Hypertension (high blood pressure)

What is it?

When our heart contracts, it pushes blood through the arteries and is, as such, responsible for the blood pressure. The blood pressure is highest when the heart contracts. This gives the top number or systolic blood pressure. When the heart relaxes, the blood pressure falls. This gives the bottom number or diastolic blood pressure Blood pressure is too high when a physician or nurse registers numbers greater than 140/90 mmHg, even after repeated measurements.

Since the blood pressure can increase due to the stress caused by a medical appointment (the so-called 'white jacket hypertension'), it may be advisable to take your blood pressure at home using an automatic blood pressure machine. These blood pressure measurements should be less than 135/90 mmHg.

Since the blood vessels lose elasticity with the ageing process, blood pressure increases with age. That is why the top number in persons older than 80 years old can go as high as 150-160 mmHg.

In 90-95% of the cases, there is no clear cause for high blood pressure.

Symptoms

Having high blood pressure does not cause any pain or immediate symptoms. If high blood pressure goes untreated, it can lead to important cardiovascular disease or other organ abnormalities. Hypertension can be at the root of a heart attack, heart failure, reduced kidney function, stroke and eye abnormalities.

High blood pressure can damage blood vessel walls. This damage causes arterial calque and increases the risk of cardiac and vascular disease.

How is the diagnosis made?

Blood pressure is not a static measurement, but rather fluctuates throughout the day. Physical exertion, emotions - they all can increase blood pressure. For that reason, it is necessary for multiple measurements to be taken throughout the day. There are also day and night fluctuations.

With a 24-hour blood pressure measurement, you can get a good idea of your blood pressure during daily activities, during the day as well as at night.

If the diagnosis is made, your physician will investigate to see if there has been damage to various organs. Additional tests may be performed such as:

• Blood test
• Urinalysis
• Electrocardiogram (ECG)
• Echocardiography through the chest (transthoracic echocardiography)
• Eye examination

Other risk factors will also be considered and will be treated appropriately. It will also be checked to see if there is a secondary form of arterial hypertension. Your sleep pattern will also be analysed if you have high blood pressure that is difficult to treat in order to see if you have sleep apnoea syndrome.

Treatment

Lifestyle recommendations are absolutely necessary:

• Weight loss in the case of obesity or being overweight
• Dietary changes
• Less salt
• More vegetables and fruit
• Limit alcohol
• Exercise
• Smoking cessation

If a health lifestyle and dietary measures are not sufficient, treatment with medication will be proposed. We currently have a few large classes of medications available:

• Diuretics
• Beta blockers
• Calcium blockers
• Inhibitors of the renin-angiotensin system
• Centrally working antihypertensives
• Alpha blockers

Latest publication date: 24/01/2024
Supervising author: Dr Provenier Frank