Endocrine hypertension

Hypertension is an extremely common disorder, affecting 15% to 20% of the population.  More than 95% is of unknown etiology, termed primary or essential hypertension.

Patients who develop hypertension before the age of 30 who have a strong family history of hypertension, adrenal tumors, or develop a low potassium level (hypokalemia) should be screened for endocrine hypertension.

Various endocrine disorders may lead to the development of mild or severe hypertension and the elevation of blood pressure can be either permanent or only transient.

There are several causes of endocrine hypertension with the most common forms being renal artery stenosis, primary aldosteronism, and pheochromocytoma.

Pheochromocytoma are tumors from the chromaffin cells located in the adrenal medulla that produce catecholamines.

Pheochromocytoma can be detected with high sensitivity and specificity using urine and plasma catecholamine measurements.
Endocrine hypertension

What is primary hypertension?

There are two main categories of hypertension: primary hypertension and secondary hypertension. Primary hypertension, also known as essential hypertension, is responsible for 90% to 95% of all hypertension. 

Secondary hypertension accounts for the remaining percentage.

The genesis of primary hypertension is multifactorial and complex. Primary hypertension usually begins insidiously as a benign disease, slowly progressing to malignant state.

A simplistic explanation of the pathogenesis is that there is specific mechanism appear to be involved in the development of primary hypertension: altered regulation of the sympathetic nervous system, abnormalities of the rennin-angiotensin- aldosterone system, salt sensitivity, as well as other vascular and hormonal factors. 

Carefully managed treatment, which may include lifestyle modification and drug therapy, improves the prognosis. Untreated, it carries a high mortality rate.

Risk factors associated with the development of primary hypertension include elevated blood lipid levels, smoking, diabetes, age older than 60 years, gender and family history of cardiovascular disease.

The majority of patients who developed primary hypertension do so between 20 to 50 years of age. 

Primary hypertension has a strong link with obesity and insulin resistance and it is greater in those patients with central obesity.

Obesity and the concomitant resultant hyperinsulinemia stimulate the sympathetic nervous system, thereby contributing to hypertension.
What is primary hypertension?