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EssentialhypertensionWikipedia,thefreeencyclopedia

Essentialhypertension
FromWikipedia,thefreeencyclopedia

Essentialhypertension(alsocalledprimaryhypertensionoridiopathichypertension)istheformofhypertensionthatbydefinitionhasnoidentifiablecause.It
isthemostcommontypeofhypertension,affecting95%ofhypertensivepatients,[1][2][3][4]ittendstobefamilialandislikelytobetheconsequenceofan
interactionbetweenenvironmentalandgeneticfactors.Prevalenceofessentialhypertensionincreaseswithage,andindividualswithrelativelyhighbloodpressure
atyoungeragesareatincreasedriskforthesubsequentdevelopmentofhypertension.Hypertensioncanincreasetheriskofcerebral,cardiac,andrenalevents.[5]

Contents
1 History
2 Classification
3 Riskfactors
3.1 Geneticvariation
3.2 Aging
3.3 Obesity
3.4 Salt
3.5 Alcohol
3.6 Renin
3.7 Diabetes
3.8 Smoking
3.9 Vitamindeficiency
3.10 Lackofexercise
4 Pathophysiology
5 Seealso
6 References

History
PriortoAustraliancardiovascularphysiologistPaulKorner,inthe1940s,littlewasknownaboutessentialhypertension.[6]

Classification
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Arecentclassificationrecommendsbloodpressurecriteriafordefiningnormalbloodpressure,
prehypertension,hypertension(stagesIandII),andisolatedsystolichypertension,whichisa
commonoccurrenceamongtheelderly.Thesereadingsarebasedontheaverageofseated
bloodpressurereadingsthatwereproperlymeasuredduring2ormoreofficevisits.In
individualsolderthan50years,hypertensionisconsideredtobepresentwhenaperson'sblood
pressureisconsistentlyatleast140mmHgsystolicor90mmHgdiastolic.Patientswithblood
pressuresover130/80mmHgalongwithType1orType2diabetes,orkidneydiseaserequire
furthertreatment.[7]
Classification
Normal

Systolicpressure

Diastolicpressure

mmHg kPa(kN/m2) mmHg kPa(kN/m2)

90119 1215.9

Thevariationinpressureintheleftventricle(blueline)andtheaorta
(redline)overtwocardiaccycles("heartbeats"),showingthe
definitionsofsystolicanddiastolicpressure.

6079 8.010.5

Prehypertension 120139 16.118.5

8189 10.811.9

Stage1

140159 18.721.2

9099 12.013.2

Stage2

160

21.3

100

13.3

Isolatedsystolic
140
hypertension

18.7

<90

<12.0

Source:AmericanHeartAssociation(2003).[7]
Resistanthypertensionisdefinedasthefailuretoreducebloodpressuretotheappropriatelevelaftertakingathreedrugregimen.[7]Guidelinesfortreating
resistanthypertensionhavebeenpublishedintheUK,andUS.[8]

Riskfactors
Hypertensionisoneofthemostcommoncomplexdisorders.Theetiologyofhypertensiondifferswidelyamongstindividualswithinalargepopulation.[9]Andby
definition,essentialhypertensionhasnoidentifiablecause.However,severalriskfactorshavebeenidentified.

