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Hypertension

Disease Details

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Description: Hypertension, or high blood pressure, is a condition where the force of the blood against the artery walls is consistently too high, often leading to heart disease, stroke, or kidney problems.
Type: Hypertension, or high blood pressure, is typically categorized into two types: primary (essential) hypertension and secondary hypertension.

Primary hypertension is the most common type and has no identifiable cause, often associated with genetic and lifestyle factors. The genetic transmission of primary hypertension is complex and not linked to a single gene, but rather involves multiple genes that may interact with environmental factors.

Secondary hypertension is less common and results from an underlying condition such as kidney disease or endocrine disorders. The genetic transmission of secondary hypertension can vary depending on the underlying cause. If the underlying condition has a genetic component, then secondary hypertension could also follow a similar pattern of inheritance.
Signs And Symptoms: Hypertension is rarely accompanied by symptoms, and its identification is usually through health screening, or when seeking healthcare for an unrelated problem. Some people with high blood pressure report headaches (particularly at the back of the head and in the morning), as well as lightheadedness, vertigo, tinnitus (buzzing or hissing in the ears), altered vision or fainting episodes. These symptoms, however, might be related to associated anxiety rather than the high blood pressure itself.On physical examination, hypertension may be associated with the presence of changes in the optic fundus seen by ophthalmoscopy. The severity of the changes typical of hypertensive retinopathy is graded from I to IV; grades I and II may be difficult to differentiate. The severity of the retinopathy correlates roughly with the duration or the severity of the hypertension.
Prognosis: Hypertension is the most important preventable risk factor for premature death worldwide. It increases the risk of ischemic heart disease, strokes, peripheral vascular disease, and other cardiovascular diseases, including heart failure, aortic aneurysms, diffuse atherosclerosis, chronic kidney disease, atrial fibrillation, cancers, leukemia and pulmonary embolism. Hypertension is also a risk factor for cognitive impairment and dementia. Other complications include hypertensive retinopathy and hypertensive nephropathy.
Onset: Hypertension, commonly known as high blood pressure, typically has an insidious onset, meaning it develops gradually over many years without causing noticeable symptoms initially. It is often detected during routine medical checkups.
Prevalence: Hypertension, or high blood pressure, is a common condition affecting a significant portion of the global population. Its prevalence varies by region, age, and lifestyle factors. Globally, the World Health Organization estimates that around 1.13 billion people have hypertension, representing about 30-45% of the adult population. The prevalence tends to increase with age and is often higher in low- and middle-income countries due to factors like diet, economic stress, and limited access to healthcare.
Epidemiology: Hypertension, or high blood pressure, is a major global health issue affecting approximately 1.13 billion people worldwide. Prevalence increases with age and is higher in populations with risk factors such as obesity, high salt intake, excessive alcohol consumption, and a sedentary lifestyle. It is often more prevalent in low- and middle-income countries due to limited access to healthcare and effective preventive measures. Uncontrolled hypertension is a leading cause of cardiovascular diseases, including stroke, heart attack, and heart failure.
Intractability: Hypertension, or high blood pressure, is generally not considered intractable. Many cases can be managed effectively with lifestyle changes, medications, and regular monitoring. However, some individuals may experience resistant hypertension, which is more difficult to control despite treatment. In such cases, specialized medical interventions may be necessary.
Disease Severity: Hypertension, or high blood pressure, can vary in severity. It is often categorized as follows:

1. **Elevated Blood Pressure (Prehypertension):** Systolic pressure of 120-129 mmHg and diastolic pressure less than 80 mmHg.
2. **Stage 1 Hypertension:** Systolic pressure of 130-139 mmHg or diastolic pressure of 80-89 mmHg.
3. **Stage 2 Hypertension:** Systolic pressure of 140 mmHg or higher, or diastolic pressure of 90 mmHg or higher.
4. **Hypertensive Crisis:** Systolic pressure over 180 mmHg and/or diastolic pressure over 120 mmHg, requiring immediate medical attention.

