Primary Hypertension Overview

Primary or essential hypertension, marked by a gradual onset and minimal, if any, symptoms, stands as the most prevalent type of high blood pressure.

The origins of primary hypertension are complex, involving a intricate interplay of various factors that influence total peripheral resistance, ultimately giving rise to primary hypertension.

Factors such as heredity, salt intake, stress, sleep disorders/apnea, and obesity may be associated with primary hypertension.

Typically, primary hypertension is initially identified during a routine physical examination, with patients often exhibiting no discernible symptoms.

While some individuals may describe symptoms related to hypertension, including headaches, facial flushing, nosebleeds, nervousness, dizziness, fatigue, palpitations, and chest discomfort, these symptoms and their intensity generally do not correlate well with blood pressure levels.

Primary hypertension remains asymptomatic until complications arise.
Primary Hypertension Overview

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

Aetiology of primary hypertension

Aetiology of Primary Hypertension Although pathogenesis of essential or primary hypertension is uncertain, specific mechanisms appear to be involved in the development of primary hypertension: altered regulation of the sympathetic nervous system, abnormalities of the enin-renin-angiotensin-aldosterone system, salt sensitivity as well as other vascular and hormonal factors.

In addition to these multiple physiologic abnormalities diet, environment, other lifestyle fantoms and most certainly genetics frequently play a role in the development of hypertension.

Among the risk factors fro primary hypertension
*Age
*Alcohol
*Tobacco diabetes mellitus
*Elevated drum lipids
*Excess dietary sodium
*Gender Family history
*Obesity ethnicity
*Sedentary lifestyle
*Socioeconomic status
*Stress

Once diagnosed, the treatment of essential hypertension is often multifaceted and will depend on the severity and responsiveness of the particular patient to various therapies. Management of the hypertensive patient should always include some modification of lifestyle and diet. Aetiology of Primary 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?