Chronic hypertension causes

Hypertension Main page
Overview
Causes
Classification Primary Hypertension Secondary Hypertension Hypertensive Emergency Hypertensive Urgency
Screening

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Assistant Editor-In-Chief: Taylor Palmieri

Salt sensitivity

Sodium is the environmental factor that has received the greatest attention. Approximately 60% of the essential hypertension population is responsive to sodium intake. This is due to the fact that increasing amounts of salt in a person's bloodstream causes the body to draw in more water, increasing the pressure on the blood vessel walls. In addition to sodium, choride plays an important role as it causes volume expansion increasing blood pressure as sodium with combined with other anions does not increase blood pressure. Also salt sensitivity is known to be increased with increasing age, obesity, in African americans and in the metabolic syndrome.

Mechanisms

The proposed mechanism for salt-sensitvity is incraesed salt intake over a long period of time leads to impaired excretion of salt which causes hypertension. There may be several other pathways involved in the pathophysiology of salt-sensitivity leading to hypertension. Salt-sensitive patients are known to have a dysregulated renin-angiotensin pathway and patients show an abnormal vascular response to angiotensin II. Increased sodium re absorption, though not well understood, is mostly related abnormalities across Na-H proximal tubule channels, Na-K-Cl co-transporter across the thick ascending limb, Na-Cl distal tubule co-transporter and epithelial Na channels. Dietary deficiency in potassium is also known to trigger increased sodium sensitivity in patients in particular African-Americans, but the mechanism is still not clearly determined.

Role of renin

Renin is a hormone secreted by the juxtaglomerular cells of the kidney and linked with aldosterone in a negative feedback loop. The range of renin activity observed in hypertensive subjects tends to be broader than in normotensive individuals. In consequence, some hypertensive patients have been defined as having low-renin and others as having essential hypertension. Low-renin hypertension is more common in African Americans than Caucasians and may explain why they tend to respond better to diuretic therapy than drugs that interfere with the renin-angiotensin system.

High Renin levels predispose to Hypertension: Increased Renin --> Increased Angiotensin II --> Increased Vasoconstriction, Thirst/ADH and Aldosterone --> Increased Sodium Reabsorption in the Kidneys (DCT and CD) --> Increased Blood Pressure.

Insulin resistance

Insulin is a polypeptide hormone secreted by the pancreas. Its main purpose is to regulate the levels of glucose in the body antagonistically with glucagon through negative feedback loops. Insulin also exhibits vasodilatory properties. In normotensive individuals, insulin may stimulate sympathetic activity without elevating mean arterial pressure. However, in more extreme conditions such as that of the metabolic syndrome, the increased sympathetic neural activity may over-ride the vasodilatory effects of insulin. Insulin resistance and/or hyperinsulinemia have been suggested as being responsible for the increased arterial pressure in some patients with hypertension. This feature is now widely recognized as part of syndrome X, or the metabolic syndrome.

Sleep apnea

Sleep apnea is a common, under-recognized cause of hypertension. It is best treated with UPPP, tonsilectomy, adenoidectomy, sinus surgery, or weight loss, nocturnal nasal positive airway pressure, or the Mandibular advancement splint (MAS).

Genetics

Hypertension is one of the most common complex disorders, with genetic heritability averaging 30%. Data supporting this view emerge from animal studies as well as in population studies in humans. Most of these studies support the concept that the inheritance is probably multifactorial or that a number of different genetic defects each have an elevated blood pressure as one of their phenotypic expressions.

More than 50 genes have been examined in association studies with hypertension, and the number is constantly growing.

Causes of Secondary Hypertension

Only in a small minority of patients with elevated arterial pressure, can a specific cause be identified. These individuals will probably have an endocrine or renal defect that, if corrected, could bring blood pressure back to normal values. Common causes include:

Renal hypertension

Hypertension produced by diseases of the kidney. This includes diseases such as polycystic kidney disease or chronic glomerulonephritis. Hypertension can also be produced by diseases of the renal arteries supplying the kidney. This is known as renovascular hypertension; it is thought that decreased perfusion of renal tissue due to stenosis of a main or branch renal artery activates the renin-angiotensin system.

