Hypertension causes and treatment

For more than 30 years, hypertension has been one of the most commonly reported conditions in western industrialized nations and can thus be regarded as a widespread disease in Germany as well. While a temporarily elevated blood pressure may be a symptom of various diseases or side effects of certain drugs, a chronic increase in blood pressure in the arterial blood vessels is to be assessed as a disease, which in turn can bring numerous complications. High blood pressure, for example, is considered a major risk factor for potentially fatal cardiovascular diseases, such as a heart attack or stroke.

contents

• definition
• Blood pressure and high blood pressure
• Dissemination of the complaint
• Hypertension often goes unnoticed
• causes
• Unclear causes of primary hypertension
• Possible causes of secondary hypertension
• diagnosis
• Diagnostic options in naturopathic practice
• therapy
• Naturopathy in high blood pressure

definition

The World Health Organization (WHO) defines "normal" blood pressure with a systolic value of 120 mmHg and a diastolic value of 80 mmHg. If the systolic blood pressure reaches 140 mmHg and the diastolic blood pressure reaches 90 mmHg or higher, this is defined by the WHO as arterial hypertension. Transient deviations of the blood pressure, for example due to the intake of medicines, are not covered by this definition. In addition, a distinction is made between primary (without recognizable physical cause) and secondary hypertension (immediate consequence of underlying diseases). In addition, special forms of hypertension, such as pulmonary hypertension (increased blood pressure in the pulmonary circulation, for example due to smoker's cough or heart disease) and portal hypertension (high blood pressure in the hepatic portal vein, often resulting in cirrhosis of the liver), are considered separate complaints.

Blood pressure and high blood pressure

The heart pumps the blood, which comes from the lungs enriched with oxygen, through the arteries, which branch out more and more finely towards the extremities and finally pass into the venous system in order to - with the detour via the liver - begin the "way back". The force exerted by the blood on the vessel walls of arteries and veins is called blood pressure. The upper, so-called systolic value indicates the pressure with which the blood is pumped by a larger artery (usually the upper arm) during contraction of the heart muscle. The lower, so-called diastolic value, indicates the pressure in the same artery at rest. The measuring unit mmHg comes from the earlier measuring instruments, where the pressure values ​​were read off at the level of the mercury column. Values ​​around 120/80 mmHg (systolic / diastolic) are considered optimal. Since there is a relationship between the occurrence of hypertension and age, the rule of thumb "age plus 100" for systolic blood pressure was previously used to determine the optimal individual blood pressure, which has long been considered obsolete. Today, by international agreement, there is hypertension above 140/90 mmHg. The most severe stage of hypertension is reached at values ​​exceeding 180/110 mmHg.

Dissemination of the complaint

More than a third of adults worldwide have high blood pressure, according to the WHO. High blood pressure causes "around half of all deaths from strokes and heart disease." In 2004, 7.5 million deaths were directly attributable to hypertension, WHO continued. Nearly half of the population in Germany suffers from hypertension, reports the German Hypertension League (DHL), citing figures from the Robert Koch Institute (RKI). However, only one in two knew about the disease and "of the people who know about it, only about 40 percent are treated," explains DHL. However, according to the WHO, significantly improved diagnosis and treatment with low-cost medicines in recent years has led to a significant reduction in high blood pressure deaths.

Although the probability of developing hypertension increases with age, young people in general may also suffer from hypertension. All age groups and both sexes are affected and there is a high risk of dangerous sequelae. Since in most cases no complaints occur for a long time, however, necessary countermeasures are often taken late.

Hypertension often goes unnoticed

Most of the high blood pressure patients initially show no noticeable symptoms. The delay in diagnosis is usually delayed. However, quite a few complaints may indicate hypertension early on. The German high pressure league calls here sleep problems, internal restlessness, nosebleeds, tinnitus, headache and heat feeling as possible warning signs. In addition, dizziness, nausea, a general weakness in performance, shortness of breath during physical exertion and blurred vision may be associated with high blood pressure. If, in addition to the above-mentioned symptoms, a strong palpitation is noticeable, a high-pressure crisis may already have occurred which requires immediate emergency medical care.

