Essential hypertension

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Classification according to ICD-10
I10.– Essential (primary) hypertension
45.30 Psychogenic hypertension

Somatoform autonomic dysfunction of
the cardiovascular system

F54 + I10.- Psychological and behavioral factors in essential hypertension
ICD-10 online (WHO version 2019)

The essential hypertension or essential hypertension (also primary hypertension and genuine hypertension called) represents one of the many functional syndromes represent, which are characterized by the fact that, despite extensive diagnostic for the purposes of diagnosis of exclusion here initially no anatomical or endocrinological relevant organ findings (etiological) to raise is. It is concluded from this that there is no underlying primary disease caused by physical findings. (a) Essential hypertension is the one for which the doctor has no explanation. By definition, this presupposes the first group of arterial hypertension , primary hypertension according to the etiological disease classification. - The essential hypertension, a term introduced by the Breslau doctor Erich Frank in 1911, is one of the 7 classic psychosomatoses ( Holy Seven ). (b)

If physical findings without a certain pathogenetic cause are found or suspected, such as genetic factors, reference should be made to → arterial hypertension, section Primary hypertension .

Symptoms

Initially, the only symptom is the increased blood pressure, which usually does not lead to a doctor's visit because those affected usually feel well. Symptoms that are more physically perceived and can be objectively identified must be distinguished from symptoms that are more psychological. Among the physical symptoms, increased blood pressure can be assumed today from blood pressure values ​​of 120/80 mmHg. Values ​​of up to 130/85 mmHg are already regarded as highly normal . (a) According to the recommendations of the WHO, hypertension is to be assumed if values ​​of at least 140 mmHg systolic and 90 mmHg diastolic are reached after multiple measurements over a longer period of time. (c) Headaches, ringing in the ears and red complexion or nosebleeds only partially occur in those affected who are subjectively symptom-free. This is the reason why two thirds of all adults suffering from high blood pressure in German-speaking countries do not know about their illness or are not adequately treated. (b) Other less common symptoms are angina pectoris, increased palpitations, exertional dyspnea, resting dyspnea, and encephalopathy. Adolescents often complain of functional complaints such as sweating, freezing, cold hands and feet, insomnia and uncertain feelings of pressure and pain in the heart area. A slight excitability can often be seen in psychological symptoms, see Chap. Psychodynamics . (d)

Epidemiology and Risk Factors

The importance of essential hypertension can be measured epidemiologically by the fact that over 90% of all cases with high blood pressure can be described as essential hypertension. In Germany there are 20 million people who suffer from high blood pressure. It represents one of the most important risk factors for arteriosclerosis , heart attack and stroke . Today more people die of heart attacks and strokes in the western industrial nations than of all types of cancer and AIDS combined. (c)

The cause of essential hypertension is a combination of the factors genetic predisposition (essential hypertension is inherited in 60% of cases), salt sensitivity (i.e. hypertension is developed even with normal salt consumption), improper nutrition (especially obesity ) and hyperactivity of the sympathetic system (e.g. in the case of chronic stress).

The importance of psychosomatic diseases for high blood pressure is complex and is still being researched today. A positive connection between high blood pressure and anxiety disorders was found. There are contradicting findings for depression , but a 2012 meta-analysis found an increase in the incidence rate of high blood pressure among depression patients.

There is an additional risk of some secondary diseases if essential high blood pressure is not associated with a nightly drop in blood pressure of 10–20% ( non-dipping ).

psychotherapy

Psychosomatic effects on blood pressure were investigated as early as the middle of the 20th century (cf. Franz Alexander's Holy Seven 1950), with efforts to influence blood pressure through psychotherapy. Since then, various studies have found lower blood pressure through psychotherapy; in a Kazakh study from 2014, psychotherapy for high blood pressure was even assessed as economically beneficial.

Two main reasons for the effectiveness of psychotherapy are mentioned: Since studies (see above ) show that anxiety or anxiety disorders increase blood pressure, psychotherapy should be able to lower it, as far as it - even simply by means of supportive procedures - reduces the anxiety. On the other hand, psychoanalysts such as Franz Alexander, Carl Binger or Helen Flanders Dunbar argue that people with high blood pressure cannot handle aggressive and hostile impulses; According to this doctrine, psychodynamic therapies can support high blood pressure patients in dealing with the corresponding conflicts and thereby achieve a reduction in blood pressure.

Psychodynamics

The psychodynamics of the functional developmental conditions was examined by Franz Alexander , who dealt extensively with vegetative disease causes and coined the term vegetative neurosis . According to him, the following factors are important:

  • Defense against dependency desires
  • Avoidance of an inner aggressive willingness to act externally with a slight excitability
  • the inner conflict between ambivalent relationship tendencies (problem of so-called pseudo - independence )

In terms of their personality, hypertensive sufferers are described as performance-oriented, conscientious and socially overadapted with high demands on themselves. Developmental psychology has established relationships with the anal phase . Essential hypertension is classified by psychosomatics in the group of organ diseases with a psychosocial component ( availability disease ). (e) Experimental studies prove the importance of emotional factors in fixed essential hypertension.

According to psychodynamic doctrine, psychotherapy is indicated if there is a corresponding conflict awareness, possibly in combination with antihypertensive medication.

