Blood pressure that is too high is dangerous because it hardly causes any symptoms and therefore often goes unnoticed. In the long term, however, hypertension can damage the heart, brain and other organs. How does high blood pressure manifest itself and what helps against it?
Quick overview: Frequently asked questions and answers
When does high blood pressure start? If blood pressure is permanently elevated to values of more than 140/90 mmHg, experts speak of high blood pressure.
How does high blood pressure occur? In 90 percent of cases it is primary hypertension, the cause of which cannot be clearly clarified. In the other cases there is secondary hypertension that can be traced back to another disease.
What are the symptoms of high blood pressure? In most cases, high blood pressure does not cause any symptoms. Only when it is very high do dizziness, headaches, ringing in the ears, visual disturbances or shortness of breath occur during exertion.
What helps against high blood pressure? If a change in lifestyle does not bring the desired result, medication against high blood pressure is prescribed.
When does high blood pressure become fatal? A critical situation arises in a hypertensive crisis when blood pressure rises to 180/110 mmHg or more. If diastolic pressure rises above 120 mmHg, there is a hypertensive emergency, which can be fatal.
Article contents at a glance:
What is high blood pressure?
With every heartbeat, blood is pumped from the heart through the artery into the body. The pressure that the blood exerts on the walls of the blood vessels from the inside is called blood pressure. It is measured in millimeters of mercury (mmHg) and is expressed by two values:
The systolic (upper) Blood pressure value indicates the pressure in the arteries when the heart contracts to pump blood into the circulation. This is the higher of the two values.
The diastolic (lower) blood pressure value represents the pressure in the arteries between heartbeats when the heart is relaxed and filling with blood. This is the lower of the two values.
If blood pressure is permanently above 140/90 mmHg, experts speak of arterial hypertension, also known as high blood pressure. Depending on the blood pressure values, three different levels of severity are distinguished.
Table: Overview of guideline values for hypertension
| Blood pressure range | systolic Value | more diastolic Value |
| optimal blood pressure | <120 | <80 |
| normal blood pressure | 120 to 129 | 80 to 84 |
| high-normal blood pressure | 130 to 139 | 85 to 89 |
mild hypertension (grade 1) | 140 to 159 | 90 to 99 |
| moderate hypertension (grade 2) | 160 to 179 | 100 to 109 |
| severe hypertension (grade 3) | > 180 | > 110 |
| Hypertensive crisis | > 230 | > 130 |
Source: ESC/ESH guidelines from August 2018
When does high blood pressure become fatal?
High blood pressure can be fatal in certain circumstances, but this depends on various factors. A critical situation is the hypertensive crisis, in which blood pressure rises to over 180/110 mmHg. Although such values carry the risk of acute organ damage, they are not immediately fatal if they occur once.
If the diastolic value rises above 120 mmHg and symptoms such as neurological disorders, chest pain and shortness of breath occur, a potentially fatal hypertensive emergency exists. In such cases, intensive and controlled treatment in hospital is necessary.
High blood pressure: causes and risk factors
In the vast majority of cases it is primary high blood pressure, the cause of which cannot be clarified beyond doubt. Experts attribute the development of primary hypertension to an interplay of genetic, environmental and behavioral factors. This includes:
- hereditary predisposition
- Overweight
- Lack of exercise
- high salt intake
- unhealthy diet
- stress
- Alcohol and nicotine
In around ten percent of cases, people suffer from secondary hypertension: the high blood pressure is due to another disease.
This includes:
Taking certain medications – such as non-steroidal anti-inflammatory drugs, antidepressants or birth control pills – can also lead to an increase in blood pressure.
Typical symptoms of high blood pressure
High blood pressure (hypertension) is often called the “silent killer” because it often causes no obvious symptoms. Only when blood pressure is very high or has already caused subsequent damage to the body do the following symptoms sometimes occur:
- dizziness
- Headache
- tinnitus
- Nosebleeds
- Shortness of breath on exertion
- heart palpitations
- Vision problems
- Difficulty falling asleep and staying asleep
- Potency problems
Those affected should have these complaints clarified immediately by a doctor in order to avoid health consequences.
Diagnosis: This is how high blood pressure is diagnosed
Since high blood pressure often does not cause any symptoms for a long time, it is usually discovered accidentally during preventive examinations. A single increase in blood pressure is not a cause for concern and is often due to nervousness in the doctor’s office (“white coat syndrome”).
For a confirmed diagnosis, repeated blood pressure measurement is required – ideally at rest. Sometimes doctors also order 24-hour blood pressure monitoring: Patients are equipped with a measuring device that automatically measures blood pressure repeatedly over 24 hours.
If the diagnosis of high blood pressure is confirmed, a detailed discussion follows in the doctor’s office (anamnesis). The risk factors for high blood pressure, any previous illnesses and medications taken are asked. This is followed by a physical examination:
- Determination of body mass index (BMI)
- Listening to the heart and carotid arteries
- Blood draw
- Urinalysis
If necessary, imaging tests or a long-term ECG can be ordered.
Therapy: What to do if you have high blood pressure?
If the high blood pressure is secondary hypertension, the underlying disease is treated. In the case of primary hypertension, patients are initially recommended to make lifestyle changes to lower blood pressure and thus reduce the risk of cardiovascular disease.
The measures include, among others:
If lifestyle changes are not enough to permanently lower blood pressure, antihypertensive medications are used. Various active ingredients are available here, which are often combined with each other:
ACE inhibitors block a specific enzyme that is involved in the production of a hormone that increases blood pressure.
Sartans (angiotensin antagonists) reverse the effects of this blood pressure-increasing hormone.
Beta blockers slow the heartbeat and not only lower blood pressure, but also relieve the strain on the heart.
Diuretics (water tablets) increase urine output. This causes the amount of fluid in the blood vessels to decrease and blood pressure to drop.
Calcium antagonists inhibit the muscles in the vessel walls. The vessels expand and blood pressure drops.
Course and prognosis of high blood pressure
If blood vessels are constantly under pressure, they become damaged over time. Untreated high blood pressure over years can lead to cardiovascular diseases and/or impair the functionality of organs.
Possible complications of untreated hypertension include:
The earlier high blood pressure is detected and treated, the sooner the risk of these complications can be reduced.
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