Türkçe
Français
Deutsch
Italiano
Español
Hypertension is the condition in which the pressure exerted by the blood pumped by the heart on the arterial walls remains chronically and continuously high. Symptoms of high blood pressure usually include a throbbing headache spreading from the nape of the neck, sudden nosebleeds, severe ringing in the ears, dizziness, loss of balance, blurred vision, and shortness of breath felt during exertion. This high pressure, which continuously strains the circulatory system, is a dangerous physiological process that, when not brought under control, completely disrupts vascular elasticity and tires all organs at the cellular level. Because of the damage it creates in the body’s systemic circulation network, correctly reading the physiological signals given by the body is of vital importance.
What Does the Concept of Hypertension (High Blood Pressure) Mean Medically?
Blood pressure emerges as a result of the complex relationship between two basic elements. The first is the force and amount with which the heart pumps blood, and the second is the resistance shown by the vessels against this blood flow. Advancing age, unhealthy nutrition, stress, or genetic factors may cause structural deterioration in the vessel walls. When the vessels lose their elasticity and become stiff, they show greater resistance against the blood sent by the heart. As this resistance increases, the pressure inside also rises.
The continuous elevation of pressure begins to damage the smooth structure lining the inner surface of the vessels. Cracks and microscopic tears occur. While the body tries to repair these tears, substances such as cholesterol and calcium accumulate in these areas, further accelerating the condition we call vascular stiffness. In other words, hypertension is not only an elevated numerical value but a dynamic and dangerous process that wears down the entire vascular system.
What Is the Hypertension Limit in Blood Pressure Values?
When blood pressure is measured, two different numbers always appear. Systolic blood pressure is the highest pressure formed at the moment when the heart contracts and ejects blood into the vessels. Diastolic blood pressure is the basic pressure remaining in the vessels when the heart relaxes and rests between two beats.
In an adult, measurements performed under standard and correct conditions showing systolic blood pressure at 140 mmHg and above and diastolic blood pressure at 90 mmHg and above are sufficient for the diagnosis of the disease. However, modern medicine believes that the disease should be stopped before it reaches these levels. Therefore, systolic blood pressure ranging between 120 and 139 and diastolic blood pressure ranging between 70 and 89 are considered “elevated blood pressure.” Although these values do not yet mean a definite disease, they are an extremely valuable early warning sign showing that alarm bells have started ringing and that permanent hypertension may develop in the near future.
Which Measurement Methods Are Used in the Diagnosis of High Blood Pressure?
The fact that blood pressure does not always remain at the same level may make the diagnostic process difficult. Stress, fatigue, joy, or sadness brought by daily life causes momentary fluctuations in blood pressure. Even simply being in a healthcare institution or seeing a doctor or nurse may create tension in the body and make blood pressure rise sharply. This condition is called white coat hypertension. On the other hand, blood pressure values that are completely normal in the hospital may reach dangerous levels in the person’s stressful home or workplace environment. This is called masked hypertension.
To prevent these misconceptions, devices called 24-hour blood pressure Holters are quite valuable. This device, worn on the arm for one day, creates a blood pressure map of the patient during all activities, including sleep. Whether blood pressure drops during nighttime sleep and whether there are sudden rises in the morning can only be understood definitively with this method. Regular and properly performed measurements at home are also indispensable for monitoring the course of treatment.
Why Is Hypertension a Disease That Remains Silent for Years?
In the medical world, hypertension is often described as the “silent killer,” and this is an extremely accurate definition. Even if blood pressure reaches levels considered dangerous for the vessels, the human body has an extraordinary ability to adapt. The vessels and organs try to resist and adapt to this increased pressure for a certain period of time. The body almost begins to accept this new and high pressure as its “normal.”
