The various mechanisms affecting cardiac outputperipheral resistance involved in the development of essential hypertension are covered. Hypertension is caused by increased cardiac output andor increased peripheral resistance areas covered. The cause, or pathogenesis, of hypertension depends on the type of hypertension involved. Diagnosis, pathophysiology, and treatment of essential tremor. The lancet hypothesis pathogenesis of essential hypertension j. Nephron number, uric acid, and renal microvascular disease in. Essential hypertension aetiology bmj best practice. Hypertension is a cause of morbidity and mortality. Articles pathogenesis of essential hypertension br med j 1949. The supplementation of antioxidants, particularly in the form of fresh fruit and. A clearer understanding of the pathogenesis of hypertension will probably lead to more highly targeted therapies and to greater reduction in hypertensionrelated cardiovascular disease morbidity than can be achieved with current empirical treatment. High blood pressure is a leading risk factor for heart disease, stroke, and kidney failure. Blood pressure unit, western infirmary, glasgow g11 6nt, united kingdom b academische ziekenhuis rotterdam, rotterdam 3002, the netherlands it is proposed that essential hypertension is an exaggeration of the tendency for bloodpressure to rise with age, that it. Family and twin studies estimate that the heritability fraction of the trait explained by genes of blood pressure is 30 to 50.
Renal 5% parenchymal renovascular 0,3% corrected to normal by balloon treatment or surgery. In this paper, we present the hypothesis, with preliminary evidence, that an elevation in uric acid may have a key role in the pathogenesis of essential hypertension, and we also present evidence that it may be a factor for the presence of a lower nephron number in subjects with essential hypertension. Hypertension can be classified by cause as either essential also known as primary or idiopathic or secondary. Psychological stress in pathogenesis of essential hypertension volume. This type of high blood pressure is called primary or essential hypertension. Apr 27, 2020 the cause, or pathogenesis, of hypertension depends on the type of hypertension involved. Essential hypertension pathogenesis and pathophysiology. Over time intrarenal injury develops with microvascular disease, interstitial t cell and macrophage recruitment with the induction of an. Importantly, ang ii increases preglomerular vascular resistance by inducing structural changes in renal cortical resistance arteries and arterioles. Nov 04, 2003 a clearer understanding of the pathogenesis of hypertension will probably lead to more highly targeted therapies and to greater reduction in hypertension related cardiovascular disease morbidity than can be achieved with current empirical treatment.
Ninetyfive percent have essential hypertension for which the pathogenesis is unknown, although both genetic and environmental factors probably are important. To study the role of increased sympathetic tone in pathogenesis of hypertension in patients with essential hypertension with neurovascular compression. The first page of the pdf of this article appears above. Hypertension can be classified by cause as either essential also. Furthermore, it is becoming increasingly apparent that the pathogenesis of most forms of hypertension including primary and secondary involve an important role of the kidney. Pathogenesis of the essential hypertensions springerlink. The observation that uric acid may have a pathogenic role in essential hypertension led to a hypothesis to account for how a lbw and a low nephron number might predispose to hypertension later in life. The pathogenesis of hypertension is complex with a significant diversity and variability of the mechanisms involved in individual patient.
The pathogenesis of essential hypertension is multifactorial and highly complex. Essential hypertension a pathogenesis and pathophysiology. Isbn 9789535102823, pdf isbn 9789535152347, published 20120309. There is currently only one fda approved medication, propranol, for its treatment. Unknown factors cause vasoconstriction of arterioles. Hypertension is due to specific causes in a small fraction of cases, but in the vast majority of individuals. The supplementation of antioxidants, particularly in the form of fresh fruit and vegetables, reduces blood pressure. Essential or primary hypertension occurs when the condition has no known cause. Nephron number, uric acid, and renal microvascular disease. It is also established that high normal blood pressure 98589 mm hg progresses to stage 1 hypertension 14090 mm hg in 37% of individuals 49% of those 65 yr. Some of the findings in animal models have ispired new fields and technical approaches for studying eh in man. Hypertension pathophysiology, causes and complications howmed. Uric acid, nephron number, and the pathogenesis of essential hypertension.
