved in its development. It is also referred to as multifactorial, which may or may not be controllable.

Professionally, it is also referred to as essential hypertension.

95% of patients have a primary form of hypertension.

Secondary hypertension, on the contrary, is one whose cause is known. The cause may be in another disease. Examples are kidney disease, hormonal influence, pregnancy, and pre-eclampsia or eclampsia.

The term used for conditions where symptoms are manifested is symptomatic.

Table: How hypertension is defined by the European Society of Hypertension and the European Society of Cardiology

Uncontrollable risk factors:

1. age, higher blood pressure at older age
2. sex, with a higher likelihood of elevated blood pressure in women in menopause
3. genetic predisposition and familial burden, when hypertension is also expected to occur in offspring, 
   30 to 60 per cent of genetic information is assumed
4. imbalance of vasomotor regulation

Risk factors that are associated with a rise in blood pressure and are controllable:

• being overweight and obesity - mainly BMI above 30
• insulin resistance
• excessive intake of NaCl (Na - sodium - salt) in the diet and fluids such as salt and highly mineralised beverages
• magnesium (Mg) deficiency, potassium (K) deficiency andcalcium (Ca) deficiency
• smoking
• excessive alcohol intake
• stress, excessive psychological load
• inappropriate lifestyle as well as lack of rest
• lack of physical activity
• pollution of the external environment, air

Are you familiar with the term hypertensive crisis?

This term denotes a severe and acute form of blood pressure output. In this case, the increase in pressure is manifested in some body system (the nervous system, the visual system, the heart, and so on).

With this type of high blood pressure, there is a high risk of developing complications such as stroke or acute heart failure.

Hypertension is the second most common cause of heart failure.
The first on the list is ischaemic heart disease. 
Learn more: Hypertensive crisis. 

In a hypertensive crisis, blood pressure rises above values of 210 / 130.

It can arise as a consequence of inadequately or improperly treated hypertension. Alternatively, as a complication of secondary hypertension.

The severity is influenced by what the original blood pressure was, what it is currently at the onset of difficulties, and the rate of ascent of blood pressure values.

The reactions of a person with long-term hypertension to an acute rise in blood pressure, and a person who has had normal blood pressure for a long time will be different.

The severity, which is also professionally referred to as an emergent or urgent condition, depends on this.

Table: information on emergent and urgent status

What is blood pressure?

Blood pressure is the hydrostatic pressure that is generated by the blood against the walls of blood vessels. Blood is ejected into the bloodstream, and therefore into the blood vessels, from the left ventricle of the heart.

The heart is a pump that pumps oxygenated blood to the body, organs, tissues. 

Blood pressure depends on the force of contraction of the heart ventricle, on the resistance of the vessels and on the volume of blood. Simply described, when the myocardium, i.e. the heart muscle of the left ventricle, contracts, the blood is expelled into the aorta. We get systolic pressure.

Systolic blood pressure is the highest blood pressure.

It should not exceed 140 mm Hg. The systolic pressure is written above the slash and the diastolic pressure second (below the slash). It is labelled as sTK (systolic blood pressure).

Systolic blood pressure gradually rises with a person's age.

After the heart stops expelling blood from the heart, i.e. when the heart muscle relaxes between the beats, it creates diastolic pressure. At that point, blood is sucked back into the heart, more specifically the right atrium.

Diastolic blood pressure is the lowest blood pressure.

The value should not exceed 90 mm Hg. And the value of diastolic pressure is written after the slash. It is labelled as dTK (diastolic blood pressure).

In the home environment, we measure blood pressure most often with a digital blood pressure monitor. On the screen of the blood pressure monitor we can then see two readings.

Example:

120 / 80 mmHg

In addition, the blood pressure monitor can also show us the value of the heart rate, i.e. the pulse and its regularity.

In the magazine article, we also provide an overview table of blood pressure.

Blood pressure also varies depending on:

• circadian rhythm - biologický rytmus, čiže zmeny fyziologických funkcií ovplyvnené dennou periódou a striedaním dňa a noci
• sex, with men having higher blood pressure
• body position, lying, sitting or standing
• increases with physical stress or mental strain
• increases with age

How is blood pressure measured correctly?

Given the current availability of blood pressure monitors, we can also measure blood pressure in the comfort of the home. Digital blood pressure monitors are automatic. The advantage is that they measure blood pressure automatically and the measured values are visible on the overview display.