Depending on the causes of hypertension, secondary hypertension may be accompanied by a variety of concomitant symptoms, which are explained in more detail below in connection with the underlying disorders. However, primary as well as secondary arterial hypertension can, for their part, also promote or trigger complications that cause additional discomfort. "The higher the blood pressure, the higher the risk of damage to the heart and blood vessels in important organs such as the brain and kidneys," explains the World Health Organization. For example, uncontrolled blood pressure can lead to abnormal enlargement of the heart, congestive heart failure, aneurysm (bulging of the blood vessels), or a heart attack, according to the WHO. Also threaten blood vessels due to the increased pressure rather burst. In addition, the "pressure in the blood vessels can cause a leak of blood into the brain and a stroke," warns the WHO. In addition, renal failure and cognitive impairments or disturbances of consciousness are mentioned as potential consequences of hypertension.

The increased blood pressure also increases the risk of arteriosclerosis, coronary heart disease (CHD) and permanent damage to the heart muscle. The latter, in turn, causes impaired cardiac function, which may be associated with cardiac arrhythmia or atrial fibrillation, for example. Last but not least, the so-called hypertensive crisis, in which a sudden increase in blood pressure to values ​​of 230/130 mmHg or higher, is often associated with acute damage to the heart, brain and lungs. Here, action must be taken immediately to avoid potentially fatal consequential damage.

causes

In many patients, arterial hypertension is not due to direct physical causes, so the medical diagnosis is "primary" or "essential" hypertension. According to the German Hypertension League, more than 90 percent of sufferers suffer from primary hypertension, while secondary hypertension accounts for a relatively small proportion of total disease. "The blood pressure in the human body is regulated by a very complex mechanism", whereby "biochemical messengers, organs, blood vessels and the nervous system interact with each other", continues the high-pressure league. To date, however, the underlying mechanism has only been partially explored.

Vascular constrictions can be a cause of hypertension. Image: www.fotolia.com © psdesign1

Unclear causes of primary hypertension

In particular, in primary hypertension, the interactions in the organism remain largely unclear. However, there is obviously a connection with the genetic material or genes. In addition, several major risk factors for primary hypertension have been identified in several studies. For example, the German Hypertension League calls it lack of exercise, unhealthy diet, obesity and stress as major factors. In addition, tobacco consumption is considered a major risk factor for primary hypertension. In addition, diabetes mellitus and lipid metabolism disorders as well as a high-salt and high-fat diet, various medications (such as the pill) and alcohol are evaluated as favoring factors. In addition, naturopathy also considers possible interference fields which irritate and impair the natural regulation mechanisms of the cardiovascular system as the cause of hypertension.

Possible causes of secondary hypertension

In secondary hypertension, certain physical causes of hypertension can be determined by definition. These may be, for example, diseases of the kidneys, certain diseases of the cardiovascular system, hormonal disorders or the so-called sleep apnea syndrome.

Renal diseases that can cause secondary hypertension include chronic kidney disease, kidney damage from diabetes, and cystic kidney disease. Narrowing the renal artery can also cause secondary hypertension. In addition to the increased blood pressure sufferers here show symptoms such as kidney pain or flank pain, blood in the urine and the development of edema (fluid retention in the tissue).

Cardiovascular impairments such as a narrowing of the main artery (aortic cough, usually due to a congenital heart defect) or vasculitis (inflammation of the blood vessels) are also known as possible causes of secondary hypertension. In addition, so-called endocrine diseases (diseases of the endocrine glands), which lead to disturbances in the hormone balance and bring in this way the blood pressure out of balance. For example, a so-called primary hyperaldosteronism (Conn's syndrome, characterized by an increased aldosterone level in the blood), Cushing's syndrome (increased cortisol concentration in the blood) and hyperparathyroidism (hyperparathyroidism) are possible endocrine disorders leading to a secondary hypertension. In sleep apnea syndrome, pauses in breathing occur during sleep, accompanied by a drastic drop in blood oxygen levels, subsequent wakefulness and, consequently, an increase in blood pressure.