Individual evidence

  1. ↑ Hans Morschitzky : Psychotherapie Ratgeber: A guide to mental health . Springer-Verlag, 2007, ISBN 978-3-211-33616-8 , pp. 86 ( limited preview in Google Book search).
  2. ↑ Sybille Disse: Paukbuch Heilpraktiker Psychotherapy: Effective preparation for examination & practice . epubli, 2013, ISBN 978-3-8442-4915-6 , pp. 41 ( limited preview in Google Book search).
  3. ^ Herbert Reindell , Helmut Klepzig: Diseases of the heart and the vessels. In: Ludwig Heilmeyer (ed.): Textbook of internal medicine. Springer-Verlag, Berlin / Göttingen / Heidelberg 1955; 2nd edition ibid. 1961, pp. 450-598, here: pp. 580-584 ( Die essential hypertension ).
  4. ^ A b c Jan Steffel, Thomas F. Lüscher: Cardiovascular system. Springer Verlag, 2011, ISBN 978-3-642-16717-1 , p. 30.
  5. ↑ a b c d e Sven Olaf Hoffmann , G. Hochapfel: Theory of Neuroses, Psychotherapeutic and Psychosomatic Medicine. Compact textbook. 6th edition. Schattauer, Stuttgart 2003, ISBN 3-7945-1960-4 ; (a) p. 311 on head. “ Diagnosis per exclusionem ”; (b) p. 304 to district “Holy Seven”; (c) p. 311 re. “Standard value RR according to WHO”; (d) p. 312 re. “Further symptoms”; (e) pp. 40, 218, 312 ff on the section “Psychodynamics”.




  6. ↑ Horst Kremling : On the development of clinical diagnostics. In: Würzburger medical history reports 23, 2004, pp. 233–261; here: p. 252.
  7. ↑ a b c Peter W. Gündling : Focus on the heart. Naturally prevent and cure cardiovascular problems. 1st edition. Aurelia-Verlag, Baden-Baden 2004, ISBN 3-936676-14-3 ; all passages on taxation “high blood pressure”, pp. 12, 19, 88–96; Quoted text: (a) p. 89 on Stw. “Normwert RR”; (b) p. 88 re. “Frequency of undetected cases”; (c) p. 88 to district “Epidemiology and Risk Factors”.


  8. ^ MS Player, LE Peterson: Anxiety disorders, hypertension, and cardiovascular risk: a review. In: International journal of psychiatry in medicine. Volume 41, Number 4, 2011, ISSN  0091-2174 , pp. 365-377, PMID 22238841 (review).
  9. ↑ L. Meng, D. Chen, Y. Yang, Y. Zheng, R. Hui: Depression increases the risk of hypertension incidence: a meta-analysis of prospective cohort studies. In: Journal of hypertension. Volume 30, Number 5, May 2012, ISSN  1473-5598 , pp. 842-851, doi: 10.1097 / HJH.0b013e32835080b7 , PMID 22343537 (review).
  10. ↑ Routledge, FS; McFetridge-Durdle, JA; Dean, CR (2007) Night-time blood pressure patterns and target organ damage: A review. Canadian Journal of Cardiology 23 (2): 132-138.
  11. ^ Stanley Cobb, Henry HW Miles: Psychotherapy of a psychosomatic illness: Essential hypertension. In: The American Journal of Medicine. 11, 1951, pp. 381-386, doi : 10.1016 / 0002-9343 (51) 90172-6 .
  12. ^ Wolfgang Linden: Psychological Perspectives of Essential Hypertension: Etiology, Maintenance, and Treatment. Karger Medical and Scientific Publishers, 1984. especially p. 6, with follow-up after up to 24 months.
    Alvin P. Shapiro: Hypertension and Stress: A Unified Concept. Psychology Press, 1996, p. 68.
    Gene L Stainbrook, John W Hoffman, Herbert Benson: Behavioral therapies of hypertension: psychotherapy, biofeedback, and relaxation / meditation. In: Applied Psychology. 32, 1983, pp. 119-135, doi: 10.1111 / j.1464-0597.1983.tb00899.x .
    according to abstract z. B. also for the Russian area in the following study with follow-up after 6 months: MV Golubev, TA Aĭvazian, VP Zaĭtsev: [The efficacy of psychotherapy with biofeedback in the rehabilitation of hypertension patients]. In: Voprosy kurortologii, fizioterapii, i lechebno? fizichesko? culture. Number 6, 1998 Nov-Dec, ISSN  0042-8787 , pp. 16-18, PMID 9987969 .
  13. ↑ Zhanna Kalmatayeva, Ainur Zholamanova: Cost-effectiveness analysis of psychotherapy in treatment of essential hypertension in primary care. In: Archives of Psychiatry and Psychotherapy. 2014; 4, pp. 57-64.
  14. ^ Alvin P. Shapiro: Hypertension and Stress: A Unified Concept. Psychology Press, 1996, p. 68.
    on Dunbar see in particular: Carl Alfred Lanning Binger, Nathan Ward Ackerman, Alfred Elustein Cohn, Henry Alfred Schroeder, John Murray Stecie: Personality in arterial hypertension. In: Psychomatic Medicine Monograph. 1945.
  15. ^ Franz Alexander : Psychosomatic medicine . Its principles and applications. Norton, New York 1950, DNB 993025870 . German: Psychosomatic Medicine. Basics and areas of application. De Gruyter, Berlin 1951, DNB 450046567 .
  16. ↑ J. Schunk: Emotional factors in the pathogenesis of essential hypertension. In: Journal of Clinical Medicine . (1953); 152, p. 251.
  17. ↑ Sven Olaf Hoffmann , G. Hochapfel: Neuroses, psychotherapeutic and psychosomatic medicine. 6th edition. Compact textbook, Schattauer, Stuttgart 2003, ISBN 3-7945-1960-4 , p. 315.