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Blood Pressure

Information about blood pressure

Blood pressure or the story of how your blood knocks against the vessels

Learn all about your blood pressure, systolic and diastolic numbers and what they mean

There is no better way to say it – it’s all wired to our source of life. The Global Health Observatory (GHO) estimates that no less than 1.13 billion people worldwide are affected by raised blood pressure. The WHO has identified high blood pressure as the world’s most prevalent preventable disease and reports that more than 1 in 5 adults worldwide have raised blood pressure – a condition that causes around half of all deaths from stroke and heart disease in the WHO European Region.
Complications from hypertension account for 9.4 million deaths worldwide every year. There is no doubt: If our blood pressure is out of control, our lives are in danger.

Why? Well, blood pressure describes the force of blood that is flowing through the blood vessels. It is recorded as two values, the systolic blood pressure (the first number) and the diastolic blood pressure (the second number). Whereas the first value is generated when the heart contracts and blood is pumped into the blood vessels, the diastolic (second) value describes the pressure when the heart is relaxed and is filling with blood again. The values are displayed in mmHg (millimetres of mercury).

According to the WHO and other leading health organisations, the systolic and diastolic values of blood pressure are divided into five categories: normal (120/129 systolic and 80-84mmHg diastolic), normal threshold (130-135 systolic or 85-89 mmHg diastolic), Grade 1 hypertension (140-159/90-99mmHg or higher), Grade 2 hypertension (160-179/100-109mmHg) and Grade 3 hypertension (also called hypertensive crisis) with above 179/above 110 mmHg.

The reasons for high blood pressure are numerous: overweight, smoking, stress, organ damage and age-related stiffness of large arteries or plaque inside the arteries. A different type of hypertension is “secondary hypertension”. Organic problems, such as kidney diseases, that cause high blood pressure. By treating the underlying problem, blood pressure values may return to normal.

According to a recent study by Springer’s hypertension reports, the risk of permanent damage to the whole body doubles with every 20 mmHg systolic or 10 mmHg diastolic in case high blood pressure remains untreated. However, if regularly monitored and treated, the risk of severe physical damage can be drastically reduced.

The only way to find out if you suffer from high blood pressure is to have it regularly measured by yourself, your doctor or medical professional who can also help you understand the blood pressure values.

Tabelle Blutdruck
 

Get to know your blood pressure’s secret codes

Secret codes and solid values – become the expert of your own blood pressure

We follow the people’s silent killer all the way into the arteries
High blood pressure threatens almost half of the population as “silent killer”

What’s up with high blood pressure?

blood pressure

Get into the nitty gritty of high blood pressure and learn how to handle hypertension

High blood pressure is a tricky one, some call it “silent killer”. It doesn’t come with recognizable symptoms and may remain undetected for years. However, a single measurement of high blood pressure is not yet an indicator of hypertension. Blood pressure values may vary immensely during the day. Only consistently elevated values indicate hypertension.

The reasons for high blood pressure vary – from an unbalanced diet to overweight, genetics, age or organ damage. Experts of the
International Journal of Medicine describe three major risk groups for high blood pressure: the general population above 50 years, African-Caribbean and South Asian communities and people with a known family history of high blood pressure. The same report goes as far as suggesting that hypertension is one of the major causes of death in the UK and other Western countries.


Even people with normal threshold blood pressure (systolic between 130 and 139 or diastolic between 85 and 89) are recommended a better diet, which suggests, above all, less salt and regular exercise. Values of Grade 1 hypertension (140-159/90-99mmHg or higher) and above require more profound lifestyle changes, such as muscle strengthening activities twice per week, less alcohol, no tobacco and regular check-ups. Medication complements these lifestyle changes, ideally not the other way round.

