High Blood Pressure (Hypertension) and Its Treatment

What is high blood pressure (hypertension)?

High blood pressure (hypertension) is a condition in which the pressure exerted by the blood pumped by the heart on the walls of the arteries is higher than the healthy level.
The WHO (World Health Organization) considers sustained blood pressure above 140/90 mmHg to be disease in its campaigns. Such values or higher clearly lead to the development of complications.

Cardiologists regard even lower values — around 120/80 — as normal. If they see higher values, they quickly diagnose hypertension and prescribe medication.

You can detect high blood pressure yourself in time with a simple arm blood pressure monitor.

In this article I explain how to measure so that you get valid and comparable results.

• Rules for measuring blood pressure. Do you know them?

In this article I also explain why doctors accept measurements taken on the upper arm.

• Blood pressure measurement: wrist or upper arm?

White-coat hypertension? What is it?

For some people, approaching the clinic, seeing the doctor, or the whole clinic situation causes strong stress.

It is very common for the doctor to measure extremely high values in these situations, and if the physician does not notice the patient’s anxiety, they may even give medication.

Attention! A single high value measured in the clinic does not necessarily mean disease!!! It is forbidden to start long-term medication based on a single measurement. We can speak of disease only if the measured values are regularly high at different times of the day.

Why is high blood pressure unhealthy?

Because sustained high pressure in your arteries slowly but surely leads over years to serious cardiovascular disease. High pressure overworks and eventually damages the walls of the heart chambers. The arterial walls gradually stiffen and these narrowed vessels deliver oxygen and nutrients to the organs less effectively. This means high pressure destroys a little more every day.

Symptoms – the "silent killer"

High blood pressure doesn’t hurt! It is usually symptomless for a long time, so it is not recognised in time.

This is precisely the greatest risk, because it "hides" and causes damage while steadily increasing the chance of heart attack, stroke, kidney failure, heart failure, retinopathy (damage to the retina) and other conditions day by day.

That is why it is called the "silent killer".

It can be indicated by the following symptoms:

• Headache: rising pressure can increase pressure in the cerebral vessels and trigger headaches.
• Dizziness: increased pressure can impair the blood supply to the balance organ, causing balance disturbance and dizziness.
• Vision problems: high blood pressure damages the vessels of the eye, which can cause blurred vision or small field defects (dark spots in the visual field).
• Palpitations: maintaining high pressure increases the heart’s workload, which can lead to a rapid heartbeat even at rest.
• Nosebleeds: high pressure can cause the fragile superficial vessels of the nasal mucosa to rupture, leading to frequent nosebleeds.
• Fatigue, reduced exercise tolerance: this is related to heart rate as well. High pressure increases the heart’s workload; on exertion this increases further, reducing physical capacity. You may also feel tired at rest.

The disease behind these symptoms is usually only discovered when a doctor measures your blood pressure.

However, if you regularly measured your blood pressure with a simple monitor (every few weeks), you could detect it in time!

Risk factors for high blood pressure

In the vast majority of cases (at least 90%) the cause of high blood pressure is not identified. In such cases it is treated as "essential" hypertension of unknown origin.

There is agreement, however, that the following risk factors — to varying degrees in different individuals — play a role in the background of high blood pressure:

• Genetic predisposition: high blood pressure can run in families, so if someone in your family had hypertension, you may be more prone to it. Genetic predisposition alone does not mean the condition will definitely appear, because lifestyle can prevent it.
• Stress: raises blood pressure. Constant tension is the body’s defensive reaction to external threats and causes rapid and significant blood pressure elevations. High blood pressure due to long-term stress can become permanent over time.
• Lack of exercise: regular physical activity ensures healthy cardiovascular function. With inactivity, the elasticity and performance of the heart and vessels deteriorate.
• Obesity: excess weight forces the heart to work harder to deliver blood to the increased body mass.
• Low-fibre diet: indirectly raises blood pressure because such diets tend to be higher in calories, leading to overweight and overloading the heart.
• Carbohydrates: high-sugar diets promote fat storage and obesity.
• High blood sugar: damages vessels and increases the risk of atherosclerosis.
• High oxidised cholesterol: elevated oxidised cholesterol can cause blockages in the arteries.
• High salt intake: sodium binds water in the body, increasing blood volume.
• Smoking: some substances in tobacco smoke constrict blood vessels. After every cigarette there is hours-long vasoconstriction. It’s not hard to see how harmful hourly cigarette effects are — the vessels never get into a normal, relaxed state.

What complications can occur?

The greatest danger of long-term high blood pressure is that it significantly increases the risk of cardiovascular diseases. Because vessels run throughout your body, complications can appear anywhere.

