HYPERTENSION AS A LEADING RISK FACTOR IN INTERNAL MEDICINE: PATHOPHYSIOLOGY, DIAGNOSIS, COMPLICATIONS, AND EVIDENCE-BASED MANAGEMENT

Abstract

Hypertension is the single most prevalent modifiable risk factor for cardiovascular, cerebrovascular, and renal disease, affecting approximately 1.28 billion adults worldwide and contributing to over 10.8 million deaths annually. Despite decades of research, global control rates remain alarmingly low, seldom exceeding 20–25% even in high-income countries.

Objective: To provide an evidence-based synthesis of the pathophysiology, clinical diagnosis, end-organ complications, and pharmacological management of arterial hypertension within the broader context of internal medicine practice.

Methods: A systematic review of eight primary peer-reviewed sources was conducted, encompassing randomized controlled trials, meta-analyses, and authoritative clinical guidelines.

Results: Hypertension is pathophysiologically driven by interactions among the renin-angiotensin-aldosterone system (RAAS), sympathetic nervous system overactivation, endothelial dysfunction, and salt-sensitive renal sodium retention. Office blood pressure thresholds (≥140/90 mmHg) are supplemented by ambulatory monitoring for white-coat and masked hypertension. Target organ damage encompasses left ventricular hypertrophy, chronic kidney disease, hypertensive retinopathy, and ischemic cerebrovascular events. First-line pharmacotherapy comprises ACE inhibitors or ARBs, calcium channel blockers, and thiazide diuretics, with combination therapy recommended for most patients with BP ≥160/100 mmHg.

Conclusion: Achieving systolic BP targets below 130 mmHg in high-risk patients significantly reduces major adverse cardiovascular events. Integrated management combining lifestyle modification with individualized pharmacotherapy remains the cornerstone of hypertension control in internal medicine.