However, if high blood pressure is not treated accordingly, it can cause a series of problems, ranging from chest pain, kidney problems, shortness of breath, headaches and heart attacks to strokes at worst.
The best tricks how to deal with symptoms of low blood pressure
Why low blood pressure doesn’t always make us feel good

No disease but nevertheless troubling: Low blood pressure

When low becomes dizzy – learn how to differentiate low blood pressure from severe hypotension

It’s no secret: people with high blood pressure may envy people with low blood pressure. Though low blood pressure is not medically defined as illness, it still causes quite a lot of discomfort.
In contrast to hypertension, symptoms of hypotension can be quite clearly experienced: fatigue, light-headedness, dizziness, nausea, clammy skin, loss of consciousness and a blurry vision. 

Researchers of the American MayoClinic list the following reasons for low blood pressure: pregnancy, significant blood loss, shock, infections, impaired blood circulation after heart attacks, faulty heart valves, diabetes or low blood sugar (hypoglycaemia) or a thyroid malfunction. It can also be the side-effect of certain medications, such as beta-blockers or the heart-medication Nitroglycerin (also called glyceryl trinitrate (GTN)).

Generally, blood pressure is described as being too low (hypotension) with values less than 105 mmHg (systolic) and 60 mmHg (diastolic). However, the threshold between normal and low blood pressure (hypotension) is not as strictly specified as the threshold for high blood pressure (hypertension). 

A further form of low blood pressure is orthostatic hypotension, which refers to the drop in blood pressure after changing position, e.g. from lying down to standing up. Postprandial hypotension is a drop in blood pressure that occurs right after eating. And neurally mediated low blood pressure can affect children and adults who are standing for a long time. Parkinson’s disease and diabetes patients often suffer from hypotension.

A simple but effective method to answer most symptoms is to keep the body constantly hydrated.
A
nd to take it easy, sit up after lying down and take a few minutes after eating to allow the body to return to normal blood pressure before you head off.

In order to ensure that hypotension or the associated symptoms are not signs of a serious illness, a doctor should be consulted in case of doubt. However, rare cases of severe hypotension can deprive the whole body of sufficient oxygen which can lead to a damage of heart and brain. Extreme hypotension can result in life-threatening conditions, such as shocks, confusion (especially older people), rapid, shallow breathing and a weak but rapid pulse.

Once is simply not enough – why only multiple blood pressure measurements lead to a diagnosis
Pinpoint blood pressure problems despite a myriad of popular symptoms

Be ahead of the diagnosis: recognize blood pressure problems

The diagnosis of blood pressure problems is key to understanding the symptoms

Diagnosing blood pressure problems is not always so straightforward. Symptoms such as headaches, face flushing, dizziness, vision problems, chest pain or fatigue relate to many illnesses. There is no single indicator or symptom of too high or too low blood pressure. The only way to diagnose blood pressure problems is through regular check-ups. You can have your blood pressure tested in a broad range of places: pharmacies, at your health care provider, at your family doctor, at specialists such as cardiologists or nephrologists (kidney specialists) or at home with a blood pressure monitor.

However, a single measurement of high blood pressure is not yet a diagnosis of hypertension or hypotension. In order to find out if you really suffer from blood pressure problems, at least two measurements per day over a period of seven days have to take place, recommends the European Society of Cardiology. If the values are elevated, health professionals suggest time intervals for regular check-ups that range from every four weeks to three months. Only consistently elevated values indicate the diagnosis of hypertension.

According to a recent study by the German Robert Koch Institute, 20% of the people affected are completely unaware that they suffer from too high blood pressure. Another 28% decide against any treatment. The authors estimate that half of all heart attacks and strokes would be avoidable if the blood pressure problem had been treated. A study by the Epidemiologisches Bulletin 5/2015 suggests that a mere 52% of concerned people are successfully treated. The “silent killer” with its fuzzy symptoms is among the population’s greatest sources of health-related problems.

You simply can’t overestimate it – high blood pressure is your body’s highway to hell
The real challenge is to do it right – again and again

Put yourself in charge and measure your blood pressure at home

Why blood pressure measurement works best on bare skin above the brachial artery

Basically two non-invasive blood measurement strategies exist: the oscillometric and the auscultatory method. Regardless of how you decide to measure the blood pressure, your target is always the same: the brachial artery that you can find best on your upper arm or wrist. Most devices for the upper arm come with a wrap-around cuff and a monitor, devices for the wrist with a thinner elastic cuff and a monitor.

