Hypertension is a systemic, chronic and serious disease that can affect almost every organ that blood vessels reach, but mostly damages the heart, kidney and brain.

High blood pressure (Hypertension) 

In a normal adult, blood pressure is expected to average 120/80 mmHg. Blood pressure is affected by many factors such as a person’s characteristics, age, weight or eating habits. For this reason, systolic blood pressure (also known as systolic blood pressure) can vary between 90-140 and diastolic blood pressure (also known as diastolic blood pressure) can vary between 60-90. These values are considered as normal blood pressure. A blood pressure of 140/90 mmHg and above is called hypertension (high blood pressure), and values below 90/60 mmHg are called low blood pressure (hypotension).



Hypertension is a systemic, chronic and serious disease that can affect almost every organ that blood vessels reach, but mostly damages the heart, kidney and brain.

The World Health Organization (WHO) states that nearly half of the patients are not aware of their disease. According to WHO data, approximately 1.3 billion people in the 30-80 age range worldwide have been diagnosed with hypertension. However, about 270 million of them can control blood pressure with appropriate treatment.

Although the incidence of the disease has been reduced by one third with the control programs implemented by countries under the leadership of WHO in recent years, hypertension is still among the most important causes of death.

How to measure blood pressure? 

Blood pressure is the pressure that blood exerts on the vessel wall as it passes through the arteries. The value that occurs during the heartbeat is the high blood pressure (systolic), the value that occurs at other times is the small blood pressure (diastolic) value. Blood pressure is measured with a sphygmomanometer and is affected by many factors. Accurate measurement of blood pressure is important.



Mercury, aneroid and electronic blood pressure monitors are available. Although mercury sphygmomanometers are more preferred, electronic sphygmomanometers are preferred for home use due to their ease of use and the fact that they do not require special training.

The sphygmomanometer must be approved and calibrated by the relevant institutions. The sphygmomanometer should be suitable for the arm of the person. In measurements from the arm, the width of the cuff should cover two-thirds of the arm.

The points to be considered in blood pressure measurement (for measurement from the arm) are as follows:

  • Blood pressure measurement should be done in a quiet and calm environment.
  • Before the measurement, the patient is seated and asked to rest for five minutes.
  • It is recommended to measure blood pressure at least half an hour after tea, coffee or smoking.
  • While measuring blood pressure, both feet of the patient should be on the ground, legs should not be crossed.
  • During the measurement, do not talk or move.
  • The clothes that will squeeze the arm are removed. The clothes that do not tighten on the arm are folded, the arm is wide open.
  • Blood pressure is not measured on the dress.
  • The upper arm should be at heart level.
  • The cuff of the blood pressure monitor is wrapped around the arm so that it is 2 cm above the elbow pit.
  • The blood pressure monitor’s manometer is visible and easily readable.
  • The stethoscope head is placed over the artery in the arm.
  • The cuff is inflated by pressing the vein on the arm with a finger until the pulse disappears. Then the screw on the side is loosened and the air is allowed to come out, the air is slowly deflated until the cuff is loosened in the arm.
  • The first sound heard while deflating the cuff gives the systolic blood pressure (systolic blood pressure). The point where the sound disappears gives the diastolic blood pressure (low blood pressure).

Blood pressure is measured in both arms. It is normal to have a difference of 20 mmHg between the arms. It is then measured again from the higher side.

It is important that the batteries of electronic blood pressure devices measuring from the wrist are not weak and that they are calibrated. In a calm and quiet environment, the measurement is taken with the feet parallel to the ground, touching, without moving, without speaking. The diastolic and diastolic blood pressure values are read from the screen.



In blood pressure measurements, there may be changes in blood pressure due to the white coat effect of patients in health institutions. For this reason, instead of diagnosing hypertension with a single measurement, sequential measurements and, if necessary, non-health institution measurements may be required. If there is an opportunity to measure blood pressure at home, a follow-up card can be issued to the patient and asked to record the measurement results at certain times of the day.

What are the types of hypertension? 

Although hypertension is common, an underlying disease cannot be detected most of the time.

Experts evaluate hypertension in two groups:

  • Primary hypertension : It is the group in which an underlying disease cannot be detected, which is thought to be due to genetics or vital habits and constitutes the majority of cases.
  • Secondary hypertension : It is a less common group in which an underlying disease (diabetes mellitus, kidney diseases, endocrine diseases, other drugs used, etc.) is detected and its treatment is possible by correcting this factor.

 What are the risk factors for hypertension? 

Although hypertension is mostly a disease of unknown cause, some factors may predispose to the disease. Risk factors for the disease include:

  • History of hypertension, heart disease in the family, especially in first-degree relatives,
  • Obesity,
  • Sedentary life,
  • Irregular diet,
  • Excessive salt intake
  • Age (over 50 years old),
  • Gender (more common in men up to age 50, more common in women after age 50),
  • Use of tobacco and tobacco products,
  • Alcohol addiction.

 Why does hypertension develop? 

