Clinical Case
A 52-year-old woman. Over the past few months, she began experiencing frequent headaches, fatigue when performing simple activities, and occasional episodes of dizziness. During a routine consultation, her blood pressure was measured and was 158 x 96 mmHg.
After further measurements on different days, the diagnosis was confirmed: Systemic Arterial Hypertension.
Her reaction was the same as millions of people:
"But I feel fine. How can I have a disease?"
This is one of the most dangerous characteristics of hypertension.
What is Arterial Hypertension?
Arterial hypertension is a disease in which the pressure exerted by blood against the walls of the arteries remains elevated for long periods.
Arteries function like roads through which blood circulates to carry oxygen and nutrients to all organs.
When pressure remains constantly high, these roads begin to suffer wear and tear. The problem is that this wear happens slowly and, often, without symptoms.
This is why hypertension is known as the "silent enemy".
What is blood pressure?
Every time the heart beats, it pumps blood throughout the body. This force generates blood pressure.
When we say "120 by 80", we are talking about:
- 120 mmHg of systolic pressure (when the heart contracts)
- 80 mmHg of diastolic pressure (when the heart relaxes)
Blood Pressure Classification
According to current guidelines:
- Less than 120 x 80 = Normal
- Between 120 and 129 with diastolic less than 80 = Elevated pressure
- Between 130–139 or 80–89 = Hypertension stage 1
- Above 140 or 90 = Hypertension stage 2
What happens inside my body?
Imagine your heart is a water pump. Imagine also that your arteries are pipes. Now imagine that these pipes start to become narrower and stiffer.
To continue sending water throughout the house, the pump needs to work harder. This is exactly what happens.
Factors that increase pressure
Various factors cause the body to increase pressure:
- Excess weight
- Excess salt
- Sedentary lifestyle
- Chronic stress
- Genetic predisposition
- Hormonal changes
- Kidney disease
Physiological process
When this happens:
- Blood vessels become more constricted
- The kidneys begin to retain more sodium and water
- Blood volume increases
- The heart needs to work harder to pump this blood
The result is persistent elevation of blood pressure.
What happens to the arteries?
Arteries are made to withstand a certain amount of pressure. When pressure remains elevated for years, small lesions begin to appear in their walls.
The body tries to repair these lesions. However, along with this process, cholesterol and fat can accumulate in these places. This phenomenon is called atherosclerosis.
Over time, the arteries become:
- Thicker
- Harder
- Less elastic
- Narrower
This makes blood circulation more difficult.
What happens to the heart?
The heart is a muscle. Like any muscle subjected to constant strain, it increases in size.
At first it seems like a positive adaptation. But over the years, the heart begins to lose efficiency. It becomes stiffer and less able to pump blood adequately.
This can lead to:
- Cardiac hypertrophy
- Heart failure
- Arrhythmias
- Atrial fibrillation
- Myocardial infarction
What happens to the brain?
The brain depends on an extremely delicate blood circulation. Elevated pressure can:
- Clog cerebral blood vessels
- Rupture cerebral blood vessels
- Reduce oxygenation of brain tissue
The consequences may include:
- Ischaemic stroke
- Haemorrhagic stroke
- Memory loss
- Difficulty reasoning
- Vascular dementia
What happens to the kidneys?
The kidneys function as filters. They have millions of small blood vessels.
High pressure constantly damages these vessels. Over time, the kidneys begin to lose their ability to filter blood adequately.
This can result in:
- Chronic kidney disease
- Renal insufficiency
- Need for dialysis in advanced cases
Moreover, when the kidneys become diseased, they can raise blood pressure even further, creating a dangerous cycle.
What happens to the eyes?
The retina has very fine blood vessels. These vessels can be damaged by elevated pressure.
This can cause:
- Blurred vision
- Small bleeds
- Retinal changes
- Progressive vision loss
Who is at greater risk of developing hypertension?
The main risk factors are:
- Family history
- Advanced age
- Overweight and obesity
- Sedentary lifestyle
- Diet high in salt
- Smoking
- Excessive alcohol consumption
- Sleep apnoea
- Diabetes
- High cholesterol
The more risk factors a person has, the greater the chance of developing hypertension.
What diseases can cause hypertension?
Although most cases do not have a single identifiable cause, some diseases can cause increased pressure:
- Chronic kidney disease
- Obstructive sleep apnoea
- Thyroid disease
- Hyperaldosteronism
- Cushing's syndrome
- Phaeochromocytoma
- Some vascular diseases
How is diagnosis made?
The diagnosis should not be made from a single isolated measurement. The doctor may use:
- Repeated measurements at consultation
- Residential Blood Pressure Monitoring (RBPM)
- Ambulatory Blood Pressure Monitoring (ABPM)
The objective is to confirm that the pressure actually remains elevated over time.
How to prevent hypertension?
The most effective measures are:
- Maintain a healthy weight
- Exercise regularly
- Reduce salt consumption
- Avoid ultraprocessed foods
- Consume fruits, vegetables and legumes
- Sleep adequately
- Do not smoke
- Limit alcohol consumption
- Control diabetes and cholesterol
What is the goal of treatment?
Treatment does not exist merely to "lower a number". The true objective is to protect:
- Heart
- Brain
- Kidneys
- Eyes
- Blood vessels
For most people, the current target is to keep blood pressure below 130 x 80 mmHg, significantly reducing the risk of stroke, myocardial infarction, heart failure and kidney disease.
Conclusion
Hypertension is a silent, progressive and potentially serious disease. It affects not just blood pressure. It affects the entire circulatory system and can compromise organs that are fundamental to life.
The good news is that, when identified early and treated correctly, it is possible to control the disease, protect organs and maintain quality of life for many years.
Understanding what happens inside your own body is the first step to better care for your own health.
This content is informative and does not replace a medical consultation.
Dr. Rebeca Soares Andrade CRM-GO 39335