In recent years much attention has focused on the renal mechanisms that underlie the defect in pressure natriuresis in essential hypertension. Use of allopurinol in slowing the progression of renal disease through its ability in lowering serum uric acid level. Apr 14, 2001 there is still much uncertainty about the pathophysiology of hypertension. Apr 10, 20 pathophysiology of hypertension secondary hypertension h. Pathophysiology is a branch of medicine which explains the function of the body as it relates to diseases and conditions. A multifactorial and heterogeneous etiology of essential hypertension has been proposed. The hypertension optimal treatment hot study indicates that the treatment goal is to reduce blood pressure to 14085 mm hg. In general practice, the level of blood pressure above which treatment of hypertension is indicated is now set at 14090 mm hg. Multiple factors modulate the blood pressure bp including humoral mediators, vascular reactivity, circulating blood. Pathogenesis of essential hypertension jama internal.
Pathophysiology of hypertension secondary hypertension h. A small number of patients between 2% and 5% have an underlying renal or adrenal disease as the cause for their raised blood pressure. Essential hypertension is currently understood as a multifactorial disease arising from the combined action of many genetic. Essential hypertension accounts for 95% of all cases of hypertension. The following factors have been shown to disrupt the d disturbance of autoregulation reflex and persistently increasing vascular resistance to match an increased cardiac output. The pathogenesis of essential hypertension is multifactorial and complex. Genetic factors in the pathogenesis of hypertension uptodate. Essential hypertension pathogenesis and pathophysiology sanjay vikrant, sc tiwari population studies suggest the blood pressure bp is a continuous variable, with no absolute dividing line between normal and abnormal values1. Pathogenesis of structural vascular changes in hypertension. In children, hypertension is often the appearance of a renal or endocrine disease, whereas in adults, the large majority of patients with hypertension have an essential hypertension, a denomination reflecting that the mechanisms are not fully understood although some welldefined pathogenic factors have been described in patients with. Get a printable copy pdf file of the complete article 2. As blood pressure rises, renal ischemia is ameliorated and sodium balance restored completely in saltresistant or partially in saltsensitive hypertension, but at. Bp is a quantitative trait that is highly variable 1.
Hypertension is another name for high blood pressure. Pathophysiology of essential hypertension american journal of. An imbalance in superoxide and nitric oxide production may account for reduced vasodilation, which in turn can favor the development of hypertension. The pathogenesis of essential hypertension, which accounts for 95% of the cases of hypertension seen clinically, is still unknown in spite of extensive clinical and laboratory studies during the past 20 years.
Although genetics appears to contribute, the exact mechanisms underlying essential hypertension have not been established. Hypertension pathophysiology, diagnosis, and management. Some of the findings in animal models have ispired new fields and technical approaches for studying. In 90% to 95% of patients, the cause of hypertension cannot be clearly identified. The pathophysiology of hypertension is an area which attempts to explain mechanistically the causes of hypertension, which is a chronic disease characterized by elevation of blood pressure. However, some initiating factors may be dampened as the hypertensive state progresses. Georgievsky crimean federal university named after v. It can lead to severe health complications and increase the risk of heart disease, stroke, and sometimes death. I am probably only one of too many physicians who have incorrectly assumed for too many years that essential meant idiopathic. Primary hypertension, also known as essential or idiopathic hypertension, accounts for as many as 95% of all cases of hypertension. This is marked by a loss of elastic tissue and arteriosclerotic changes in the aorta and larger vessels, coupled with decreased caliber of the arterioles.
More than 90% of individuals with hypertension have essential hypertension. In this paper, we present the hypothesis, with preliminary evidence, that an elevation in uric acid may have a key role in the pathogenesis of essential hypertension, and we also present evidence that it may be a factor for the presence of a lower nephron number in. May 18, 2017 the pathogenesis of essential hypertension is multifactorial and highly complex. Jul 22, 2019 hypertension is another name for high blood pressure. From these various insights, we propose a current paradigm to explain the renal mechanisms underlying the hypertension epidemic today. Little is known about the cause of primary hypertension other than it is congenital. Pathophysiology of essential hypertension seminars in nephrology. Typically diagnosed by screening of an asymptomatic individual. Hypertension, defined as systemic blood pressure equal to or exceeding 14090 mm hg, is a common health problem afflicting approximately 20% of the adult population of the united states.
Increased systemic vascular resistance, increased vascular stiffness, and increased vascular responsiveness to stimuli are central to the pathophysiology of hypertension. What is the pathogenesis of essential hypertension high. Abstract since its first identification in the late 1800s, a variety of etiologies for essential hypertension have been proposed. According to one view, hypertension is a sign of disease, as are fever and leucocytosis, and essential is expressive of our ignorance of its pathogenesis. May 09, 2020 the pathogenesis of essential hypertension is multifactorial and complex. Diagnosis, pathogenesis, and management of essential. Salt intake, salt restriction, and primary essential hypertension view in chinese smoking and hypertension view in chinese other genetic factors in the pathogenesis of hypertension view in chinese hypertensive complications in black patients view in chinese increased pulse pressure view in chinese labile hypertension.
