Hypertension: The Silent Enemy

Hypertension, which can progress insidiously, can affect the brain, heart, kidneys, and vascular system over the years without showing any symptoms. Therefore, regular monitoring with correct measurement techniques, early management of risk factors, and medical evaluation when necessary are of vital importance.

What is hypertension?

Hypertension is the clinical term used for a condition where systolic blood pressure (large tension) is above 140 mmHg and diastolic blood pressure (small tension) is above 90 mmHg. Although values may vary in different guidelines, the essential point is the detection of persistent elevation.

How is it diagnosed?

• High values must be detected in at least two measurements repeated within the same day and/or in measurements taken on different days.
• If the physician deems it necessary, they may request home blood pressure monitoring or 24-hour ambulatory blood pressure monitoring (Holter).
• A single high value does not lead to a diagnosis; repetition under appropriate conditions is important.

Why is it important?

Hypertension can often progress for years without symptoms and cause permanent damage to target organs such as the brain, heart, kidneys, eyes, and peripheral vessels. Therefore, the “no symptoms, no problem” approach is incorrect.

Symptoms and Signs

Hypertension does not produce symptoms in most people. Complaints that may be seen include headache, dizziness, tinnitus (ringing in the ears), imbalance, and easy fatigue; however, the absence of these does not mean that hypertension is not present.

Which organs are affected?

• Brain: Increased risk of transient ischemic attack and stroke.
• Heart and large vessels: Left ventricular hypertrophy, coronary artery disease, aortic diseases.
• Kidneys: Loss of function that can progress to chronic kidney disease.
• Peripheral vessels: Signs of peripheral artery disease such as leg pain while walking and early fatigue.
• Eyes: Damage to retinal vessels and vision problems.

[Image showing target organ damage caused by chronic high blood pressure]

How to measure blood pressure correctly?

• Sit quietly for at least 3–5 minutes before measuring.
• Avoid caffeine, smoking, and intense exercise 30 minutes before the measurement.
• The cuff should be suitable for your arm circumference, and the arm should be supported at heart level.
• Initial assessment should be done from both arms. In follow-ups, it should generally be measured from the same arm.
• Take at least two measurements. Wait 1–2 minutes between them and note the average.

How common is hypertension?

It affects a significant portion of adults, and many people are unaware of their condition until they are diagnosed. Family history, advanced age, obesity, diabetes, high cholesterol, and a sedentary lifestyle are associated with an increased risk.

Can you be a hypertensive patient even if you have no complaints?

Hypertension can progress for years without symptoms in most people. A situation where values that appear normal during a clinical examination are high at home or during the day is called masked hypertension. This picture can affect heart, brain, kidney, and vascular health in the long run; therefore, regular measurement and correct follow-up are very important.

What is masked (hidden) hypertension?

Masked hypertension is when blood pressure that appears normal during a doctor’s examination is found to be high during home measurements or 24-hour ambulatory blood pressure monitoring. An office measurement alone is not a guarantee; daily life values reflect the real risk better.

Why might it not show symptoms?

Blood pressure elevation is slow and insidious in most people. Because the body “gets used to” this high pressure, complaints such as headache, dizziness, and palpitations may not be seen. The absence of symptoms does not mean there is no risk of organ damage.

Who is more at risk?

Masked hypertension may be seen more frequently in those with a family history of hypertension, individuals with high salt consumption, those leading a sedentary lifestyle, overweight/obese individuals, those with diabetes or high cholesterol, smokers, and those carrying a heavy workload or stress.

Which lifestyle changes should you make?

In individuals at borderline or stage 1 levels, if the physician deems it appropriate, these changes may be the first step:

• Regular aerobic exercise (at least 150 minutes of moderate intensity per week).
• Salt restriction, Mediterranean/DASH style diet.
• Returning to a healthy weight range.
• Limiting alcohol, quitting smoking.
• Stress management and adequate sleep.

When is drug treatment necessary?

If blood pressure does not drop to the target despite lifestyle changes, or if initial values are high, the physician may start single or combined drug therapy. The choice of medication is determined according to individual risks, co-occurring diseases, and tolerance. Treatment requires regular follow-up; medications should not be discontinued without a physician’s recommendation.

When to consult a doctor?

• Repeated values of ≥140/90 mmHg in home measurements.
• Severe headache, chest pain, shortness of breath, vision changes, weakness, or speech impairment.
• If there are co-occurring conditions such as kidney disease, diabetes, or cardiovascular disease, evaluation is required at lower thresholds.