Table of Contents
What exactly is blood pressure?
Blood pressure is the force exerted by the blood on the blood vessels. It has different values depending on whether we are at rest or working hard at a given moment. Blood pressure is measured with a blood pressure monitor and is expressed in mmHg.
Systolic blood pressure (SBP) is a measure of the pressure of the blood on the blood vessels during cardiac contraction. It is highest then - in the pressure record it is expressed by the first number. Diastolic blood pressure (DBP) is the pressure exerted during cardiac diastole, when it is physiologically the lowest. In the recording of the measurement result, it is expressed by the second number.
What blood pressure depends on:
- The force with which the heart pumps blood into the vessels;
- the elasticity of blood vessel walls.
By circulating blood through the blood vessels at a certain pressure, it is possible to supply the entire body with oxygen and nutrients. However, the value of this pressure is crucial. When the pressure is too low, hypoxia can occur. Too high a pressure leads to damage to the blood vessels and organ complications.
Blood pressure, when is it high or low?
Hypertension is a consistently elevated blood pressure that reaches values equal to or greater than 140/90 mmHg. The first, higher value is the systolic pressure, created when the heart is in the process of contracting. The second, lower value is the diastolic pressure, measured when the muscle is contracting and has a pause before the next contraction. The amplitude between the two values should not exceed 30-50 mmHg. The classification of blood pressure for office measurements is shown below.
Check out the article: Tonerin for hypertension
High blood pressure is now considered to be 140/90 mmHg, but raising the bar in this range also means fewer people taking the anti-hypertensive drugs betablockers, which new research suggests can have deadly effects. Researchers estimate that about 800,000 people across Europe have died from stroke or hypotension (dangerously low blood pressure) in the past few years as a result of their use. Despite this, information about the findings was removed from the website of an academic journal just hours after publication.
Medicine is constantly changing its mind about what exactly constitutes high blood pressure and its threshold values that are indications for treatment. As shown below, the definitive definitions of high and low blood pressure change with each decade.
1960s: >100 + number of years/100 mmHg |
1980s: >160/100 mmHg |
1990s: >140/90 mmHg |
2014 r. - Hypertension (US): >150/90 mmHg |
2014 r. - normal values: ≤120/80 mmHg |
Doubts about normal blood pressure values are strange for a disease often called the "silent killer." Hypertension is considered a significant risk factor for heart attack or heart failure, stroke and kidney disease.
But after all, determining what high blood pressure is has always been as much a matter of fashion as of science. Less than 50 years ago, doctors used a simple unwritten rule to determine whether a patient's health was at risk. Since blood pressure tends to increase with age, the old method was to add 100 to the patient's number of years of life.
The established threshold of 140/90 mmHg is dangerous for people in their 30s or younger, as well as patients with diabetes or chronic kidney disease.
Thus, for 60-year-olds, the acceptable upper limit for systolic blood pressure values was 160 mmHg. It affects an estimated 30 percent of the adult population, according to the British National Health Service. Many of them are not even aware that they have the disease - hence the term "silent". Basically, high blood pressure means too much strain on the heart and arteries, which over time can cause damage to them.
Although there is little evidence to suggest that more people were dying from hypertension at that time and a value of 160/100 mmHg was set for all ages.
How to measure blood pressure?
Your blood pressure usually rises and falls throughout the day. The highest blood pressure readings are reached in the morning. In addition, blood pressure readings may vary depending on which arm is being measured.
However, perhaps the most well-known phenomenon is the so-called white coat hypertension. What is it? The idea is that your systolic blood pressure - the first of two numbers measured when your heart pumps blood - can rise by as much as 30 mmHg when you're sitting and impatiently stressing until your doctor takes a reading.
Doctors should take this into account when assessing whether a patient needs to start antihypertensive medication, but a lot depends on the specialist and the extent to which they are doing their job.
