Hypertension - High Blood Pressure Management

Hypertension, medically known as arterial hypertension and commonly called “high blood pressure,” is a chronic health condition affecting millions worldwide. In Turkey, approximately 30% of the adult population has hypertension, with a significant portion remaining undiagnosed or inadequately treated. Known as the silent killer, this condition can lead to serious complications such as heart attack, stroke, kidney failure, and vision loss if not properly controlled.

What is Hypertension?

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Hypertension is a condition where blood pressure remains consistently above normal levels. Blood pressure is defined as the force of blood against arterial walls and is measured using two values:

• Systolic pressure (upper value): Pressure in the arteries when the heart contracts
• Diastolic pressure (lower value): Pressure in the arteries when the heart relaxes

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

Symptoms of Hypertension

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The reason hypertension is called the “silent killer” is that it can damage the body for years without causing noticeable symptoms. However, some patients may experience:

• Headaches, particularly in the back of the head during morning hours
• Dizziness and lightheadedness
• Blurred vision or visual changes
• Shortness of breath, especially after exertion
• Chest pain or discomfort
• Heart palpitations
• Nosebleeds
• Fatigue and weakness

Critical Warning: Symptoms such as severe headache, chest pain, shortness of breath, vision loss, or difficulty speaking may indicate a hypertensive emergency and require immediate medical attention.

Causes of Hypertension

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Hypertension is divided into two main categories based on cause:

Primary (Essential) Hypertension

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This accounts for 90-95% of all hypertension cases. No specific cause can be identified, but the following factors play a role:

• Genetic predisposition and family history
• Advanced age (decreased vascular elasticity)
• Excessive salt consumption
• Obesity and sedentary lifestyle
• Stress and anxiety
• Alcohol and tobacco use

Secondary Hypertension

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This accounts for 5-10% of cases and is caused by an underlying condition:

• Kidney diseases (renal artery stenosis, glomerulonephritis)
• Hormonal disorders (hyperaldosteronism, pheochromocytoma, Cushing’s syndrome)
• Sleep apnea
• Thyroid diseases
• Certain medications (birth control pills, NSAIDs, steroids)
• Congenital vascular anomalies (aortic coarctation)

Diagnostic Methods

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Hypertension cannot be diagnosed based on a single measurement. A comprehensive evaluation is required for accurate diagnosis:

Blood Pressure Measurements

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• Office measurement: At least two separate measurements on different days
• Ambulatory blood pressure monitoring (ABPM): 24-hour automatic monitoring - the “gold standard”
• Home measurements: Regular monitoring by the patient at home

Laboratory Tests

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• Complete blood count
• Fasting blood glucose and HbA1c
• Lipid profile
• Kidney function tests (BUN, creatinine, GFR)
• Electrolyte levels (sodium, potassium)
• Urinalysis and microalbuminuria
• Thyroid function tests

Imaging and Additional Tests

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• Electrocardiography (ECG): Assessment of left ventricular hypertrophy
• Echocardiography: Detailed examination of heart structure and function
• Fundoscopy: Evaluation of hypertensive retinopathy
• Renal Doppler ultrasound: Assessment of kidney arteries
• Carotid Doppler: Evaluation of atherosclerosis

Our Treatment Approaches

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The goal of hypertension treatment is to reduce blood pressure to target levels, preventing organ damage and reducing cardiovascular risk. Treatment includes lifestyle modifications and, when necessary, medication therapy.

Lifestyle Modifications

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Lifestyle modifications form the foundation of treatment and can control mild hypertension on their own:

Nutrition (DASH Diet)

• Reduce salt intake to below 5 grams per day
• Consumption of potassium-rich fruits and vegetables
• Whole grain products
• Low-fat dairy products
• Reduction of red meat and processed foods

Physical Activity

• At least 150 minutes of moderate-intensity aerobic exercise per week
• Activities such as walking, swimming, cycling
• Gradually increasing exercise program

Weight Control

• Target body mass index: 18.5-24.9 kg/m²
• Each 1 kg of weight loss provides approximately 1 mmHg blood pressure reduction

Stress Management

• Regular sleep (7-8 hours)
• Meditation and relaxation techniques
• Hobbies and social activities

Elimination of Harmful Habits

• Complete smoking cessation
• Limiting alcohol consumption

Medication Therapy

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If blood pressure cannot be controlled despite lifestyle modifications, or in high-risk patients, medication therapy is necessary. Modern antihypertensive medications are safe and effective.

First-Line Medications:

• ACE inhibitors (enalapril, ramipril, lisinopril)
• Angiotensin receptor blockers (ARBs) (losartan, valsartan, irbesartan)
• Calcium channel blockers (amlodipine, nifedipine)
• Thiazide diuretics (hydrochlorothiazide, indapamide)

Second-Line and Combination Therapies:

• Beta-blockers (metoprolol, bisoprolol)
• Aldosterone antagonists (spironolactone)
• Alpha-blockers
• Direct vasodilators

Medication selection is personalized based on the patient’s age, comorbidities, and organ damage status.

Resistant Hypertension Treatment

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If blood pressure cannot be controlled despite the use of three different classes of medications, “resistant hypertension” is present. In this case:

• Evaluation of medication adherence
• Investigation of secondary causes
• Addition of aldosterone antagonist
• Renal denervation (in suitable cases)

Complications and Organ Damage

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Uncontrolled hypertension causes damage to multiple organs over time:

• Heart: Left ventricular hypertrophy, heart failure, coronary artery disease
• Brain: Stroke, transient ischemic attack, vascular dementia
• Kidneys: Chronic kidney disease, kidney failure
• Eyes: Hypertensive retinopathy, vision loss
• Peripheral arteries: Peripheral artery disease, aneurysm

Frequently Asked Questions

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Appointment and Contact

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If you would like to schedule an appointment for blood pressure control or hypertension treatment:

📍 Avrasya Hospital - Beştelsiz Mah. 101. Sokak No:107, Zeytinburnu, Istanbul

📞 Phone: +90 212 665 50 50 (Ext: 4012)

This content has been prepared by Assoc. Prof. Dr. Habib Çil for general informational purposes. Please consult a cardiology specialist for definitive diagnosis and treatment.

Related Cardiology Treatments

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Other cardiology treatments related to hypertension:

• Renal Artery Stenosis - Renal artery stenosis treatment
• Coronary Artery Disease - About coronary artery disease
• Heart Failure - Heart failure treatment
• Echocardiography - Heart ultrasound
• EKG - Electrocardiography