What is blood pressure?
The blood carries oxygen and other substances necessary for the body’s tissues. The heart is a pump that circulates the blood to the tissues. Heart contraction creates pressure that pushes the blood to flow in the blood vessels (arteries and veins). The pressure is higher as the heart contracts (systole) and lower as the heart relaxes and expands (diastole). The blood pressure in the arteries does not drop to zero, even when the heart is loose.
The standard units of measurement for blood pressure are a millimeter of mercury (mmHg). Typical values are 120 mmHg during systole (systolic blood pressure) and 80 mmHg during diastole (diastolic blood pressure). It is common to write 120/80 and to say “120 by 80”.
What is high blood pressure (hypertension)?
Blood pressure above 140/90 (i.e., systolic pressure above 140 mmHg or diastolic pressure above 90 mmHg) is considered high blood pressure (hypertension or HTN for short).
Why is it determined that blood pressure above 140/90 is high?
This threshold was determined after it became clear that those who have blood pressure higher than 140/90 for a long time (years) are at increased risk of suffering from cardiovascular disease, including a heart attack, stroke, impaired kidney function, and impaired vision.
It has also been found that treatment to lower blood pressure reduces the risk of these diseases appearing, so it is important to diagnose and treat them.
What are the causes of high blood pressure?
Although it is a common disease, there is no complete answer to this question. We still do not know all the causes of high blood pressure.
The blood is made of muscle tissue. As this muscle contracts, the diameter of the blood vessels decreases. Reducing the diameter of blood vessels causes increased pressure to be applied to the blood flowing in them. The degree of contraction of the walls of the blood vessels is determined by various hormones, some of which are secreted by the kidneys. The amount of fluid and the number of salts in the body also determine the volume of blood flowing in the blood vessels: the greater the amount of water and salt, the higher the blood pressure. The amount of water and fluid in the body is also determined to some extent by the kidneys.
In elderly patients, there is probably another mechanism that causes high blood pressure: vasoconstriction. The heart contracts and injects a lot of blood into the main arteries in a short time (about 70 milliliters in half a second). Blood cannot be pumped at such a high rate to the whole body, so blood accumulates temporarily inside the large arteries – which are flexible blood vessels that can temporarily expand and contain the “excess blood” and gradually flow into the continuation of the tubes – into the smaller arteries and veins.
The large blood vessels can be compared to a balloon: the heart contracts and fill the balloon, and then the balloon gradually empties into the continuation of the piping. As we know, when we inflate a flexible balloon, we do not have to put in much effort, and it is possible to put in a large volume of air without applying strong pressure with the help of the cheeks. On the other hand, when we inflate a rigid balloon, in order to get the same amount of air, we need to apply strong pressure with the help of the cheeks.
As people get older, their blood vessels become stiffer, so the blood ejected from the heart has to force the walls of the hard arteries more forcefully, so the pressure created in them is high.
In most cases, the causes of high blood pressure are the ones described. Such blood pressure is considered “normal” and is also called “Essential Hypertension.”
In a small proportion of cases (5% to 15%), there is another cause, which causes an increase in blood pressure (kidney problems, hormone problems, taking medication, and more). Such hypertension is called “secondary.”
What are the symptoms of high blood pressure?
There are usually no symptoms of high blood pressure, which is why it is called the “silent killer.” Only if the blood pressure is particularly high (systolic pressure close to 200) can it cause symptoms such as headache, changes in vision, chest pain, and shortness of breath?
How is blood pressure diagnosed?
Since, in most cases, you do not feel that your blood pressure is high, you need to measure your blood pressure from time to time to find out. Blood pressure can be measured using a simple device when visiting a family doctor, and can even be measured at home, using a home blood pressure monitor that can be purchased at pharmacies or pharma chains.
When to do a high blood pressure survey?
When it comes to a screening test, blood pressure should be checked in every adult over the age of 18. After a normal initial test, the test should be repeated at intervals of between one year and five years—the more normal (lower) the values, the greater the interval between tests.
What is “white coat syndrome”?
Some people suffer from “white coat syndrome,” which means that the test in the presence of a doctor or nurse causes excitement and anxiety, and the result is that high blood pressure is measured that does not characterize that person’s “true” values. To overcome this problem, one has to repeat the measurement once and even twice with a difference of a minute or two between the tests, and usually, the values in the repeat tests will be lower, and it is common to see them as the true values.
What are the benefits of measuring blood pressure at home?
Another option is to measure blood pressure alone at home, and even in such a case, it is sometimes advisable to repeat the test immediately to see if the initial measurement is true or expresses excitement and anxiety. It should be noted that the home measurements are considered to better represent the real situation compared to the tests in the clinic. However, since the patient’s home is calmer, and lower values can be expected, even values above 135/85 in-home tests indicate high blood pressure (compared to values above 140/90 in tests performed in the clinic).
Three tips for measuring blood pressure
- It is advisable to check your blood pressure at different times during the day (for example, in the morning and evening).
- It is advisable to check the blood pressure for the first few times with both hands, and if a difference is obtained between the two hands, then the high blood pressure between the two hands is the determining factor. Once you know which of the two hands, the blood pressure is usually higher, be sure to measure in the arm where the blood pressure is higher.
- It is important that the sleeve size of the pressure gauge fits the patient. In an overweight patient who uses a sleeve that is too small, values that are slightly higher than the true values will be obtained. Conversely, if the patient uses too large a sleeve, values lower than the true values will be obtained.
What is blood pressure holter?
There is another diagnostic tool that may be useful in some patients – a blood pressure holter. It is a device that is mounted on the arm for 24 hours and automatically measures blood pressure, again and again, both day and night. It is an effective tool for getting a more comprehensive picture of blood pressure throughout the day. It also helps to neutralize the component of mental stress at the time of measurement (“white coat syndrome”). The threshold for high blood pressure in Holter measurement is 130/80 (average of day and night).
