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What is hypertension?
Hypertension is common disease with the increased pressure in the arteries. Blood pressure measurements above 140/90 mmHg are determined for establishing the diagnosis. In recent guidelines in the United States, those values are reduced to the 130/80 level. It occurs among 1 of the 4-5 people in the society. In the long run, high pressure results in damage to the vessel walls, and causes problems in many organ systems such as brain, eye, heart and kidneys.
The two components contributing to the formation of blood pressure are blood volume pumped by the heart and the resistance of the arterial walls. In other words, as the heart rate, volume of the blood pumped and the vessel tension increase, blood pressure also increases.  As can be seen in the above definition, two values which are stated as big and small indicate in blood pressure measurements. Among those values, the smaller one is the value of the pressure detected in the artery when the heart contracts and the other one is the value of the pressure detected in the artery when heart is relaxed. For the diagnosis of hypertension, it is enough to have at least one of the blood pressure values above specified levels.
Hypertension is an insidious enemy;
Many hypertension patients do not feel any symptoms unless their blood pressure elevates too high. Therefore, most of the patients are unaware that their blood pressure is high. Since it does not show any important symptoms, even those who know that they have hypertension do not care about this insidious enemy, do not apply lifestyle changes, and do not even use their medication. Unfortunately, in the long term, damage in the heart, brain, eyes, and kidneys occur and situations such as heart attack or stroke may emerge. In order to prevent all these unwanted health problems, it is important to detect hypertension patients with regular checkups and ensure blood pressure control.
Symptoms of high blood pressure include; headache, dizziness, nosebleed and tinnitus in the ears. Of course, in patients exposed to high blood pressure for a long period of time, there may be many different symptoms due to organ damage. Those include; shortness of breath, chest pain, visual disturbances, stroke and heart attack.
What are the reasons for hypertension?
Genetic and environmental factors together play a role in the emergence of hypertension. The reason for elevation of the blood pressure can only be detected in a small number of patients (5-10 percent). This group of patients is called secondary hypertension patients. Reasons could be detected include; renal dysfunction, renal vascular diseases, hormonal disorders, drug use and sleep apnea syndrome. If these problems can be cured, high blood pressure will disappear in most of the patients. In the remaining 90 per cent of the patients, no direct cause can be found and this group is named as primary or essential hypertension group.
Who are at risk for hypertension?
One of the most important risk factors is familial predisposition, to illustrate, if mother or father has high blood pressure, the probability of their children having high blood pressure in one stage of their life increases at least twice. High salt consumption, lack of movement, excess weight, intense psychological stress, tobacco and alcohol use are other risk factors contributing to hypertension.
Hypertension may later occur by 50% in patients who have not been diagnosed with hypertension but have blood pressure over 120/80 optimal level. In order to prevent this, lifestyle changes should be recommended to these patients.
What kind of diseases does high blood pressure cause?
In the vessels of the body damages occur due to the effect of high pressure, the higher the pressure and the longer the damage exists, the more and earlier is the damages in vascular wall and organs. Diseases caused by high blood pressure include cerebral hemorrhage, cerebral vascular obstruction, dementia, cardiovascular obstruction, aortic vascular dilatation, renal failure and visual disturbances.
How is hypertension diagnosed?
Having a properly measured blood pressure above 140/90, or even above 130/80 according to the new regulations in subsequent clinical examinations makes a diagnose for hypertension. Sometimes, blood pressure may increase due to excitement in the hospital settings (white coat hypertension) or it may be incorrectly low in the hospital settings, but high at home settings (masked hypertension).In such cases, 24-hour blood pressure measurement and recording blood pressure holter devices can also be used. This device helps to diagnose by recording 24-hour blood pressure course, and to assess to what degree blood pressure is under control.
How to treat hypertension?
The basic principle in the treatment of high blood pressure is to keep blood pressure values at target levels with or without medication. In general, this value is below 140/90. In the aforementioned group of secondary hypertension patients, underlying causes shouldbe treated in the first place. The healthier way of blood pressure control is to achieve blood pressure control with lifestyle changes, but this is not possible in some patients and it is necessary to use medication for blood pressure control.
Lifestyle changes that could be suggested for high blood pressure include; limitation of salt intake, smoking cessation, minimization of alcohol intake, doing regular exercise, potassium-rich nutrition, stress relief and weight control. Each of these recommendations helps to control blood pressure by providing approximately 3-5 mmHg drop in blood pressure. In a group of patients, lifestyle changes are not enough to control blood pressure, and some patients cannot implement those lifestyle changes. In those patients, blood pressure must be controlled with drug support.
What is meant by life style changes?Salt consumption which is normally above 15 gram in the society, should be reduced below 6 grams in high blood pressure patients by eating less salty foodsand mainly fruits and vegetables. This corresponds to approximately 1 teaspoon of salt per day. Patients should also avoid pickles, salted olives, salted cheese and ready-to-eat foods due to their high salt content.
Having mainly fruits and vegetables as it is in the Mediterranean diet, is beneficial both for weight control and blood pressure control because of the potassium it contains.
Second one is to do regular exercise. The important thing here is to walk at least 4-5 days a week for 30 minutes, according to their living conditions patients can do different exercise types with different intensities and durations. For example, swimming, running or cycling for 1 hour 2-3 days a week are also acceptable types of exercise.
For weight control,it is recommended to keep the body mass index below 25. In addition to regular exercise,patients should be advised to reduce their daily calorie intake for weight control. Many patients can reduce their weight by stop eating pastries, minimizing bread and avoiding fatty foods.
In addition, patients should be informed about smoking and alcohol as they raise blood pressure in addition to their other damages and should be supported to quit.
After all;
As a result; hypertension is a commonly encountered insidious disease which may cause significant health problems if not detected and left untreated. Patients should be detected with regular blood pressure measurements in the community and their blood pressure should be taken to appropriate levels. Lifestyle changes in the treatment are just as important as medications.

Doç. Dr. M. Fatih Özlü

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