High blood pressure

Our bodies need oxygen and nutrients. Our heart takes care of this, it pumps oxygen-rich blood in the arteries to supply the muscles and organs with oxygen and nutrients. It pumps about five litres of blood per minute. It does so by contracting and relaxing. When pumping the blood, there is pressure in the blood vessels and on the wall, this pressure is called blood pressure. High blood pressure is not a disease in itself, but it must be treated, because blood pressure that is too high for too long can have a (major) impact on health and lead to heart disease and vascular diseases.  

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What is high blood pressure? 

High blood pressure is when the blood pumped around our body presses too hard against the walls of the blood vessels. This pressure can be measured with a blood pressure monitor. It measures two values, upper and lower pressure, expressed in mmHg (millimetres of mercury). The supra-pressure or systolic pressure is the pressure on the vessel wall when the heart contracts and forcefully pumps the blood into the arteries. The vacuum or diastolic pressure is the pressure when the heart relaxes, causing the pressure in the veins to drop. High blood pressure occurs when the blood pressure value exceeds a certain limit value. When the upper pressure exceeds 140 mmHg, we speak of high blood pressure or hypertension. With a resting home measurement this is 135 mmHg. When the lower value exceeds 90 mmHg, we also speak of hypertension, often the upper value is too high. Blood pressure must be elevated on several days and over a longer period of time before we speak of high blood pressure or hypertension. The aforementioned values apply to people under the age of 80. In people of 80 years and older we speak of a high blood pressure with an upper pressure of 150 mmHG or 160 mmHG measured several times at rest.  

What are the causes of high blood pressure? 

There are different types of high blood pressure. Such as: 

  • Primary high blood pressure: this occurs in 90-95% of people with high blood pressure. The cause of this is not known. There may be hereditary factors. In the family we see that there is a lot of high blood pressure.  
  • The secondary high blood pressure: where the cause can be determined. 
  • The hypertensive crisis: which occurs when the blood pressure is severely increased, above 200 over 120 mmHg. This is an acute situation because it can cause acute damage to the organs.  
  • The pregnancy hypertension: blood pressure must therefore be monitored regularly during pregnancy because high blood pressure is a health risk for both the mother and the unborn child. 

 

How do you recognise high blood pressure? 

High blood pressure is difficult to recognise because you do not notice it (usually). Complaints may occur, but they are often not recognised. Possible complaints include: 

  • Chest pain 

  • Headache 

  • Weariness 

  • Nosebleeds 

  • Change in sight 

With hypertensive blood pressure there are often clear symptoms, these include: 

  • Blurred vision 

  • Severe headache 

  • Nausea and/or vomiting 

  • Confusion 

  • Shortness of breath 

  • Red or brown urine 

  • Shortness of breath 

  • Chest pain 

 

Is there anything I can do myself about high blood pressure? 

You can do something yourself about high blood pressure. First of all, live healthily. The following are recommendation for a healthy lifestyle: 

  • The fight against obesity

  • Stop smoking

  • Healthy and varied diet: plenty of fruit and vegetables, little salt (liquorice, liquorice tea)

  • Moderate alcohol consumption

  • Exercise enough: at least half an hour a day

  • Learning to deal with tension and stress

Although you have followed all these recommendations, blood pressure can still remain high and the doctor can prescribe medication to lower the blood pressure. It is important to remember that anti-hypertensive medicines do not replace a healthy lifestyle, but are complementary to the lifestyle recommendations. 

What are the forms of treatment? 

There are different kinds of medicines to treat hypertension. The choice of a particular medicine depends on which hypertensionit involves, (primary or secondary hypertension). The doctor considers all the data when choosing a medicine or a combination of medicines. This is done based on:

the blood pressure level:

  • Age

  • Weight

  • Gender

  • Race

  • Additional conditions (e.g. diabetes, heart disease, kidney damage)

  • Other medicines used

  • Side effects

When the blood pressure has been well controlled for a year, an attempt can be made to reduce the medication intake. However, you should never do this without consulting your doctor.

Medicines all interact differently with the different control systems. They are classified as follows: 

  • Hypoglycemics/urinary products or diuretics: urinary products cause the kidneys to excrete more salt, which draws moisture with it and is discharged through the urine. This means that less fluid remains in the bloodstream, which causes the blood pressure to drop.

They are again subdivided into:    

  • Weak urinary products: they are often prescribed in case of high blood pressure

  • Strong urinary products: have a fast and powerful effect. They are prescribed when the body suddenly retains a lot of fluid. Once the fluid has drained away, these strong medications are no longer needed. They are often only prescribed for a short period of time

Side effects of urinary products: 

  • Muscle pain or muscle weakness in the thighs and upper arms

  • (Severe) fatigue

  • Palpitations

  • Severe abdominal discomfort

If you have any side effects when taking any of the medicines in this group, you should always consult a doctor. In case of a potassium deficiency, the doctor will be able to prescribe potassium-saving medicines.

  • Potassium-saving urinary products are prescribed if the potassium level is too low. They are often prescribed in combination with another blood pressure reducer because they do not have a strong effect. They can also be prescribed to improve the pumping power of the heart in the event of heart failure.

