Hypertension is also known as high blood pressure which is a medical condition in which a person?s blood pressure in arteries in the body remains chronically elevated. Many types of hypertension are there like systemic or arterial hypertension and portal hypertension and others but the word Hypertension in general implies to systemic or arterial hypertension.

 

There are two types of hypertension that are usually defined i.e. Primary and Secondary Hypertension. Primary Hypertension is also known as essential hypertension. Primary hypertension or essential hypertension will not have any cause predefined while the secondary hypertension will be secondary to any other medical causes like some tumors or some systemic diseases. More than 90% patients will have essential hypertension which means that no cause will be found out. Hypertension is one of the risk factors for strokes, heart attacks, heart failure and arterial aneurysm, and it leads to chronic renal failure. Moderate elevation of arterial blood pressure can even lead to shortened life expectancy which decreases further with the increase in the average blood pressure.

 

Essential hypertension

Hypertension is one of the most common disorders.  It is the commonest type and it generally affects 90 of hypertensive patients. Risk factors for the essential hypertension are sedentary lifestyle, obesity, salt, alcohol intake, smoking and vitamin D deficiency. It is also related to increased age and to some inherited genetic mutations. Family history of hypertension will increase the risk of a person getting hypertension. Elevated renin is one of the risk factor which is an enzyme secreted by the juxtaglomerular apparatus of the kidney and linked with aldosterone.

 

Secondary hypertension

Secondary hypertension is results from an identifiable cause. The recognition of this type of secondary hypertension is necessary as the management of this type of hypertension will depend on the underlying cause like Cushing's syndrome. Cushing's syndrome is a condition where both adrenal glands overproduce the hormone cortisol which leads to hypertension. More than 80% of patients with Cushing's syndrome have hypertension.

 

Other causes

• Mineral corticoid excess syndrome - is an autosomal recessive disorder results from mutations in gene encoding 11β-hydroxysteroid dehydrogenase which normal patient inactivates circulating cortisol to the less-active metabolite cortisone
• Prolonged ingestion of liquorice
• Conn's disease - It is an adrenocortical tumor which causes excess release of aldosterone that leads to hypertension
• Polycystic kidney disease - It is characterized by the presence of multiple cysts. It can be autosomal dominant or autosomal recessive in nature.  It leads to progressive cyst development and bilaterally enlarged kidneys with multiple cysts, with concurrent development of hypertension, renal insufficiency and renal pain.
• Chronic glomerulonephritis - It is characterized by inflammation of the glomeruli, or small blood vessels in the kidneys.
• Renal arterial hypertension - It is known as renovascular hypertension due to decreased perfusion of renal tissue due to stenosis of a main or branch renal artery activates the renin-angiotensin system.
• Juxtaglomerular cell tumor
• Wilms' tumor
• Renal cell carcinoma
• Pheochromocytoma - It leads to increased secretion of catecholamines such as epinephrine and norepinephrine, causing excessive stimulation of adrenergic receptors, which results in peripheral vasoconstriction and cardiac stimulation.
• Medications - Some medications like NSAIDs and steroids can cause hypertension. Rebound Hypertension is due to sudden withdrawal of various antihypertensive medications. Medications commonly associated with rebound hypertension include centrally-acting antihypertensive agents, such as clonidine and beta-blockers.
• Pregnancy - It is associated with increased blood pressure and it may lead to certain complications of pregnancy like pre-eclampsia, HELLP syndrome and eclampsia.
• Sleep disturbances - like sleep apnea, binswanger's disease and other neurological syndromes are associated with hypertension.