Diabetes is one of the common diseases in the community like hypertension. Risk of hypertension is more in patients with diabetes. There are many common points between diabetes and hypertension:

Both of them are present together in most patients.

Both are common today due to lifestyle.

Both cause arteriosclerosis by affecting blood vessels.

They increase the damaging effect of each other to the vessels / organs.

Both are parts of metabolic syndrome.

Obesity facilitates the formation both.

To inform the patients about the disease accurately is also very important in both.

The treatment of hypertension in patients with diabetes and medications to be chosen should carry some features. Most of the patients require two or more medications.

The role of the kidneys in the development of hypertension is very important. The possibility of an underlying kidney disease in a patient with hypertension is approximately 5%. Therefore, all hypertensive patients should be examined in terms of kidney diseases. Detection of kidney disease in a patient with hypertension enables early diagnosis and also the treatment of kidney disease. In some cases, hypertension can lead to kidney disease; it can be hard to distinguish whether hypertension is first or kidney disease.

Excessive salt consumption leads to hypertension. Our country is one of the countries that consume the most salt in the world. According to SALTURK study carried out in 2008 by Turkish Society of Hypertension and Renal Diseases we are consuming about 18 grams of salt per day (19 grams in men, 17 grams in women). 18 grams of salt per day is 3 times more than the amount of salt allowed for patients with kidney disease and high blood pressure even for healthy individuals.

Anyone, patient or not, who wants maintain a healthy life should limit their daily salt intake with 5-6 grams. A life without salt cannot be thought, however even 5-6 grams of salt per day may be too much, when daily salt intake of people lived 5000 years ago was 100 mg in other words one in 180 of 18 grams is considered.

According to SALTURK2 study carried out in 2012 by Turkish Society of Hypertension and Renal Diseases salt added during cooking and salt in bread are our most important sources of salt.

Hypertension is a major problem that threatens both mother’s and also the baby’s health. Blood pressure to be higher than 140/90 mmHg in pregnancy is considered as hypertension. If the patient’s blood pressure values are known before pregnancy the increase of sistolic pressure of 30 mm Hg or diastolic pressure of 15 mmHg can be considered as hypertension.

Hypertension in pregnancy can occur in four ways:

1. A woman with hypertension can get pregnant.

2. Preeclampsia (toxemia) induced hypertension may occur.

3. Additional preeclampsia is present in a patient with hypertension before pregnancy.

4. Pregnancy induced hypertension may occur.

Treatment of hypertension in pregnancy has some features. To terminate pregnancy early may be needed. Care is taken not to damage the baby in drug selection. Hypertension of most patients is recovered after the delivery, but these patients may be suffering from hypertension in the future. Therefore, women that have encountered problems with hypertension in their pregnancy should not neglect to get their blood pressure measured at regular intervals.

The frequency of hypertension in young people is steadily increasing due to sedentary life, obesity and salty diet. It is more likely to have another disease causing hypertension in young people, especially in patients who are known to have normal blood pressure earlier. Therefore, it may be misleading to connect hypertension in young people with detected high blood pressure to psychological factors such as exam stress. Another disease that may lead to hypertension (kidney disease, hormonal disorders …) should always be investigated.

Young patients can see great benefit from treatment with early diagnosis. Therefore, there are benefits in having blood pressure measured in 1-2 years for also young people whether they have a complaint or not.

Today, hypertension is a disease that can be treated. High blood pressure is taken under control in most patients with correct and regular use of medications. Blood pressure cannot be controlled in some patients despite treatment. If the patient uses her/his medication correctly and blood pressure is not under control, the reason of this should be investigated.

Hypertension is due to another disease in 5-10% of the patients. It is possible to divide these diseases into 3 groups.

1. Kidney diseases

2. Hormonal diseases

3. Other diseases

The majority of diseases that lead to hypertension are with kidney origin. While hormonal diseases constitute another significant group.

The cause of hypertension in young, newly diagnosed patients with very high blood pressure or those with blood pressure that cannot be taken under control with treatment should be investigated. If a disease that causes hypertension is present and the cause cannot be found, the treatment fails. The chance of treating hypertension in a permanent way is also lost. High blood pressure may be permanent due to the damage in the vessels caused by hypertension, even the disease that lead to hypertension is diagnosed after many years.

Renal artery stenosis is one of the reasons of hypertension that can be treated. Renal artery stenosis is very important from 3 aspects:

1. It is possible to treat high blood pressure permanently with the removal of the stenosis, so the patient can get rid of taking medication lifelong.

