High Blood Pressure - Basic facts

High blood pressure or hypertension occurs when blood vessels have persistently raised pressure. If the pressure is high in the vessels, the heart has to work harder in order to pump blood into them. If left untreated, high blood pressure may cause heart attack, heart enlargement, heart failure or even stroke. But hypertension can also lead to kidney failure or blindness.

Definition of High Blood Pressure

Blood pressure is measured in mmHg (millimetres of mercury) and it is indicated by two numbers. The systolic blood pressure is the upper number and recorded when the heart beats. The diastolic blood pressure is the lower number and recorded when the heart is at rest. Clinic and ambulatory (Holter) hypertension values are defined differently.

Stage 1 Hypertension

When clinic blood pressure is > 140/90 mmHg and ambulatory (Holter) blood pressure daytime average is > 135/85 mmHg.

Stage 2 Hypertension

When clinic blood pressure is > 160/100 mmHg and ambulatory (Holter) blood pressure daytime average is > 150/95 mmHg.

Severe Hypertension

When clinic blood pressure is > 180/110 mmHg.

Causes of High Blood Pressure

There are socioeconomic, behavioural and metabolic risk factors that should be considered when assessing the causes of high blood pressure.

Socioeconomic Factors

Socioeconomic factors such as income, education or housing may have an effect on the ability of developing high blood pressure. For example, unemployment or bad living or working conditions cause stress, which results in high blood pressure. On the other hand, the risk of hypertension increases with age due to stiffening of blood vessels.

Behavioural Factors

Unhealthy diet, tobacco use, physical inactivity, excess use of alcohol may all lead to high blood pressure.

Metabolic Factors

In some cases genetic factors may also play a role and sometimes it is imporatnt to rule out secondary cause of hypertension, especially when it develops in people under 40. Secondary hypertension may be caused by kidney disease, malfunction of blood vessels or pregnancy. Hypertension occurs in women during pregnancy is called preeclampsia. Finally, when blood pressure is measured in clinic environment, due to anxiety of visiting a doctor, it may be higher than it usually is. This is the white-coat syndrome.

White-Coat Hypertension

Around 15-30% of people who show elevated blood pressure measured in the doctor's office have white coat hypertension. White-coat hypertension is one of the most important reasons for ambulatory (Holter) blood pressure monitoring.

In case of white-coat hypertension, the clinic blood pressure is above 140/90 mmHg, while the average daytime ambulatory (Holter) blood pressure is normal, that is it is below 135/85 mmHg.

Further Indications of Ambulatory (Holter) Blood Pressure Monitoring

- resistant hypertension

- masked hypertension

- childhood hypertension

- assessing the efficacy of anti-hypertensive drug therapy on a 24-hour basis

- nocturnal hypertension

- episodic hypertension and/or anxiety disoredrs

- hypotensive symptoms

- changes in diet and daily routine designed to reduce hypertension

- hypertension in pregnancy

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