High blood pressure
High blood pressure, medically known as arterial hypertension, is a disease of the cardiovascular system in which the pressure in the arterial vessels is permanently elevated. In Germany, around 30 million people suffer from high blood pressure.
The likelihood of developing arterial hypertension increases with age: in people over 60, the incidence is 60 per cent. In addition to age, factors such as lifestyle (e.g. lack of exercise or a high-calorie, high-salt diet) and obesity also contribute to the increasing incidence of arterial hypertension.
If the increase in pressure persists, important organs such as the heart, brain, kidneys and eyes are damaged. Possible consequences include stroke, chronic kidney failure, heart attack, heart failure, deterioration of visual acuity and circulatory disorders of the limbs (peripheral arterial occlusive disease).
In order to avoid this end-organ damage caused by arterial hypertension, patients should achieve the currently recommended target blood pressure values (German Society of Cardiology, German Hypertension League, European Society of Cardiology). Unfortunately, only just under half of the patients treated manage to do so. High blood pressure is one of the most important modifiable risk factors.
High blood pressure often remains undetected at first: around 20 per cent of those affected do not know that they suffer from hypertension. For this reason, blood pressure should always be measured at every ‘doctor's appointment’ - from school enrolment, to the recruitment examination, an appointment with the company doctor or a ‘check-up’. From the age of 40, blood pressure should be measured at least once a year. It is important that it is measured ‘correctly’, i.e. that the appropriate cuff size is selected, that there is a calm atmosphere, etc. Your doctor will give you the right tips!
In order to diagnose arterial hypertension, repeated blood pressure measurements are usually necessary - either by a doctor or as a self-measurement, which is then confirmed. The diagnosis can also be confirmed by a 24-hour long-term measurement.
High blood pressure often remains undetected for a long time. For this reason, blood pressure should be measured at every ‘doctor's appointment’ - with portable measuring devices, patients can also take the measurement themselves at home.
High blood pressure often remains undetected for a long time. For this reason, blood pressure should be measured at every ‘doctor's appointment’ - with portable measuring devices, patients can also take the measurement themselves at home.
Classification of blood pressure
Blood pressure is categorised into optimal, normal and high-normal blood pressure. We speak of arterial hypertension if the blood pressure is >/= 140 mmHg systolic and/or >/= 90 mmHg diastolic. In comparison, the optimal blood pressure is below 120/80 mmHg.
Once arterial hypertension has been diagnosed and the patient is being treated, the target value for therapy is
- in the 18 to 65 age group: 120-130/70-79 mmHg
- and for those over 65: 130-139/70-79 mmHg
Consequences of arterial hypertension
As blood pressure often remains undetected for a long time, it is important never to regard arterial hypertension as an ‘isolated’ disease. Instead, treating physicians should look for possible end organ damage caused by high blood pressure. Possible secondary diseases include
- Coronary heart disease
- Myocardial infarction (heart attack)
- stroke
- Heart failure
- Severe circulatory disorders (peripheral arterial disease)
- Chronic kidney disease
- Diseases of the retina (hypertensive retinopathy
Causes and risk factors
In over 95 per cent of people with high blood pressure, no cause can be identified (doctors refer to this as ‘primary hypertension’). A cause for the disease can only be identified in around five per cent of those affected. If another disease is the trigger, it is referred to as ‘secondary hypertension’, which can often be treated by eliminating the cause.
The experienced doctors at the DHZC Hypertension Centre are trained and certified in accordance with the guidelines of the German Society for Hypertension (DHL) to diagnose secondary hypertension reliably and treat it comprehensively.
It is not yet known exactly what causes primary hypertension. However, the following risk factors favour the development of high blood pressure:
- Family tendency to high blood pressure (hereditary displacement)
- being overweight
- lack of exercise
- High salt consumption
- High alcohol consumption
- An unhealthy diet with little fruit and vegetables
- smoking
- stress
- older age
- certain medications (especially painkillers and rheumatism medication)
Primary hypertension often occurs together with obesity, type 2 diabetes and elevated blood lipid levels. If these three factors occur simultaneously with high blood pressure, doctors speak of metabolic syndrome.
In secondary hypertension, the causes of high blood pressure can be found in another disease. These are usually kidney diseases, metabolic disorders or vascular diseases.
The most important causes and pre-existing conditions include
- Narrowing of the renal arteries
- Increased hormone production due to tumours (e.g. aldosterone, glucocorticoids, but also catecholamines)
- Interrupted breathing during sleep (sleep apnoea)
- Disorders of the hormone balance (e.g. hyperthyroidism)
Symptoms
Most patients hardly show any clear symptoms of hypertension, which means that high blood pressure often goes unnoticed for a long time. However, early treatment is very important to prevent consequential damage. Possible signs of high blood pressure should always be taken seriously. Symptoms of arterial hypertension include
- Dizziness
- headaches
- insomnia
- nervousness
- ringing in the ears
- tiredness
- nosebleeds
- Shortness of breath
- Nausea
Diagnosis
The most important test to detect high blood pressure is a blood pressure measurement. However, as blood pressure fluctuates throughout the day and is elevated after exercise, for example, a single measurement says nothing about whether the blood pressure requires treatment or not.
In order to obtain meaningful values, blood pressure should therefore be measured several times - for example at three different times during the day. Long-term measurements over 24 hours are also useful for diagnosis. They allow the treating physicians to precisely observe diurnal fluctuations.