Adrenal hypertension

Hypertension is a feature of a variety of adrenal cortical abnormalities. In primary aldosteronism there is a clear relationship between the aldosterone-induced sodium retention and the hypertension.

In patients with pheochromocytoma increased secretion of catecholamines such as epinephrine and norepinephrine by a tumor (most often located in the adrenal medulla) causes excessive stimulation of [adrenergic receptors], which results in peripheral vasoconstriction and cardiac stimulation. This diagnosis is confirmed by demonstrating increased urinary excretion of epinephrine and norepinephrine and/or their metabolites (vanillylmandelic acid).

Diet

The North American diet that is high in fat and salt has been proven to exacerbate hypertension. A study in the U.S. found that patients placed on a strict vegetarian diet showed a significant benefit to their condition over the one year. Certain medications, especially NSAIDS (Motrin/ibuprofen) and steroids can cause hypertension. Imported licorice (Glycyrrhiza glabra) inhibits the 11-hydroxysteroid hydrogenase enzyme (catalyzes the reaction of cortisol to cortison) which allows cortisol to stimulate the Mineralocorticoid Receptor (MR) which will lead to effects similar to hyperaldosteronism, which itself is a cause of hypertension.

Age

Over time, the number of collagen fibers in artery and arteriole walls increases, making blood vessels stiffer. With the reduced elasticity comes a smaller cross-sectional area in systole, and so a raised mean arterial blood pressure.