The cause of most cases of hypertension is unknown. Although some lifestyle habits are thought to have a causal relationship, the cause of the disease can only be interpreted in less than 5% of the cases.



In addition to vital habits (obesity, dietary habits, smoking, alcohol, inactivity, etc.) and genetic factors that may pose a risk for the development of hypertension, the following factors may play a role:

  • Kidney diseases (Chronic kidney failure, infections, glomerulonephritis etc.)
  • Cushing’s syndrome (a disease characterized by excessive production of cortisol from the adrenal glands),
  • SLE (an autoimmune disease in which the immune system attacks organs for no reason),
  • Thyroid diseases,
  • Diabetes mellitus,
  • Pheochromocytoma,
  • Birth control pills,
  • Medications (corticosteroids, drugs used to treat depression, etc.).

 What are the symptoms of hypertension? 

About half of hypertension cases do not show any symptoms. Patients either do not know their disease or are diagnosed incidentally in blood pressure measurements. It would not be wrong to call it the “silent killer” because the disease and its complications are among the leading causes of death.

Possible signs and symptoms that can be seen in cases of hypertension are:

  • Headache,
  • Neck pain,
  • Weakness, fatigue,
  • Feeling of drowsiness,
  • Frequent urination,
  • Nausea, vomiting,
  • Visual disturbances,
  • Swelling in the legs,
  • Nose bleeding,
  • Tinnitus,
  • Heart rhythm disorders,
  • Palpitation,
  • Respiratory problems.

Diagnosis of hypertension 

Hypertension is a disease that can be easily diagnosed with blood pressure measurements made under appropriate conditions. In most patients, anamnesis and examination findings may be normal.

Blood pressure values of 140/90 mmHg and above in the measurements made in the health institution, 135/85 mmHg and above in the measurements made while awake at home, and 120/80 mmHg and above in the measurements made while sleeping at home can be considered as hypertension. It is recommended that everyone over the age of 40 take blood pressure measurements at regular intervals.

In the anamnesis, the patient’s other existing diseases, medications, smoking, alcohol use, eating habits, exercise status, and family history are questioned.



The important thing in the diagnosis of hypertension is to detect and treat an underlying disease. Because:

  • Blood glucose level (fasting/fasting blood sugar, Hemoglobin A1C etc.)
  • Hormonal tests (thyroid tests etc.)
  • EKG,
  • Urine tests (proteinuria, infection, etc.)
  • Kidney function tests (BUN, creatinine etc.)
  • Lower abdominal ultrasonography etc. can be done.

Hypertension treatment

Hypertension treatment is grouped as prevention of risk factors, drug therapy and treatment of the underlying disease. The primary treatment step in all patients is the elimination of risk factors. This can also be recommended for the prevention of hypertension.

Control of risk factors: 

  • Obesity control : Excess weight is very effective in raising blood pressure. With proper diet and regular physical activity, every 5 kilograms lost means about 40 mmHg improvement in blood pressure.
  • Salt restriction : Sodium chloride (salt) is an important risk factor for the development of hypertension. Restricting daily salt intake gives very good results in the treatment of both hypertension and related heart diseases.
  • Regular physical activity: Physical activity is an effective method in the prevention and treatment of hypertension. It also reduces the risk of developing heart diseases. It is recommended to exercise at least five days a week and at least half an hour.
  • Smoking cessation: Due to the content of tobacco and tobacco products, it is a serious risk factor in hypertension as in many diseases. It increases the risk of developing hypertension, reduces the success of treatment, and increases the risk of developing complications. Tobacco and tobacco products should be avoided.
  • Nutrition: Products containing mostly vegetables and fruits, low-fat or fat-free, fibrous foods should be preferred. Along with regular physical activity, it is very effective in weight control and reducing the risk of hypertension.
  • Stress management: Avoiding stress and getting support, if necessary, are important in terms of prevention and treatment in most of the hypertension and related diseases.

Medication: 

In the treatment of hypertension, appropriate drug therapy can be applied, taking into account the severity of the disease, its duration, the underlying disease, the general characteristics of the patient, etc.

Drugs used in the treatment of hypertension include:

  • Diuretics (indapamide, furosemide, bumetanide, spironolactone etc.)
  • Betblockers (atenolol, metoprolol, bisoprolol, carvedilol etc.)
  • Calcium antagonists (nifedipine, amlodipine, verapamil, ditiazem etc.)
  • ACE-I (angiotensin converting enzyme inhibitors) (captopril, enalapril, ramipril, lisinopril, trandolapril etc.),
  • Alphablockers (doxazosin etc.),

Complications of hypertension: 

If hypertension is not properly treated, it can lead to serious health problems. Possible complications include:

  • Heart attack,
  • Bleeding in brain vessels,
  • Stroke,
  • Heart failure,
  • Heart rhythm disorders,
  • Rupture of the aorta,
  • Kidney failure,
  • Eye problems,
  • Peripheral vascular diseases,
  • Pregnancy poisoning (preeclampsia).

 


Tags: