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HYPERTENSION (HIGH BLOOD PRESSURE)


High blood pressure can be briefly defined as "blood pressure". Blood in veins creates a pressure during circulation. This pressure may exhibit small alterations with a day depending on food taken, work performed and force expended.

Blood pressure is expressed in two measurements:
 • Systolic pressure (systolic pressure)
 • Diastolic pressure (diastolic pressure)

Hypertension (high blood pressure) is a condition where blood pressure is high for a certain time within a day. Blood pressure is expressed as "millimeters of mercury (mmHg)". That systolic blood pressure is 120 mmHg and diastolic blood pressure is 80 mmHg is the most appropriate values.

Hypertension and problems trigged by hypertension concern more than approximately one billion people all over the world. Independent risk factor for Blood Pressure-Cardiovascular diseases (CVD) When Blood Pressure increases, possibility of myocardial infarction, heart failure, stroke and kidney failure increases. 

Hypertension is a very common problem in our country. 1 out of every 3 adults has hypertension. Hypertension is more frequent in women than men. A significant portion of hypertensive patients (53%) in Turkey is in middle age group accepted as economically the most productive age group. Considering that population structure in our country is more young population, prevalence of hypertension seen under the age of 30 (12%) is not to be neglected. Incidence of hypertension over the age of 60 rises up to 60-80 %. Although incidence of hypertension in our country is high, only 40 % of patients are aware of this case. 

Even if it has symptoms such as headache, dizziness, feeling of whistling or pressure sense and nose bleeding, it mostly does not cause an important complaint. Everyone over 40 years of age as well as the people with family history (Genetics), obesity, diabetics, COPD, sleep apnoea sufferers and people consuming excessive salt under the risk. Regular blood pressure should be checked in these individuals and should be taken under control without irrevocable damage.

Systolic and diastolic blood pressure measurements at various stages of hypertension in adults

Blood pressure  Systolic (mmHg) Diastolic (mmHg)
Optimal
Normal    
High Normal
Hypertension Stage 1
Stage 2    
Stage 3
<120
<130
130-139
140-159
160-179
>180
<80
<85
85-89
90-99
100-109
>110

 

Classification of hypertension based on its causes
1- Primary (Essential) Hypertension

It is a form of hypertension that is not connected with a specific reason.  Increasing risk factors are excessive alcohol intake, smoking, sedentary life, polycythemia, nonsteroidal anti-inflammatory and low potassium intake. 

 • Genetic predisposition
 • Excessive salt consumption
 • Obesity
 • Over working of sympathetic nervous system
 • Role of the renin-angiotensin system
 • Renal disorder in salt discharge
 • Intracellular sodium and calcium increase
 • Low birth weight
 • Rash, impatient, stressful personality

2. Secondary Hypertension

This is a form of hypertension connected with a specific disease or cause. 

Renal causes
 • Chronic pyelonephritis
 • Acute and chronic glomerulonephritis
 • Polycystic kidney disease
 • Renal artery stenosis
 • Arteriolar nephrosclerosis
 • Diabetic nephropathy
 • Renin secreting tumors

Endocrine causes
 • Oral contraceptives
 • Adrenocortical hyperfunction
 • Cushing's syndrome
 • Primary hyperaldosteronism
 • Congenital adrenal hyperplasia (17 -hydroxylase and 11 ß- hydroxylase deficiency)
 • Pheochromocytoma
 • Myxoedema
 • Acromegaly
 • Hypothyroidism, hyperthyroidism
 • Hyperparathyroidism

  Sleep-apnea syndrome
 • Neurological causes
 • Aortic coarctation

Cardiovascular (CV ) Risk 
It is usually encountered with metabolic disease risk factors and subclicnic (silent) organ damages in hypertension patients. Patients should be classified by evaluating total CV risk arising out of accompanying various risk factors, organ damages and diseases rather than hypertension degree.

Total risk defines an absolute risk pertaining a CV incident likely to be attained within generally 10 years. Since this case is dependent on age so closely, absolute total CV risk is even lower in high Blood Pressure and additional risk factors. Insufficiency in treatment may create irrevocable high risk in the following years. While starting treatment in young people, people are better oriented by considering risk increase in the person according to average risk in a society.

Life style changes reducing blood pressure and CV Risk factors

 • Quitting smoking
 • Losing weight and maintaining weight
 • Reducing excessive alcohol consumption
 • Physical exercise
 • Restricting salt intake
 • Increasing fruit and vegetable consumption, reducing saturated fat and total oil consumption.