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Essential hypertension

Hypertension or high blood pressure is a medical condition where the blood pressure is chronically elevated. While it is formally called arterial hypertension, the word "hypertension" without a qualifier usually refers to arterial hypertension. more...

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Persistent hypertension is one of the risk factors for strokes, heart attacks, heart failure and arterial aneurysm, and is a leading cause of chronic renal failure.

Definition

Blood pressure is a continuous variable, and risks of various adverse outcomes rise with it. A blood pressure of less than 120/80 mmHg is defined as "normal" in adults. Hypertension is usually diagnosed on finding blood pressure of 140/90 mmHg or above, measured on both arms on three occasions over a few weeks.

Recently, the JNC VII (The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure) has defined blood pressure 120/80 mmHg to 140/90 mmHg as "prehypertension". Prehypertension is not a disease category. Rather, it is a designation chosen to identify individuals at high risk of developing hypertension (JNC VII).

In patients with diabetes mellitus or kidney disease studies have shown that blood pressure over 130/80 mmHg should be considered a risk factor and may warrant treatment.

Etiology

Essential hypertension

  • Age. Over time, the number of collagen fibres in artery and arteriole walls increases, making blood vessels stiffer. With the reduced elasticity comes a smaller cross-sectional area in systole, and so a raised mean arterial blood pressure.
  • High salt intake
  • Sedentary lifestyle
  • Tobacco smoking
  • Alcohol abuse
  • High levels of saturated fat in the diet
  • Obesity. In obese subjects, losing a kilogram of mass generally reduces blood pressure by 2 mmHg.
  • Stress
  • Low birth-weight
  • Diabetes mellitus
  • Various genetic causes

Secondary hypertension

While most forms of hypertension have no known underlying cause (and are thus known as "essential hypertension" or "primary hypertension"), in about 5% of the cases, there is a known cause, and thus the hypertension is secondary hypertension.

Pathophysiology

The mechanisms behind the factors associated with inessential hypertension are generally fully understood, and are outlined at secondary hypertension. However, those associated with essential hypertension are far less understood. What is known is that cardiac output is raised early in the disease course, with total peripheral resistance normal; over time cardiac output drops to normal levels but TPR is increased. Three theories have been proposed to explain this:

  • Inability of the kidneys to excrete sodium, resulting in natriuretic factor (note: the existence of this substance is theoretical) being secreted to promote salt excretion with the side-effect of raising total peripheral resistance.
  • An overactive renin / angiotension system leads to vasoconstriction and retention of sodium and water. The increase in blood volume leads to hypertension.
  • An overactive sympathetic nervous system, leading to increased stress responses.

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Treating Obstructive Sleep Apnea Improves Essential Hypertension and Quality of Life
About one half of patients who have essential hypertension have obstructive sleep apnea, and about one half of patients who have obstructive sleep apnea ...
Obstructive Sleep Apnea and Essential Hypertension—Is There a Link?
Obstructive sleep apnea (OSA) occurs in 2 percent of women and 4 percent of men between 30 and 60 years of age.(1) (This compares with an incidence of 4.5 percent for asthma in this age category.)(
Home Monitoring in Patients with Essential Hypertension
Results of studies using self-reporting of blood pressure measurement by way of telecommunication systems have demonstrated declines in both systolic ...
Microcirculatory efficacy of topical treatment with aescin plus essential phospholipids gel in venous insufficiency and hypertension: new clinical observations
Belcaro G, Cesarone MR, Dugall M. Angiology 2004;55:S1-S5. Aescin plus essential phospholipids (AEPL) topical gels are used for local treatment of ...
The treatment of adults with essential hypertension - Applied Evidence
Hypertension is arbitrarily defined as diastolic blood pressure (DBP) of 90 mm Hg or higher, systolic blood pressure (SBP) of 140 mm Hg or higher, or ...
Blood pressure variability and stress management training for essential hypertension
Blood pressure (BP) is essentially variable; it fluctuates continuously because of the influence of spontaneous rhythmical variations associated ...
The Diagnosis of Essential and Secondary Hypertension in Adults
KEY POINTS * Hypertension contributes substantially to morbidity and mortality associated with renal failure, cardiovascular disease, and stroke. * Cardiovascular risk factors and end-organ dam
Soy milk for essential hypertension - Literature Review & Commentary - Brief Article
Forty men and women (mean age, 48 years) with mild-to-moderate hypertension were randomly assigned to receive, in double-blind fashion, 500 ml twice ...

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