You most commonly encounter the following complications:

• Heart attack: high blood pressure damages the vessels that supply the heart muscle (coronary arteries). Damage to these vessels increases the risk of heart attack.
• Stroke: high blood pressure damages cerebral vessels. Some vessels may rupture (hemorrhagic stroke) or become blocked (ischemic stroke). These damage brain tissue and can cause paralysis, speech disorders, etc.
• Kidney failure: if the renal vessels are most affected, the kidney may slowly deteriorate, leading to kidney failure (loss of kidney function).
• Heart failure: sustained high pressure increases the heart’s workload and over time (especially with heart attack, diabetes, inactivity, obesity) damages the heart muscle.
• Retinopathy: damage to the eye’s vessels causes degeneration of the retina, leading to vision loss and potentially blindness.
• Peripheral artery disease: high blood pressure can damage vessels in other parts of the body, such as the legs. This peripheral artery disease causes leg pain when walking, difficulty walking, and may eventually lead to amputation.
• Dementia (mental deterioration): high blood pressure damages cerebral vessels, causing impaired oxygen supply to the brain and slow degeneration, resulting in gradual cognitive decline.

High blood pressure damages every artery in your body to some degree. However, it varies by individual where the first complications appear!

Just because it currently only causes leg pain for you does not mean you won’t have a heart attack or stroke tomorrow! If you have already experienced any of the complications listed above, your body is a "time bomb." Additional organs can become involved at any time.

Prevention and treatment of high blood pressure are necessary to avoid exposing yourself to these life-threatening complications.

Establishing the diagnosis

I already wrote that a single high value should not be used to declare disease or to initiate treatment.

A diagnosis of hypertension should only be made based on the results of at least 24 hours of blood pressure monitoring, the so-called ABPM test.

If your treating doctor does not perform ABPM testing, that is not a good sign!

What is ABPM?

Ambulatory blood pressure monitoring (ABPM) is a method that allows blood pressure measurement during your daily activities, even at work.

The essence of ABPM is that you wear a portable device that automatically measures blood pressure at set intervals — usually every 10 minutes during the day and every 30 minutes at night. One test lasts at least 24 hours but can be up to 7 days. The longer the monitoring, the more accurate picture you get of your blood pressure. In general, a 24-hour measurement is sufficient.

With ABPM the doctor can more precisely determine daily fluctuations, low and high values. Based on the data it is possible to say more precisely which drug, at what time and in what dose should be taken to achieve the desired effect.

Without ABPM the doctor does not know the detailed pattern of your blood pressure and adjusts your treatment "blindly." You may be overtreated or undertreated; without ABPM the chance of correct adjustment is small.

Find a doctor who bases the diagnosis of hypertension on ABPM and provides ABPM monitoring year to year to check treatment.

How can high blood pressure be treated?

Treatment protocols for high blood pressure can vary case by case, but generally consist of the following steps:

Lifestyle change

Lifestyle change plays the most important role in treating high blood pressure (not medications)!

It is true that in most cases the behaviours that lead to hypertension are lifestyle-related: inactivity, obesity, unhealthy diet, harmful habits, too much stress and too little sleep.

These factors can be influenced and changed.

Lifestyle change is the only method to cure high blood pressure!

The only possible way to cure hypertension is switching to a healthy lifestyle and eliminating the behaviours that cause the disease. High blood pressure caused by damage to the body — if detected early and lifestyle is changed — can still be reversible. If organ complications have already developed, these cannot be reversed, but further deterioration can still be stopped.

In treating hypertension, regular exercise, stress management, adequate sleep and a healthy diet are recommended. Avoiding harmful habits such as smoking and alcohol consumption is also important.

To get help with the lifestyle changes needed to treat high blood pressure, ask a medical fitness specialist!

In treating high blood pressure it is worth changing the following:

• Regular physical activity. It lowers blood pressure and thus the heart’s load. It makes heart function more efficient and improves vessel flexibility, while reducing atherosclerosis, lipid metabolism disorders and obesity.
• Manage and eliminate stress.
• Ensure adequate sleep to allow the body to regenerate and to help reduce stress.
• Healthy diet. Avoid processed foods high in carbohydrates, sodium and trans fats to reduce blood pressure and prevent obesity.
• Give up harmful habits, especially smoking and excessive alcohol consumption.

Starting lifestyle changes in time helps control blood pressure, but it is important to note that the beneficial effects often take a long time to appear. For example, realistically it may take about two years to get rid of 50 kg of excess weight and its harmful effects. Therefore, blood pressure–lowering medications may also be necessary in many cases to keep blood pressure low.