When should secondary blood pressure be suspected?
When a diagnosis of high blood pressure is made, there are circumstances in which we assume that it is not normal hypertension, but we are looking for a special cause that causes the high pressure – a condition that is called secondary hypertension. Such situations should be suspected in the case of young people under 40 years of age who suffer from severe hypertension (above 160/100) or in the case of patients in whom the high (or very severe) blood pressure suddenly appeared. It should also be suspected that this is secondary blood pressure if the patient’s medical history includes one or more of the following conditions:
- Kidney or Urinary tract infection.
- Use of medications such as steroids or nasal drops.
- Sudden onset of sweating or flushing or palpitations.
- Thyroid problems.
- Snoring and sleep apnea.
Read Also: 6 ways to lower blood pressure
How common is high blood pressure, and who is at increased risk?
20% to 40% of adults suffer from high blood pressure. As you grow older, the risk of high blood pressure increases, and after the age of 60, the incidence of this disease is more than 60%. It is a disease that is usually not cured, but it accompanies the person until the end of his life (chronic illness).
Other factors that increase the risk of developing high blood pressure are lack of exercise or too little exercise and being overweight (lack of movement and being overweight usually worsen as you get older).
Who needs treatment, and how is it treated?
After accumulating some measurements, it is possible to assess the significance of blood pressure. Values below 120/80 are considered optimal, but even slightly higher values are not usually required – as long as they are not above 140/90.
As mentioned, high blood pressure over time involves disease of the heart and blood vessels, and the goal of treatment is to reduce the risk of developing these diseases. Thus, in the case of those at very high risk (patients whose medical history includes cardiovascular disease such as myocardial infarction or stroke), the tendency is to give them a treatment to reduce blood pressure – even to values slightly below 140/90.
Before starting treatment, one should assess the damage that has already been caused as a result of the high blood pressure. The test is performed on “target organs” – organs that tend to be damaged as a result of high blood pressure values: check if there is a thickening of the heart muscle (by ECG or by echocardiography ), check if there is a history of arrhythmias such as atrial fibrillation, check the Kidney function (do a protein test in the urine and a blood test for kidney function) and refer to an ophthalmologist to check the condition of the blood vessels in the retina.
When blood pressure values are not very high (i.e., above 140/90 but below 160/100), the first step in treatment will usually be lifestyle modification guidelines:
- Weight loss for those who are overweight (the required target is a BMI below 30; the desired target is a BMI between 20 and 25).
- Limiting salt intake: up to 5 grams of salt per day (which is 2 grams of sodium) per day. At the same time, increase the consumption of fruits and vegetables and limit the consumption of saturated fat.
- Aerobic exercise (30 minutes at medium intensity, 5 to 7 times a week).
- Smoking rehab.
- Moderate consumption of red wine.
When do you start medication?
When it comes to values, moderate hypertension ((below 160/100) begin medication if not achieved satisfactory results after a few months of changing the light H. life; begin medication immediately if it is the patient who suffers from very high blood pressure (greater than – 160/100).
In the elderly (aged 65 and over and especially those aged 80 and over) – especially if they are thin and fragile – the tendency is to minimize medication as much as possible. If their blood pressure is very high – above 160/90 – there is no escape from drug treatment, but the decision to treat values that are above 140/90 but below 160/90 is conditional on the adults being able to tolerate the treatment well without noticeable side effects (such as weakness and dizziness ).
If a decision has been made to start drug treatment, it is common today to start a combination of two different preparations, preferably two preparations combined in one pill. A single preparation is sufficient if the blood pressure values are borderline or in the case of the elderly.
The primary goal is to reach blood pressure values lower than 140/90, but in most patients, the aspiration is to reach even lower values: less than 130/80 – if the treatment is well tolerated (without side effects) and if the patient is not elderly (in the elderly the aspiration is not To fall below 130 systolic).
After starting drug treatment, the blood pressure values should continue to be monitored, and it should be checked whether the goals have been achieved after 3 to 6 months of treatment.
Which doctor treats high blood pressure? When should you see a specialist?
High blood pressure is a very common condition, and GPs are knowledgeable and experienced in diagnosing and treating it. In most cases, the involvement of another physician is not necessary.
In exceptional cases, there are clinics designed for high blood pressure. The doctors in the field are nephrologists, specialists in kidney diseases.
Who needs a referral to a high blood pressure clinic?
Such referral is needed for patients who are suspected of having secondary high blood pressure as well as patients whose high blood pressure is resistant to treatment (i.e., the medications prescribed by the GP have not achieved the required target).
What is malignant blood pressure?
Malignant hypertension is very high blood pressure (more than 180/110) that usually rises suddenly and very quickly. It is a medical emergency that is usually accompanied by symptoms (headache, visual disturbances, chest pain, shortness of breath, drowsiness, seizures) and which requires rapid evacuation to the emergency room.
Blood pressure and coronary heart disease
One of the risk factors for coronary heart disease (COVID 19) is high blood pressure.
When the epidemic broke out, fears were raised that certain drugs to treat high blood pressure could increase the risk of contracting the virus. These are drugs from the family of ACE inhibitors (such as Tritase, Ramipril, Celeril) or from the family of angiotensin receptor blockers (such as Oxer, Lotan, Duban). In retrospect, it turned out that the fear was not justified, and it is even possible that these drugs may facilitate the course of lung disease in those who have been infected with the virus. Therefore, the unequivocal guideline today is that patients who have been recommended to use these drugs will continue to take them and will not stop for fear of contracting the coronavirus.