Hypertension is the medical term for high blood pressure (BP)
Symptoms may come from secondary causes, concomitant diseases, or from target organ damage (TOD)
Assessment with lab tests and imaging may be done to exclude secondary causes, additional cardiovascular risk factors, or TOD
Epidemiology
The World Health Organization (WHO) estimated hypertension to occur in 1.28 billion adults aged 30-79 years old and â…” of these are living in low- and middle-income countries
Global prevalence of hypertension using the 2017 American College of Cardiology (ACC) and American Heart Association (AHA) definition of hypertension was estimated in 2019 at 1.3 billion
About 46% of adults with hypertension are not aware that they have hypertension
About 42% of adults with hypertension are diagnosed and managed, and only approximately 21% (1 in 5 adults) have controlled hypertension
Pathophysiology
Due to multiple factors including neural and chemical disorders, alterations of vascular caliber and elasticity, cardiovascular (CV) reactivity, blood volume and viscosity
BP maintenance is complex and involves several physiological mechanisms including arterial baroreceptors, the renin-angiotensin-aldosterone system, atrial natriuretic peptide, endothelins, and mineralocorticoid and glucocorticoid steroids, which together manage the degree of vasoconstriction or vasodilation within the systemic circulation, and the retention of water and sodium to maintain adequate circulating blood volume and a dysfunction in any of these processes can lead to hypertension development
Sympathetic neural activation modulates hypertension by enhancing vasoconstriction and vascular remodeling, producing renal renin via beta 1 adrenergic receptors in the juxtaglomerular apparatus and increasing renal sodium resorption and inflammation