By organ system

Cardiovascular	Aortic regurgitation, Aortic dissection, Acute severe vascular damage, Adams Nance syndrome , Aneurysm, Aortic coarctation , Aortic stenosis, Arterial occlusive disease, progressive - -- heart defects -- bone fragility -- brachysyndactyly , Arteriosclerosis, Atheroma, Avasthey syndrome , Carotid paraganglioma ,Congenital Mitral stenosis , Eisenmenger's Syndrome , Fibromuscular dysplasia of arteries , Grange syndrome , Hemangiomatosis - familial pulmonary capillary, Hypertensive heart disease , Pulmonary artery agenesis , Vasculitis , Patent ductus arteriosus, Third degree AV block
Chemical / poisoning	Acetaldehyde , Aristolochic acid poisoning , Arizona Bark Scorpion poisoning , Black widow spider envenomation , Cadmium poisoning, Cocaine poisoning , Ecstasy abuse , Ginseng , Heavy metal poisoning, Indian Tobacco poisoning, Jimsonweed poisoning , Lead poisoning , Lockwood-Feingold syndrome , Mustard tree poisoning , Nicotine addiction , Pseudoephedrine poisoning , Silicosis , Toxic mushrooms -- Psychedelic
Dermatologic	No underlying causes
Drug Side Effect	Almotriptan, Dihydroergotamine, Ergotamine, Frovatriptan, Isometheptene, Rizatriptan, Sumatriptan, Zolmitriptan, Amitriptyline, Cyclosporine, Desipramine, Dexamethasone sensitive hypertension, Doxepin, Ephedrine poisoning, Glucocorticoid resistance , Imipramine, Nasal decongestants, Nortriptyline, Combined oral contraceptive pill, Phencyclidine, Phenylpropanolamine, Protriptyline, Sedative dependence, Serotonin toxicity, Steroid abuse
Ear Nose Throat	Nephrosis -- deafness -- urinary tract -- digital malformation , Fitzsimmons-Walson-Mellor syndrome
Endocrine	Carcinoid Syndrome, Acromegaly , Adrenal incidentaloma , Alcohol-induced pseudo-Cushing syndrome , Apparent mineralocorticoid excess , Congenital adrenal hyperplasia - 11-Beta-hydroxylase deficiency, Congenital adrenal hyperplasia - 17-alpha-hydroxylase deficiency, Conn's syndrome, Cushing's disease, Cushing's syndrome , Diabetes, Familial Cushing syndrome , Graves Disease , Hyperadrenalism , Hyperparathyroidism , Hyperpituitarism , Hyperthyroidism, Hypothyroidism,Isolated secretion of corticosterone, Isolated secretion of deoxycorticosterone, Lobelia poisoning , Mineralocorticoid excess, Multiple endocrine neoplasia type 1, Myxoedema, Pheochromocytoma, Primary aldosteronism, Primary cortisol resistance, Pseudohyperaldosteronism , Pseudohypoaldosteronism , Schroeder syndrome 1 , Hyperthyroidism, Hypoglycemia, Isolated secretion of 18-hydroxy-deoxycorticosterone, Renin-secreting tumors
Environmental	No underlying causes
Gastroenterologic	Hepatorenal tyrosinemia , Pancreatitis, Retroperitoneal Fibrosis
Genetic	11-Hydroxylase deficiency, 17-Hydroxylase deficiency, Cockayne syndrome , Down Syndrome , Fabry's Disease , Isolated secretion of 18-hydroxy-deoxycorticosterone, Pierre Robin's sequence , Senior-Loken Syndrome, Turner Syndrome , Vater-like syndrome with pulmonary hypertension, abnormal ears and growth deficiency , Von Hippel-Lindau Disease , Werner syndrome , Williams Syndrome , Gaucher disease type 3 , Mucopolysaccharidosis type I Hurler syndrome
Hematologic	Atypical Hemolytic uremic syndrome, Catastrophic Antiphospholipid Syndrome , Essential mixed Cryoglobulinemia , Faye-Petersen-Ward-Carey syndrome , Hemolytic uremic syndrome , Hypereosinophilic syndrome , Liddle's syndrome, Multicentric Reticulohistiocytosis , Polycythemia , Thromboembolism , Thrombotic thrombocytopenic purpura
Iatrogenic	No underlying causes
Infectious Disease	Poliomyelitis, Meningitis, Post streptococcal glomerulonephritis , Renal tuberculosis, Nipah virus encephalitis
Musculoskeletal / Ortho	Acrodynia , Allain Babin Demarquez syndrome , Familial Osteodysplasia - Anderson type, Paget's disease of bone , Grange syndrome , Faye-Petersen-Ward-Carey syndrome , Oculo skeletal renal syndrome , Thieffry and Sorrell Dejerine syndrome