If you are concerned that you will get a falsified result that will trigger what is really unnecessary pharmacotherapy, you should monitor your blood pressure in your own home by checking it regularly throughout the day. The best devices designed for this purpose are fully automated digital monitoring devices that measure pressure at the upper arm rather than at the wrist or finger. Be sure to carefully measure the circumference of your upper arm so that you order the right size blood pressure cuff for you.
How often should I measure my blood pressure?
People with normal blood pressure values should measure them periodically several times a year, usually enough during a doctor's visit. However, Patients with known hypertension should have their blood pressure checked regularlyThe measurement should ideally be taken twice daily, usually in the morning and in the evening at regular intervals. Measurements should be taken before meals and before taking blood pressure lowering medications, if you are already taking them.
How you can lower your blood pressure
The first step is a proper diet: less salt and sodium, sugar and processed foods, while eating more healthy meals, rich in foods with proven blood pressure benefits.
Non-pharmacological measures also play a very important role in the treatment of hypertension. Reducing excess body weight promotes normalization of blood pressure values. Weight reduction can be achieved by following a Mediterranean-type diet, eating fish at least twice a week, and reaching for about 400 grams of fruits and vegetables a day. By limiting salt intake to about 5 grams per day, we can reduce blood pressure by 2-8 mm Hg.
Blood pressure values increase linearly with the amount of alcohol consumed. When it is not possible to eliminate alcohol completely, alcohol intake should be limited. The total weekly alcohol intake should not exceed 140 grams of pure alcohol in men and 80 grams of pure alcohol in women.
Smoking cessation not only reduces blood pressure values, but additionally reduces the risk of stroke, ischemic heart disease, and peripheral artery disease.
Daily exercise is recommended of moderate intensity for about 30 minutes a day. To achieve a 4-9 mm Hg reduction in blood pressure, perform endurance exercises such as walking, swimming, and trotting, supplemented with resistance exercises (e.g., squats). Be sure to tailor exercise to the patient's age, preferences, and comorbidities.
One of the cornerstones of hypertension prevention is to strive to maintain a normal body weight, and if you are overweight or obese, to follow a reduction diet. BMI (Body Mass Index) is an index that helps determine whether our current body weight is within or above the normal range.
In situations where the BMI value exceeds 25, follow a negative calorie dietThe pace of a proper weight reduction should include the loss of about 0.5 - 1 kg every week. The pace of proper weight reduction should be to lose about 0.5 - 1 kg every week.
Obese people in particular should take care of their nutrition, as obesity has been shown to be a factor that increases the risk of hypertension by 4 times. In patients reduce excessive body weight will be associated not only with lower blood pressure, but also with the possibility of taking lower doses of hypotensive drugs.
In approximately 50% patients, losing each kilogram of body weight has been shown to reduce systolic blood pressure by 1 to 4 mm Hg and diastolic blood pressure by 1 to 2 mm Hg.
Symptoms of hypertension
People with primary hypertension usually do not experience specific discomfort and generally feel well. This is why it is colloquially said that hypertension is a "silent killer." Patients often find out about high blood pressure values by accident, such as when performing periodic preventive examinations or when visiting a doctor for other reasons.
A sudden rise in blood pressure to high levels can cause symptoms such as:
- Headaches - usually throbbing in nature, felt between the eyes, in the early morning hours,
- visual disturbances,
- nausea and vomiting,
- nosebleeds.
Some of the symptoms that accompany high blood pressure may be due to organ damage and are consistent with secondary (symptomatic) hypertension. These may include, for example:
- headaches,
- feelings of anxiety,
- increased sweating,
- skin pallor,
- accelerated heart rate,
- reduced potassium levels.
Complications when you don't treat hypertension
The most common type of hypertension is the so-called primary hypertension, the causes of which are associated with genetic factors, age, excessive body weight, high-sodium diet, low fruit and vegetable intake, alcohol abuse, cigarette smoking, physical inactivity, and chronic stress.
Secondary hypertension is a consequence of regular intake of certain drugs (e.g., those containing pseudoephedrine) or the result of kidney disease, Cushing's syndrome, sleep apnea, or Conn's syndrome.
