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Never stop blood pressure medication on your own — not even when the readings are good. A sudden stop can drive blood pressure up to dangerous levels.
We speak of high blood pressure (arterial hypertension) when the pressure in the arteries is permanently too high. Blood pressure is given as two values: the systolic value (the higher one, when the heart pumps) and the diastolic value (the lower one, when the heart fills). It is expressed in millimetres of mercury (mmHg), for example "130 over 80".
The tricky part: high blood pressure does not hurt and often causes no complaints for years. That is precisely why it is frequently found by chance — and otherwise goes unnoticed for a long time. Left untreated, however, the high pressure slowly damages the vessels and puts a strain on the heart, brain, kidneys and eyes. It is one of the most important risk factors for stroke, heart attack and heart failure.
Why is permanently raised pressure so harmful? You can picture the vascular system as a network of pipes that is under too much pressure for years: the inner walls of the arteries are damaged, thicken and calcify faster (atherosclerosis). The heart has to pump against the increased resistance and thickens its muscle, which over time can lead to heart failure. In the fine vessels of the kidneys and eyes, the pressure gradually causes a loss of function. Because this process is slow and painless, consistent treatment is so important — it prevents damage that you would otherwise only notice once it has occurred.
The following values apply to measurement at the practice. Values measured at home are usually somewhat lower — more on this in the chapter on measuring.
| Category | Systolic (mmHg) | Diastolic (mmHg) |
|---|---|---|
| Optimal | below 120 | below 80 |
| Normal | 120–129 | 80–84 |
| High-normal | 130–139 | 85–89 |
| Hypertension grade 1 | 140–159 | 90–99 |
| Hypertension grade 2 | 160–179 | 100–109 |
| Hypertension grade 3 | 180 and above | 110 and above |
For the diagnosis, the higher of the two values always counts: someone who measures, for example, 135 over 92 already has grade 1 hypertension, because the diastolic value is in the hypertension range. A single raised reading, however, does not yet mean a diagnosis — that requires repeated measurements on different days.
The most important point first: high blood pressure usually runs without symptoms — which is why it is also called the "silent killer". Many of those affected feel completely healthy and only learn of their raised values through a routine measurement. So you cannot "sense" high blood pressure, and the absence of complaints is no reliable sign of a healthy value. If any complaints do occur, they are non-specific and are often attributed to other causes:
Important: the absence of symptoms does not mean that the blood pressure is harmless. Even completely symptom-free high pressure damages the vessels. Conversely, very high values together with clear symptoms (see warning signs) are a reason to act quickly.
In the vast majority of cases (around 90%) no single cause can be found — this is then called primary or essential hypertension. It arises from an interplay of predisposition and lifestyle.¹
In a smaller share, another condition lies behind it (secondary hypertension). Common triggers are kidney diseases, hormonal disorders (such as an overproduction of the hormone aldosterone or an overactive thyroid), obstructive sleep apnoea, as well as certain medications and substances — these include the contraceptive pill, cortisone, anti-inflammatory painkillers (NSAIDs) and high consumption of liquorice. A secondary cause is considered above all when the high pressure appears very early (at a young age), very suddenly or very severely, or does not fall sufficiently despite several medications. In these cases a targeted investigation is worthwhile, because if the underlying cause is treated, the blood pressure can sometimes return to normal.
A single high reading is not enough for the diagnosis. Excitement, exertion, or the doctor's visit alone (so-called white-coat hypertension) can drive the value up briefly. That is why blood pressure is confirmed several times and under resting conditions.¹,²
How to measure correctly at home (the right cuff, resting phase, sitting posture) is explained in the guide Measuring blood pressure correctly.
At the start of every treatment — and alongside every tablet — comes lifestyle. With slightly raised values it can be enough on its own; with higher values it reduces the need for medication.¹
Particularly well documented is a diet rich in vegetables, fruit and fibre with little red meat and little sugar, combined with a deliberate reduction in salt — known internationally as the DASH principle. You do not have to overhaul your whole diet for this: simply reaching for unprocessed foods instead of ready meals, more potassium from vegetables and nuts, and dropping the habit of adding salt at the table, all adds up over the day. The individual building blocks — less salt, more exercise, weight loss, less alcohol — also work additively: combining several of them achieves a blood-pressure reduction that can well match that of a medication.
If lifestyle is not enough, medications are added. This is not a sign of failure but the normal case — many people permanently need tablets to bring their blood pressure safely into the target range. Modern practice often begins directly with a two-drug combination in a single tablet (single pill), instead of first slowly increasing one active ingredient up to the maximum dose. The reason: two active ingredients in a low dose complement each other, work more strongly and together often cause fewer side effects than a single one in a high dose. If the two-drug combination is not enough, it is expanded to three active ingredients.
There are five major classes of active ingredient. They differ above all in their mechanism of action and their side-effect profile — which one suits you depends on age, comorbidities and tolerability. Here is an overview in plain terms:¹
Which combination is the right one depends on age, comorbidities and tolerability. Side effects are no reason to quietly stop — often a switch within or between the classes already helps. More on this: Drug interactions.
brite reminds you of every tablet and documents your values without gaps — ready for your next appointment with the doctor.
The target value is not the same for everyone. As a rule: first get below 140/90 mmHg, and if well tolerated, continue towards 120–130 mmHg systolic. In very old or frail people, control is more individual and cautious in order to avoid dizziness and falls.¹
| Group | Systolic target range (practice) | Note |
|---|---|---|
| Adults in general | 120–129 mmHg, if well tolerated | First safely below 140 |
| From about 65 years | 130–139 mmHg | Tolerability takes priority |
| Very old / frail | Individual | Consider fall and dizziness risk |
| With diabetes | around 130 mmHg | Kidney protection especially important |
| With kidney disease | around 130 mmHg | ACE inhibitor/sartan preferred |
The values are a guide, not a rigid law — the personal target value is set together with the practice. Target values measured at home are each about 5 mmHg lower. It is also important that the pressure is not lowered too quickly: especially in older people, a too rapid or too deep drop can promote dizziness and falls. The adjustment therefore happens step by step over weeks, with regular checks of the values and of tolerability.
Record in brite where your personal target value lies and how your measurements develop — ideal for your next appointment with the doctor.
The treatment of high blood pressure takes place for the most part in everyday life — not at the practice. A few habits make the difference between well- and poorly-controlled values:
High blood pressure is not treated in weeks but over years — often with several active ingredients. The treatment only works if it runs reliably and the values stay in view. That is exactly what brite supports.