To measure blood pressure at home, either method can be applied: the auscultatory method focuses on the Korotkoff sounds of your blood flow. The oscillometric method operates by sensing the magnitude of oscillations caused by the blood as it begins to flow again into the limb. To measure blood pressure at home, either method can be applied: the auscultatory method focuses on the Korotkoff sounds of your blood flow. The oscillometric method operates by sensing the magnitude of oscillations caused by the blood as it begins to flow again into the limb. Some home measurement devices also offer a combination of both methods or are equipped with integrated arrhythmia detection or a mobile ECG for the prevention of strokes.

It is known that the systolic and diastolic pressures vary substantially in different parts, so it’s best to always return to the same position as well as to the same arm or wrist for comparable results. Patients usually sit and lean against the backrest and have their arm propped up at heart level. It is also important that blood pressure measurement has to take place at the same time of the day to increase the comparability of the data – and to write it down or load it into health management systems on your computer or smartphone or online into a Cloud-system.

These are the ten golden rules for measuring your blood pressure:

1.   Rest for about 5 minutes before measuring blood pressure. Even working at your desk                  increases blood pressure by an average of about 6 mmHg systolic and 5 mmHg diastolic.

2.   Do not consume any nicotine or coffee for up to one hour before taking the measurement.

3.   Do not take a measurement while you have a strong urge to urinate. A full bladder can       
      increase blood pressure by about 10 mmHg.

4.   Take measurements on a bare upper arm and while sitting upright.

5.   If you are using a wrist monitor, hold the cuff at heart level during the measuring
      procedure. The cuff of an upper arm monitor is naturally positioned at the correct height.

6.   Please do not talk or move during the measuring procedure. Talking increases values by
      about 6 - 7 mmHg.

7.   Wait at least one minute between two measurements, so that the blood vessels are not
      compressed, to prepare for a new measurement.

8.   Record date and time as well as the values and any medication you might have taken.

9.   Take measurements regularly. Even if your values have improved, you should continue to
      check them for monitoring purposes.

10. Always take measurements at the same time of day. Because a person has about 100,000
      different blood pressure values every day, individual measurements have no significance.
      Only regular measurements taken at the same time each day over a longer period of time,
      give a meaningful assessment of blood pressure values.

An app doesn’t do the job! Why home monitoring has to be done properly.
Learn the specs about blood pressure monitors

Your way to the values: blood measurement monitors

Find your right fit when it comes to blood measurement monitors and learn how to use it properly

The most common home measurement devices are either for the upper arm or the wrist. Upper arm monitors come with an inflatable cuff and a monitor, wrist monitors mostly come with an elastic wrist band and a monitor.

It is important to find the right blood pressure monitor for home monitoring since the device is used frequently. Cuffs have to be applied on bare skin which might be more of a hassle in winter. Wrist bands are easier to apply though the position of the wrist has to be at heart level. This is given with upper arm cuffs.

The golden rule for any type of domestic blood pressure monitors is: it has to be clinically validated. Everything else isn’t reliable. A quick and easy way to ensure that your blood pressure monitor fulfils the requirements are quality seals, e.g. by the German Hypertension League, the European Society of Cardiology or the British Hypertension Society. You might also want a device that keeps an eye on your cardiac arrhythmias. The European Society of Cardiology strongly recommends that devices should be validated according to standardized conditions and protocols.

Various apps on mobile phones promise to check the blood pressure, but their results are anything but accurate, clinically not viable or recommendable in general. Using an app, however, is a good method to track the results for better comparison by your family doctor afterwards. Alternatively you may want to use your device’s software or app to record your values

It’s not rocket science: learn how to understand your blood pressure value’s systolic and diastolic numbers
Five categories for a better understanding of blood pressure values

Where normal blood pressure begins – and ends

Your blood pressure value is divided in five categories for easy understanding of where normal blood pressure begins – and ends.

