What Is Hypertension? What Are Its Symptoms and Treatment Methods?

What is hypertension or high blood pressure, and what causes it?
Blood pressure is the force exerted by the blood on the vessel walls as the heart pumps it. When this pressure is above the desired levels, the condition is defined as hypertension. Approximately 20% of the population has hypertension; this rate increases to about 40% in individuals aged 45–54 and about 50% in those aged 55–64. Therefore, individuals of all ages should have their blood pressure checked at least once a year.

Blood pressure consists of two values: systolic (upper value) and diastolic (lower value). Normal blood pressure values are ≤130 mmHg for systolic and ≤85 mmHg for diastolic pressure. High-normal values are 130–139 mmHg systolic and 85–89 mmHg diastolic. The threshold for hypertension is ≥140 mmHg systolic or ≥90 mmHg diastolic. Hypertension is classified as primary (essential) and secondary hypertension. Although genetic factors, excessive salt intake, sedentary lifestyle, excessive weight, stress, smoking, and heavy alcohol consumption are well-known contributors, the cause of hypertension remains unknown in 90–95% of patients. Secondary hypertension, seen in 5–10% of cases, develops due to an underlying condition. The most common causes include kidney diseases, adrenal disorders, renal artery stenosis, congenital narrowing of part of the aorta, sleep apnea, thyroid diseases, oral contraceptives, cold medications, nasal decongestants, and certain drugs used for rheumatologic and psychiatric conditions.

What complications may arise from hypertension?
Hypertension increases the risk of many cardiovascular diseases such as ischemic heart disease, heart attack, stroke, peripheral vascular disease, heart failure, aortic aneurysm, and diffuse atherosclerosis. It is also a risk factor for cognitive impairment, dementia, and chronic kidney disease. It may cause progressive damage in the eyes leading to vision loss, and the kidneys are particularly vulnerable—especially in malignant hypertension.

How is hypertension diagnosed, and what are its symptoms?
Hypertension is diagnosed when a person consistently has elevated blood pressure. Traditionally, diagnosis requires three separate measurements taken at intervals within a certain period. Evaluation begins with medical history and physical examination. The gold standard for diagnosis is a 24-hour ambulatory blood pressure monitoring. Although office measurements and home monitoring over seven days may also be used, ambulatory monitoring is ideal and should be used whenever possible. Hypertension is diagnosed when the 24-hour average is ≥130/80 mmHg, or the daytime average is ≥135/85 mmHg, or the nighttime average is ≥120/70 mmHg.

Hypertension rarely presents with symptoms and is often detected incidentally or during routine screening. Some individuals with high blood pressure report headaches, neck or back pain, occasional chest discomfort, shortness of breath, easy fatigue, lightheadedness, dizziness, tinnitus (ringing in the ears), visual disturbances, or fainting.

How is hypertension treated, and what are the treatment methods?
From a public health perspective, adults should adopt appropriate lifestyle changes regardless of the stage of their blood pressure levels. Lifestyle modifications are known to be as important as medication therapy. The main recommendations for patients include achieving an ideal body weight, reducing salt intake, adopting a healthy diet, quitting smoking, limiting alcohol consumption, increasing physical activity, and practicing stress management.

The decision to start antihypertensive medication depends on blood pressure values as well as accompanying risk factors and comorbidities. In the general population, the threshold for initiating drug therapy is a clinical systolic blood pressure ≥140 mmHg or a diastolic pressure ≥90 mmHg; in individuals aged 80 years or older, the threshold for systolic pressure is ≥150 mmHg. In Stage 1 hypertension, drug therapy should be initiated immediately if diabetes mellitus, chronic kidney disease, coronary artery disease, cerebrovascular disease, or target organ damage is present. If these conditions are absent, lifestyle modifications are recommended first. If after one month blood pressure remains in Stage 1, medication should be started. However, if the patient experiences hypertension-related symptoms that affect daily life, medication may be started earlier. In Stage 2 hypertension and above, medication should be initiated immediately.

What should patients with hypertension pay attention to?
Since hypertension is a chronic condition, regular follow-up with a physician, lifelong adherence to lifestyle modifications, and daily use of prescribed medications without interruption are essential for controlling high blood pressure. With proper diet, exercise, and weight control, the need for medication may be reduced. However, medications should never be discontinued or altered without medical advice. The success of hypertension treatment largely depends on the patient: adherence to medication and lifestyle changes yields highly effective results.