What is Hypertension (High Blood Pressure)?

What is Hypertension?

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Hypertension is a condition where blood pressure consistently remains above normal levels. Blood pressure is the force that blood exerts on the walls of arteries as the heart pumps it through the body. This pressure is expressed as two values:

Systolic pressure (top number): The pressure in the arteries when the heart contracts Diastolic pressure (bottom number): The pressure in the arteries when the heart rests between beats

For example, in a reading of 120/80 mmHg, the systolic pressure is 120 and the diastolic pressure is 80.

Blood Pressure Values and Categories

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According to current guidelines from the American Heart Association and European Society of Cardiology, blood pressure values are classified as follows:

Globally, approximately one billion people have hypertension, and this number continues to rise. In developed countries, about 30% of the adult population is affected, with rates exceeding 60% in those over 65 years of age.

Types of Hypertension

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Primary (Essential) Hypertension

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This accounts for approximately 90-95% of hypertension cases. There’s no identifiable cause; rather, genetic predisposition, lifestyle factors, and environmental influences play combined roles. It typically develops gradually over many years.

Secondary Hypertension

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This develops as a result of an underlying health condition and accounts for approximately 5-10% of cases. Causes include:

• Kidney diseases: Chronic kidney failure, polycystic kidney disease
• Hormonal disorders: Pheochromocytoma, hyperaldosteronism, Cushing syndrome, thyroid diseases
• Sleep apnea: Obstructive sleep apnea syndrome
• Aortic coarctation: Congenital narrowing of the aorta
• Medications: Birth control pills, NSAIDs, decongestants, certain antidepressants

When secondary hypertension is treated and the underlying cause is addressed, blood pressure may return to normal.

Symptoms of Hypertension

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The reason hypertension is called the “silent killer” is that most people experience no symptoms for years. The condition is often discovered incidentally during a routine health check-up. However, when blood pressure reaches very high levels, some symptoms may appear:

Common Symptoms

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• Headache: Especially in the morning, throbbing pain at the back of the head
• Dizziness and lightheadedness
• Blurred vision: Decreased visual acuity
• Shortness of breath: Especially during exertion
• Nosebleeds: Recurring epistaxis
• Facial flushing
• Ringing in the ears (tinnitus)

Hypertensive Crisis Symptoms

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When blood pressure reaches very high levels (above 180/120 mmHg), an emergency situation develops requiring immediate intervention:

• Severe headache
• Chest pain
• Difficulty breathing
• Visual disturbances
• Altered consciousness
• Difficulty speaking
• Weakness in arms or legs

Risk Factors

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Factors that increase the risk of hypertension are divided into modifiable and non-modifiable categories:

Non-Modifiable Risk Factors

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• Age: Risk increases significantly after 65
• Gender: More common in men at younger ages; equalizes in women after menopause
• Family history: Having a parent with hypertension increases risk 2-3 fold
• Ethnicity: More prevalent in certain ethnic groups
• Genetic factors: Certain gene variants create predisposition

Modifiable Risk Factors

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• Obesity: Excess weight makes the heart work harder
• Excessive salt intake: Consuming more than 5 grams of salt daily
• Insufficient potassium intake: Potassium is important for balancing sodium
• Sedentary lifestyle: Not exercising regularly
• Smoking: Accelerates hardening of arteries
• Alcohol consumption: Excessive alcohol raises blood pressure
• Chronic stress: Long-term stress leads to hormonal imbalance
• Sleep disorders: Especially sleep apnea
• Dietary habits: Saturated fats, sugar, and processed foods

Complications of Hypertension

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When left untreated, hypertension damages multiple organs throughout the body:

Cardiovascular Complications

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• Heart attack (Myocardial infarction): Damage to coronary arteries
• Heart failure: Reduced pumping capacity of the heart
• Left ventricular hypertrophy: Thickening of heart muscle
• Atrial fibrillation: Irregular heart rhythm
• Aortic aneurysm and dissection: Expansion or tearing of the aorta

Cerebral (Brain) Complications

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• Stroke: Blockage or bleeding of brain vessels
• Transient ischemic attack (TIA): Mini-stroke
• Vascular dementia: Dementia due to brain vessel damage

Kidney Complications

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• Chronic kidney disease: Progressive loss of kidney function
• Kidney failure: May require dialysis or transplant

Eye Complications

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• Hypertensive retinopathy: Damage to retinal blood vessels
• Optic neuropathy: Optic nerve damage
• Vision loss

Peripheral Artery Disease

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• Narrowing and blockage of leg vessels
• Reduced walking distance (claudication)

Diagnosing Hypertension

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Hypertension diagnosis is based on properly performed blood pressure measurements:

Office Measurement

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• In a quiet, calm environment
• After 5 minutes of rest
• Seated with back supported, arm at heart level
• Using appropriately sized cuff
• Measuring in both arms
• At least 2-3 measurements at different times

Ambulatory Blood Pressure Monitoring (ABPM)

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24-hour monitoring with an automatic measuring device. Shows day and night values. Useful for distinguishing “white coat hypertension.”