At the DHZC, the long-term measurement is carried out as a home blood pressure measurement by the patient themselves. For this purpose, the patient wears a portable measuring system consisting of a small recording device and an upper arm blood pressure cuff connected to it. Over a period of 24 hours, the cuff inflates automatically at certain intervals - every 15 minutes during the day and every 30 minutes at night. When the air is slowly released, the measuring device records pulse-synchronised amplitude fluctuations and thus determines the systolic and diastolic blood pressure. The small recording device stores the measured blood pressure values and the heart rate. In this way, a blood pressure profile is created from 40 to 60 measurements.
Patient self-measurement (e.g. in the morning and evening) also provides valuable information. This is because blood pressure rises not only with exertion, but also with excitement. One example is the so-called ‘white coat blood pressure’, i.e. the phenomenon that the blood pressure in the practice is higher than the blood pressure at home. In order to eliminate this effect and to monitor blood pressure regularly, patients should measure their own blood pressure at home. It is important that the measurement is carried out correctly: in a sitting position, after three to five minutes of rest, legs not crossed, cuff/measuring device placed at heart level, arm placed on the table. We will be happy to train you in this.
As blood pressure often remains undetected for a long time, the search for existing secondary diseases (e.g. heart, blood vessels, kidneys) plays an important role. This includes laboratory and urine tests, ultrasound examinations of the heart and blood vessels, as well as examinations of the back of the eye.
The search for secondary hypertension is also important. By identifying the disease causing the blood pressure, it can be eliminated and the arterial hypertension improved or even cured. These examinations include specialised laboratory and urine tests as well as procedures such as computer tomography (CT) and magnetic resonance imaging (MRI).
Self-measurement of your own blood pressure
The International Society of Hypertension (ISH) gives clear recommendations on what patients should pay attention to when measuring their blood pressure.
(Image: Own illustration based on information from the ISH)
Self-measurement of your own blood pressure
The International Society of Hypertension (ISH) gives clear recommendations on what patients should pay attention to when measuring their blood pressure.
(Image: Own illustration based on information from the ISH)
Therapy
The treatment of arterial hypertension consists of several pillars:
- The basis of any high blood pressure therapy is initially a change in lifestyle: giving up cigarettes and alcohol, a healthy, balanced, low-salt diet, plenty of exercise and weight reduction.
- If this is not enough, the doctor will also prescribe antihypertensive medication. Which medication is chosen depends on the patient's age and possible concomitant illnesses such as heart failure or kidney disease. As a rule, treatment is now started with a combination of medication taken in a pill. This increases the effect compared to the use of a single active ingredient, as the body always reacts to antihypertensive medication with a counter-regulation.
- It is important to measure blood pressure to monitor therapy: either as a self-measurement with documentation or as a 24-hour long-term measurement. The medication should be taken for 4 to 6 weeks before the effect of the medication can be assessed. The treatment of arterial hypertension is lifelong; if the medication is discontinued, the blood pressure rises again.
Secondary hypertension can often be treated by treating the underlying disease - patients therefore do not have to take medication for the rest of their lives. For example, narrowed renal arteries can be treated by balloon dilatation or hormone-producing tumours can be operated on.
At the DHZC, we carry out all treatments for heart and vascular diseases at the highest medical level and according to the latest scientific findings.
Hypertension Centre
In order to improve the quality of care for hypertension patients, the ‘Deutsche Hochdruckliga e.V. DHL® - Deutsche Gesellschaft für Hypertonie und Prävention’ (German Hypertension League - German Society for Hypertension and Prevention) audits medical facilities and awards them the title ‘Certified Hypertension Centre DHL®’ depending on their suitability.
The Clinic for Internal Medicine - Cardiology at the DHZC was awarded the DHL certificate at the beginning of 2014. The Hypertension Centre at the German Heart Centre Berlin - one of only three centres in Berlin - is under the medical direction of Prof. Dr Philipp Stawowy. Staff at the clinic are hypertensiologists certified by the German Hypertension League, guaranteeing a high level of expertise.
Certified hypertension centre
Staff at the clinic are certified hypertensiologists by the German Hypertension League, guaranteeing a high level of expertise.
Certified hypertension centre
Staff at the clinic are certified hypertensiologists by the German Hypertension League, guaranteeing a high level of expertise.
Our offer
Using guideline-based treatment paths, our doctors - together with the appropriate equipment in the clinic and the possibilities of interdisciplinary cooperation (endocrinology, nephrology, neurology) - guarantee optimal treatment of arterial hypertension.
One of the main focuses of the Hypertension Centre at the DHZC is the diagnosis and treatment of secondary hypertension.
In addition to the usual diagnostic procedures, we can offer you the following services:
- Hormone analyses and hormone stress tests
- Ultrasound examinations of the blood vessels and heart, including three-dimensional analyses
- Magnetic resonance imaging (MRI) and computer tomography (CT)
- angiography
- Balloon dilatation and stent placement in renal artery stenoses
- Surgical treatment of hormone-producing tumours in close cooperation with other specialist disciplines
Another focus is the treatment of patients with so-called ‘therapy-resistant hypertension’ who are difficult to control. In these cases, patients are unable to lower their blood pressure sufficiently despite taking several medications and changing their lifestyle (weight reduction, exercise).
At the DHZC Hypertension Centre, our doctors first rule out the possibility that the patient is suffering from secondary hypertension. If this is not the case, we use various methods to adjust the blood pressure: We customise drug therapy and also offer innovative interventional treatment procedures such as renal nerve ablation (‘sclerotherapy’) to lower blood pressure.