This adaptation process causes the disease to progress completely secretly for years without causing any symptoms. The person may feel extremely healthy and energetic. However, in the background of this silent period, high pressure tires the heart muscle, wears down the brain vessels, damages the filtering units of the kidneys, and destroys the fine vessels at the back of the eye. The disease is usually first noticed through very loud and serious complications such as stroke, heart attack, or kidney failure that appear as a result of this wear lasting for years. The importance of regular check-ups also comes from this silent progression.
What Signals Does Our Body Give as Symptoms of High Blood Pressure?
Although the disease often causes no symptoms, when the organs can no longer resist the increased pressure or when the pressure suddenly rises to very high values, the body sends some warnings.
The main symptoms to pay attention to are as follows:
- Headache
- Nosebleed
- Dizziness
- Feeling lightheaded
Throbbing headaches that begin from the nape of the neck when waking up in the morning and spread toward the back of the head, and sometimes toward the temples, are especially typical. The main reason for this pain is that the vessels inside the skull expand under high pressure and press on the sensitive nerve networks around them.
Nosebleeds occur when the very fine vascular network located close to the surface inside the nose suddenly ruptures because it cannot withstand the increased intravascular pressure. Unexplained nosebleeds that start spontaneously should always be taken seriously. Deterioration in the quality of blood flow to the brain and pressure fluctuations may cause momentary dizziness, loss of balance, and a feeling of not being able to stand firmly.
What Are the Symptoms of High Blood Pressure Seen in the Eyes and Ears?
Our eyes are the only organ through which we can see the vascular network in our body from the outside in the most transparent and living way. The retina layer located at the back of the eye consists of millions of nerve cells that provide vision and the capillaries that nourish them. Hypertension directly disrupts the structure of these capillaries. Leaks, small hemorrhages, or edema may occur in the vessels. This condition causes the patient to have blurred vision, double vision, or feel black floating spots in front of the eye.
Ringing or buzzing in the ears is a much more mechanical problem. Blood passing with high pressure and speed through the large arteries that run on both sides of our neck and enter the skull turns from a straight flow into a swirling, turbulent flow. The whistling and buzzing sound produced when pressurized water passes through a narrow pipe is reflected directly from these vessels, which are very close to the inner ear, to the hearing center. Buzzing sounds that are especially synchronized with the heartbeat and beat like a pulse may be a sign of blood pressure.
How Are the Heart and Lungs Affected in High Blood Pressure?
The organ most strained by hypertension in the body is undoubtedly the heart. The heart is a muscle and must pump blood into the resistant, high-pressure vascular system in front of it. Just as the arm muscles of a person lifting weights grow over time, the heart muscle also begins to thicken because of this continuous and excessive effort. A significant enlargement occurs in the walls of the chamber on the left side of the heart.
However, this type of enlargement of the heart is not a healthy condition. The thickened muscle tissue loses its elasticity over time and becomes rigid. A heart that cannot relax cannot receive a sufficient amount of blood into itself. This reduces the pumping efficiency of the heart. The patient feels this as suddenly becoming short of breath while climbing stairs or making mild effort, feeling pressure in the chest, or the heart beating irregularly and very fast (palpitations). These respiratory and rhythm problems are the clearest evidence that the heart is now being strained.
What Are the Differences Between Essential and Secondary Hypertension?
The vast majority of patients with high blood pressure are in the primary (essential) hypertension group, in which the cause cannot be linked to a single organ or disease. In this group, the disease is the combined result of genetic inheritance, years of improper nutrition, excessive salt consumption, inactivity, stress, and aging. Its solution is lifelong lifestyle change and regular medication use.
However, a small but very critical portion of all hypertension patients is called secondary hypertension. In this group, there is a concrete underlying anatomical or hormonal problem that causes blood pressure to rise. Causes such as blockages in the kidney vessels due to calcification, overactivity of the adrenal glands and hormone secretion, or congenital vascular narrowing cause blood pressure to rise sharply. The most important feature of this patient group is that this concrete underlying problem can be corrected with interventional methods or surgery and that the patient has a chance to completely get rid of the high blood pressure problem.