Neurologic	Guillain-Barre Syndrome, Autonomic dysreflexia syndrome , Binswanger's Disease , Brain stem encephalitis, Central sleep apnea , Choroideremia -- hypopituitarism , Disequilibrium syndrome , Dysautonomia , Hereditary sensory and autonomic neuropathy 3 , Increased intracranial pressure, Neurofibromatosis syndrome Type II , Neurogenic hypertension , Nipah virus encephalitis , Obstructive sleep apnea , Sneddon Syndrome , Upper spinal cord lesions, Wolfram's disease, Meningitis, Polyradiculitis, Quadriplegia, Adams Nance syndrome , Glycine encephalopathy - classical neonatal form, Pituitary Cancer , Fitzsimmons-Walson-Mellor syndrome
Nutritional / Metabolic	Abdominal obesity metabolic syndrome , Acute intermittent porphyria , Congenital hepatic porphyria , Gaucher disease type 3, Glycine encephalopathy - classical neonatal form, Glycine synthase deficiency , Gouty nephropathy, Metabolic syndrome, Tyrosinemia , Von Gierke disease IB, Increased salt intake, Mucopolysaccharidosis type I Hurler syndrome, Fabry's Disease
Obstetric/Gynecologic	Eclampsia , Fowler-Christmas-Chapple syndrome , Gestational hypertension, HELLP syndrome , Ovarian dysgenesis, PCOS, Pregnancy toxemia /hypertension , Twin-Twin Transfusion Syndrome
Oncologic	Endothelin producing tumor, Adrenal Cancer , Familial Adrenal adenoma , Renal Cancer , Neuroblastoma Pituitary Cancer , Renin-secreting tumors, Rhabdoid tumor , Wilms' tumor , Adrenal incidentaloma , Familial renal cell carcinoma
Opthalmologic	Isolated Ectopia lentis, Oculo skeletal renal syndrome
Overdose / Toxicity	Amphetamine abuse
Psychiatric	Anxiety
Pulmonary	Asphyxia , Bronchopulmonary dysplasia, COPD , Goodpasture syndrome , Pulmonary cystic lymphangiectasis , Pulmonary embolism , Pulmonary fibrosis /granuloma , Pulmonary veno-occlusive disease , Pulmonary Lymphangiomatosis, Respiratory acidosis , Respiratory failure , Unilateral pulmonary agenesis , Hyperventilation, Obstructive sleep apnea , Wegener's granulomatosis
Renal / Electrolyte	Bartter's Syndrome, Dissection of the renal arteries, Acid-Base Imbalance , Acute Renal Failure , Albuminuria , Analgesic nephropathy syndrome , Autosomal dominant Polycystic kidney disease , Autosomal Recessive Polycystic Kidney Disease , Bilateral Renal artery stenosis , Bright's Disease , Chronic kidney disease , Chronic pyelonephritis, Congenital Membranous Glomerulonephritis, Congenital stenosis of renal artery, Congenital Hydronephrosis , Diffuse Mesangial sclerosis, Familial Renal cell carcinoma , Fitzsimmons-Walson-Mellor syndrome , Glomerulonephritis , Hereditary nephritis (X-linked), Hypoplastic kidney, IgA nephropathy , Kidney arteriovenous fistula , Kimmelstiel-Wilson disease, Lupus nephritis , Nephrocalcinosis , Nephrosclerosis , Nephrosis -- deafness -- urinary tract -- digital malformation , Nephrotic syndrome , Oculo skeletal renal syndrome , Pierson syndrome , Severe infantile Polycystic kidneys with Tuberous sclerosis , Post streptococcal glomerulonephritis , Renal artery thrombosis, Renal emboli, Renal segmental hypoplasia-induced Hypertension , Renal tuberculosis, Salcedo syndrome , Simple kidney cysts , Thieffry and Sorrell Dejerine syndrome , Urinary tract infections , Urinary tract obstruction, Vesicoureteral reflux , Wegener's granulomatosis , Gitelman's Syndrome, Hepatorenal tyrosinemia , Atypical Hemolytic uremic syndrome, Gouty nephropathy, Goodpasture syndrome
Rheum / Immune / Allergy	Autoimmune Vasculitis , Systemic lupus erythematosus, Diffuse systemic sclerosi , Polyarteritis nodosa , , Takayasu arteritis
Sexual	No underlying causes
Trauma	Electrical burns , Head injury, Skull fracture
Urologic	No underlying causes
Dental	No underlying causes
Miscellaneous	Acquired total Lipodystrophy , After Kidney transplantation, Age, Alcohol withdrawal, Amyloidosis , Bone cement implantation syndrome , Brachydactyly with hypertension, Carnevale-Canun-Mendoza syndrome , Codeine withdrawal , Collagen disease, Essential hypertension, Gram's syndrome , Hypothermia, Irradiation, Kashani-Strom-Utley syndrome , Lymphomatoid Granulomatosis , MSBD syndrome , Neuroleptic Malignant Syndrome , Obesity, Physical inactivity , Selye syndrome , Serotonin Syndrome , Shaken Baby Syndrome , Stress-Induced Hypertension , Type A personality, Vitamin D -- adverse effects, Wagener syndrome , Pain, Post-exercise, Transfusion of large blood volumes, White coat hypertension