There are two types of digital blood pressure gauges:

• the first type uses a wrist cuff
  • taking measurements should be taken as an approximation compared to an arm pressure gauge
  • the correct way of placing the pressure gauge at the level of the heart is important before measuring
  • there may be deviations from the correct value
  • the pressure gauge is positioned according to instructions
  • steps for correct measurement have to be followed
• the second type uses a shoulder cuff
  • semiautomatic measurement
  • fully automatic measurement

Another important feature is that the pressure gauge should have sufficiently charged batteries, or even better, if it has an adapter to power directly from a power outlet.

Consequently, following the instructions for correct measurement is crucial.

It is important that you pay attention to the following points:

• sitting position
• or in a lying position
  • the value of diastolic pressure is approximately 5 mmHg lower in the supine position than in the sitting position
• lower limbs loose on the floor, not crossed
  • in some cases it is also measured after a change in standing position
• silence and peace in the room
• adequate temperature in the room where the blood pressure is measured
• when measuring pressure, the person should not talk
• do not drink coffee and other stimulating beverages, do not smoke 30 minutes before the measurement
• po náročnej práci dve hodiny odpočinku
• not to be stressed before the measurement
• 5 minutes before measurement sit quietly, lie down
• measurement with an empty bladder
• the resulting value is the average of 2 - 3 measurements with 2 minute pauses
  • if the person suffers from a heart rhythm disorder, repeat the measurement 5 times
  • and from it the average will be the resulting value
• measurement on the arm, shoulder, with the elbow resting on the pad
• the cuff of the pressure gauge should be in the correct size
• and should be at heart height = 1-3 cm above the elbow socket
• the cuff should not be too tight or loose
• the clothing on the upper limb must be loose
  • not to restrict blood flow to the limb
• blood pressure measurement can be performed on both upper limbs
• measurement on the side where blood pressure values tend to be higher is preferred

What if the blood pressure is different in each upper limb?

Each blood pressure measurement will show us a different value. It will never be exactly the same reading on a digital blood pressure monitor. In the same way, blood pressure is also normally slightly different in the two limbs.

However, if your blood pressure is more than 20 mmHg higher, it may indicate a health problem.

Example:

Blood pressure in the right upper limb 120/70 mmHg.

And...

Blood pressure in the left upper limb 150/90 mmHg.

This difference is also referred to as asymmetry of blood pressure in the extremities. And in its case, a professional examination is necessary.

Torr or mmHg?

On older pressure gauges we could also find the designation torr. This is an older form of expressing the pressure value. 

1 torr = hydrostatic pressure exerted by 1 millimetre of the mercury column.

The column of mercury is denoted mm Hg or mmHg. In the past, pressure measurements were made on pressure gauges that had glass columns filled with mercury.

A mercury pressure gauge, also referred to as a sphygmomanometer, is composed of a manometer that has a mercury column and an inflatable balloon system. A phonendoscope - a stethoscope that intensifies auscultatory sounds - is also used in the measurement.

The phonendoscope is used to listen to the vibration of the artery caused by the swirling of the blood flow during the change in pressure induced from the outside by the inflated cuff. They are also referred to as Korotkoff sounds.

The cause of high blood pressure may not be known. As is the case with essential hypertension. In the case of primary, there is no organic, that is, bodily cause.

Several factors are assumed to be at work. The multifactorial risk factors are mentioned above. The combination of genetic factors and other external factors subsequently increases the predisposition to develop high blood pressure.

Stage 1:

It is described when no organic changes are present.

Stage 2:

It occurs when prolonged exposure to higher blood pressure causes changes to organ systems or organs.

However, so far these changes have not negatively affected function. Examples include the change in the blood vessels on the ocular background, but also the enlargement of the left ventricle of the heart.

Stage 3:

At this time, organic changes are already manifested by impaired function, for example, left-sided heart failure, kidney damage, stroke or hypertensive retinopathy described in the article on retinal and vitreous disease.

The opposite of essential is secondary hypertension. This kind of high blood pressure arises on the basis of an organic cause, and therefore on the basis of another disease.

The most common causes of secondary hypertension:

• kidney disease - the kidneys are directly involved in the regulation of blood pressure
  • kidney inflammation
  • tumour
  • trauma, injury
• pathological narrowing of renal vessels
• endocrine disease
  • primary hyperaldosteronism (when the adrenal gland releases too much of the hormone aldosterone into the blood)
  • hyperthyroidism - a disorder of thyroid function
  • pheochromocytoma (a tumour)

It is very important to remember that high blood pressure does not have to have any symptoms. And especially if it increases gradually, for years. A person overlooks it, does not go to preventive checkups.

