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Pathophysiology of hypertension
The pathophysiology of hypertension is an area which attempts to explain mechanistically the causes of hypertension, which is a chronic disease characterized by elevation of blood pressure. Hypertension can be classified by cause as either essential or secondary. Essential hypertension indicates that no specific medical cause can be found to explain the hypertension. About 90-95% of hypertension is essential hypertension.〔(【引用サイトリンク】title=Hypertension: eMedicine Nephrology )〕 Secondary hypertension indicates that the hypertension is a result of a specific underlying condition with a well-known mechanism, such as chronic kidney disease, narrowing of the aorta or kidney arteries, or endocrine disorders such as excess aldosterone, cortisol, or catecholamines. Persistent hypertension is a major risk factor for hypertensive heart disease, coronary artery disease, stroke, aortic aneurysm, peripheral artery disease, and chronic kidney disease. The pathophysiology of essential hypertension remains an area of active research, with many theories which are not mutually exclusive.
Cardiac output and peripheral resistance are the two determinants of arterial pressure. Cardiac output is determined by stroke volume and heart rate; stroke volume is related to myocardial contractility and to the size of the vascular compartment. Peripheral resistance is determined by functional and anatomic changes in small arteries and arterioles.
==Genetics==
Single gene mutations can cause Mendelian forms of high blood pressure; ten genes have been identified which cause these monogenic forms of hypertension.〔 These mutations affect blood pressure by altering renal salt handling.〔 name="pmid10373210">〕 There is greater similarity in blood pressure within families than between families, which indicates a form of inheritance, and this is not due to shared environmental factors. With the aid of genetic analysis techniques, a statistically significant linkage of blood pressure to several chromosomal regions, including regions linked to familial combined hyperlipidemia, was found. These findings suggest that there are many genetic loci, in the general population, each with small effects on blood pressure. Overall, however, identifiable single-gene causes of hypertension are uncommon, consistent with a multifactorial cause of essential hypertension.〔
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