Introduction.
Hypertension is one of the most serious lifestyle-related diseases in Japan and is a "silent disease" that progresses without many people being aware of it. However, the damage is not limited to the blood vessels and heart, but affects the brain, kidneys, and even cognitive functions. In this issue, we will first sort out the symptoms, causes, and effects of hypertension when left untreated, and finally, we will provide specific information on how it is actually addressed in the clinic.
1. what are the symptoms of hypertension?
Unfortunately, hypertension has few obvious symptoms in its early stages. At best, it is a "vague" feeling of discomfort such as light-headedness, dizziness, or tinnitus, and in most cases it is not enough to be called a symptom. For this reason, many people often neglect it, saying, "I was told that my blood pressure is a little high recently, but I have no particular symptoms.
However, what comes after that are serious diseases such as "stroke (cerebral hemorrhage/stroke)," "myocardial infarction," "chronic kidney disease," "heart failure," and "dementia. For example, data show that for every 10 mm Hg increase in systolic blood pressure, the risk of stroke is approximately 1.4 times greater, and the risk of myocardial infarction is approximately 1.3 times greater (see the following table).Hypertension Management Guidelines 2025 (Suggestions based onStatesman)。
2. why does hypertension occur? What are its causes?
Primary (essential) hypertension
Most often, this is the case when the cause cannot be identified. The causes are complex, including
- genetic background
- excessive salt intake(Water retention in the kidneys progresses)
- excessive drinking: a contributing factor to elevated blood pressure.
- Obesity and visceral fat: Stimulates sympathetic nerves and the RAAS (renin-angiotensin system) and increases blood pressure
secondary hypertension
When other diseases are the cause, the following are typical examples
- Kidney disease (e.g., glomerular disorders)
- Hormonal abnormalities such as primary aldosteronism
- Side effects of certain drugs
These can be found with appropriate tests (blood, urine, hormones, imaging, etc.).
3. what happens if left untreated? What are the long-term risks?
If left untreated, hypertension causes a chronic buildup of burden in the blood vessels and organs:
- heart: Hypertrophy of left atrium and left ventricle, increased risk of heart failure
- 脳: Progression of stroke, dementia, and memory loss
- kidney: from reduced renal function to renal failure.
- aorta: Prone to aortic aneurysm and atherosclerosis
In addition, the latest guidelines state,Brain health and cognitive preventionThe significance of early blood pressure control is also emphasized for the sake of (www.heart.org)。
4. flow of hypertension evaluation and treatment at Ikejiri-Ohashi Sera Clinic
(1) Correct blood pressure measurement
Based on appropriate measurement methods,Clinic room measurement + home blood pressure measurementCombined use of the following. Prevents white coat hypertension and masked hypertension from being missed.
(2) Evaluation of causes
Blood tests (kidney function, electrolytes, hormones, etc.), urinalysis, evaluation of visceral fat and hormonal screening as needed.
(3) Risk assessment
Using the PREVENT Risk Calculation tool based on the new 2025 guidelines,10 and 30 yearsEstimating the risk of cardiovascular events in the (myjournalcourier.com). We will discuss a treatment plan based on individual risks.
(4) Planning a treatment plan
- Lifestyle improvement is a priorityThe following are some examples: reduce salt, exercise, proper weight, quit smoking, and moderate alcohol consumption.
- Timing of drug treatment initiationIf blood pressure does not decrease with lifestyle modification, consider starting in 3 to 6 months.
- Drugs to be used: In principle, start with one drug. If necessary. Utilization of single and combination tablets Improved adherence with
(5) Regular follow-up
- Monitoring blood pressure and organ assessment
- Continued lifestyle support (exercise, nutrition, sleep)
- Comprehensive medical care system including fundus examination as a complication prevention
summary
| (data) item | Contents |
| symptoms | Basically asymptomatic. Headache" and "dizziness" are present but vague. |
| cause | Excess salt, obesity, alcohol consumption, heredity, etc. |
| Abandonment Risk | Major complications such as heart failure, stroke, renal failure, dementia, etc. |
| Correspondence at the clinic | Correct measurement, cause evaluation, risk estimation, lifestyle guidance / drug therapy, follow-up |
References
- ACC/AHA et al. 2025 High Blood Pressure Guideline(JACC)
- AHA/ACC 2025 Guidelines