With up to 95% of patients no cause of elevated blood pressure can be identified. This primary or essential hypertension is multifactorial and has not yet entirely been clarified. A genetic component plays a role, different mutations are known, but it is not itself a disease that can be explained (polygenic cause). In addition, extremely rare forms of hypertension are known, based on the change of a single gene (monogenic). For a genetic cause is also indicated that the majority of hypertensive patients had a positive family history, i.e. other family members are also affected. Several lifestyle factors (constitution, salt, alcohol and tobacco consumption, stress, hormonal reasons) play a strong role in perpetuating.
For the pathogenesis of primary hypertension, there are several theories. Often, hypertension occurs in the context of a metabolic syndrome. The order has associated insulin resistance and consecutive hyperinsulinemia while it gives two mechanisms for blood pressure. On One hand, insulin causes a direct salt and water retention in the kidney, other insulin has a proliferative effect on vascular smooth muscle cells, leading to an increase in resistance in the bloodstream.
Disruption of ion transport across the membrane of vascular cells is responsible for an increased responsiveness of arterial resistance vessels. In patients with arterial hypertension is still often a decreased activity of endothelial Nitric oxide synthase with decreased NO production (nitric oxide) detected. These changes seem to play a role in hypertension, which is not fully understood. The RAAS in primary hypertension, however, seems to play only a minor role.
Primary hypertension is a diagnosis of exclusion and may only be made when other causes can be excluded. They must be dealt with long-lasting or life with antihypertensive action.
More about Hypertension from the author, Adithya Adi: Description on Primary, Secondary hypertensionPrevention and Diet during Hypertension
