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Pathophysiology of Hypertension

Pathogenesis of Essential Hypertension

The pathogenesis of essential hypertension is multifactorial and highly complex. 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. Factors that play an important role in the pathogenesis of hypertension include genetics, activation of neurohormonal systems such as the sympathetic nervous system and renin-angiotensin-aldosterone system, obesity, and increased dietary salt intake.

Arterial hypertension is the condition of persistent elevation of systemic blood pressure (BP). BP is the product of cardiac output and total peripheral vascular resistance. Multiple factors are involved in short-term and long-term regulation of BP for adequate tissue perfusion; these include the following:

Cardiac output and circulatory blood volume

Vascular caliber, elasticity, and reactivity

Humoral mediators

Neural stimulation

Over the course of its natural history, essential hypertension progresses from occasional to established hypertension. After a long, invariable, asymptomatic period, persistent hypertension develops into complicated hypertension, in which target organ damage to the aorta and small arteries, heart, kidneys, retina, and central nervous system is evident.

The progression of essential hypertension begins with prehypertension in persons aged 10-30 years (by increased cardiac output); then advances to early hypertension in persons aged 20-40 years (in which increased peripheral resistance is prominent); then progresses to established hypertension in persons aged 30-50 years; and finally advances to complicated hypertension in persons aged 40-60 years.

Go to Hypertension, Hypertensive Heart Disease, and Hypertensive Emergencies for more complete information on these topics.

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