Geneticvariation
HavingapersonalfamilyhistoryofhypertensionincreasesthelikelihoodthatanindividualdevelopsHTN.[10]
Essentialhypertensionisfourtimesmorecommoninblackthanwhitepeople,acceleratesmorerapidlyandisoftenmoreseverewithhighermortalityin
blackpatients.[10][11][12][13]
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Morethan50geneshavebeenexaminedinassociationstudieswithhypertension,andthenumberisconstantlygrowing.Oneofthesegenesistheangiotensinogen
(AGT)gene,studiedextensivelybyKimetal.TheyshowedthatincreasingthenumberofAGTincreasesthebloodpressureandhencethismaycause
hypertension.[9]Insinglevarianttests,ithasbeenshownthatSNPswereenrichedforvariantsassociatedwithadiposity,type2diabetes,coronaryheartdisease
andkidneyfunctioninpreviouslypublishedGWAS,providingevidencethatgeneticlocirelatedtobloodpressurecontributetocardiovascularoutcomes.[14]Twins
havebeenincludedinstudiesmeasuringambulatorybloodpressurefromthesestudiesithasbeensuggestedthatessentialhypertensioncontainsalargegenetic
influence.[9]Supportingdatahasemergedfromanimalstudiesaswellasclinicalstudiesinhumanpopulations.Themajorityofthesestudiessupporttheconcept
thattheinheritanceisprobablymultifactorialorthatanumberofdifferentgeneticdefectseachhasanelevatedbloodpressureasoneofitsphenotypicexpressions.
However,thegeneticinfluenceuponhypertensionisnotfullyunderstoodatthemoment.Itisbelievedthatlinkinghypertensionrelatedphenotypeswithspecific
variationsofthegenomemayyielddefinitiveevidenceofheritability.[15]Anotherviewisthathypertensioncanbecausedbymutationsinsinglegenes,inherited
onaMendelianbasis.[16]

Aging
Hypertensioncanalsobeagerelated,andifthisisthecase,itislikelytobemultifactorial.Onepossiblemechanisminvolvesareductioninvascularcompliance
duetothestiffeningofthearteries.Thiscanbuildupduetoisolatedsystolichypertensionwithawidenedpulsepressure.Adecreaseinglomerularfiltrationrateis
relatedtoagingandthisresultsindecreasingefficiencyofsodiumexcretion.Thedevelopingofcertaindiseasessuchasrenalmicrovasculardiseaseandcapillary
rarefactionmayrelatetothisdecreaseinefficiencyofsodiumexcretion.Thereisexperimentalevidencethatsuggeststhatrenalmicrovasculardiseaseisan
importantmechanismforinducingsaltsensitivehypertension.[17]

Obesity
Obesitycanincreasetheriskofhypertensiontofivefoldascomparedwithnormalweight,anduptotwothirdsofhypertensioncasescanbeattributedtoexcess
weight.[18]Morethan85%ofcasesoccurinthosewithaBodymassindex(BMI)greaterthan25.[18]Adefinitivelinkbetweenobesityandhypertensionhasbeen
foundusinganimalandclinicalstudiesfromtheseithasbeenrealizedthatmanymechanismsarepotentialcausesofobesityinducedhypertension.These
mechanismsincludetheactivationofthesympatheticnervoussystemaswellastheactivationofthereninangiotensinaldosteronesystem.[19]

Salt
Anotherriskfactorissalt(sodium)sensitivitywhichisanenvironmentalfactorthathasreceivedthegreatestattention.Approximatelyonethirdoftheessential
hypertensivepopulationisresponsivetosodiumintake.[20][21]Whensodiumintakeexceedsthecapacityofthebodytoexcreteitthroughthekidneys,vascular
volumeexpandssecondarytomovementoffluidsintotheintravascularcompartment.Thiscausesthearterialpressuretoriseasthecardiacoutputincreases.
Localautoregulatorymechanismscounteractthisbyincreasingvascularresistancetomaintainnormotensioninlocalvascularbeds.Asarterialpressureincreases
inresponsetohighsodiumchlorideintake,urinarysodiumexcretionincreasesandtheexcretionofsaltismaintainedatexpenseofincreasedvascular
pressures.[10]TheincreasedsodiumionconcentrationstimulatesADHandthirstmechanisms,leadingtoincreasedreabsorptionofwaterinthekidneys,
concentratedurine,andthirstwithhigherintakeofwater.Also,thewatermovementbetweencellsandtheinterstitiumplaysaminorrolecomparedtothis.
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Alcohol
Excessivealcoholconsumptionwillincreasebloodpressureovertime.Alcoholalsocontainsahighdensityofcaloriesandmaycontributetoobesity.[22]

Renin
Reninelevationisanotherriskfactor.Reninisanenzymesecretedbythejuxtaglomerularapparatusofthekidneyandlinkedwithaldosteroneinanegative
feedbackloop.Inconsequence,somehypertensivepatientshavebeendefinedashavinglowreninandothersashavingessentialhypertension.Lowrenin
hypertensionismorecommoninAfricanAmericansthanwhiteAmericans,andmayexplainwhyAfricanAmericanstendtorespondbettertodiuretictherapy
thandrugsthatinterferewiththeReninangiotensinsystem.Highreninlevelspredisposetohypertensionbycausingsodiumretentionthroughthefollowing
mechanism:IncreasedreninIncreasedangiotensinIIIncreasedvasoconstriction,thirst/ADHandaldosteroneIncreasedsodiumreabsorptioninthe
kidneys(DCTandCD)Increasedbloodpressure.