The opposite is a sudden increase in blood pressure - accelerated hypertension to hypertensive crisis. When an urgent or emergent condition arises.

In the worst cases, it happens that a sudden deterioration in health is the first symptom of high blood pressure. For example, a stroke or heart attack.

People being treated for high blood pressure sometimes have the problem of their blood pressure rising. The cause can be agitation, mental or physical stress, a change in the weather, lack of rest or sleep.

Those who do not yet have experience, hypertension should be thought of especially in the event of the occurrence of the following difficulties:

• fatigue and weakness
• headache
  • unpleasant feeling in the head, pressure in the head
• dizziness, i.e. light-headedness, when changing or still
• balance disorders, pulling to the side
• tinnitus, ringing in the ear or other noises
• visual impairment
  • blurred vision
  • hazy vision
  • double vision
• redness or pallor to the face
• hot flashes
  • in the face
  • all over the body
  • in the chest
• sweating
• feeling like vomiting
• vomiting
• body tremors
• sleep disorder
• difficulty concentrating
• bleeding from the nose - epistaxis, after lowering the pressure mostly subsides
• chest pain
  • pressure in the chest
  • other imprecise feeling in the chest
• heart palpitations
• shortness of breath, subjective sensation of impaired breathing - dyspnoea
  • in heart failure, the overall picture changes
  • visible impaired breathing
  • gurgling sounds in the lungs can be heard at a distance - pulmonary edema
• swelling of the lower limbs, also as a manifestation of worsening heart function

Complications of high blood pressure at a glance

Prolonged elevated blood pressure causes problems throughout the body. The blood vessels, the heart, the brain, the blood vessels of the eye, the kidneys, and even the kidneys themselves are affected.

The consequence of hypertension is seen in the blood vessels and heart, accelerating and worsening atherosclerosis. The latter in turn exacerbates hypertension again. Reduced blood supply to the heart results in ischaemic heart disease, and acute hypertension in turn results in myocardial infarction.

A chronic complication is heart failure. And here, hypertension is cited as one of the most common causes of chronic heart failure.

Next is the nervous system, and therefore the brain. Here, too, atherosclerosis signs as a negative. It increases the risk of stroke, which can be due to restricted blood supply, that is, ischaemia of the brain, but also as a result of bleeding in the brain.

Hypertension also puts a strain on the kidneys, the blood vessels of the eyes and other parts of the body.

The risk also increases if there is another condition, such as diabetes, in addition to high blood pressure.

The diagnosis is mainly based on history taking. Information is obtained from the person concerned. This is followed by a professional examination. A general practitioner, an internist (internal medicine doctor) or a cardiologist collaborate in the diagnosis.

The cooperation of the doctor and his patient is important. The person measures and writes down blood pressure readings taken at the appointed time. He then informs his doctor.

A diagnosis is made if high blood pressure is measured in at least two measurements out of three. The person must be at physical and mental rest.

It is necessary to distinguish an increase in pressure during the examination for - white coat syndrome.

Alternatively, a pressure Holter is supplemented. This is a 24-hour examination, when the pressure is measured with a cuff and a pressure gauge throughout the day and night. The person carries out normal daily activities and records significant activity. Which is then assessed by a specialist.

With high blood pressure, it is also important to examine other organs and organ systems. This is of importance in revealing the complications that hypertension can provoke.

Physical checkup, laboratory blood tests, urine test (kidney function) are carried out. The screening suite also includes ECG (as well as stress ECG or even an ECG Holter with 24-hour recording), echocardiography, chest X-ray, USG, or sonography. An eye examination will look at the back of the eye.

The disease may initially proceed asymptomatically. Which makes it a very dangerous enemy of health. It happens that the diagnosis of hypertension is arrived at accidentally during a preventive checkup. Since the person has not had any difficulties up to that time.

This is due to a gradual and long-running increase in blood pressure. The body gets used to it. However, high pressure, despite the asymptomatic course, creates difficulties.

Then comes the stage when organic changes are already present that interfere with the function of individual organs.

Another example is also a sudden increase in blood pressure when one is still completely healthy. Alternatively, it may be the first symptom of as yet undetected hypertension.

Such serious conditions include, for example, stroke or heart attack.

If high blood pressure is neglected, left untreated or inadequately treated, it may cause the development of serious complications. At that time, difficulties associated with a specific problem (brain, heart, kidneys, eyesight) are already associated.

Therefore, early diagnosis and early treatment are essential. Again, the role of preventive checkups is important indeed.