Beta blockers 

Beta blockers slow down the heartbeat so that the heart starts pumping more quietly and they dilate the blood vessels. This lowers the blood pressure. If you have asthma or COPD(chronic lung disease) then beta blockers are less suitable as they can cause an asthma attack. 

Side effects of beta blockers: 

  • Dizziness 

  • Gastrointestinal complaints (nausea, vomiting, diarrhoea or constipation)

  • Sweating 

  • Cold hands and feet 

  • Weariness 

  • Many of the side effects are often seen at the start of treatment, the body still needs to get used to the lower heart rate and blood pressure.

  • There may also be a hypersensitivity to beta blockers. This manifests itself in skin rash, itching and hives, among other things. The hypersensitivity can occur to a slight degree, but also to a severe degree with tightness of the chest and swollen face. Then see a doctor immediately.

  • Beta blockers can affect your sporting performance. Talk to a doctor about which sports you should not do. Ask for advice when you want to work out intensively.

RAS inhibitors: ACE inhibitors and Angiotensin II blockers

RAS inhibitors dilate the blood vessels so that the blood flows better, causing the blood pressure to drop. They also affect the excretion of sodium with the urine. This also helps to lower the blood pressure.

Side effects of RAS inhibitors: 

  • Low blood pressure when standing up

  • Decline in renal function

  • Increase in potassium in the blood

  • Stimulus cough (stimulus coughing medication does not help)

  • Allergic skin reactions, itching, spots

  • Taste disorder

  • Angioedema, rare but very serious (this usually occurs at the beginning of treatment), swelling of the face, lips and tongue. If you have ever had this, you are not allowed to use RAS inhibitors.

Calcium blocker 

Calcium blockers reduce the tension in the muscles around the blood vessels, causing the blood vessels to relax and widen. This allows the blood to flow through better and lowers the blood pressure. Calcium blockers are only prescribed if other anti-hypertensive agents do not work properly or cannot be used.  

Side effects of calcium blockers: 

  • Headache

  • Blush

  • Swollen feet and ankles

  • Heart failure or its worsening

  • Dizziness or light sensation in the head

  • Gastrointestinal complaints 

Alphablockers 
Alpha blockers make the blood vessels widen, the blood can flow better and the blood pressure goes down. They are often used in combination with other anti-hypertensive products. Alpha-blockers are not first choice medicine because of side effects such as dizziness. They are only prescribed if other anti-hypertensive medicines do not work properly or if you are not allowed to use them. Alpha blockers are often used in combination with other anti-hypertensive agents. 

Side effects of alpha blockers (especially in the first few weeks): 

  • Weakness 

  • Ejaculatory disorders 

  • Headache 

  • Dizziness 

  • Weight gain 

  • Dizziness 

  • Slight drowsiness 

  • Low blood pressure when standing up 

  • Inflammation of the nasal mucosa 

  • A positive side effect is that alpha blockers can lower LDL (known as bad cholesterol) 

Ketanserin 
Ketanserin makes the blood vessels wider. The blood can flow better through the vessels and the blood pressure goes down. Ketanserin is only prescribed if other anti hypertensive medicines do not work properly or if you are not allowed to use them. Ketanserin may be prescribed in combination with other medicines. 

Side effects of ketanserin: 

  • Dizziness (often) 

  • Headache 

  • Reduced awareness 

  • Sleep disorder, drowsiness, fatigue 

  • Eye conditions  

  • Gastrointestinal disorders, abdominal pain.  

  • Dry mucous membranes, dry mouth 

  • Weight gain 

  • Lethargy 

  • Loss of concentration 

  • Decrease in calcium and cholesterol levels, increase in creatinine levels 

Vasodilators

Vasodilators help dilatate the blood vessels because they have a direct relaxing effect on the vascular wall. The blood can flow better and the blood pressure goes down. They are always prescribed in combination with urinary products and beta blockers in order to alleviate certain side effects of vasodilators.  

Side effects of vasodilators: 

  • Light headed 

  • Dizzy 

  • Headache 

  • Blush 

  • Hay fever 

  • Influenza 

  • Asthma 

Centrally acting anti-hypertensive products 

High blood pressure can be caused by the brain sending a signal to the blood vessels to constrict. Too narrow blood vessels cause high blood pressure. Centrally acting anti-hypertensive products prevent this signal so that the increase in blood pressure does not occur.  

Methyldopa 

is also a centrally acting anti-hypertensive product and is usually only prescribed to pregnant women with high blood pressure as it has been proven to be safe for the unborn child. 

Side effects of centrally acting anti-hypertensive products:  

  • Drowsy, sleepy and dizzy: do not drive a car for the first few days. After a few days it is usually over and you can drive again.  

  • Nausea 

  • Diarrhoea 

  • Backache 

  • Sleep problems and depression 

Aliskiren

Aliskiren reduces the action of renin. This substance, which is native to the body, can cause blood vessels to narrow and blood pressure to rise. By inhibiting the action of renin, the blood vessels do not constrict and the blood can flow better. This lowers the blood pressure. 

