Summary
High blood pressure
High blood pressure (arterial hypertension): A persistent increase in blood pressure to 140/90 mmHg or higher
Primary hypertension: high blood pressure with no identifiable cause
Secondary hypertension: High blood pressure resulting from another medical condition or from identifiable risk factors
Risk factors: age, genetic predisposition, being overweight, lack of exercise, high salt intake, high alcohol consumption, prolonged stress
Possible consequences: including angina pectoris, heart failure, heart attack, stroke, impaired kidney function up to and including kidney failure, and peripheral arterial disease
Diagnosis: medical history and physical examination, repeated blood pressure measurements, 24-hour blood pressure monitoring, laboratory tests of blood and urine, ECG, ultrasound scan of the heart and kidneys, Doppler ultrasound of the carotid arteries
Treatment: Lifestyle changes (e.g. increased physical activity, a healthy diet and weight loss), drug therapy (diuretics, beta-blockers, ACE inhibitors, angiotensin receptor blockers, calcium channel blockers)
What is blood pressure?
Blood pressure refers to the pressure within the blood vessels. It usually refers to the pressure in the arteries. The heart and blood vessels together form the cardiovascular system. This system ensures that all organs and tissues are supplied with oxygen and nutrients. The heart pumps blood through the body, thereby maintaining blood circulation. Arteries and veins: Blood pressure is usually measured in the large arteries. Blood flows away from the heart through the arteries and returns to the heart via the veins. To ensure that blood reaches all parts of the body, a certain level of pressure must be maintained in the circulatory system. As the pressure in the arteries changes in time with the heartbeat, two figures are given when blood pressure is measured.
- Systolic blood pressure: The upper figure. This indicates the highest pressure in the arteries, which occurs when the heart contracts and pumps blood into the circulatory system (systole).
- Diastolic blood pressure: The lower figure. This describes the lowest pressure when the heart relaxes between two heartbeats and refills with blood (diastole).
What is high blood pressure?
High blood pressure (arterial hypertension) is a condition in which blood pressure in the arteries is persistently elevated. Over time, this can damage the heart, blood vessels and other organs. Depending on the cause, a distinction is made between primary and secondary hypertension.
Primary hypertension
Primary (essential) hypertension is the most common form of high blood pressure and is a condition in its own right. It develops without any clearly identifiable cause. Rather, it is the result of various factors acting together. These include, amongst others, age, genetic predisposition and lifestyle.
Secondary hypertension
Less commonly, high blood pressure can be traced back to a specific medical condition or another trigger. This is referred to as secondary hypertension. Possible causes include, for example:
- kidney diseases
- hormonal disorders, such as those affecting the thyroid or adrenal glands
- certain vascular diseases
- sleep apnoea
- Tumours
Certain medicines, such as cortisone preparations or some painkillers, can also raise blood pressure. If the underlying cause is successfully treated, blood pressure can improve significantly and, in some cases, return to normal. 
What blood pressure readings are normal, and at what point are they considered too high?
Blood pressure readings are given in millimetres of mercury (mmHg). A measurement always provides two figures: the systolic and the diastolic blood pressure. The following guideline values generally apply to blood pressure measurements in adults:
| systolic | diastolic | |
|---|---|---|
| Optimal | < 120 mmHg | < 80 mmHg |
| Normal | < 120–129 mmHg | 80–84 mmHg |
| High-normal | 130–139 mmHg | 85–89 mmHg |
| Stage 1 hypertension | 140–159 mmHg | 90–99 mmHg |
| Stage 2 hypertension | 160–179 mmHg | 90–99 mmHg |
| Stage 3 hypertension | ≥ 180 mmHg | ≥ 110 mmHg |
High blood pressure (arterial hypertension) is diagnosed when blood pressure is consistently elevated across repeated measurements. This is the case when
- the systolic blood pressure (upper figure) is 140 mmHg or higher and/or
- the diastolic blood pressure (lower figure) is 90 mmHg or higher.
Blood pressure readings change over the course of a person’s life. Infants and children normally have lower blood pressure than adults. As people get older, their blood pressure often rises slightly. For this reason, different reference values apply depending on age.
What are the risk factors for high blood pressure?
Several factors usually interact in the development of high blood pressure. Some of these can be influenced, whilst others cannot. The most important risk factors include:
- genetic predisposition
- advancing age
- being overweight
- lack of exercise
- smoking
- high salt intake
- high alcohol consumption
- Chronic stress
What are the symptoms of high blood pressure?
High blood pressure usually causes no symptoms for a long time. It often develops gradually and goes unnoticed for many years. The only way to be sure whether your blood pressure is high is to have it measured.
Possible signs of high blood pressure
- Headaches
- Dizziness
- Nosebleeds
- Tiredness and reduced energy levels
- Shortness of breath during physical exertion
- Heart palpitations or a racing heart
- Nervousness
These symptoms are non-specific and can have many different causes. You should therefore not rely on symptoms alone to detect high blood pressure. Regular blood pressure checks help to identify elevated readings at an early stage.
Why is high blood pressure dangerous?
Many people feel healthy despite having persistently high blood pressure. This is why high blood pressure is often underestimated. However, if left untreated, it can cause permanent damage to the heart, blood vessels and other organs. High blood pressure puts strain on the arteries. Over time, their walls can become damaged and stiffer. This promotes atherosclerosis and can impair blood flow to various organs. The heart also has to work harder to pump blood around the body when blood pressure is high. If this strain continues over a long period, the heart muscle can thicken and suffer permanent damage.
What are the possible consequences of high blood pressure?
Persistently high blood pressure can damage various organs. Possible complications include:
- coronary heart disease and angina pectoris
- heart failure
- heart attack
- stroke
- Kidney damage, potentially leading to kidney failure
- Peripheral arterial disease
How is high blood pressure diagnosed?