The only way to find out if someone has normal, low or high blood pressure values is to have the blood pressure tested. Each value consists of the systolic (the first) and diastolic (the second) number. It is read as “120 over 80”. Both numbers have to be in the same category. If one value is higher (e.g. 115/92) it is read and understood as hypertension stage 1. In case of elevated values, consulting your family doctor is essential for your health.

The Hypertension Guidelines of the European Society of Cardiology, which is in line with all major heart associations, agree on a chart comprising five categories for blood pressure values:

Normal: systolic mmHg 120-129 and diastolic mmHg 80-84.
Advice: Normal blood pressure means that nothing needs to be changed.

High normal (or normal threshold): systolic mmHg 130-135 and diastolic mmHg 85-89.
Advice: Elevated blood pressure might develop into a high blood pressure.

High blood pressure/Grade 1 hypertension: systolic mmHg 140-159 or diastolic mmHg 90-99.
Advice: Lifestyle changes are necessary, and in case of high-risk atherosclerotic cardiovascular diseases (heart attacks or strokes) blood pressure medication is unavoidable.

High blood pressure/Grade 2 hypertension: systolic mmHg 160-179 or diastolic mmHg 100-109.
Advice: Doctors are most probably going to prescribe blood pressure medication along with more severe lifestyle changes including reducing weight, salt, alcohol, processed foods and cigarettes.

Grade 3 hypertension/ hypertensive crisis is considered: systolic mmHg higher than 179 and/or diastolic mmHg higher than 110.

If blood pressure values exceed 180/120 mmHg twice within five minutes, patients need to immediately seek medical help by calling 911 or the national emergency number. A hypertensive crisis might have one or more of the following symptoms: chest pain, shortness of breath, back pain, numbness, vision or speaking problems. If untreated, patients are in danger of a heart attack or stroke.

Your legs hurt? The reason might not be in your limbs but deep down in your arteries.
Do you know which diseases can stem from high blood pressure?

Be aware of the silent killer’s network in your body

Symptoms of blood pressure problems are often linked to peripheral arterial diseases.

The difficulty in diagnosing the symptoms of blood pressure problems is its lack – not for no reason is it called the “silent killer”. High blood pressure puts extra strain on the heart and vessels, which can at some point lead to health issues and symptoms that only in turn lead to the diagnosis of blood pressure problems.

Among the most common problems are peripheral arterial diseases. Narrowed and weakened central and peripheral arteries cause pain in the legs or non-healing foot wounds. The authors of the paper “Peripheral Artery Disease: Current Insight into the Disease and Its Diagnosis and Management” report that up to half of the patients suffer from high blood pressure.

High blood pressure can also cause kidney diseases, such as renovascular hypertension (or renal artery stenosis) – and vice versa. The kidney’s arteries are narrowed or blocked due to high cholesterol. The kidneys release hormones to hold on to more salt and water, which causes the blood pressure to rise.

A further consequence of high blood pressure can be a stroke. In case of a stroke, blood can’t transport energy and oxygen to parts of the brain, which leads to cell damage. At worst, people can be left temporarily or permanently disabled or even dead.

It’s safe to say that patients with diabetes or high cholesterol are strongly advised to lower their high blood pressure to avoid further health problems – with or without symptoms of blood pressure problems.

A little wonder-pill has yet to be invented but you can still do a lot to reduce your blood pressure.
The real impact of blood pressure medication and changes in lifestyle

It’s for the best, it’s for you: blood pressure therapy

Appropriate blood pressure medication goes hand in hand with lasting lifestyle changes to reduce blood pressure

A little wonder-pill to reduce blood pressure has yet to be invented. However, the foundation of any treatment is constant monitoring since the values vary massively during the day and a single measurement is therefore no indication. Basically blood pressure therapy is divided in two broad patterns: medical and non-medical approaches. The NIH, National Heart, Lung and Blood Institute of the U.S. Department of Health & Human Services, recommends the ‘Dietary Approaches to Stop Hypertension’ – short DASH - diet as non-medical therapy approach. The DASH-eating plan recommends:

  • Eating vegetables, fruits, and whole grains
  • Including fat-free or low-fat dairy products, fish, poultry, beans, nuts, and vegetable oils
  • Limiting foods that are high in saturated fat, such as fatty meats, full-fat dairy products, and tropical oils such as coconut, palm kernel, and palm oils
  • Limiting sugar-sweetened beverages and sweets

Smoking is to be reduced or given up entirely, and alcohol reduced to its minimum. If the BMI index is elevated, a reduction of weight is strongly recommended.

These changes in lifestyle might be accompanied by medication. Scientists of the Department of Physiology, University of Melbourne, Victoria, Australia grouped the most common blood pressure drugs into four main types of medicine: ACE inhibitors, Angiotensin receptor blockers, Calcium channel blockers and Thiazide diuretics. None of these are suitable for self-medication.

In most cases of high blood pressure, values return to their previous high levels if blood pressure medication is stopped. Therefore patients are more likely to take medication for the unforeseeable future.

Follow your blood pressure diet and enjoy the freshest foods that can lower your blood pressure
Think of fresh foods and vital vitamins when you shop for your blood pressure diet

Yummy, healthy and good for your blood pressure as well

The four principles of your blood pressure diet and how to enjoy foods with less sodium

No matter how much you search for foods that lower your blood pressure, it all comes down to the four DASH-principles of any blood pressure diet: more fruit, vegetables, less saturated fat, more whole-grain foods and nuts and less sodium, sweets, sugary drinks and red meats. Though many aspects can support your diet, the main focus should be on reducing sodium. Incredibly high amounts of salt are hidden in processed foods, such as frozen pizza, in bread, breakfast cereals and many convenience products. It’s worth checking the sodium amount next time you go shopping, as well as asking at your local deli for sodium-reduced ingredients. 

However, any blood pressure diet works best in combination with a bunch of lifestyle changes, such as more exercise, less nicotine and alcohol and a moderate stress level (at best). Since none of these aspects are temporary, it might be best to introduce them slowly as new routines. For example, the perception of “salty” changes, this makes it (over time) easier to reduce sodium even further. The same is true for amounts of foods that lower blood pressure and the feeling of saturation. Exercising 15 minutes a day might be a challenge in the beginning but once muscles are built up, it’ll be an easy task. Another benefit of exercising regularly is a significant reduction of the heart rate during exercises. 

Losing weight (ideal target is a BMI smaller than 25) and designated relaxation periods (a few times per week) support the blood pressure diet and reduce stress-related headaches.

Note: some diets suggest grapefruits or grapefruit juice. However, this needs to be checked with your doctor as some medicines don’t agree with grapefruit acid.

Ready, steady, go! A few minutes a day can already make a change and lower your blood pressure
Take time for your wellbeing – and start with a few exercises to lower your blood pressure

How exercising can lower your blood pressure

Exercises to lower blood pressure can be easily incorporated into the lives of high blood pressure patients

Excuses not accepted! Exercises to lower your blood pressure don’t take much time, don’t have to cost a penny and have a real impact on lowering your blood pressure. However, for those who haven’t been active in a long time, it is crucial to start slowly. Nobody expects you to run a marathon by tomorrow: Start walking a bit more, take the stairs instead of the elevator and keep standing for a few minutes rather than sitting the whole time. Slowly and over time you then increase the intensity of the exercises to lower your blood pressure.

Those who are more used to exercising might think of doing more of the activities they enjoy, such as yoga, Pilates, walking, swimming, jogging, dancing, golf, cycling or tennis. The benefit of aerobic activities comes with repetition; the aim of blood pressure lowering exercises is to build up muscles in your legs, shoulders and arms – and to lose weight. However, it’s best to talk to a doctor about very intensive exercises, such as sprinting or weightlifting since they might put too much strain on the heart. Scuba-diving and parachuting are not recommended either as exercises to lower blood pressure.
Why not motivate yourself by regularly tracking your results and checking your weight? Whatever works best to keep you motivated is valid. Best news is: You won’t have to wait long: after around three months your exercises to lower blood pressure will already have an impact.

