Eitiology of Hypertension -various aspects Hypertension is mainly either Essential hypertension or Secondary hypertension
Essential hypertension is a major risk factor for several cardiovascular diseases especially if early diagnosis and treatment is not done.This signifies the importance of health check ups. Most people say that they do not have any problem, so why to do not have any problem, so why to do health check ups, but mild hypertension does not have any signs and symptoms. It is only during routine check up, that it is detected.
By routine check up we mean– blood pressure assessment, ECG, random blood sugar, lipid profile, serum creatinine, SGOT ,SGPT. The cause of essential hypertension is not known-this thing is partially true and partially untrue. Investigations can give some clue towards the eitiology of hypertension.
The reason for this is that we have little information on genetic variations or genes that are overexpressed or underexpressed as well as regarding the intermediary phenotypes that they regulate to cause elevation of blood pressure.
Certain genes in DNA are linked to a higher risk for hypertension. Almost nothing can be done to change our genetics, it’s important to know about family history -all these things are linked to the eitiology of hypertension .If family members have hypertension, you may also be at greater risk of developing hypertension. There are also certain physical conditions that you may be born with that can raise your blood pressure like problems with the aorta and other blood vessels, which are usually diagnosed in childhood.
Eitiology of hypertension-various factors that increase the blood pressure –
(1) obesity,
Obesity can cause hypertension by causing fluid retention.
Obesity can do the following things –
Harm the kidneys
Problems with hormone balance
Cause inflammation and injury to the blood vessels
Contribute to sleep apnea, which is a risk factor for hypertension
(2) insulin resistance,
(3) high alcohol intake,
(4) high salt intake (in salt-sensitive patients),(5) aging and perhaps
(6) sedentary lifestyle,
(7) stress,
(8) low potassium intake, and
(9) low calcium intake.
(10)-Gender -Males under the age of 60 are more likely to have hypertension than women. After 60, females start to take the lead.
(11)-Older age
Older people tend to experience higher rates of hypertension. For example, nearly 75% of people ages 65 and older are estimated to have hypertension. In contrast, only about 27% of men and 12% of women in their 20s have hypertension.
(12)Race –
Black and South Asian Americans are more likely to have hypertension compared with other racial groups.
(13)Eating too much salt(sodium chloride)
Taking too much of salt in diet may raise your risk of hypertension. Processed foods and restaurant food are having more salt content. Less than 2300 mg of sodium per day should be consumed.
Too much salt can raise the risk of stroke, heart problems, and other health issues.All these above things are important factors in the eitiology of hypertension.
(14)-Some people may have more sensitivity to salt. –
Adults over 65
Black Americans
People with obesity
People living with diabetes
People with kidney problems
Information is not available on which genes cause BP to vary . Inherited BP can range from low normal BP to severe hypertension.
Eating too little potassium
Not enough potassium can cause problems. We get potassium from fruits and vegetables. Minimum 4700 mg of potassium per day should be consumed
Always consult your physician (MD General Medicine) before trying potassium supplements.
Sedentary (inactive) lifestyle
The less active you are, the higher your risk of developing high blood pressure. Regular physical exercise should be done.
Chronic, excessive alcohol consumption
Excessive alcohol use is a significant cause of high blood pressure. Drinking too much alcohol can also raise your cholesterol and triglyceride levels. Alcohol intake should be less than two drinks a day for men and less than one drink a day for women.Alchohol is an important factor in the eitiology of hypertension.
. Medication side effects
Certain medications can raise your blood pressure as a side effect. If your blood pressure goes up suddenly then you need to consult your physician (MD General Medicine) doctors as a simple alteration in your medications can make a difference.
Smoking
Smoking contributes to hypertension, especially in men over the age of 45.
High blood sugar
If an individual has high blood sugar, for prolonged periods, he may be at risk for developing hypertension later in life.
Some medical conditions can cause hypertension. In some of these cases, treating problems can treat hypertension. Following are a few examples of this-
Kidney problems
The kidneys are responsible for excretion of waste products through the urine. When the kidneys don’t work properly they are less able to flush out fluid and toxins. This can lead to hypertension .Narrowing of arteries to the kidneys can lead to hypertension. Blood and urine tests , ultrasound, CT-Scan imaging testing is needed to confirm the diagnosis.Other factors in eitiology of hypertension are-
Obstructive sleep apnea
Many individuals with sleep apnea will develop hypertension. If you experience disrupted sleep or heavy snoring, it is important to consult a chest physician. A sleep study is necessary for diagnosis of sleep apnea. and SOS a breathing device (known as a CPAP machine) or a special mouth guard to use at night. Treatment of sleep apnea may help to bring hypertension under control .
