According to the studies of the Turkish Kidney Diseases and Hypertension Society in our country, the incidence of this disease in our country is 35%. The incidence in men over 60 years of age is between 60-80%. Studies investigating the prevalence in the world in general show that one out of every 3-5 people is hypertensive. On the other hand, according to the results of an American study (NHANES) conducted since the 1970s, only half of the patients are aware of their disease. Only half of those who are aware of this apply to a physician. When we look at the results of this study published every ten years for 30 years, we see that this fact has not changed. On the other hand, hypertension is one of the most important risk factors for cardiovascular diseases (coronary artery disease, heart failure) and cerebrovascular diseases (stroke, cerebral hemorrhage), which are the most serious causes of death. I would like to list the things we need to know about high blood pressure, namely hypertension:
What should blood pressure be normally? Systolic blood pressure, which is called systolic blood pressure in the society, should be 140mmHg at most, diastolic blood pressure should be 85mmHg at most. Values above these pressures are called hypertension. In the treatment of patients with hypertension, the goal of treatment is to normalize blood pressure. However, the target for diabetics and kidney patients is 130mmHg.
When should blood pressure be measured? Blood pressure shows daily changes within normal limits. During the day, the lowest is in the hours before waking up in the morning and increases towards the evening during the day and starts to decrease during sleep hours. If the person does not fall before this awakening, it means that the risk of hypertensive is higher for the patient. Therefore, in some patients, it is useful to monitor the 24-hour change in blood pressure with a device called Holter. If blood pressure is to be measured once a day, it is reasonable to measure it in the evening. In people with hypertension, the high blood pressure can be variable, labile, or high only when they go to the doctor, which we call “white coat hypertension”. Even if the blood pressure rises to high values once in a while, it is always meaningful.
What are the causes of hypertension? 90% of hypertension is not due to a cause, which we call “primary” or “essential” hypertension. In these patients, risk factors such as familial tendency, obesity, diabetes, high lipids, and smoking attract attention. It is most common in men after the age of 40 and in postmenopausal women. It is found at a level of 70% in advanced age. The remaining 10% of all hypertensive patients have “secondary or secondary” hypertension due to one cause.
What does secondary hypertension mean? 80% of the causes of secondary hypertension are kidney diseases, which are nephritis and kidney failure. About 10% is renal vascular stenosis. Some of the endocrine gland diseases, especially the adrenal gland, are among the secondary causes. In the first case of hypertension, these secondary conditions should be investigated first. Because the treatment of these conditions is completely different. For example, renal vascular stenosis can be treated by dilating it with a balloon, just as in coronary vessels. Although it should be investigated at a young age, that is, at the age when hypertension can be seen relatively less, it should be kept in mind that it may occur in older ages, and secondary causes should definitely be reviewed in the first patient. If there is resistance to treatment in a patient under hypertension treatment, a secondary condition should be investigated.
Why is high blood pressure important? Hypertension is a life-threatening disease. The most common causes of death or disability are cardiovascular diseases, cerebrovascular diseases (stroke, cerebral hemorrhage), vision loss, and the presence of hypertension behind some kidney diseases. Is it necessary to take medication in hypertension? First of all, this depends on the severity of hypertension and the presence or absence of target organ involvement such as heart, kidney and eye. If there is no mild hypertension and target organ involvement, non-drug measures such as diet and exercise may be sufficient for risk factors such as obesity, smoking, diabetes, high blood fats (cholesterol, triglyceride). At the beginning of the measures to be taken is salt restriction in the diet. If their application is not sufficient for 6 months, drug therapy will come into play, sometimes a single drug or sometimes more than one drug will need to be used together, and these non-drug measures will also be continued. No benefit can be expected from drug therapy, especially if a salt-free diet cannot be followed.
What should we know about drugs? Today, there are many drugs on the market with 4-5 group action mechanisms that have been proven to be effective in studies conducted with large patient groups. These drugs differ especially in their side-effect profile and prevention of target organ damage. At the same time, factors such as the patient’s age, co-existing diseases, diabetes, heart disease and kidney disease are taken into account when using the drug in a hypertension patient. For example, if a patient with diabetes has proteinuria in the urine, a certain group of drugs is preferred. The effectiveness of certain drug groups in an elderly patient and the success of preventing complications have been demonstrated by studies. Therefore, your doctor will make the choice of medication by taking into account other medical conditions you have, target organ involvement, and even your social characteristics. We should also point out that there cannot be a drug without side effects. When using a drug, do not worry about side effects, or even read the leaflet. If there is a situation that you think is drug-related, do not stop the drug on your own, but share the situation with your doctor and discontinue it when necessary. Hypertension drugs are drugs to be used for life, there is no decrease in effectiveness in long-term use, but the character of high blood pressure may change or other diseases may be added, then it may be necessary to change the drug. But I must state that the treatment of hypertension is successful and today there is no patient with uncontrolled hypertension. Usually, the first thing that comes to mind when blood pressure control is good, when it gets out of control, is either the patient has stopped taking the drug or has broken the salt diet.
Who should treat a hypertension patient? Considering that hypertension is a very common disease, it is predicted that this disease should be followed by primary care physicians, that is, general practitioners all over the world. Guidelines issued by health organizations around the world for medical education and treatment are based on this foresight. However, it is appropriate to evaluate and treat patients with early-onset or treatment-resistant hypertension by an internal medicine specialist or a cardiologist, where a nephrologist is not available, in order to investigate the causes of secondary hypertension and/or to treat them in cases where hypertension-related target organ problems occur.