Diabetes
HypertensioncanalsobecausedbyInsulinresistanceand/orhyperinsulinemia,whicharecomponentsofsyndromeX,orthemetabolicsyndrome.Insulinisa
polypeptidehormonesecretedbycellsintheisletsofLangerhans,whicharecontainedthroughoutthepancreas.Itsmainpurposeistoregulatethelevelsof
glucoseinthebodyantagonisticallywithglucagonthroughnegativefeedbackloops.Insulinalsoexhibitsvasodilatoryproperties.Innormotensiveindividuals,
insulinmaystimulatesympatheticactivitywithoutelevatingmeanarterialpressure.However,inmoreextremeconditionssuchasthatofthemetabolicsyndrome,
theincreasedsympatheticneuralactivitymayoverridethevasodilatoryeffectsofinsulin.
Recentstudiesclaimsthatobesityisariskfactorforhypertensionbecauseofactivationofthereninangiotensinsystem(RAS)inadiposetissue,[23][24]andalso
linkedreninangiotensinsystemwithinsulinresistance,andclaimsthatanyonecancausetheother.[25]

Smoking
Smokingdoesnotdirectlycausehighbloodpressure.Howeveritisaknownriskfactorforotherseriouscardiovasculardisease.[22]

Vitamindeficiency
IthasbeensuggestedthatvitaminDdeficiencyisassociatedwithcardiovascularriskfactors.[26]IthasbeenobservedthatindividualswithavitaminDdeficiency
havehighersystolicanddiastolicbloodpressuresthanaverage.VitaminDinhibitsreninsecretionanditsactivity,itthereforeactsasa"negativeendocrine
regulatorofthereninangiotensinsystem".Hence,adeficiencyinvitaminDleadstoanincreaseinreninsecretion.Thisisonepossiblemechanismofexplaining
theobservedlinkbetweenhypertensionandvitaminDlevelsinthebloodplasma.[27]

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Also,someauthoritiesclaimthatpotassiummightbothpreventandtreathypertension.[28]

Lackofexercise
Regularphysicalexercisereducesbloodpressure.TheUKNationalHealthServiceadvises150minutes(2hoursand30minutes)ofmoderateintensityaerobic
activityperweektohelppreventhypertension.[22]

Pathophysiology
Cardiacoutputandperipheralresistancearethetwodeterminantsofarterial
pressureandsobloodpressureisnormallydependentonthebalancebetween
cardiacoutputandperipheralresistance.[29]Cardiacoutputisdeterminedby
strokevolumeandheartratestrokevolumeisrelatedtomyocardial
contractilityandtothesizeofthevascularcompartment.Peripheralresistance
isdeterminedbyfunctionalandanatomicchangesinsmallarteriesand
arterioles.Thepathophysiologyofessentialhypertensionisanareaofresearch,
anduntilnowremainsnotwellunderstood,butmanytheorieshavebeen
proposedtoexplainthis.
Whatisknownisthatcardiacoutputisraisedearlyinthediseasecourse,with
totalperipheralresistance(TPR)normalovertimecardiacoutputdropsto
normallevelsbutTPRisincreased.Threetheorieshavebeenproposedto
explainthis:

Adiagramexplainingfactorsaffectingarterialpressure

AnoveractiveReninangiotensinsystemleadstovasoconstrictionandretentionofsodiumandwater.Theincreaseinbloodvolumeleadstohypertension.
Anoveractivesympatheticnervoussystem,leadingtoincreasedstressresponses.
Itisalsoknownthathypertensionishighlyheritableandpolygenic(causedbymorethanonegene)andafewcandidategeneshavebeenpostulatedintheetiology
ofthiscondition.[30][31][32]

