Clinical ReviewABC of hypertension

BMJ 2001; 322 doi: http://dx.doi.org/10.1136/bmj.322.7291.912 (Published 14

April 2001)Cite this as: BMJ 2001;322:912
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Gareth Beevers,
Gregory Y H Lip,
Eoin O'Brien
There is still much uncertainty about the pathophysiology of hypertension. A
small number of patients (between 2% and 5%) have an underlying renal or
adrenal disease as the cause for their raised blood pressure. In the
remainder, however, no clear single identifiable cause is found and their
condition is labelled essential hypertension. A number of physiological
mechanisms are involved in the maintenance of normal blood pressure, and
their derangement may play a part in the development of essential
hypertension.
This article has been adapted from the newly published 4th edition of ABC of
Hypertension. The book is available from the BMJ bookshop and at
http://www.bmjbooks.com/
The relative frequency of primary and secondary hypertension

It is probable that a great many interrelated factors contribute to the raised

blood pressure in hypertensive patients, and their relative roles may differ
between individuals. Among the factors that have been intensively studied
are salt intake, obesity and insulin resistance, the renin-angiotensin system,
and the sympathetic nervous system. In the past few years, other factors
have been evaluated, including genetics, endothelial dysfunction (as
manifested by changes in endothelin and nitric oxide), low birth weight and
intrauterine nutrition, and neurovascular anomalies.

Physiological mechanisms involved in development of essential

hypertension
Cardiac output
Peripheral resistance
Renin-angiotensin-aldosterone system
Autonomic nervous system

Other factors:
Bradykinin
Endothelin
EDRF (endothelial derived relaxing factor) or nitric oxide
ANP (atrial natriuretic peptide)
Ouabain

Cardiac output and peripheral resistance

Maintenance of a normal blood pressure is dependent on the balance
between the cardiac output and peripheral vascular resistance. Most patients
with essential hypertension have a normal cardiac output but a raised
peripheral resistance. Peripheral resistance is determined not by large
arteries or the capillaries but by small arterioles, the walls of which contain
smooth muscle cells. Contraction of smooth muscle cells is thought to be
related to a rise in intracellular calcium concentration, which may explain the
vasodilatory

Hypertension (high blood preassure) also called silent killer is a chronic medical
condition characterized by constant elevation of the systolic or diastolic pressure
above 140/90 mmHg. Because hypertension is almost without symptoms except for
headaches in some patients, it hides in the body without knowing it.

Types of Hypertension
A person with blood pressure levels distinctly above average and with no evident cause
for the raise level is referred as having essential or primary hypertension. This type
accounts for about 90 percent of all cases of hypertension. The remaining 10 percent
of hypertensive people suffer is called secondary hypertension, which means that a
specific cause for raised blood pressure levels can be identified. The younger the
hypertensive patient, the more likely it is an identifiable cause for the condition may be
found.
Hypertension usual organ affected

Heart leads to heart attack and heart failure

Brain leads to stroke and internal bleeding

Kidneys leads to renal failure and the need for dialysis

Eyes leads to blindness

Peripheral Blood Vessels leads to peripheral vascular diseases like

limping (claudication) and tissue death (gangrene).Left untreated, the disease
will progress and will eventually lead to death.

Hypertension Pathophysiology & Disease Process(Diagram)

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