The most important test for diagnosing high blood pressure is a blood pressure reading. During the initial examination, blood pressure should be measured on both arms. However, a single elevated reading is not sufficient to diagnose high blood pressure. Blood pressure fluctuates throughout the day and can be influenced by factors such as physical activity, stress or anxiety. Therefore, several blood pressure readings are required. To confirm the diagnosis, regular measurements at home or a 24-hour blood pressure monitor may also be carried out. If blood pressure is consistently high, the following will also be assessed:
- how high the individual’s cardiovascular risk is
- whether any secondary damage is already present
- whether another medical condition is causing the high blood pressure
In addition to a detailed medical history and a physical examination, this may involve further tests depending on the situation, for example:
- blood and urine tests, such as blood glucose, blood lipids and kidney function tests
- Electrocardiogram (ECG)
- Ultrasound scans of the heart, kidneys or blood vessels
- Doppler ultrasound of the carotid arteries
Exactly which tests are required may vary and will be determined on an individual basis.
What can you do yourself if you have high blood pressure?
The following recommendations relate primarily to the treatment of primary hypertension. An important basis of treatment is to identify and reduce modifiable risk factors. Lifestyle changes can lower blood pressure and should be a permanent part of treatment. Depending on the level of blood pressure and your personal cardiovascular risk, medication may also be necessary. The following measures are recommended:
- Weight loss
- a healthy diet (plenty of fruit and vegetables, a high-fibre diet, low in animal fats)
- reduced salt intake
- limited alcohol consumption
- physical activity, regular endurance exercise
- Giving up smoking
- Stress reduction and relaxation
If lifestyle changes alone are not sufficient, or if blood pressure is significantly elevated, antihypertensive medication is also used. These can lower blood pressure and reduce the risk of secondary conditions. 
What medicines are available for high blood pressure?
Various groups of active ingredients are available for the medicinal treatment of high blood pressure. These include, amongst others:
- ACE inhibitors
- Angiotensin receptor blockers (sartans)
- Calcium channel blockers
- Diuretics
- Beta-blockers
Some patients only need one medicine (monotherapy). In some cases, several medicines must be combined (combination therapy). This depends, amongst other things, on the severity of the condition, any accompanying or related conditions, and cardiovascular risk. Combination preparations are also available for this purpose; these contain several active ingredients in a single tablet and can make taking the medication easier. All medicines should be taken at the correct dosage and tailored to the patient’s individual needs. To ensure the treatment is successful, medication should not be stopped or altered without consulting a doctor.
FAQ
High blood pressure is one of the most common chronic conditions in Austria. It is estimated that around one in four people have high blood pressure. As high blood pressure often causes no symptoms for many years, the condition frequently goes unnoticed. Many of those affected are therefore unaware that their blood pressure is consistently high.
Yes, high blood pressure should be treated in most cases. If left untreated, high blood pressure can cause long-term damage to the heart, brain, kidneys and eyes, and significantly increase the risk of a heart attack or stroke. Regular blood pressure checks are therefore particularly important, even if you have no symptoms.
The typical symptoms of high blood pressure do not differ fundamentally between women and men. Both sexes may suffer from morning headaches, dizziness, blurred vision, nosebleeds or palpitations. In men, high blood pressure can also lead to erectile dysfunction. However, high blood pressure often causes no symptoms at all.
Differences tend to lie in the prevalence of the condition: men are more frequently affected up to around the age of 60. After the menopause, the risk for women increases significantly, meaning that older women are more likely to develop high blood pressure. During pregnancy, there is also a specific form of high blood pressure, pre-eclampsia, which affects only women and carries particular risks. Overall, the symptoms themselves are similar, whilst hormonal changes and life stages influence the prevalence of the condition.
There is no fixed blood pressure reading at which high blood pressure automatically becomes life-threatening. It becomes particularly dangerous when blood pressure suddenly rises to levels above 180/120 mmHg. If symptoms such as chest pain, shortness of breath, paralysis, speech difficulties or severe headaches occur, this constitutes a hypertensive emergency that requires immediate medical attention.
In the long term, it is primarily untreated high blood pressure that is dangerous, as it damages blood vessels and organs. This significantly increases the risk of heart attacks, strokes, heart failure, kidney failure or damage to the eyes. In most cases, it is not the high blood pressure itself that leads to death, but its complications. Early diagnosis and consistent treatment can significantly reduce this risk.
Yes, high blood pressure during pregnancy can be dangerous for both the mother and the unborn baby. A slight rise in blood pressure often causes no major problems. However, if blood pressure rises significantly, blood flow to the placenta may be impaired. This increases the risk of the baby’s growth being stunted, premature birth or premature placental abruption.
Furthermore, high blood pressure can be an early sign of pre-eclampsia – a serious pregnancy complication characterised by high blood pressure and organ damage. That is why blood pressure and urine are regularly monitored during antenatal check-ups. In severe cases, medication or even early delivery may be necessary to protect both mother and baby.
In healthy adults, a blood pressure reading of around 120/80 mmHg is considered optimal. Readings below 130/85 mmHg are generally regarded as normal. Blood pressure readings often rise slightly with age because the blood vessels become less elastic. Nevertheless, a consistently measured blood pressure of 140/90 mmHg or higher should be investigated by a doctor, regardless of age.
For children and adolescents, reference values based on age and height are used, which are assessed by paediatricians. It is not just a single measurement that is decisive, but several measurements taken on different days. Regular check-ups are particularly important for older people, as high blood pressure often causes no symptoms and, if left untreated, can lead to serious complications.
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Heart attacks in women