Home Blood Pressure Monitoring (HBPM)

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Patient measures regularly at home. At least twice daily (morning and evening), 4-7 days per week is recommended.

Additional Tests

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• Blood tests: Kidney function, electrolyte levels, blood sugar, lipid profile
• Urinalysis: Protein excretion, microalbuminuria
• ECG: Assessment of left ventricular hypertrophy
• Echocardiography: Heart structure and function
• Fundoscopy: Retinal vascular changes
• Carotid ultrasound: Atherosclerosis in neck vessels

Treatment Approaches

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Hypertension treatment includes lifestyle modifications and, when necessary, medication:

Lifestyle Modifications

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Forms the foundation of treatment for all hypertension patients:

1. DASH Diet (Dietary Approaches to Stop Hypertension)

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• Plenty of fruits and vegetables: 4-5 servings daily
• Whole grains: Instead of refined grains
• Low-fat dairy products
• Lean meats, fish, poultry
• Nuts and legumes
• Limited saturated fats and sugar

2. Salt Restriction

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• Keep daily sodium intake below 2.3 grams (about 1 teaspoon of salt)
• Ideal target: 1.5 grams of sodium per day
• Avoid processed foods, pickles, and preserved products
• Add flavor with fresh herbs and spices

3. Regular Physical Activity

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• At least 150 minutes of moderate aerobic exercise per week
• Or 75 minutes of vigorous exercise
• Walking, swimming, cycling, dancing
• Resistance exercises 2-3 days per week

4. Weight Control

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• Maintain body mass index (BMI) between 18.5-24.9
• Each 1 kg of weight loss reduces blood pressure by approximately 1 mmHg
• Waist circumference: <40 inches (102 cm) for men, <35 inches (88 cm) for women

5. Alcohol Restriction

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• Men: No more than 2 standard drinks per day
• Women: No more than 1 standard drink per day
• Ideal: No consumption at all

6. Quit Smoking

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• Smoking accelerates arterial stiffening
• Quitting is beneficial at any age
• Utilize support programs

7. Stress Management

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• Meditation and mindfulness practices
• Deep breathing exercises
• Yoga and tai chi
• Hobby activities
• Adequate sleep (7-8 hours per day)

Medication Therapy

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When lifestyle changes alone are insufficient or when there’s high initial risk, medication therapy is started:

First-Line Medications

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• ACE Inhibitors: Enalapril, ramipril, lisinopril
• ARBs (Angiotensin Receptor Blockers): Losartan, valsartan, telmisartan
• Calcium Channel Blockers: Amlodipine, nifedipine, diltiazem
• Thiazide Diuretics: Hydrochlorothiazide, indapamide

Second-Line Medications

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• Beta Blockers: Metoprolol, bisoprolol, nebivolol
• Alpha Blockers: Doxazosin, prazosin
• Aldosterone Antagonists: Spironolactone, eplerenone
• Centrally Acting Agents: Clonidine, methyldopa

Combination Therapy

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Most patients cannot reach target with a single medication. Combining drugs with different mechanisms is usually necessary:

• ACE inhibitor/ARB + Calcium channel blocker
• ACE inhibitor/ARB + Diuretic
• Calcium channel blocker + Diuretic

Home Blood Pressure Monitoring: Proper Technique

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Home blood pressure monitoring is crucial for tracking treatment. For accurate results:

Preparation Before Measurement

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1. Avoid caffeine, smoking, and alcohol 30 minutes before measurement
2. Empty your bladder
3. Rest for at least 5 minutes in a calm environment
4. Don’t talk during measurement

Correct Measurement Position

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1. Sit upright with back supported
2. Feet flat on the floor (don’t cross legs)
3. Arm supported at heart level on a table or pillow
4. Cuff wrapped on bare skin, about 2-3 cm above the elbow

Measurement Routine

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1. Morning: Before breakfast and medications
2. Evening: Before dinner or before bed
3. Take 2 measurements 2 minutes apart each time
4. Record the average
5. Show results to your doctor during check-ups

Frequently Asked Questions (FAQ)

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When Should You See a Doctor?

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Seek medical help without delay in the following situations:

• Blood pressure readings consistently above 140/90 mmHg
• Severe headache, chest pain, or shortness of breath
• Blurred vision or vision loss
• Altered consciousness or difficulty speaking
• Numbness or weakness in arms or legs
• Nosebleed that won’t stop

Regular blood pressure monitoring is essential for early diagnosis and treatment. When hypertension is controlled, the risk of complications is greatly reduced.

If you have concerns about your blood pressure readings or want to consult about hypertension treatment, please feel free to contact me.