2. It is very difficult to take blood pressure under control, if stenosis cannot be detected.

3. If the stenosis is not treated, it will cause that kidney not to function by leading to complete blockage after a while; if complete stenosis occurs in two renal veins kidney failure develops in the patient.

If treatment-resistant hypertension, difference in the size of the kidneys or incipient kidney failure with uncertain cause is present the occurrence risk of hypertension due to renal artery stenosis is high. Different radiological imaging methods are used for diagnosis.

Multiple factors rather than a single factor are held responsible in the formation of primary hypertension (hypertension not linked to a disease with known causes). Two of the most important of these factors are hereditary (genetic) factors and excessive salt intake.

Today’s lifestyle (salty, less moving, prone to gain weight…) has the effect of facilitating the formation of primary hypertension. Healthy lifestyle can prevent the formation of hypertension or delay the onset of hypertension for many years even though hereditary factors are present in the person.

One of the problems that patients diagnosed with hypertension encounter is often having normal blood pressure and increase occasionally. Occasional increases are more encountered in the early stages of hypertension. To begin using medication after a single or a small number of measurements sometimes causes unnecessary use of medication. The only way to prevent unnecessary use of medication is multiple measurements and follow-up of blood pressure at home.

Therefore, it is not right to give a decision by looking at the small number of measurements in the diagnosis of hypertension or arranging the treatment. The most practical way to understand the general trend is to measure the blood pressure at home. Differences of 10-20 mmHg within the day should be considered normal. The importance of informing the patients on this subject accurately is great.

The patients with new onset hypertension are the luckiest patients, because many of the problems that may occur due to hypertension can be prevented with the correct treatment. The blood pressure of many patients with previously normal blood pressure increases in later times. Patients learn that they have high blood pressure at the physician’s office where they admit with a complaint or by chance. This is a frequently encountered condition as blood pressure increases with age. The take blood pressure under control is easy with the changes of lifestyle such as reducing salt intake, regular exercise, weight loss, limiting alcohol consumption and quitting smoking namely a healthy lifestyle, as well as reduces the need for medication. Accurate assessment and direction of patients with new onset hypertension have great importance.

Hypertension-induced damages may have arisen in the body in the patients with newly detected hypertension. Physical examination and laboratory tests give an idea about this matter. If hypertension can not be understood to be new or old patients with newly detected hypertension should be considered as patients with new onset hypertension. Accurate assessment and direction of patients with newly detected or new onset hypertension have great importance.

Target blood pressure cannot be achieved despite three medications (one with the requirement to be a diuretic) in approximately 10-15% of the patients, that’s to say blood pressure cannot be decreased below 140/90 mmHg. These patients are called resistant hypertension. Diseases that can lead to hypertension should be investigated in order to put resistant hypertension diagnosis and the patient’s compliance to the treatment should be complete. Renal denervation targeting renal nerves is performed in recent years in the treatment of resistant hypertension. This treatment method is also performed in resistant hypertension treatment at our hospital with great success.

The reason of hypertension is not due to a known disease in 90-95% of the patients. There are names of hypertension with unknown cause such as primary, essential.

Also, hypertension is due to another disease in 5-10% of the patients. Hypertension with a reason associated with another disease is called secondary hypertension.

Another disease causing hypertension should come to mind if the blood pressure is difficultly responding to treatment with medication, well-controlled hypertension starts to rise out of control or hypertension is detected for the first time in a patient previously known to be normal.

A disease that may cause hypertension in young patients should always be investigated.

It is preferred to control blood pressure with the treatment of the disease that leads to high blood pressure (for example; removal of stenosis if stenosis is present in renal veins) and losing excess weight, lifestyle changes such as reducing salt intake, but unfortunately most of the patients need the use medication.

Today, patients with hypertension are lucky because there are many alternatives of medications; most of the side effects are mild if occur and most of the medications are suitable for the use of daily single dose. The most appropriate medication for the patient will be determined with a healthy physician-patient relationship.

The treatment of hypertension consists of three phases; treatment of the underlying disease that leads to high blood pressure (if any), changes of lifestyle and medications.

It is preferred to control blood pressure with the treatment of the disease that leads to high blood pressure (for example; removal of stenosis if stenosis is present in renal veins) and losing excess weight, lifestyle changes such as reducing salt intake, but unfortunately most of the patients need the use medication.

Today, patients with hypertension are lucky because there are many alternatives of medications; most of the side effects are mild if occur and most of the medications are suitable for the use of daily single dose. The most appropriate medication for the patient will be determined with a healthy physician-patient relationship.

The treatment of hypertension consists of three phases; treatment of the underlying disease that leads to high blood pressure (if any), changes of lifestyle and medications.