But be aware that the positive impact on your blood pressure only lasts as long as you continue with the exercises to lower blood pressure.

Fight or flight – save your arteries with less stress or at least better stress management
How stress affects your blood pressure

Not the positive kind: learn how to deal with stress symptoms

How to handle stressful situations and save blood pressure spikes for real emergencies

Most people would agree that our lives are stressful. The natural “fight or flight” stress-reaction saves our lives in cases of emergencies – and it’s doing the job well. However, the consequences of stress for high blood pressure patients can be quite malicious. Calming down and relaxing is crucial and yet for many difficult to achieve. Particularly after the initial diagnose of high blood pressure many people find it challenging to adapt to a new lifestyle, to shoulder the additional financial expenses and to make time for measurements their daily lives.

Since there is no single solution to stress, there is no single answer to stress-management either. However, reliable approaches to fight stress symptoms are physical activity, meditations, simplifying the schedule and plenty of sleep.

Reducing the daily stress level and stress management techniques can introduce many good aspects to your life, such as a more relaxed behaviour, more time for things you enjoy, more time for your family and friends – and less spikes of your heart rate and blood pressure.

Not a fun trip! Keep your heart from tripping over high blood pressure and avoid arrhythmia at best
When your heartbeat trips over high blood pressure

An unfortunate team: Arrhythmia and high blood pressure

Scientists found the medical link between arrhythmia and high blood pressure

The list of experts couldn’t be more prestigious: The European Heart Rhythm Association (EHRA) and European Society of Cardiology (ESC) Council on Hypertension, endorsed by the Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE) report in the European Heart Journal (Vol. 38, Issue 4, 21 January 2017) that hypertension has been recognized as the principal and most common risk factor responsible for death and disability of non-communicable diseases worldwide. They state that high blood pressure leads to heart failure, coronary artery disease, stroke, peripheral artery disease, and chronic renal failure. In short: High blood pressure is considered one of the main risk factors for arrhythmia.

Heart rhythm problems are the result of irregular electrical impulses that coordinate the heartbeat. If the heart beats too fast, too slowly or irregularly, it might feel unpleasant – at best. At worst it can be life-threatening. Tachycardia refers to a fast heartbeat; Bradycardia refers to a slow heartbeat.

The first step to find out if you suffer from arrhythmias is to measure them. Many domestic blood pressure monitors are able to detect arrhythmias. However, in case arrhythmias occur, blood pressure monitors with oscillometric measurement methods may display incorrect values. By adding the Korotkoff measurement method the blood pressure can be measured correctly.

In case medical treatment is advised to treat heart arrhythmia, a pacemaker or cardioverter-defibrillator has to be implemented. However, this only affects a certain percentage of arrhythmia-patients.

If your heart is full of chaotic electrical signals, it’s nothing to celebrate – you need to act quickly
How to recognize atrial fibrillations and what to do

The Grim Reaper of our century: atrial fibrillations

If your heart experiences chaotic electrical signals, it’s high time to check your blood pressure

Another heart rhythm problem which causes hundreds of thousands of deaths each year is atrial fibrillation. It’s an irregular and most often rapid heart rate, also perceived as palpitations or anginal chest pain. It happens when the two upper heart chambers experience chaotic signals. However, atrial fibrillation doesn’t necessarily have symptoms at all, which makes it hard to detect. The underlying problems of atrial fibrillation are high blood pressure, an overactive thyroid gland or a lung disease.

Since atrial fibrillations occur at irregular intervals and can therefore only be detected as they happen, monitoring the heart rhythm with electrocardiogram-equipped blood pressure devices, portable ECG devices (holter monitors), event or specific mobile heart rhythm monitors can literally save lives.

Cardiac arrhythmias, such as dangerous atrial fibrillations and high blood pressure, are the main risk factors for developing strokes.