Europe's 'silent killer': Which country has the highest blood pressure and how can we prevent it?

Europe's 'silent killer': Which country has the highest blood pressure and how can we prevent it?

Hypertension, which is also known as high blood pressure, is a common condition that affects an estimated one in three people globally, but if left untreated, it can lead to heart attack and stroke.

It’s a number that has doubled in the last two decades, with nearly half of people with the condition unaware of it, the World Health Organization (WHO) said last year.

"It's a concern because it's a potentially life-threatening condition, and it largely goes unnoticed because when you have high blood pressure, you rarely have any symptoms," Julie Ward, a senior cardiac nurse at the British Heart Foundation (BHF), told Euronews Health.

"You might get the odd headache, a bit of dizziness or a bit of blurred vision, but that's usually if the high blood pressure is quite severe," she added.

Friday marks World Hypertension Day, as experts work to raise awareness about how people can prevent and manage the condition.

What is hypertension?

High blood pressure is when the “force of your blood pushing against the walls of your blood vessels is consistently too high,” according to the American Heart Association.

It is recorded with two numbers measuring systolic and diastolic pressure.

Systolic pressure, the higher number, is the pressure in your arteries when your heart pumps blood, while diastolic pressure, the lower number, is the force when your heart relaxes between heartbeats.

High blood pressure, according to the UK's National Health Service (NHS), is when those numbers are higher than 140/90 millimetres of mercury (mmHg) when taken at a pharmacy or medical clinic. But anything above 120/80 mm Hg is considered elevated.

What are the risk factors for high blood pressure?

Some common risk factors for hypertension include getting older, having family members with hypertension, and being overweight.

It can also be impacted by lifestyle factors such as smoking, drinking too much alcohol, eating too much salt, or not getting enough exercise.

Ricardo Ladeiras Lopes, a cardiologist and assistant professor with the University of Porto’s faculty of medicine, said that stress is another common risk factor for hypertension.

Chronic conditions such as diabetes and kidney disease can also increase the risk of it.

Evidence has also shown that it can disproportionately affect people with black African or Caribbean heritage, according to the UK’s National Institute for Health and Care Excellence.

What health problems can it cause?

Most people with high blood pressure do not have any symptoms, but excess pressure on the arteries can damage your organs.

"High blood pressure does actually account for nearly half of all heart attacks and strokes in the UK. That's a really significant problem," said Ward.

Ladeiras Lopes, who is also a fellow of the European Society of Cardiology, said hypertension is "a major risk factor for cardiovascular diseases, [including] heart attacks and strokes".

"It also can lead to other serious health issues, like kidney failure, vision loss, heart failure. Then the thing about hypertension is that it's also commonly referred to as the 'silent killer' [because] it can exist without noticeable symptoms for years and could lead to severe complications if left untreated," he said.

How many people in Europe have high blood pressure?

Nearly a quarter of people in the European Union have high blood pressure, according to figures from Eurostat, the statistical arm of the bloc.

The number of people with high blood pressure varies across EU states, ranging from 37 per cent of people in Croatia to 12 per cent of people in Ireland, according to the most recently available data.

According to the data, as well as being the worst hit, Croatia also saw a large increase in the number of people with hypertension between 2014 and 2019.

"Although we can not be sure of exact reasons for the increase in reported hypertension data for Croatia between 2014 and 2019, hypertension is one of the most significant public health problems in Croatia," said Ana Ivičević Uhernik from the Croatian Institute for Public Health, referring to the increase in reported high blood pressure shown in the European Health Interview Survey.

A study led by Ivičević Uhernik and published last year found there was a high prevalence of hypertension in Croatia, and “a significant, although smaller than expected, proportion of undiagnosed hypertension”.

"Due to the ageing of the Croatian population and increase in the prevalence of obesity, we expect a further increase in the prevalence of hypertension in the future," she told Euronews Health.

Meanwhile, according to Blood Pressure UK, around one in three adults has high blood pressure in England in line with the global average.

What can people do to treat or prevent it?

"There's lots of things you can do, and it's usually lifestyle-related," says Ward, adding, however, that people "can't prevent it totally because everybody over the age of 65 could potentially get high blood pressure because it is an ageing disease".

Lifestyle changes such as not smoking, reducing alcohol intake, not adding extra salt to food, and eating a healthy diet with fresh food can help.

Studies have also shown that a Mediterranean-style diet rich in fresh vegetables, healthy fats, and fish can reduce the risk of hypertension. People should also exercise and maintain a healthy weight, experts say.

"Stress management in our daily busy life is really important," added Ladeiras Lopes, as well as regular monitoring.

'Empower patients'

Ward, who also answers questions as part of the British Heart Foundation’s helpline, said they get a "very significant amount of queries around high blood pressure".

"We try and empower the patients to manage it themselves at home," she said, such as by getting a blood pressure machine and keeping a diary to see when it goes up as well as speaking to a doctor to talk about potential lifestyle changes.

There are also medications available to help people manage high blood pressure.

Most importantly you should "know your numbers," she said.

Ladeiras Lopes said that it’s a "global concern," adding that the hypertension guidelines from the European Society of Cardiology are set to be updated this year.

"Ageing is a risk factor. It's also important to consider urbanisation and lifestyle changes. Because they lead to reduced physical activity and increased consumption of processed foods and also higher levels of stress," he said, which should be addressed.