JHSM

Journal of Health Sciences and Medicine (JHSM) is an unbiased, peer-reviewed, and open access international medical journal. The Journal publishes interesting clinical and experimental research conducted in all fields of medicine, interesting case reports, and clinical images, invited reviews, editorials, letters, comments, and related knowledge.

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Original Article
End-organ damage in hypertension: clinical and public health insights from Turkiye
Aims: Hypertension affects 1.3 billion adults globally yet remains substantially underdiagnosed. In Turkiye, national screening programs exist for several conditions, but universal hypertension screening is not implemented despite hypertension being more prevalent than diseases currently screened. Understanding presentation patterns is essential for informing screening policy. This study aimed to assess hypertension severity and end-organ damage at diagnosis and determine whether symptoms or routine clinical variables can identify patients with more severe blood pressure elevation.
Methods: This cross-sectional study examined 126 new hypertension patients presenting to a nephrology clinic in Turkiye between August-October 2025. Participants completed 7-day home blood pressure monitoring before treatment initiation. Sociodemographic characteristics, symptoms, comorbidities, anthropometric measurements, and laboratory parameters were collected. Hypertension severity was classified using 2023 ESC/ESH criteria. Associations between blood pressure and clinical variables were examined using correlation analyses and multiple regression models.
Results: At diagnosis, mean systolic blood pressure was 159.75±15.74 mmHg and diastolic was 99.01±10.57 mmHg. Over two-thirds (64.3%) presented with grade 2-3 hypertension. Furthermore, 58 patients (46%) had retinopathy, whereas 10 had microalbuminuria and 11 had left ventricular hypertrophy and 69 (54.7%) presented with insulin resistance as calculated by HOMA-IR scores. Almost all patients (92.8%) reported symptoms, most commonly headache (88.1%) and tinnitus (46.8%), yet symptom burden showed no correlation with blood pressure levels (p>0.05). Several biochemical markers showed weak univariable correlations with blood pressure, but none remained significant in multivariable models. Mean BMI was 31.37±6.10 kg/m², with laboratory findings suggesting increased cardiometabolic risk.
Conclusion: Relatively young adults are being diagnosed with hypertension only after years of silent damage, presenting with moderate-to-severe disease and coexisting cardiometabolic abnormalities in addition to potential signs of end-organ damage; mainly retinopathy. Symptoms cannot guide detection, and clinical variables cannot identify high-risk individuals. This late diagnosis perpetuates preventable cardiovascular morbidity, mortality, end-organ damage and escalating healthcare costs. Systematic, population-based blood pressure screening is urgently needed to interrupt this trajectory of invisible harm.