The kidney is both the contributing and the target organ of the hypertensive processes, and the disease involves the interaction of multiple organ systems and numerous mechanisms of independent or interdependent pathways. Pathogenesis of hypertension annals of internal medicine. A possible pathogenesis of essential hypertension has been proposed in which multiple factors, including genetic predisposition, excess dietary salt intake, and adrenergic tone, may interact to produce hypertension. Lifestyle changes are recommended for all patients. Over time intrarenal injury develops with microvascular disease, interstitial t cell and macrophage recruitment with the. Specifically, we propose that hypertension is initiated by agents that cause systemic and intrarenal vasoconstriction. Recently oxidative stress has been proposed as the cause of hypertension. Essential hypertensionpathogenesis and pathophysiology. Blood pressure unit, western infirmary, glasgow g11 6nt, united kingdom b academische ziekenhuis rotterdam, rotterdam 3002, the netherlands it is proposed that essential hypertension is an exaggeration of the tendency for. In vitro and in human studies support this hypothesis.
A clearer understanding of the pathogenesis of hypertension will probably lead to more highly targeted therapies and to greater reduction in hypertension related cardiovascular disease morbidity than can be achieved with current empirical treatment. Possible role of oxidative stress in the pathogenesis of. The pathogenesis of essential hypertension is still unknown, although progress toward an answer has been made in the past 20 years. Essential hypertension, a rise in blood pressure of undetermined cause, includes 90% of all hypertensive cases and is a highly important public health challenge that remains, however, a major modifiable cause of morbidity and mortality. Essential, primary, or idiopathic hypertension is defined as high bp in which secondary causes such as renovascular disease, renal failure, pheochromocytoma, aldosteronism, or other causes of secondary hypertension or mendelian forms monogenic are not present. However, these studies have indicated neurogenic, endocrine anterior pituitaryadrenal. The kidney is both the contributing and the target organ of the hypertensive processes, 1 and the disease involves the interaction of multiple organ systems and numerous mechanisms of independent or interdependent pathways. Essential hypertension affects 25% of the worlds population and is a major cause of stroke, congestive heart failure, endstage renal disease, and myocardial infarction. Population studies suggest the blood pressure bp is a continuous. Treatment of uncontrolled hypertension reduces the risks of mortality and of cardiac, vascular, renal, and cerebrovascular complications. Smirk the subject matter of lectures delivered as visiting professor of medicine at the british postgraduate medical school, hammersmith. Vikrant and others published essential hypertensionpathogenesis and pathophysiology find, read and cite all. Blood pressure is a major cardiovascular risk factor and also a classic quantitative genetic trait. Essential hypertension accounts for 90% of cases of hypertension.
Factors that play an important role in the pathogenesis of hypertension include genetics. The pathogenesis of secondary hypertension typically includes accompanying medical conditions, a sedentary lifestyle, an unhealthy diet, and structural defects. In the remainder, however, no clear single identifiable cause is found and their condition is labelled essential hypertension. Pathophysiology and treatment international online.
Psychological stress in pathogenesis of essential hypertension. There is still much uncertainty about the pathophysiology of hypertension. Genetics and pathophysiology of essential hypertension. The potent role of increased sympathetic tone in pathogenesis. Essential tremor essential tremor is characterized by a postural andor kinetic tremor and is one of the most common tremor disorders in the world.
What is the pathogenesis of essential hypertension high blood. Pathogenesis of essential hypertension jama jama network. There is a strong positive and continuous correlation between bp and the risk of cvd stroke, myocardial infarction, heart failure, renal disease, and mortality, even in the normotensive range. Pathogenesis of hypertension jacobi medical center. This form of hypertension cannot be cured, but it can be controlled. Pathogenesis of essential hypertension sciencedirect. Genetic factor may play an important role in the development of essential hypertension.
780 1463 256 1381 133 144 98 646 741 1011 691 1256 487 1202 11 1002 1053 1270 1113 930 667 1464 854 486 1144 1344 1067 89 932 1070 191 810 852 1263 83 205 582 303 1061 205 1459 497 25