Other possible causes include the use of drugs with drugs such as epinephrine, corticosteroids or methylphenidate. Drugs such as cocaine can also raise blood pressure. In addition, the blood pressure often rises significantly during pregnancy. However, these transient derangements of blood pressure are to be distinguished from the above-mentioned pathological forms of hypertension. All in all, it remains to be stated: As complex as our tubular blood vessel system is, it is also prone to external influences. Acute increases in blood pressure are also associated with physical exertion, anger and anxiety, with blood pressure dropping rapidly at rest. Here it is also clear why constant stress and anxiety disorders are associated with a chronic increase in blood pressure.

diagnosis

Blood pressure measurements are the basic diagnostic tool for detecting hypertension. An increased value with a single measurement, however, says little. To determine hypertension, blood pressure should be measured three times daily for at least one week and a table should be kept. Measurements should always be taken at the same times, so that comparable values ​​are created and the circadian rhythm is visible, as the daily rhythm can cause typical fluctuations in blood pressure. It is also important to ensure that the measurement is taken at rest. Patients should therefore sit down and pause for about five minutes before taking the measurement. In addition, according to the German Hypertension League, care must be taken that the measuring devices are placed at approximately the level of the heart. Because "if the measuring point is below the heart level, the measured values ​​are too high. If the measuring point is above the heart level, the values ​​are too low, "explains DHL.

To date, the blood pressure is usually determined by means of an inflatable cuff, according to the German Hypertension League is to ensure that the inflatable part is located on the inside of the upper arm, the closure is outside and the hose pointing down to the hand. The correct height for attachment is "two cross fingers above the elbow."

When putting it on, the cuff should not be tightened too tight to avoid falsification of the results. For people with particularly strong or very thin upper arms special cuffs are available here. Although some sphygmomanometers also make it possible to take a measurement on the wrist, the hypertension league "may make more frequent mistakes because the posture can vary more." New devices would not start measuring until the measurement point is at heart level and the posture is correct , If the blood pressure is measured by the doctor, this is often accompanied by a certain nervousness of the patients, which per se can lead to an increase in blood pressure and falsified results. If there is a suspicion of this so-called "white coat effect", independent measurements by the patients in their home environment are advised.

When confirming hypertension by blood pressure measurements, it is also important to determine possible causes of secondary hypertension and to assess cardiovascular risk and to detect end organ damage and concomitant diseases, as stated in the "Guidelines for the management of arterial hypertension ", Published by the European Society of Cardiolgy, the Europen
ociety of Hypertension, the German Society of Cardiology and the German Hypertension League. The "personal history, family history, physical examination, laboratory diagnostics and other special diagnostic tests" are important steps on the way to a reliable diagnosis.

Overview of possible heart diseases. Image: www.fotolia.com © Henrie

If there is a suspicion of hypertension, the history includes interviewing the patients about previous increases in blood pressure in the patients and known secondary hypertension in the family environment. It is also important to check the intake of drugs and medications. In addition, concomitant symptoms such as sweating, headache, dizziness, visual disturbances, anxiety, muscle weaknesses and so-called tetany (motor disorders and abnormalities due to over-excitement of the muscles and nerves) are queried. In addition, risk factors such as dietary habits, lack of physical activity or tobacco consumption are to be reviewed.