By alphabetical order

Abdominal obesity metabolic syndrome Absence of pulmonary artery Acetaldehyde Acid-Base Imbalance Acquired total Lipodystrophy Acrodynia Acromegaly Acute intermittent porphyria Acute renal failure Acute severe vascular damage Adams Nance syndrome Adrenal Cancer Adrenal incidentaloma After Kidney transplantation Age Albuminuria Alcohol withdrawal Alcohol-induced pseudo-Cushing syndrome Allain Babin Demarquez syndrome Almotriptan Amitriptyline Amphetamine abuse Amyloidosis Analgesic nephropathy syndrome Aneurysm Angiotensin/rennin/aldosterone hypertension Anxiety Aortic coarctation Aortic regurtitation Aortic stenosis Apparent mineralocorticoid excess Aristolochic Acid poisoning Arizona Bark Scorpion poisoning Arterial occlusive disease, progressive - -- heart defects -- bone fragility -- brachysyndactyly Arteriosclerosis Asphyxia Atheroma Atypical Hemolytic uremic syndrome Autoimmune Vasculitis Autonomic dysreflexia syndrome Autosomal dominant Polycystic kidney disease Autosomal Recessive Polycystic Kidney Disease Avasthey syndrome Bartter's Syndrome Bilateral renal artery stenosis Binswanger's Disease Black widow spider envenomation Bone cement implantation syndrome Brachydactyly with hypertension Brain stem encephalitis Bright's Disease Bronchopulmonary dysplasia Cadmium poisoning Carcinoid Syndrome Carnevale-Canun-Mendoza syndrome Carotid paraganglioma Catastrophic Antiphospholipid Syndrome Central sleep apnea Choroideremia -- hypopituitarism Chronic kidney disease Chronic pyelonephritis Cocaine poisoning Cockayne syndrome Codeine withdrawal Collagen disease Congenital adrenal hyperplasia - 11-Beta-hydroxylase deficiency Congenital adrenal hyperplasia - 17-alpha-hydroxylase deficiency Congenital hepatic porphyria Congenital Membranous Glomerulonephritis Congenital Mitral stenosis Congenital stenosis of renal artery Congenital Hydronephrosis Conn's syndrome COPD Cushing's disease Cushing's syndrome Cyclosporine Desipramine Dexamethasone sensitive hypertension Diabetes Diffuse Systemic sclerosis Diffuse Mesangial sclerosis Dihydroergotamine Disequilibrium syndrome Aortic dissection Dissection of the renal arteries Down Syndrome Doxepin Dysautonomia Eclampsia Ecstasy abuse

