Chief Adeleke had stopped his blood pressure medications 2 years ago because he felt fine. He felt fine right up until the headaches and blurred vision started. At Mascot Healthcare, his BP was 178/114 — dangerously high. The work to protect his organs started immediately.
Business owner. Presented with recurrent occipital headaches and two episodes of blurred vision. BP at presentation: 178/114 mmHg. Had been aware of "high blood pressure" for 3 years but stopped medication after 6 months feeling well. End-organ assessment required.
Stage 2 HypertensionChief Adeleke was prescribed amlodipine three years ago by a clinic in. He took it for 6 months. He felt fine. He saw no benefit — there was nothing to feel getting better, because there had been nothing to feel getting worse. He stopped. "I felt the same without it," he told the Mascot Healthcare doctor.
"That's exactly how hypertension works," the doctor said. "You feel nothing while it silently damages your blood vessels, kidneys, heart, and brain. You feel something only when the damage is significant."
The blurred vision episode two weeks ago had frightened him enough to come in. His BP on three separate readings was 174, 178, and 181 mmHg systolic. "We need to act today," the doctor said.
Hypertension is called the "silent killer" because it causes no symptoms until end-organ damage is occurring. Symptoms like headache and blurred vision at high blood pressure levels indicate the heart, kidneys, and eyes are already under strain.
Throbbing headaches at the back of the head — worse in the morning, often on waking.
Brief episodes of visual blurring — a warning sign of hypertensive retinopathy or transient cerebral ischaemia.
Stage 2 hypertension — significantly above the 140/90 threshold requiring treatment.
Had stopped amlodipine 2 years earlier after feeling well — a very common and dangerous error.
Absence of current cardiac decompensation — allowing outpatient management.
Amlodipine OD (stopped 2 years ago) — was controlling BP; stopping allowed it to climb back.
Salt reduction (partial) — appropriate but insufficient alone at this BP level.
Occasional paracetamol for headaches — symptom management; not addressing the cause.
Traditional blood pressure remedies (garlic tablets, moringa) — no clinical evidence for BP reduction at this severity.
Immediate management: his previous blood pressure medication was restarted. Given the severity (Stage 2 + symptoms), a second blood pressure medication of a complementary type was added (the combination gives better BP control in Black African patients). A urine dipstick showed trace protein — a potential sign of renal end-organ effect.
End-organ assessment ordered: renal function tests, urine protein creatinine ratio (PCR), fasting lipid profile, fasting glucose, ECG (LVH assessment), and fundoscopy (retinal assessment). Results at follow-up: creatinine mildly elevated, PCR 45 (mild microalbuminuria), mild LVH on ECG, early hypertensive retinopathy grade 1 on fundoscopy.
Target BP < 130/80 mmHg. Review in 4 weeks for BP response; medication titration as needed.
Stage 2 Hypertension (BP 178/114 mmHg) with early end-organ damage: mild LVH, grade 1 hypertensive retinopathy, microalbuminuria
Two complementary blood pressure medications; lifestyle modification (salt restriction, weight management, exercise); end-organ monitoring; monthly BP review; ophthalmology referral for retinal follow-up
At 4 weeks: BP 142/88. Medication adjusted: the second medication dose increased. At 3 months: BP 128/82. LVH regression on 6-month ECG.
BP target achieved at 3 months (128/82). Headaches resolved. Visual symptoms absent. End-organ markers improving on 6-month review. Chief Adeleke is committed to lifelong medication.
Feeling fine does not mean the blood pressure is fine. Hypertension causes silent, progressive damage to blood vessels, kidneys, the heart, and the eyes. Medication controls it — stopping medication reverses all that protection.
Blurred vision and morning occipital headaches at significantly elevated BP are warning signs that organ damage is already occurring. These symptoms require same-day assessment.
You can't feel high blood pressure — until the damage is done. Take the medication, even when you feel fine.
Book an appointment at Mascot Healthcare, Akoka — same-day slots often available, 4.9★ rated.