cardiovascular disorders
Hypertension
Etiology of Hypertension
Hypertension may be Primary (no specific cause—85% of cases) Secondary (an identified cause) Hemodynamics and physiologic components (eg, plasma volume, activity of the renin-angiotensin system) vary, indicating that primary hypertension is unlikely to have a single cause. Even if one factor is initially responsible, multiple factors are probably involved in sustaining elevated blood pressure (the mosaic theory). In afferent systemic arterioles, malfunction of ion pumps on sarcolemmal membranes of smooth muscle cells may lead to chronically increased vascular tone. Heredity is a predisposing factor, but the exact mechanism is unclear. Environmental factors (eg, dietary sodium, stress) seem to affect only people who are genetically susceptible at younger ages; however, in patients > 65 years, high sodium intake is more likely to precipitate hypertension. Common causes include Obesity None Primary Aldosteronism Obstructive Sleep Apnea (OSA) None Renal parenchymal disease (eg, chronic glomerulonephritis or Chronic Pyelonephritis , polycystic renal disease, lupus nephritis, Renovascular Hypertension None Other, much rarer, causes include Pheochromocytoma , Excessive alcohol intake and use of oral contraceptives are common reversible causes of hypertension. Also, use of sympathomimetics, nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids,cocaine, or licorice may contribute to worsening of blood pressure control. Although hypertension is common in patients with Diabetes Mellitus (DM) , diabetes is not considered a cause. 1.Brown JM, Siddiqui M, Calhoun DA, et al: The unrecognized prevalence of primary aldosteronism: A cross-sectional study.Ann Intern Med173(1):10–20, 2020. doi:10.7326/M20-0065 