1. Zhou B, Carrillo-Larco RM, Danaei G, et al. Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. The Lancet. 2021;398(10304):957-980. doi:10.1016/S0140-6736(21)01330-1
2. World Health Organization, hypertension fact sheet 2025.
3. Adediran E, Owens R, Gardner E, et al. Risk factors of undiagnosed and uncontrolled hypertension in primary care patients with hypertension: a cross-sectional study. BMC Prim Care. 2024;25:311. doi:10.1186/s1287 5-024-02511-4
4. Wall HK, Hannan JA, Wright JS. Patients with undiagnosed hypertension: hiding in plain sight. JAMA. 2014;312(19):1973-1974. doi: 10.1001/jama.2014.15388
5. Yurekli AA, Bilir N, Husain MJ. Projecting burden of hypertension and its management in Turkey, 2015-2030. PLOS ONE. 2019;4(9):e0221556.c. doi:10.1371/journal.pone.0221556
6. Altun B, rici M, Nergizoğlu G, et al. Prevalence, awareness, treatment and control of hypertension in Turkey (the PatenT study) in 2003. J Hypertens. 2005;23(10):1817-1823. doi:10.1097/01.hjh.0000176789.89505.59
7. Sengul S, Akpolat T, Erdem Y, et al. Changes in hypertension prevalence, awareness, treatment, and control rates in Turkey from 2003 to 2012. J Hypertens. 2016;34(6):1208-1217. doi:10.1097/HJH.0000000000000901
8. Oğuz A, Telci Çaklılı Ö, Tümerdem Çalık B. PURE Investigators. The Prospective Urban Rural Epidemiology (PURE) study: PURE Turkey. Turk Kardiyol Dern Ars. 2018;46(7):613-623. doi:10.5543/tkda.2018.32967
9. Ministry of Health of the Republic of Türkiye, General Directorate of Public Health.
10. Ekinci B, Chatterjee S, Ucuncu I, et al. Blood pressure control in Turkiye: a primary healthcare pilot study. Prev Med Rep. 2024;46:102867. doi:10.1 016/j.pmedr.2024.102867
11. Sengul S, Erdem Y, Akpolat T, et al. Controlling hypertension in Turkey: not a hopeless dream. Kidney International Supplements. 2013;3 (4):326-331. doi:10.1038/KISUP.2013.68
12. Mancia G, Kreutz R, Brunström M, et al. ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension: Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA). J Hypertens. 2023;41(12):1874-2071. doi:10.1097/HJH.0000000000003480
13. Mancia G, Parati G. The role of blood pressure variability in end-organ damage. J Hypertens Suppl. 2003;21(6):S17-S23. doi:10.1097/00004872-2 00307006-00004
14. Vasan RS, Song RJ, Xanthakis V, et al. Hypertension-mediated organ damage: prevalence, correlates, and prognosis in the community. Hypertension, 2022;79(3):505-515. doi:10.1161/HYPERTENSIONAHA. 121.18502
15. Grassi G, Seravalle G, Quarti-Trevano F, Dell'Oro R, Bolla G, Mancia G. Effects of hypertension and obesity on the sympathetic activation of heart failure patients. Hypertension. 2003;42(5):873-877. doi:10.1161/01.HYP.0000098660.26184.63
16. Stanciu S, Rusu E, Miricescu D, et al. Links between metabolic syndrome and hypertension: the relationship with the current antidiabetic drugs. Metabolites. 2023;13(1):87. doi:10.3390/metabo13010087
17. Mennuni S, Rubattu S, Pierelli G, et al. Hypertension and kidneys: unraveling complex molecular mechanisms underlying hypertensive renal damage. J Hum Hypertens. 2014;28(2):74-79. doi:10.1038/jhh.2013.55
18. Lakkis JI, Weir MR. Hyperkalemia in the hypertensive patient. Curr Cardiol Rep. 2018;20(2):12. doi:10.1007/s11886-018-0954-2
19. Wong TY, Mitchell P. Hypertensive retinopathy. N Engl J Med. 2004;351 (22):2310-2317. doi:10.1056/NEJMra032865
20. Kabedi NN, Mwanza JC, Lepira FB, Kayembe TK, Kayembe DL. Hypertensive retinopathy and its association with cardiovascular, renal and cerebrovascular morbidity in Congolese patients. Cardiovasc J Afr. 2014;25(5):228-232. doi:10.5830/CVJA-2014-045
21. Bhargava M, Ikram MK, Wong TY. How does hypertension affect your eyes?. J Hum Hypertens. 2012;26(2):71-83. doi:10.1038/jhh.2011.37
22. Erden S, Bicakci E. Hypertensive retinopathy: incidence, risk factors, and comorbidities. Clin Exp Hypertens. 2012;34(6):397-401. doi:10.3109/10641963.2012.663028
23. Matura LA, McDonough A, Carroll DL. Symptom prevalence, symptom severity, and health-related quality of life among young, middle, and older adults with pulmonary arterial hypertension. American Journal of Hospice and Palliative Medicine®. 2014;33(3):214-221. doi:10.1177/104990 9114554079
24. Jeemon P, Séverin T, Amodeo C, et al. World heart federation roadmap for hypertension - a 2021 update. Glob Heart. 2021;16(1):63. doi:10.5334/gh.1066
25. Abdalla M, Muntner P, Peterson ED. The USPSTF recommendation on blood pressure screening: making 2021 the transformative year in controlling hypertension. JAMA. 2021;325(16):1618-1619. doi:10.1001/ja ma.2021.4499
26. HEARTS technical package for cardiovascular disease management in primary health care: risk based CVD management. Geneva. World Health Organization 2020.
27. Ministry of health of the republic of Türkiye. Project for Improvement of Blood Pressure Control in Turkey: Assessment Report 2020 Ankara.
28. Sozmen K, Ergor G, Sakarya S, et al. Evaluation of blood pressure status and mortality in Turkey: findings from chronic diseases and risk factors cohort study. Medicina (Kaunas). 2023;59(8):1366. doi:10.3390/medic ina59081366
29. Khan M, Kisa A. Cost effectiveness of screening for hypertension in Turkey. Paper presented at: The Fifth International Conference on Health Care Systems 2008.
Volume 9, Issue 1, 2026
Page : 221-227
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