Seealso
DASHdiet

References
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1.CarreteroOA,OparilS(January2000)."Essentialhypertension.PartI:definition
andetiology".Circulation.101(3):32935.doi:10.1161/01.CIR.101.3.329.
PMID10645931.Retrieved20090605.
2.OparilS,ZamanMA,CalhounDA(November2003)."Pathogenesisof
hypertension".Ann.Intern.Med.139(9):76176.doi:10.7326/000348191399
20031104000011.PMID14597461.
3.Hall,JohnE.Guyton,ArthurC.(2006).Textbookofmedicalphysiology.St.
Louis,Mo:ElsevierSaunders.p.228.ISBN0721602401.
4."Hypertension:eMedicineNephrology".Retrieved20090605.
5."Essentialhypertension:TheLancet".Retrieved20090601.
6."Worldauthorityonbloodpressure:PaulKorner".SydneyMorningHerald.
FairfaxMedia.30November2012.
7.ChobanianAV,BakrisGL,BlackHR,etal.(December2003)."Seventhreportof
theJointNationalCommitteeonPrevention,Detection,Evaluation,andTreatment
ofHighBloodPressure".Hypertension.42(6):120652.
doi:10.1161/01.HYP.0000107251.49515.c2.PMID14656957.
8.CalhounDA,JonesD,TextorS,etal.(June2008)."Resistanthypertension:
diagnosis,evaluation,andtreatment.AscientificstatementfromtheAmerican
HeartAssociationProfessionalEducationCommitteeoftheCouncilforHigh
BloodPressureResearch"(PDF).Hypertension.51(6):140319.
doi:10.1161/HYPERTENSIONAHA.108.189141.PMID18391085.
9.DicksonME,SigmundCD(July2006)."Geneticbasisofhypertension:revisiting
angiotensinogen".Hypertension.48(1):1420.
doi:10.1161/01.HYP.0000227932.13687.60.PMID16754793.
10.Loscalzo,JosephFauci,AnthonyS.Braunwald,EugeneDennisL.Kasper
Hauser,StephenLLongo,DanL.(2008).Harrison'sprinciplesofinternal
medicine.McGrawHillMedical.ISBN0071476911.
11.HaffnerSM,LehtoS,RnnemaaT,PyrlK,LaaksoM(July1998)."Mortality
fromcoronaryheartdiseaseinsubjectswithtype2diabetesandinnondiabetic
subjectswithandwithoutpriormyocardialinfarction".TheNewEnglandJournal
ofMedicine.339(4):22934.doi:10.1056/NEJM199807233390404.
PMID9673301.Retrieved20090608.
12.LindhorstJ,AlexanderN,BlignautJ,RaynerB(2007)."Differencesin
hypertensionbetweenblacksandwhites:anoverview"(PDF).CardiovascJAfr.18
(4):24147.PMID17940670.Retrieved20090601.
13.BurtVL,WheltonP,RoccellaEJ,etal.(March1995)."Prevalenceof
hypertensionintheUSadultpopulation.ResultsfromtheThirdNationalHealth
andNutritionExaminationSurvey,19881991".Hypertension.25(3):30513.
doi:10.1161/01.HYP.25.3.305.PMID7875754.Retrieved20090601.