In addition to blood pressure measurements, the physical examination includes, among other things, palpation of the kidneys, listening to the abdomen and chest, checking the appearance of the skin, and looking for possible signs of Cushing's syndrome. In the process, laboratory examinations are also used for diagnostics. Here, the "Guidelines for the Management of Arterial Hypertension" recommend starting with a relatively simple basic examination and, if indicated, moving on to more complex examinations, if indicated. According to the treatment guidelines, the baseline investigation includes the determination of the values ​​of "hemoglobin and / or hematocrit, fasting glucose, total cholesterol, LDL cholesterol, HDL cholesterol, fasting triglycerides, serum potassium and serum and uric acid in serum." Serum creatinine, urinalysis and a 12-lead ECG are provided. If there are suspicion factors for causative diseases, further investigations include, for example, an echocardiogram, a long-term or exercise ECG, ultrasound examinations of the cervical vessels, the peripheral vessels and the thorax and an examination of the fundus. Basically, as part of the physical examination, a determination of the body mass index and the waist circumference.

Diagnostic options in naturopathic practice

In naturopathic practice, depending on the orientation, also opportunities for diagnosis are used, which provide causative evidence, even before clinically a pathological change can be detected. In the diagnosis of a flash, reddened conjunctivae, visibly tortuous temporal arteries, and a red complexion, for example, are indications of hypertension, although the latter sign may also be constitutionally conditioned. An underlying weakness of the heart or kidney is sometimes characterized by early fluid accumulation on the eyelids. In eye diagnosis, the heart and kidney sectors are examined for signs of weakness with the iris microscope. In addition, the so-called arcus lipoides or "fat ring" may be an indication of high cholesterol and lipid metabolism disorders. Especially in the event of a sudden onset of high blood pressure and in young hypertensive patients, there is a high frequency of interference, especially in the form of root-treated teeth, tonsils, paranasal sinuses, and scars resulting from injury or surgery. The lifestyle, especially in the field of nutritional behavior, is extensively inquired and analyzed in order to design a suitable diet for the person concerned.

The interview also identifies possible conflict and stress factors - for example, at the workplace, in relationships or in the personal history of the person affected - that could aggravate or cause the symptoms. From the collected hints and data an individually adapted treatment plan can be created and implemented.

therapy

The required therapeutic measures in secondary hypertension are mainly based on the possible underlying diseases, but they must generally take into account the severity of hypertension and the overall health risk.

Moderate forms of primary hypertension are also in conventional medicine usually without the use of drugs, but only on the basis of lifestyle changes (healthy diet, exercise, reduction of obesity, abstinence from tobacco and alcohol) treated. If cardiovascular risk factors such as obesity or diabetes occur in addition to hypertension, it is usually no longer possible to deal with lifestyle changes alone. Here, antihypertensive drugs are an important tool to minimize the risk of life-threatening cardiovascular damage. Reaches the blood pressure values ​​of more than 180/110 mmHg Immediate use of blood pressure medication is required, even if no other risk factors are added.

For moderate forms of primary hypertension, the treatment guidelines initially recommend proceeding for several months with the help of a lifestyle change to hypertension. "Lifestyle changes are crucial in the prevention of hypertension, but are equally important in their treatment," the experts write in the "Guidelines for the management of arterial hypertension." As a major measure, the treatment guidelines cited the "restriction of sodium chloride intake to 5 to 6 grams per day", the "restriction of alcohol consumption to not more than 20 to 30 grams of alcohol per day in men and not more than 10 to 20 grams per day in women Furthermore, "increased consumption of vegetables, fruits and dairy products with low fat content is recommended." Furthermore, regular exercise such as "moderate dynamic training, for at least 30 minutes on 5 to 7 days per week" advised and see the guidelines weight reduction to a BMI of 25 before. The waist circumference should be less than 102 centimeters in men and 88 centimeters in women, as long as there are no contraindications, the treatment guidelines recommend further. Smoking hypertensive patients are advised to cease smoking and seek therapeutic support if in doubt.

With regard to the available blood pressure medicines, the treatment guidelines explain that there are five major classes of substance, of which no clinically relevant differences were found in a large number of randomized controlled trials. According to the "Guidelines for the Management of Arterial Hypertension", diuretics, beta-blockers, calcium antagonists, ACE inhibitors and angiotensin receptor blockers are all equally suitable for initial and long-term treatment, whether as monotherapy or combination therapy Relative contraindications should be considered and use should be made according to specific indications. For example, Giese is an absolute contraindication to the use of diuretics and asthma, a contraindication for beta-blockers.