Because high blood pressure usually does not manifest itself with specific symptoms for many years and given the low percentage of patients with good blood pressure control in Poland (22.5%), the complications associated with this disease are a real threat to many people. It has been shown that as many as 12.8% of all deaths worldwide are related to the consequences of hypertension, which is an important risk factor for stroke, heart failure, aortic aneurysm formation, left ventricular hypertrophy and retinopathy.
In order to prevent these serious complications, effective prevention should be pursued and, among sufferers, blood pressure should be regulated through lifestyle changes and the use of doctor-prescribed pharmacotherapy.
Drugs that lower blood pressure
Popular and effective:
- Diuretics, or diuretics (e.g., indapamide, hydrochlorothiazide)
- beta blockers
- Drugs that lower the "tension" of the said sympathetic nervous system (e.g., carvedilol, nebivolol, bisoprolol, metoprolol)
- Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) - these drugs lower blood pressure by interfering with the renin-angiotensin-aldosterone system - e.g. perindopril, ramipril, losartan, valsartan
- Calcium channel blockers - reduce the "tension" of the vessels (such as amlodipine).
These drugs can be used either alone (known as monotherapy) or in combination. The doctor usually starts the therapy of hypertension with a single drug. In younger patients, calcium channel blockers, angiotensin-converting enzyme inhibitors and angiotensin receptor inhibitors are most indicated. In older and elderly patients, treatment usually begins with diuretics.
Non-pharmacological treatments include:
- limit alcohol consumption
- smoking cessation
- changing your diet to one rich in vegetables, fruit and fish
- Regular physical exercise of moderate intensity adapted to each individual
- Reduce table salt intake
- reduce or maintain normal body weight
Effects of untreated hypertension
Over 8 million adults in Poland have problems with hypertension. A big problem in fighting this disease is the fact that hypertension does not hurt. Of course, some headaches or nosebleeds may occur, but they are rare, and besides, these symptoms are not very characteristic - they may have many causes.
Stroke
Apart from a heart attack, stroke is one of the most common serious circulatory complications. It occurs when the work of blood vessels supplying blood to the brain is seriously disturbed. And this often happens when we have untreated hypertension. In Poland, stroke is diagnosed every year in almost 70 thousand people - 30 thousand of them die because of it.
Strokes are divided into hemorrhagic and ischemic. A hemorrhagic stroke (one in five) is commonly called a stroke because blood pours out of the damaged vessel, destroying the adjacent portion of the brain. In an ischemic stroke, the artery is not ruptured but clogged, usually due to atherosclerosis. Hemorrhagic strokes tend to be more turbulent, with the patient experiencing more rapid onset of unconsciousness and hemiparesis, for example. Ischemic strokes usually develop more slowly, with symptoms developing over several hours. Regardless of the type of stroke, the effects are the same - part of our brain stops working.
Stroke is most threatening to: people with high blood pressure, the elderly, men (they go through stroke one and a half times more often than women), people with heart rhythm disorders, diabetes, people who are obese, smokers, alcohol abusers, and those with too high cholesterol levels.
Sight
One of the organs that are particularly badly affected by excessive pressure is the eye. This may be manifested, for example, by small petechiae under the conjunctiva indicating hemorrhage. If this has happened to us once or twice in our life, e.g. during sneezing, strong coughing or vomiting, we should not worry because a small subconjunctival hemorrhage is not dangerous - it is enough to wait until the petechiae disappear. It is worse when it happens to us more often. It may be a sign of developed arterial hypertension. In this situation it is necessary to consult a cardiologist.
Hypertension is also a major risk factor for age-related macular degeneration, or AMD. Many people have never heard of this condition, and it is now a lifestyle disease, being the most common cause of vision loss after age 50.
In addition to hypertension, risk factors include gender (the disease more often affects women than men), smoking, long-term exposure to UV radiation (e.g. outdoor work) and deficiency in the diet of substances able to destroy free radicals, i.e. carotenoids, vitamin E and C, selenium.