What Is the Effect of the Kidneys on High Blood Pressure?
The kidneys are almost one of the body’s blood pressure adjustment centers. The area around the kidneys is woven with an extremely dense sympathetic nerve network that is in constant communication with the brain. This nervous system is the system that manages the body’s “fight or flight” response in times of danger. If this nerve network becomes excessively active and gets out of control for any reason, wrong signals continuously begin to go to the kidneys. The kidney gives a danger alarm, thinking that the body’s blood pressure has dropped.
As a result of this false alarm, the kidneys produce very powerful hormones that rapidly constrict blood vessels and prevent salt and water from being excreted from the body, causing them to accumulate inside. The vessels narrow, blood volume increases, and as a result blood pressure rises to dangerous levels. Moreover, this situation turns into a vicious cycle. When there is a physical narrowing in the kidney vessel, the kidney again activates the same defense mechanism because it cannot receive enough blood. The root cause of many blood pressure problems that resist medication therapy is this faulty communication between the kidneys and the brain or mechanical narrowing in the kidney vessel.
Which Imaging Tests Are Used in the Diagnosis of High Blood Pressure?
To find the underlying causes of blood pressure and detect the damage it has created in the organs, simply measuring from the arm is not enough. The patient’s vascular map must be examined in detail.
The main methods used are as follows:
- Doppler ultrasonography
- Computed tomography
- Magnetic resonance imaging
- Renal angiography
Doppler ultrasonography is a completely painless and radiation-free first-step test that measures the speed and direction of blood flow in the kidney vessels with the help of sound waves. Computed tomography and magnetic resonance create a high-resolution, three-dimensional map of all main vessels in the body by administering special medications. Calcifications or structural narrowings in the vessels are detected millimetrically. Renal angiography is the clearest method by which the definitive diagnosis is made. Just as in cardiac angiography, the inside of the kidney vessels is directly visualized by entering through the groin or arm with a very thin tube, and the source of the problem is clearly seen.
What Does Resistant Hypertension Mean When Medications Do Not Work?
Blood pressure treatment is a process that requires patience and progresses step by step. Patients usually use medications that work through different mechanisms, such as diuretics, vasodilators, or heart rate–slowing drugs, together. However, if a patient cannot still lower their blood pressure values below the target limits despite using three or more different blood pressure medications, one of which must be a diuretic, at the highest and appropriate doses recommended by the doctor, this condition is called “resistant hypertension.”
Resistant hypertension is an extremely critical condition in which the risk of stroke, heart attack, and sudden kidney failure is highest. This condition is no longer merely a metabolic problem that can be overcome with medications. The body’s physiological adjustment systems have become locked. At exactly this point, instead of condemning the patient to taking handfuls of pills, modern interventional methods that directly intervene in the source of the problem, namely the vessels and nervous system, come into play.
How Is the Renal Denervation Procedure Performed in the Treatment of Resistant Hypertension?
Renal denervation is a procedure developed for the treatment of stubborn hypertension resistant to medications, with a very simple logic but a very large effect. The basic goal is to calm the overactive sympathetic nerve network between the kidney and the brain that sends faulty signals, as mentioned above.
This procedure is performed in specially equipped angiography laboratories instead of an operating room, and the patient does not need to be put to sleep. Completely under local anesthesia, the body is entered usually through the artery in the groin area with a very flexible, very thin catheter. The catheter is carefully advanced into the kidney vessels. At the tip of the catheter, there are tiny electrodes containing special technology.
Through these electrodes, very controlled and mild radiofrequency heat energy is delivered from the inner surface of the vessel toward the outside. This mild heat silences those hyperactive nerve fibers that pass just outside the vessel wall and drive blood pressure upward. This procedure, applied to both kidney vessels, takes less than an average of one hour. With the calming of the nerves, the kidney’s secretion of blood pressure–raising hormones is cut off sharply. After the procedure, very significant and permanent decreases in blood pressure values are achieved in patients; many patients have the chance to reduce the number or dose of the medications they use by half.