Eisenmenger Syndrome Electrical burns Endothelin producing tumor Ephedrine poisoning Ergotamine Essential hypertension Essential mixed Cryoglobulinemia Fabry's Disease Familial Renal cell carcinoma Familial Adrenal adenoma Familial Cushing syndrome Faye-Petersen-Ward-Carey syndrome Fibromuscular dysplasia of arteries Fitzsimmons-Walson-Mellor syndrome Fowler-Christmas-Chapple syndrome Frovatriptan Gaucher disease type 3 Gestational hypertension Ginseng Gitelman's Syndrome Glomerulonephritis Glucocorticoid resistance Glycine encephalopathy - classical neonatal form Glycine synthase deficiency Goodpasture syndrome Gouty nephropathy Gram's syndrome Grange syndrome Graves Disease Guillain-Barre Syndrome Head injury Heavy metal poisoning HELLP syndrome Familial Hemangiomatosis - pulmonary capillary Hemolytic uremic syndrome Hepatorenal tyrosinemia Hereditary nephritis (X-linked) Hereditary sensory and autonomic neuropathy 3 Hyperadrenalism Hypereosinophilic syndrome Hyperparathyroidism Hyperpituitarism Hypertensive heart disease Hyperthyroidism Hyperventilation Hypoglycemia Hypoplastic kidney Hypothermia Hypothyroidism IgA nephropathy Imipramine Increased intracranial pressure Increased salt intake Indian Tobacco Poisoning Irradiation Isolated secretion of 18-hydroxy-deoxycorticosterone Isolated secretion of corticosterone Isolated secretion of deoxycorticosterone Isolated Ectopia lentis Isometheptene Jimsonweed poisoning Kashani-Strom-Utley syndrome Kidney arteriovenous fistula Renal Cancer Kimmelstiel-Wilson disease Lead poisoning Liddle's syndrome Lobelia poisoning Lockwood-Feingold syndrome Lupus nephritis Lymphomatoid granulomatosis Meningitis Metabolic syndrome Mineralocorticoid excess MSBD syndrome Mucopolysaccharidosis type I Hurler syndrome Multicentric Reticulohistiocytosis Multiple endocrine neoplasia type 1 Mustard tree poisoning Myxoedema Nasal decongestants Nephrocalcinosis Nephrosclerosis Nephrosis -- deafness -- urinary tract -- digital malformation Nephrotic syndrome Neuroblastoma Neurofibromatosis syndrome Type II Neurogenic hypertension Neuroleptic malignant Syndrome Nicotine addiction Nipah virus encephalitis Nortriptyline Obesity

Obstructive sleep apnea Oculo skeletal renal syndrome Oral contraceptive pill Familial Osteodysplasia - Anderson type ]] Ovarian dysgenesis Paget's disease of bone Pain Pancreatitis Patent ductus arteriosus PCOS Pheochromocytoma Phencyclidine Phenylpropanolamine Physical inactivity Pierre Robin's sequence Pierson syndrome Pituitary cancer Poliomyelitis Polyarteritis nodosa Polycystic kidneys, severe infantile, with tuberous sclerosis Polycythemia Polyradiculitis Post streptococcal glomerulonephritis Post-exercise Pregnancy toxemia /hypertension Primary aldosteronism Primary cortisol resistance Protriptyline Pseudoephedrine poisoning Pseudohyperaldosteronism Pseudohypoaldosteronism Pulmonary artery agenesis Pulmonary cystic lymphangiectasis Pulmonary embolism Pulmonary fibrosis /granuloma Pulmonary veno-occlusive disease Pulmonary Lymphangiomatosis Quadriplegia Renal artery thrombosis Renal emboli Renal segmental hypoplasia-induced Hypertension Renal tuberculosis Renin-secreting tumors Respiratory acidosis Respiratory failure Retroperitoneal fibrosis Rhabdoid tumor Rizatriptan Salcedo syndrome Schroeder syndrome 1 Scleroderma Sedative dependence Selye syndrome Senior-Loken Syndrome Serotonin Syndrome Serotonin toxicity Shaken Baby Syndrome Silicosis Simple kidney cysts Skull fracture Sneddon Syndrome Steroid abuse Stress-induced hypertension Sumatriptan Systemic lupus erythematosus Takayasu arteritis Thieffry and Sorrell Dejerine syndrome Third degree AV block Thromboembolism Thrombotic thrombocytopenic purpura Toxic mushrooms -- Psychedelic Transfusion of large blood volumes Turner Syndrome Twin-Twin Transfusion Syndrome Type A personality Tyrosinemia Unilateral pulmonary agenesis Upper spinal cord lesions Urinary tract infections Urinary tract obstruction Vasculitis Vater-like syndrome, with pulmonary hypertension, abnormal ears and growth deficiency Vesicoureteral reflux Vitamin D -- adverse effects Von Gierke disease IB Von Hippel-Lindau Disease Wagener syndrome Wegener's granulomatosis Werner syndrome White coat hypertension Williams Syndrome Wilms' tumor Wolfram's disease Zolmitriptan