https://en.wikipedia.org/wiki/Essential_hypertension

14.Kato,NorihiroLoh,MarieTakeuchi,FumihikoVerweij,NiekWang,Xu
Zhang,WeihuaKelly,TanikaN.Saleheen,DanishLehne,Benjamin(201511
01)."Transancestrygenomewideassociationstudyidentifies12geneticloci
influencingbloodpressureandimplicatesaroleforDNAmethylation".Nature
Genetics.47(11):128293.doi:10.1038/ng.3405.ISSN15461718.
PMC4719169 .PMID26390057.
15.KotchenTA,KotchenJM,GrimCE,etal.(July2000)."Geneticdeterminantsof
hypertension:identificationofcandidatephenotypes".Hypertension.36(1):713.
doi:10.1161/01.HYP.36.1.7.PMID10904005.
16.WilliamsBBritishHypertensionSocietyMichaelSutters,MDetal.(2006).
"HypertensionEtiology&ClassificationSecondaryHypertension".Armenian
MedicalNetwork.Retrieved20071202.
17.KosugiT,NakagawaT,KamathD,JohnsonRJ(February2009)."Uricacidand
hypertension:anagerelatedrelationship?".JHumHypertens.23(2):7576.
doi:10.1038/jhh.2008.110.PMID18754017.
18.HaslamDW,JamesWP(2005)."Obesity".Lancet.366(9492):1197209.
doi:10.1016/S01406736(05)674831.PMID16198769.
19.RahmouniK,CorreiaML,HaynesWG,MarkAL(January2005)."Obesity
associatedhypertension:newinsightsintomechanisms".Hypertension.45(1):9
14.doi:10.1161/01.HYP.0000151325.83008.b4.PMID15583075.
20.http://www.jstage.jst.go.jp/article/jphs/100/5/370/_pdfAMissingLinkBetweena
HighSaltIntakeandBloodPressureIncrease:MakotoKatoriandMasataka
Majima,DepartmentofPharmacology,KitasatoUniversitySchoolofMedicine,
Kitasato,Sagamihara,Kanagawa,JapanFebruary8,2006
21.http://hyper.ahajournals.org/content/27/3/481.fullSaltSensitivityofBlood
PressureinHumansMyronH.WeinbergerIndianaUniversitySchoolofMedicine,
Hypertension1996doi:10.1161/01.HYP.27.3.481
22.http://www.nhs.uk/Conditions/Bloodpressure(high)/Pages/Prevention.aspx
23.SeguraJ,RuilopeLM(October2007)."Obesity,essentialhypertensionandrenin
angiotensinsystem".PublicHealthNutrition.10(10A):115155.
doi:10.1017/S136898000700064X.PMID17903324.Retrieved20090602.
24.HasegawaH,KomuroI(April2009)."[TheprogressofthestudyofRAAS]".
NipponRinsho.JapaneseJournalofClinicalMedicine(inJapanese).67(4):655
61.PMID19348224.
25.SaitohS(April2009)."[Insulinresistanceandreninangiotensinaldosterone
system]".NipponRinsho.JapaneseJournalofClinicalMedicine(inJapanese).67
(4):72934.PMID19348235.
26.LeeJH,O'KeefeJH,BellD,HensrudDD,HolickMF(2008)."VitaminD
deficiencyanimportant,common,andeasilytreatablecardiovascularriskfactor?".
J.Am.Coll.Cardiol.52(24):194956.doi:10.1016/j.jacc.2008.08.050.
PMID19055985.
6/7

10/12/2016

EssentialhypertensionWikipedia,thefreeencyclopedia

27.FormanJP,GiovannucciE,HolmesMD,etal.(May2007)."Plasma25
hydroxyvitaminDlevelsandriskofincidenthypertension".Hypertension.49(5):
106369.doi:10.1161/HYPERTENSIONAHA.107.087288.PMID17372031.
28.EvaMayNunnelleyHamilton,M.S.,EleanorNossWhitney,R.D.,Frances
SienkiewiczSizer,M.S.,R.D.(1991).FifthEditionAnnotatedInstructor's
EditionNutritionConcepts&Controversies.WestPublishingCompany.ISBN0
314810927.OCLC22451334.
29.Klabunde,RichardE.(2007)."CardiovascularPhysiologyConceptsMean
ArterialPressure".Retrieved20080929.

30.SagnellaGA,SwiftPA(June2006)."TheRenalEpithelialSodiumChannel:
GeneticHeterogeneityandImplicationsfortheTreatmentofHighBlood
Pressure".CurrentPharmaceuticalDesign.12(14):222134.
doi:10.2174/138161206777585157.PMID16787251.
31.JohnsonJA,TurnerST(June2005)."Hypertensionpharmacogenomics:current
statusandfuturedirections".CurrentOpinioninMolecularTherapeutics.7(3):
21825.PMID15977418.
32.HideoIzawaYoshijiYamadaetal.(May2003)."PredictionofGeneticRiskfor
Hypertension".Hypertension.41(5):103540.
doi:10.1161/01.HYP.0000065618.56368.24.PMID12654703.

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