What if you had high blood pressure without realising it?

High blood pressure is often asymptomatic, but it can have serious consequences if left undiagnosed and untreated. Professor Victor Aboyans, Head of the Cardiology Department at Princess Grace Hospital Centre, helps us better understand how it works, recognise the key figures and learn how to measure your blood pressure correctly. MonacoSanté keeps you informed.

High blood pressure: a condition that is often invisible

Americans call it the "silent killer". An alarming term, but one that reflects a harsh reality. "In the population, there is a diagnostic gap: approximately one-third of people with high blood pressure are unaware they have it", confirms Professor Victor Aboyans, newly appointed Head of the Cardiology Department at Princess Grace Hospital Centre. Also Editor-in-Chief of the European Journal of Preventive Cardiology, a scientific journal dedicated to cardiovascular prevention, he has devoted many years to research on the detection and prevention of risks linked to this condition. "It is a genuine public health concern", he warns. "High blood pressure most often appears with age, but it can occur earlier and progress rapidly. Most importantly, it can cause significant damage to organs".

Our blood pressure varies constantly, in rhythm with our heartbeats. "The first figure corresponds to systolic pressure: this is when the heart contracts and propels blood into the arteries, causing pressure to rise. The second figure corresponds to diastolic pressure: when the heart relaxes and fills, the pressure drops", explains Professor Aboyans. The latter is measured in millimetres of mercury (mmHg). "During a medical consultation, blood pressure should not exceed 140 mmHg for systolic and 90 mmHg for diastolic", he specifies.

How do you know if this applies to you?

High blood pressure mainly affects older people. Two figures are worth remembering: after age 60, nearly 60% of the population is affected. Over time, arteries gradually lose their elasticity, which promotes an increase in blood pressure. However, some younger people can also be affected. "Arterial ageing can be accelerated by poor lifestyle habits: smoking, sedentary behaviour, diabetes or high cholesterol", lists Professor Aboyans. Excessive salt consumption also plays an important role. In younger people, genetics can also be a factor, particularly if there is a family history. Finally, women who suffered from high blood pressure during pregnancy face an increased risk of developing it again later.

The only way to know if you are affected is through screening. "The vast majority of patients with high blood pressure are asymptomatic. They show no clinical signs, and discovery often occurs during a simple blood pressure check at a consultation". Symptoms generally only appear at very high levels, often above 200 mmHg. "At this stage, headaches, nosebleeds, visual disturbances, such as "floaters", or ringing in the ears may occur", he specifies.

Living with undetected high blood pressure for years is therefore far from unusual. Yet in the long term, the consequences can be serious: heart disease, kidney failure or brain damage. "One of the lesser-known effects of high blood pressure concerns memory problems and even the development of vascular dementia. Conversely, we now know that good blood pressure control can slow down brain ageing", emphasises the cardiologist.

Health self-monitoring: taking control of your own health

Measuring your blood pressure is therefore taking care of your cardiovascular future. But where, how and how often? "High blood pressure is such a common disease that all healthcare professionals have a role to play: general practitioners, nurses or cardiologists", reminds Professor Victor Aboyans. Blood pressure can be taken in a medical office, but also at a pharmacy where a device can be loaned, and finally at home using an approved blood pressure monitor. "We increasingly encourage patients to practise self-measurement", he emphasises. A few simple rules must be followed. "You must measure your blood pressure using a pneumatic system that inflates and deflates to create pressure". Two types of devices are recommended by the French High Blood Pressure Society, to be placed on the arm and forearm. These devices should display three figures at the top and two figures at the bottom.

At home, blood pressure should not exceed 135/85 mmHg during the day. For an accurate measurement: it must be taken at least thirty minutes after waking, in a calm environment, sitting down, well supported, with the arm at heart level. Three successive measurements, a few minutes apart, in the morning and then in the evening before bed. "All data must be recorded accurately in a diary or dedicated application. If the blood pressure monitor shows 147/82, the doctor will note a reading of 15/8. It is therefore essential to record the exact figures", he insists.

"Regarding smartwatches and connected bracelets, these are screening devices with variable effectiveness from one device to another, and results should in any case be confirmed by conventional methods". In some cases, a cardiologist may propose a 24-hour ambulatory measurement, including during the night, to obtain a more precise assessment.

Once diagnosed, regular monitoring is necessary: generally, a consultation with your GP every three months and an annual check-up with your cardiologist.

Treatments: what can be done?

"High blood pressure is a chronic disease. It is rare for it to disappear completely", points out the doctor. Nevertheless, occasional high readings should not cause excessive concern. "Stress or lack of sleep can temporarily raise blood pressure. It is sometimes necessary to remeasure before drawing conclusions: we are not robots", he relativises. However, when systolic blood pressure is regularly between 130 and 140 mmHg, vigilance is required. "We then enter an intermediate zone that requires particular attention. The first step is to implement lifestyle and dietary measures. The first treatment for high blood pressure is to reduce salt consumption".

Eating better, engaging in regular physical activity, quitting smoking and improving sleep can sometimes be enough to restore balance. But in many cases, medication-based treatment with antihypertensive drugs is necessary. "We often combine several drugs to improve effectiveness while limiting side effects", explains Professor Aboyans. This treatment is generally taken long-term. His message is simple: "Knowing your blood pressure figures is protecting yourself for the future". A cuff, a few minutes of calm and three measurements are sometimes all that is needed to detect what the body has not yet revealed. In the age of connected devices and preventive medicine, knowing how to measure your blood pressure correctly has become a genuine tool for health self-management.