Drug treatment

If lifestyle changes are not enough to lower blood pressure, medication should be started.

Without lifestyle change, hypertension becomes a chronic condition that lasts your whole life. The aim of blood pressure–lowering drugs is to keep blood pressure artificially low to reduce the risk of cardiovascular complications.

There are several types of antihypertensive drugs and your treating doctor usually prescribes several — acting by different mechanisms — at the same time. Together they help achieve appropriate blood pressure.

Antihypertensives — zero curative effect

Blood pressure–lowering medications provide symptomatic therapy. They help reduce blood pressure but in no way or degree do they cure hypertension.

That is, they do not aim to make you "get rid of the disease"; their goal is only to "remove" the symptoms.

Think about it: if antihypertensives cured the disease, the number of patients would not increase but would steadily decrease. Instead, the reality is that the number of patients is rapidly growing.

Monitoring

One of the most important elements of treating high blood pressure is regular blood pressure measurement and monitoring the development of values.

Importance of measuring several times daily

High blood pressure is often symptomless and if you measure only very rarely, you may not notice the rise and will react late.

If you have hypertension, measure your blood pressure several times a day. Preferably always at the same times (for example at 8:00, 14:00 and 20:00). Always in the same (sitting) position and at rest. Record the values in a notebook.

You will quickly notice that blood pressure fluctuates during the day (circadian rhythm) and this variation must be monitored.

These data are outstandingly important for a thorough treating physician. This way they can precisely assess the effectiveness of your treatment and shape the best treatment strategy.

Each drug begins to act after a certain time following intake and works only for a certain duration. Regular measurement data show how each drug affects you. It becomes possible to determine more precisely which medication (and how much) you should take in the morning, at noon, in the evening or other times of day.

Fluctuations in blood pressure values can also be related to your daily activities. For example, they show when stress is too high and when you should schedule exercise into your day.

Long-term trend of blood pressure values

Monitoring the trend (long-term changes) of values helps understand how your blood pressure responds to lifestyle changes and drug treatment.

The treating physician’s general goal is for your blood pressure values to be low. Therefore, if your values do not decrease in the long term, your doctor must consider other treatment options, such as switching drugs or recommending additional lifestyle changes.

Monitoring trends helps determine risk factors and the likelihood of developing complications.

My recommendations regarding high blood pressure

• If you are over 40, buy a blood pressure monitor and check your blood pressure every 2–3 months. Preferably measure at the same time of day, seated and at rest.
• If you regularly measure values above 140/90 mmHg (even if only the systolic or the diastolic value is high), start more frequent measurements. Measure 3, at most 6 times daily at the same times and record the values. After 4–5 days you will already see the "bigger picture".
• If values rise to at most 150–160 / 80–100, consult a Medical Fitness specialist who can teach you the lifestyle changes that help stop and reverse the process.
• If values are consistently above 160/100, see your general practitioner as well, because in addition to lifestyle changes medication may be necessary.

Why I consider current treatment practice flawed

In the introduction I already wrote that in my opinion there are two main reasons why nearly 4 million Hungarians suffer from blood pressure disease:

• the seriously unhealthy lifestyle of many Hungarians, and
• the completely wrong medical treatment practice.

The vast majority of Hungarians do not exercise enough, consume unhealthy foods and many calories and are overweight. Nevertheless, many consider it foolish to claim that their complaints stem from this. Everyone is guilty (especially the doctors), but they themselves are never to blame.

A large proportion of Hungarian general practitioners are over 60. They learned about hypertension 40–50 years ago and since then have mostly updated their knowledge with new medications.
They are fatigued by the flood of patients in their practices. They meet 60–80 patients daily, most of whom present complaints caused by their own lifestyle. For decades they have done nothing for their health but expect the doctor to fix everything immediately.
The doctor is bored of explaining things to patients who do not believe a word and are absolutely unwilling to make any lifestyle changes.
Therefore the Hungarian GP tends to be strongly pro-medication. Writing a prescription takes less than two minutes and they quickly get rid of the patient.

The patient with hypertension expects medication because swallowing a few pills is not a big task… but lifestyle change is anything but easy. So they receive an antihypertensive. Yet hypertension is not curable with medication; it only suppresses symptoms. That means the patient never gets rid of high blood pressure or the awareness of being ill.

The only possible way to eliminate high blood pressure is to switch to a healthy lifestyle, i.e. to stop the behaviour that causes the disease.

I hope this article has clearly explained why it would be important for you to trust lifestyle change rather than drugs!

Wake up in time and change! Your life is in your own hands!