Determining high blood pressure: diagnosis and choice of doctor

Although hypertension is one of the most common diseases worldwide, it can sometimes take years before a clear diagnosis is made. One of the reasons for this is that high blood pressure often causes hardly any or only a few obvious symptoms. In addition, the consequences continue to be underestimated. But how does a doctor determine if someone has high blood pressure?

It is still at hypertension a disease that is usually discovered by accident. And even if the blood pressure measured during a medical examination is in the abnormally high range, this does not mean that the person is actually under high blood pressure acts in the sense of a chronic illness. However, if there is a suspicion, an investigation should always be carried out. FITBOOK about the different methods of diagnosing high blood pressure and the so-called white coat syndrome.

How is the diagnosis made?

Repeated practice measurements

A clear diagnosis requires several measurements by the doctor, since a single increase in blood pressure is not meaningful. The measurement is taken on both upper arms after a rest period of around five minutes. If the value is more than 140/90 mmHg when measured several times on different days, then it is high blood pressure that requires treatment. Tip: The diagnosis is even more meaningful if the doctor also measures the ankle blood pressure. The higher the blood pressure, the more follow-up tests are likely.

24-hour blood pressure measurement

A reliable statement can be made above all after a 24-hour blood pressure measurement. Unfortunately, this method of diagnosis is still not used by default. A Spanish registry study showed that 24-hour blood pressure measurement was better suited than office measurements to predict the risk of premature death.1

With 24-hour blood pressure measurement, patients are given a measuring device that they have to wear day and night. Measurements are then taken at regular intervals. At the same time, the patient logs any events in everyday life that may allow conclusions to be drawn about blood pressure fluctuations, such as stressful situations, physical exertion, etc.

The 24-hour blood pressure measurement is informative insofar as it offers a better overall picture due to the average values ​​and possible outliers upwards or downwards and is therefore more meaningful with regard to a potential disease value. At night, blood pressure should drop by up to 10 to 20 percent. If it stays high, this is an important indicator for diagnosing high blood pressure.

A disadvantage of the 24-hour blood pressure measurement is that the device also takes a measurement regularly at night, which is often perceived as annoying and can affect sleep.

Further investigations

Depending on age and concomitant diseases, the doctor can also order a stress ECG, an echocardiography (an ultrasound examination of the heart) and an ultrasound Doppler examination of the renal arteries. An ultrasound examination of the neck and leg vessels is also possible. If there is a suspicion that high blood pressure is affecting vision, a referral to an ophthalmologist is possible to check the back of the eye. Especially in patients suffering from glaucoma (glaucoma) suffer, it is important to adapt the hypertension therapy taking into account the eye disease.

What is white coat syndrome?

A special phenomenon can often be observed when measuring blood pressure. As soon as a doctor lends a hand, the blood pressure is higher than the values ​​measured at home. Sometimes up to 30 percent. In these cases one speaks of the so-called white coat syndrome. It’s the jitters that women and men in white coats can cause. Amazingly, this syndrome is less pronounced when a doctor’s assistant or nurse takes the blood pressure. Both the doctor and the practice staff are aware of the phenomenon and usually take it into account when interpreting the values, provided that other risk factors have been ruled out.

White coat syndrome can be tricked with 24-hour blood pressure measurement. This is the only way to make a reliable diagnosis.

Control at home: For whom blood pressure monitors are useful

In principle, it is advisable to measure your blood pressure regularly, even if you feel healthy and fit. People who have one or more risk factors together – such as being overweight, chronic stress, smoking, etc. – should determine the values ​​particularly frequently. People who have been diagnosed with high blood pressure should definitely make it a habit.

Fortunately, blood pressure monitors are now not only reserved for medical professionals, but are available relatively cheaply in pharmacies, drugstores and electronics stores. In the case of high blood pressure patients, the insurance companies even cover the cost of the purchase. There are numerous, easy-to-use, fully automatic devices available for home use. Many are even able to store the readings. However, tests repeatedly show differences in quality. It can therefore make sense to take your own device to the doctor’s office and make a comparison.

When it comes to blood pressure monitors, you have the choice between wrist and upper arm devices. Experts recommend measuring on the upper arm because the device is then definitely at heart level. Tests have also shown that they are more accurate and reliable. If you still prefer a wrist device, you should make sure to hold it at heart level when measuring. If the device is kept too low, this falsifies the values. Then they are higher.

FITBOOK has compared some blood pressure monitors:

Incidentally, the inventor of blood pressure measurement was the Italian pediatrician Scipione Riva-Rocci (1863 – 1937). While 120 years ago he was still tying off his arm with a bicycle tube, today there are cuffs with Velcro fasteners. This is part of every reliable device. You have to inflate it to the point where the artery is pinched off and blood can no longer flow. Then you slowly let the air out of the cuff. As soon as the pressure drops, blood can flow again. Exactly at this moment the systolic pressure is displayed. This is the top value. After another phase of pressure loss, the second value, the diastolic value, is measured. This happens at the time of the relaxation phase of the heart.

Also interesting: How much coffee is good for high blood pressure, how much is bad

Diagnosing high blood pressure: Which doctor is the right one?

If hypertension is suspected, general practitioners are usually the first point of contact. They make the diagnosis of high blood pressure and then determine the type of therapy. Depending on the findings, it can also make sense to see an internist, cardiologist (heart specialist) or neprohologist (kidney specialist). The additional qualification to become a hypertensiologist is still relatively new. These are doctors with specific training for high blood pressure, introduced by the German Hypertension League (DHL).

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