Naturopathy in high blood pressure

Many aspects of naturopathy are already reflected in the above-mentioned lifestyle changes, although the holistic approach to naturopathic therapy is much more in the foreground. The interaction of nutritional therapy, exercise therapy, relaxation techniques, medicinal herbs, homeopathic remedies and other naturopathic procedures is the key to success here. The treatment should be individually tailored to the patients.

In the diet, as an alternative to salt certain herbs (for example, basil and lovage), onions and garlic. They give the food a spicy taste and can also help lower blood pressure. Fruits and vegetables should anyway form a high proportion of the daily food intake due to the contained minerals.

Various medicinal plants can also be used against hypertension, in particular herbal tea mixtures of hawthorn, melissa, mistletoe and valerian have been proven many times. Also, the tea blends - depending on the individual symptoms - additional medicinal plants are attached. For example, diuretic plants such as goldenrod, horsetail or nettles contribute to a decrease in blood pressure. However, caution is advised as these may be contraindicated in a variety of medical conditions, such as kidney disease.

Other home remedies for high blood pressure from the food sector include apple cider vinegar, honey, red berries or pomegranates. As a dietary supplement in naturopathy also sometimes black cumin oil is applied. Furthermore, different essential oils that are released into the room air, for example via a so-called armomal lamp, can contribute to lowering the blood pressure. Essential oils of lavender, marjoram or lemon balm are well suited here.

As a naturopathic method, so-called hydrotherapy has been proven in the treatment of hypertension. The water applications were known by the pastor Sebastian Kneipp, who used them already in the 19th century to treat a wide variety of complaints. The external applications in the form of ablutions, baths, castings and wrapping acts according to the German high pressure league "like a stimulus therapy, which can change the organism." However, in hypertensive patients initially habituation to the hydrotherapeutic stimuli is required. Then they are performed on a body part and the water is always guided from the heart distance to the heart. For entry low-heat castings are appropriate, later will be switched to cold fonts, the high-pressure league continues. However, extreme cold applications are to be avoided as these can sometimes drastically increase blood pressure. "Extensive cold stimuli such as swimming in cold water, cold fountains or a cold shower after physical exertion or a sauna visit can raise blood pressure," warns the German Hypertension League. On the other hand, regular morning showers, rising arm baths, or rising foot baths in the evening would have a positive effect on moderately elevated blood pressure. The so-called Kneipp cure with its combination of hydrotherapy, nutritional therapy, exercise therapy, phytotherapy (herbal medicine) and order therapy (for relaxation and stress reduction) is one of the most promising naturopathic approaches against arterial hypertension.

Due to the negative effects of stress and mental stress in arterial hypertension, psychotherapeutic elements, such as the use of relaxation techniques, in natural medicine are an essential element of high blood pressure therapy. Autogenic training, yoga, tai chi or qigong are good ways to help relieve stress or prevent the onset of stress. So they often also serve to normalize blood pressure.

Further naturopathic starting points offer, for example, the homeopathy and the Schüssler salt therapy. As a homeopathic remedy, for example, Glonoinum has been proven in acute hypertension and Rauwolfia can be used against milder forms of hypertension. From the area of ​​Schüssler salt therapy, inter alia, the Schüssler salts No. 7 (magnesium phosphoricum) and No. 8 (sodium chloratum) for the treatment of hypertension into consideration. However, use should only be made in consultation with experienced therapists or a doctor.

Overall, naturopathy offers an enormously wide range of different methods for the relief of high blood pressure, whereby only an extract of the possibilities has been compiled. Which methods are ultimately used should be individually tailored between therapists and patients. However, it is always necessary to go to the doctor for signs of high blood pressure in order to rule out serious causes of the symptoms and to obtain a reliable diagnosis. (Jvs / fp)

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