Hormonal changes
Many hormones work together to control blood pressure. When the balance of these hormones is not maintained blood pressure is elevated. Problems with the thyroid gland and adrenals can lead to elevated blood pressure. With a few simple blood tests, like T3,T4,TSH your physican help you confirm if your hormone levels are out of balance.
Pegnancy and birth control pills may also affect blood pressure for some women, especially when other risk factors are present.Apart from primary hypertension some other factors for eitiology of hypertension are are mentioned below-
Secondary hypertension –
The role of this in the eitiology of hypertension is as follows-causes of secondary hypertension in children are renal parenchymal disease and coarctation of the aorta. In adults 65 years and older, atherosclerotic renal artery stenosis, renal failure, hypothyroidism are some of the causes of secondary hypertension. In such cases Nephrologist ,Endocrinologist should be consulted.
Secondary hypertension should be considered in the presence of suggestive symptoms and signs, such as severe or resistant hypertension, age of onset younger than 30 years (especially before puberty), malignant or accelerated hypertension, and an acute rise in blood pressure from previously stable readings. Certain investigations make the eitiology of hypertension clear.Additionally, renovascular hypertension should be considered in patients with an increase in serum creatinine of at least 50% occurring within one week of initiating angiotensin-converting enzyme inhibitor treatment or angiotensin receptor blocker treatment
Severe hypertension is seen in unilateral smaller kidney or difference in kidney size greater than 1.5 cm; or recurrent flash pulmonary edema.
Other underlying causes of secondary hypertension include hyperaldosteronism, obstructive sleep apnea, pheochromocytoma, Cushing syndrome, thyroid disease, coarctation of the aorta, and use of certain medications.
First the patient consults a physician, who then directs the patient for higher opinion to Nephrologist ,Endocrinologist, depending on the case.
Secondary hypertension is a type of hypertension with an underlying and potentially reversible cause. It contributes to only a small fraction (5% to 10%) of eitiology of hypertension. Extensive testing for secondary hypertension is not advisable in all patients with hypertension because of cost, low yield, and the potential for false-positive results; however, testing is advisable in patients younger than 30 years.
Factors like obesity and high alcohol and salt intake which increase the blood pressure are called “hypertensinogenic factors.” Some of these factors have inherited, behavioral, and environmental components.
Inherited BP could be considered core BP, whereas hypertensinogenic factors cause BP to increase above the range of inherited BPs, thus creating 4 main possibilities:(1) patients who have inherited BP in the optimal category (120/80 mm Hg); if 1 or more hypertensinogenic factors ,factors for eitiology of hypertension are added, BP would probably increase but remain in the normal range (135/85 mm Hg);(2) patients who have inherited BP in the normal category (130/85 mm Hg)
if 1 or more hypertensinogenic factors are added, BP will probably increase to the high normal range (130 to 139/85 to 89 mm Hg) or
to stage 1 of the hypertensive category (140 to 159/90 to 99 mm Hg)
(3) patients who have inherited BP in the high normal category (130 to 139/85 to 89 mm Hg); if 1 or more hypertensinogenic factors,factors for eitiology of hypertension are added, BP will increase to the hypertensive range (140/90 mm Hg
(4) patients who have inherited BP in the hypertensive range; addition of 1 or more hypertensinogenic factors will make hypertension more severe, changing it from stage 1 to stage 2 or 3 .
Theoretically, in a population unaffected by hypertensinogenic factors, BP will have a normal distribution; it will be skewed to the right and will have a narrow base or less variance .
When 1 hypertensinogenic factor,factor for eitiology of hypertension is added to this population, such as increased body mass, one would expect the normal distribution curve to be further skewed to the right; consequently the base will be wider (more variance) and the curve will be flatter .
If a second hypertensinogenic factor such as alcohol intake is added to increased body mass, the curve will be skewed more to the right and the variance will increase further, with more subjects classified as hypertensive .
Discovering which genetic variations place BP on the left or right side of the distribution curve is of both theoretical and practical importance. Recognition of the hypertensinogenic factors may allow nonpharmacological prevention, treatment, or cure of hypertension.
Hypertensinogenic factors ,factors for eitiology of hypertension such as obesity, insulin resistance, or high alcohol intake have an important genetic component.
Furthermore, there are interactions between genetic and environmental factors that influence intermediary phenotypes such as sympathetic nerve activity, the renin-angiotensinaldosterone and renal kallikrein-kinin systems .
Ultimately we have to stress that importance of health check ups is high. If early diagnosis and treatment is made a lot can be done to prevent disastrous complications.
