Blood pressure

BP

What is your blood pressure?

Do you know what your blood pressure is?
A substantial majority of patients are unaware of their high blood pressure. This situation causes an increase in mortality and morbidity. High blood pressure is also more common in societies with high salt consumption. In the Salturk study conducted in Turkey, it was determined that a person takes an average of 18 g/day salt. However, the daily amount of salt to be taken should be at most 6 g.

How much is it dangerous?
According to JNC (joint national committee), over 140/90 mmHg is accepted as hypertension. According to the European Society of Hypertension (AHA), blood pressure classification has been taken in more detail. The hypertension limit for home measurements was 135/85 mmHg, and the limit was 125/80 mmHg in 24-hour blood pressure follow-up. Isolated systolic hypertension is defined as a systolic (systolic) blood pressure above 140 mmHg and a diastolic (lower) blood pressure below 90 mmHg. The definition of malignant hypertension defines a clinic with papilledema, pulmonary edema, and fainting.

What are the symptoms?
A significant portion of the patients do not have any symptoms. Sometimes the only symptom is a high measured blood pressure. The most important symptoms encountered in some patients are headache, palpitation, shortness of breath, weakness, nausea, vomiting, and dizziness. Long-term uncontrolled hypertension only manifests itself with target organ damage. These organs are the brain, heart, kidney, retina and blood vessels. Findings and diseases of these organs are seen as kidney failure, proteinuria, aneurysm (abnormal enlargement) of the vessels, occlusion, stroke encephalopathy, cardiovascular disease, heart attack and heart failure.

What are the causes?
The cause of hypertension is unknown in 90-95%, while 5-10% of them have secondary hypertension.

In which situations should secondary hypertension be considered?
Considering secondary hypertension if age, history, physical examination, laboratory findings suggest a secondary cause, if blood pressure responds poorly to medication, if well-controlled blood pressure suddenly starts to rise out of control, if there is target organ damage, if blood pressure is >180/110 mmHg must.

Evaluation of the hypertensive patient

In this case, 3 points should be considered:

1 – A secondary cause of hypertension should be investigated,
2 – Target organ damage and concomitant disease
3 – Other cardiovascular risk factors should be evaluated.

How should blood pressure be measured?
In blood pressure measurement;

• The person should be comfortable in a relaxed position
• He should not have had any caffeine or eaten half an hour before
• He should not have smoked
• Rest for 5 minutes
• All clothing should be removed from the arm
• 2 or more measurements should be taken at 2-minute intervals
• The dimensions of the device used should be appropriate

Treatment how should it be?
The main goal of treatment is to reduce mortality (death) and morbidity (disability) rates. The target should be below 140/80 mmHg; if kidney disease or diabetes is present then 130/80 mmHg should be targeted below. Hypertension is a serious but treatable disease. If left untreated, it may cause undesirable conditions in organs such as the heart, brain, kidney, and eyes. The treatment should last a lifetime. The drug should be used continuously, not only when symptoms appear. It should be noted that the treatment should not be discontinued when blood pressure drops or complaints disappear. If it is not followed, it should be explained that the medicines will be insufficient, and if the patient does not do his/her duties, the doctor-to-doctor visit will not provide him any benefit.

Non-pharmacological (non-pharmacological) treatment: Lifestyle change, restriction of salt intake, reaching ideal weight, increased physical activity, quitting smoking, preventing excessive alcohol consumption, regulating diet, 5-6 meals a day often but less Eating large amounts of food, consuming foods rich in potassium and calcium, and taking a diet low in saturated fat are the basic principles of treatment methods other than drugs.

The blood pressure reduction rates of non-pharmacological treatments are as follows:

Weight loss: 5- 20 mmHg (systolic)
Vegetable-fruit-based diet: 8-14 mmHg (systolic)
Salt restriction: 5-10 mmHg (systolic)
Physical activity: 4-8 mmHg (systolic)
Restriction of alcohol intake: 2- 4 mmHg (systolic)

Medication (pharmacological therapy) : The physician tries to treat hypertension with different groups of drugs suitable for the patient’s age and other diseases. Studies have shown that at least 2-3 drugs are needed. If the blood pressure cannot be reduced despite the use of medication, it is called resistant hypertension. In this case, using drugs at least reduces cardiovascular mortality and morbidity.