What Is the Stent Procedure for Hypertension Originating from the Kidney Vessel?
If the cause of high blood pressure is not neural overactivity but a mechanical narrowing in the main vessel going to the kidney due to calcification or structural disorder, then the treatment must also be completely mechanical. You cannot open a narrowed and blocked pipe by pouring medication into it; you need to physically widen it.
Balloon and stent procedures applied in kidney vessel narrowings (renal artery stenosis) are very similar to the procedure performed to open the heart vessels during a heart attack. Again, by entering through the groin, the narrowed area in the kidney vessel is reached. First, a deflated balloon is inflated with high pressure exactly in the middle of the narrowing to open the vessel pathway. Then, to prevent this opened pathway from narrowing and closing again, a metal cage, that is, a “stent,” suitable for the diameter of the vessel is placed in that area. The moment the vessel opens and blood flow to the kidney returns to normal, the kidney relaxes, just like dry soil meeting water. It immediately stops secreting danger hormones, and blood pressure begins to normalize rapidly. The procedure is extremely safe, and the patient can return to normal life the next day.
How Does Pacemaker-Like Baroreflex Activation Therapy Work for Hypertension?
Another miraculous system our body uses to keep blood pressure under control is the pressure-sensing sensors located in the main arteries in our neck (carotid artery). When blood pressure rises, these sensors stretch and send the command to the brain: “the pressure has increased too much, relax the vessels, slow the heart.” However, in stubborn hypertension lasting for years, these sensors become insensitive and dulled.
Baroreflex Activation Therapy is a wonderful technological solution to reactivate this dulled system. Just like a pacemaker, a small device is placed under the skin beneath the collarbone. A thin cable coming out of this device is connected to the area in the neck where those sensors are located. The device continuously sends mild electrical signals to these sensors, transmitting the message “blood pressure is too high” to the brain. Believing this artificial stimulus, the brain immediately activates the body’s own blood pressure–lowering mechanisms. The vessels relax, and the heart rhythm calms down. Especially in stubborn blood pressure patients who also have heart failure, this method both incredibly reduces the burden on the heart and pulls blood pressure into safe limits.
What Should Be Done in Sudden Hypertensive Crises?
Sometimes blood pressure rises not insidiously but suddenly and explosively. Conditions in which blood pressure suddenly rises to 180 for systolic blood pressure and 120 or above for diastolic blood pressure, accompanied by unbearable chest pain, shortness of breath, speech disorder, or a feeling of paralysis on one side of the body, are called hypertensive emergencies.
This condition is a life-threatening situation in which even seconds matter. High pressure is almost tearing the organs apart at that moment. In such a situation, the patient must be taken immediately to a fully equipped emergency department. Trying to manage the situation at home with sublingual medications is nothing but a waste of time. In the hospital, blood pressure must be lowered in a controlled manner with powerful medications given through the vein, without disrupting blood flow to the organs. If catastrophic consequences such as a clot traveling to the brain or a tear in the main aortic vessel have occurred during this crisis, interventional methods such as emergency stenting and clot removal procedures performed immediately are the most important steps that will save the patient’s life and quality of life.
Prof. Dr. Kadriye Orta Kılıçkesmez is one of the leading figures in the field of Turkish cardiology. She was born on January 24, 1974, in Tekirdağ. After completing her undergraduate education at Istanbul University Cerrahpaşa Faculty of Medicine, she chose cardiology as her specialty and received her specialist training at the Cardiology Institute of the same university. In 2015, she was appointed by the university to establish the Şişli Etfal cardiology clinic and Angio laboratory. Becoming a professor in 2017, Kadriye Kılıçkesmez established the cardiology clinic and Angio laboratory of Prof. Dr. Cemil Taşçı Hospital in 2020 and ensured that the clinic became a training clinic.