Side effects of Aliskiren include: 

  • Headache 

  • Common cold symptoms 

  • Diarrhoea 

  • Seldom acute swelling of tissues (face and throat) 

  • It is not recommended during pregnancy and breastfeeding. 

 

Lifestyle changes 

A change of lifestyle is often imperative in case of high blood pressure, if necessary in combination with anti-hypertensive medicines. Quit smoking as there is a clear link between smoking and high blood pressure. You are going to have to deal with your excess weight. Eat healthily and varied (including a fibre-rich diet). Consume polyunsaturated fats. Eat 150 to 200 grams of vegetables per day and 2 pieces of fruit. Minimise the consumption of sugar (soft drinks, sweets, biscuits, etc.). Eat fatty fish such as salmon, tuna, herring, sardines, mackerel and trout twice a week. Be moderate with salt in food but also liquorice and liquorice tea. Do not consume too much alcohol, men only 2 glasses and women only 1 glass a day. Move enough, for example half an hour of walking, cycling, gardening. Get enough sleep. Combat stress

Additional risks and side effects 

An untreated high blood pressure has a number of risks. Such as damage to the arteries, heart, brain, kidneys, and eyes. Sexual dysfunction may occur. In men, in the form of an erectile dysfunction. In women, in the form of decline in sexual desire or excitement. This can lead to relationship problems.  There may be fatigue, poor sleep and poor condition. In fact, high blood pressure is a vicious circle. Excessive blood pressure can narrow the veins, causing the heart to pump harder, resulting in even higher blood pressure, damaging the vessels and causing cardiovascular disease, which in turn results in high blood pressure. 

How can you prevent high blood pressure? 

It is not always possible to prevent high blood pressure. However, a healthy lifestyle is essential in order to prevent high blood pressure. This means healthy eating, sufficient sleep, sufficient exercise and relaxation. 

 

 

References

[What is blood pressure?] (z.j.). Consulted on 2018/21/12 at https://www.hartstichting.nl/risicofactoren/gids-bloeddruk 

[What is high blood pressure?] (z.j.). Consulted on 2018/21/12 at https://www.thuisarts.nl/hoge-bloeddruk/wat-is-hoge-bloeddruk 

[Medicines for high blood pressure]. (z.j.).Consulted on 2018/21/12 at https://www.thuisarts.nl/hoge-bloeddruk/medicijnen-tegen-hoge-bloeddruk 

[Tailor-made medication/blood-pressure-reducing medication]. (z.j.). Consulted on 2018/21/12 at http://www.medicijnen-op-maat.nl/bloedsomloop/hoge-bloeddruk.htm 

[High blood pressure and kidney damage]. (z.j.). Consulted on 2018/21/12 at https://www.nierstichting.nl/over-nieren/oorzaken-nierschade/hoge-bloeddruk/?gclid=Cj0KCQiAgf3gBRDtARIsABgdL3kUhELdBGRohZeE6S-mCmlMlysiWz1Ez0p8ljgdiZnqsZLC18__lwaAqdGEALw_wcB 

[Healthy living]. (z.j.). Consulted on 2018/21/12 at https://www.hartstichting.nl/gezond-leven?gclid=Cj0KCQiAgf3gBRDtARIsABgdL3kSM9pnocpR9pH5ZFS5k52OH4IX7dE4lsBLcSO5k1cjpPfU-H4q5toaAhsjEALw_wcB 

[Beta blockers] (z.j.). Consulted on 2018/21/12 at https://www.farmacotherapeutischkompas.nl/bladeren/groepsteksten/betablokkers__systemisch 

[ACE inhibitors]. (z.j.). Consulted on 2018/21/12 at https://www.farmacotherapeutischkompas.nl/bladeren/groepsteksten/ace_remmers 

[Calcium blocker]. (z.j.). Consulted on 2018/21/12 at https://www.hartstichting.nl/hart-en-vaatziekten/behandelingen/medicijnen/calciumblokkers?gclid=CjwKCAiAx4fhBRB6EiwA3cV4KuuAIoz8RyUvg1OgeG9_QRSSV5yEGUPJqpevq-3ljdmwg51RKYT5yxoCLg4QAvD_BwE 

[Alpha blocker].(z.j.). Consulted on 2018/21/12 at https://www.farmacotherapeutischkompas.nl/bladeren/groepsteksten/alfablokkers 

[Ketanserin]. (z.j.). Consulted on 2018/21/12 at https://www.farmacotherapeutischkompas.nl/bladeren/preparaatteksten/k/ketanserine 

[Vasodilators]. (z.j.). Consulted on 2018/21/12 at https://consumed.nl/medicijnen/groepen/vaatverwijdende-middelen-vasodilatantia 

[Methyldopa]. (z.j.). Consulted on 2018/21/12 at https://www.farmacotherapeutischkompas.nl/bladeren/preparaatteksten/m/methyldopa 

[Aliskiren]. (z.j.). Consulted on 2018/21/12 at https://www.farmacotherapeutischkompas.nl/bladeren/preparaatteksten/a/aliskiren