Pathogenesis of hypertension

In case of essential hypertension, no specific cause is clearly understood at present. 
However, investigators proposed the contribution of (a) the kidney, (b) the peripheral resistance and possibly(c) the sympathetic nervous system in the etiology of HTN. In reality the problem is multifactorial. Genetic factor is an important determinant, being more common in some ethnic group, particularly Black Americans and Japanese. Important environmental factors include-

◊ High salt intake

◊ Excess alcohol consumption

◊ Obesity

◊ Lack of exercise

◊ impaired intrauterine growth

◊ Stress

In about 5% of unselected cases, hypertension can be shown to be a consequence of a specific disease or abnormality leading to sodium retention or peripheral vasoconstriction. As such, the following diseases can cause HTN and are called Secondary HTN:

◊ Renal disease

      Reno vascular disease

      Glomerulonephritis

      Poly cystic kidney disease

◊ Endocrine disease

      Chromatographic

      Primary hyperthyroidism

      Thyrotoxicosis

◊ Drugs

     Oral contraceptives

     Anabolic steroids

     Corticosteroid’

     NSAID

     Carbenexelone’

     Sympathomimetic

◊ Coarctation of the aorta
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