Clinical Case
A 52-year-old woman. Over the past few months, she began experiencing frequent headaches, fatigue performing simple activities, and occasional episodes of dizziness. During a routine consultation, her blood pressure was measured and was 158 x 96 mmHg.
After new 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 arteries remains elevated for long periods.
Arteries function like roads through which blood circulates to carry oxygen and nutrients to all organs.
When pressure stays constantly high, these roads begin to suffer wear. The problem is that this wear happens slowly and, often, without symptoms.
That's why hypertension is known as the "silent enemy".
What is blood pressure?
Every time the heart beats, it pushes 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. Also imagine your arteries are pipes. Now imagine those pipes begin to become narrower and more rigid.
To continue sending water throughout the house, the pump needs to work harder. That is exactly what happens.
Factors that increase pressure
Several 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 were 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 areas. This phenomenon is called atherosclerosis.
Over time, 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 effort, it increases in size.
At first it seems like a positive adaptation. But over the years, the heart begins to lose efficiency. It becomes more rigid and less able to pump blood adequately.
This can lead to:
- Cardiac hypertrophy
- Heart failure
- Arrhythmias
- Atrial fibrillation
- Heart attack
What happens to the brain?
The brain depends on extremely delicate blood circulation. Elevated pressure can:
- Clog cerebral blood vessels
- Rupture cerebral blood vessels
- Reduce oxygenation of brain tissue
The consequences may include:
- Ischemic stroke
- Hemorrhagic stroke
- Memory loss
- Difficulty with reasoning
- Vascular dementia
What happens to the kidneys?
The kidneys function as filters. They have millions of small blood vessels.
High pressure continuously damages these vessels. Over time, the kidneys begin to lose their ability to filter blood adequately.
This can result in:
- Chronic kidney disease
- Kidney failure
- Need for dialysis in advanced cases
Additionally, when the kidneys become diseased, they can further elevate blood pressure, 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 has a greater risk of developing hypertension?
The main risk factors are:
- Family history
- Advanced age
- Overweight and obesity
- Sedentary lifestyle
- High-salt diet
- Smoking
- Excessive alcohol consumption
- Sleep apnea
- Diabetes
- Elevated cholesterol
The more factors a person has, the greater the chance of developing hypertension.
What diseases can cause hypertension?
Although most cases don't have a single identifiable cause, some diseases can cause elevated pressure:
- Chronic kidney disease
- Obstructive sleep apnea
- Thyroid disease
- Hyperaldosteronism
- Cushing's syndrome
- Pheochromocytoma
- Some vascular diseases
How is the diagnosis made?
The diagnosis should not be made by a single isolated measurement. The physician may use:
- Repeated measurements at the consultation
- Residential Blood Pressure Monitoring (RBPM)
- Ambulatory Blood Pressure Monitoring (ABPM)
The goal is to confirm that pressure really remains elevated over time.
How can hypertension be prevented?
The most effective measures are:
- Maintain healthy weight
- Exercise regularly
- Reduce salt consumption
- Avoid ultra-processed foods
- Consume fruits, vegetables, and legumes
- Sleep adequately
- Don't smoke
- Limit alcohol consumption
- Control diabetes and cholesterol
What is the goal of treatment?
Treatment doesn't exist just to "lower a number." The true goal is to protect:
- Heart
- Brain
- Kidneys
- Eyes
- Blood vessels
For most people, the current target is to maintain blood pressure below 130 x 80 mmHg, significantly reducing the risk of stroke, heart attack, heart failure, and kidney disease.
Conclusion
Hypertension is a silent, progressive, and potentially serious disease. It affects not only blood pressure. It affects the entire circulatory system and can compromise organs fundamental to life.
The good news is that, when identified early and treated correctly, it is possible to control the disease, preserve organs, and maintain quality of life for many years.
Knowing what happens inside your own body is the first step to better caring for your own health.
This content is informational and does not replace a medical consultation.
Dr. Rebeca Soares Andrade CRM-GO 39335