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.