The severity of hypertension is determined by these blood pressure readings, and more severe stages can lead to serious health complications such as heart disease, stroke, and kidney damage. Regular monitoring and management are crucial to prevent escalation and associated health risks.
Healthcare Professionals: Disease Ontology ID - DOID:10763
Pathophysiology: In most people with established essential hypertension, increased resistance to blood flow (total peripheral resistance) accounts for the high pressure while cardiac output remains normal. There is evidence that some younger people with prehypertension or 'borderline hypertension' have high cardiac output, an elevated heart rate and normal peripheral resistance, termed hyperkinetic borderline hypertension. These individuals develop the typical features of established essential hypertension in later life as their cardiac output falls and peripheral resistance rises with age. Whether this pattern is typical of all people who ultimately develop hypertension is disputed. The increased peripheral resistance in established hypertension is mainly attributable to structural narrowing of small arteries and arterioles, although a reduction in the number or density of capillaries may also contribute.It is not clear whether or not vasoconstriction of arteriolar blood vessels plays a role in hypertension. Hypertension is also associated with decreased peripheral venous compliance which may increase venous return, increase cardiac preload and, ultimately, cause diastolic dysfunction.
Pulse pressure (the difference between systolic and diastolic blood pressure) is frequently increased in older people with hypertension. This can mean that systolic pressure is abnormally high, but diastolic pressure may be normal or low, a condition termed isolated systolic hypertension. The high pulse pressure in elderly people with hypertension or isolated systolic hypertension is explained by increased arterial stiffness, which typically accompanies aging and may be exacerbated by high blood pressure.Many mechanisms have been proposed to account for the rise in peripheral resistance in hypertension. Most evidence implicates either disturbances in the kidneys' salt and water handling (particularly abnormalities in the intrarenal renin–angiotensin system) or abnormalities of the sympathetic nervous system. These mechanisms are not mutually exclusive and it is likely that both contribute to some extent in most cases of essential hypertension. It has also been suggested that endothelial dysfunction and vascular inflammation may also contribute to increased peripheral resistance and vascular damage in hypertension. Interleukin 17 has garnered interest for its role in increasing the production of several other immune system chemical signals thought to be involved in hypertension such as tumor necrosis factor alpha, interleukin 1, interleukin 6, and interleukin 8.Excessive sodium or insufficient potassium in the diet leads to excessive intracellular sodium, which contracts vascular smooth muscle, restricting blood flow and so increases blood pressure.
Carrier Status: Carrier status does not apply to hypertension as it is not a genetic disorder inherited in a simple dominant or recessive manner. Hypertension, or high blood pressure, is influenced by a combination of genetic factors, lifestyle choices, and environmental factors.
Mechanism: Hypertension, or high blood pressure, involves a complex interplay of various mechanisms:

**Mechanism:**
Hypertension is primarily caused by an increase in the resistance of blood vessels (mainly arterioles), which forces the heart to pump blood more forcefully to maintain adequate perfusion of tissues and organs. This increased resistance can result from several factors including stiffening or narrowing of the arteries, increased blood volume, or increased activity of the sympathetic nervous system (which raises heart rate and constricts blood vessels).

**Molecular Mechanisms:**
1. **Renin-Angiotensin-Aldosterone System (RAAS):** This system plays a crucial role in blood pressure regulation. Renin, an enzyme released by the kidneys, converts angiotensinogen into angiotensin I, which is then converted to angiotensin II by the enzyme angiotensin-converting enzyme (ACE). Angiotensin II is a powerful vasoconstrictor and also stimulates the release of aldosterone, which causes sodium and water retention, increasing blood volume and blood pressure.

2. **Sympathetic Nervous System (SNS):** Overactivity of the SNS can lead to vasoconstriction and increased cardiac output, both of which raise blood pressure. This can involve increased release of neurotransmitters like norepinephrine that act on alpha and beta receptors in the heart and blood vessels.

3. **Endothelial Dysfunction:** The endothelium (inner lining of blood vessels) plays a vital role in maintaining vascular tone. Dysfunction can result in decreased production of vasodilators such as nitric oxide, and increased production of vasoconstrictors such as endothelin, leading to increased vascular resistance.

4. **Inflammation and Oxidative Stress:** Chronic inflammation and increased levels of reactive oxygen species (ROS) can damage blood vessels, leading to stiffness and impaired vasodilation. ROS can also inactivate nitric oxide, further contributing to endothelial dysfunction.

5. **Genetic Factors:** Various genetic polymorphisms can affect components of blood pressure regulation, such as genes involved in the RAAS, sodium transport, and vascular tone.

6. **Sodium Handling in the Kidneys:** Abnormalities in renal sodium handling can lead to sodium and water retention, increasing blood volume and pressure. This can involve altered function of ion channels and transporters, such as the sodium-chloride cotransporter.

These mechanisms often interact and can vary between individuals, making hypertension a multifactorial disease with complex etiology.
Treatment: Historically the treatment for what was called the "hard pulse disease" consisted in reducing the quantity of blood by bloodletting or the application of leeches. This was advocated by The Yellow Emperor of China, Cornelius Celsus, Galen, and Hippocrates. The therapeutic approach for the treatment of hard pulse disease included changes in lifestyle (staying away from anger and sexual intercourse) and dietary program for patients (avoiding the consumption of wine, meat, and pastries, reducing the volume of food in a meal, maintaining a low-energy diet and the dietary usage of spinach and vinegar).
In the 19th and 20th centuries, before effective pharmacological treatment for hypertension became possible, three treatment modalities were used, all with numerous side-effects: strict sodium restriction (for example the rice diet), sympathectomy (surgical ablation of parts of the sympathetic nervous system), and pyrogen therapy (injection of substances that caused a fever, indirectly reducing blood pressure).The first chemical for hypertension, sodium thiocyanate, was used in 1900 but had many side effects and was unpopular. Several other agents were developed after the Second World War, the most popular and reasonably effective of which were tetramethylammonium chloride, hexamethonium, hydralazine, and reserpine (derived from the medicinal plant Rauvolfia serpentina). None of these were well tolerated. A major breakthrough was achieved with the discovery of the first well-tolerated orally available agents. The first was chlorothiazide, the first thiazide diuretic and developed from the antibiotic sulfanilamide, which became available in 1958. Subsequently, beta blockers, calcium channel blockers, angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers, and renin inhibitors were developed as antihypertensive agents.
Compassionate Use Treatment: For hypertension, compassionate use treatment and off-label or experimental treatments include the following:

1. **Compassionate Use Treatments**: These are treatments that may be provided to patients who have exhausted all other options. Specific investigational drugs might be available under compassionate use, but they would be determined on a case-by-case basis by the regulatory authority, such as the FDA in the United States.

2. **Off-label Treatments**:
- **Minoxidil**: Primarily used as a hair growth treatment, minoxidil can be used off-label for severe hypertension that is resistant to other medications.
- **Spironolactone**: Used off-label for resistant hypertension, particularly in patients with primary aldosteronism.
- **Prazosin**: Primarily used for PTSD-related nightmares, it can sometimes be used off-label for hypertension.

3. **Experimental Treatments**:
- **Renal Denervation**: This is a minimally invasive procedure targeting the renal nerves, currently under investigation for its potential to treat resistant hypertension.
- **Baroreceptor Activation Therapy**: This involves electrically stimulating the baroreceptors, which can help lower blood pressure. It is still considered experimental.

These treatments are generally considered when standard therapies are not effective or suitable for the patient. Always consult healthcare providers for personalized medical advice regarding these options.
Lifestyle Recommendations: For hypertension (high blood pressure), the following lifestyle recommendations are commonly advised:

1. **Healthy Diet**:
- Focus on a diet rich in fruits, vegetables, whole grains, and lean proteins.
- Limit intake of salt (sodium), saturated fats, and cholesterol.

2. **Regular Physical Activity**:
- Aim for at least 150 minutes of moderate-intensity exercise, such as brisk walking, per week or 75 minutes of vigorous-intensity exercise.

3. **Weight Management**:
- Maintain a healthy weight. Losing even a small amount of weight if you're overweight can help reduce blood pressure.

4. **Limit Alcohol Consumption**:
- Drink in moderation. For men, this means up to two drinks per day, and for women, up to one drink per day.

5. **Quit Smoking**:
- Smoking cessation helps improve overall cardiovascular health.

6. **Stress Management**:
- Practice relaxation techniques such as deep breathing, meditation, or yoga.

7. **Limit Caffeine**:
- Reduce caffeine intake if you are sensitive to it or if it significantly raises your blood pressure.

8. **Monitor Blood Pressure at Home**:
- Regularly check your blood pressure to keep track of any changes and discuss them with your doctor.

9. **Adequate Sleep**:
- Aim for 7-9 hours of sleep per night, as poor sleep can negatively impact blood pressure.

Adhering to these lifestyle changes can help manage and reduce high blood pressure effectively.
Medication: Several classes of medications, collectively referred to as antihypertensive medications, are available for treating hypertension.
First-line medications for hypertension include thiazide-diuretics, calcium channel blockers, angiotensin converting enzyme inhibitors (ACE inhibitors), and angiotensin receptor blockers (ARBs). These medications may be used alone or in combination (ACE inhibitors and ARBs are not recommended for use together); the latter option may serve to minimize counter-regulatory mechanisms that act to restore blood pressure values to pre-treatment levels, although the evidence for first-line combination therapy is not strong enough. Most people require more than one medication to control their hypertension. Medications for blood pressure control should be implemented by a stepped care approach when target levels are not reached. Withdrawal of such medications in the elderly can be considered by healthcare professionals, because there is no strong evidence of an effect on mortality, myocardial infarction, or stroke.Previously, beta-blockers such as atenolol were thought to have similar beneficial effects when used as first-line therapy for hypertension. However, a Cochrane review that included 13 trials found that the effects of beta-blockers are inferior to that of other antihypertensive medications in preventing cardiovascular disease.The prescription of antihypertensive medication for children with hypertension has limited evidence. There is limited evidence which compare it with placebo and shows modest effect to blood pressure in short term. Administration of higher dose did not make the reduction of blood pressure greater.
Repurposable Drugs: Repurposable drugs for hypertension include:

1. **Metformin:** Traditionally used for type 2 diabetes, it has shown potential in reducing blood pressure through improved metabolic functions.

2. **Allopurinol:** Used primarily for gout, it can lower blood pressure by reducing oxidative stress and improving endothelial function.

3. **Statins:** Known for cholesterol management, they also have modest blood pressure-lowering effects, possibly due to improved arterial elasticity and reduced inflammation.

4. **Spironolactone:** Though primarily a diuretic for heart failure and hyperaldosteronism, it's effective in resistant hypertension by blocking aldosterone.

These medications are being explored for their secondary benefits in lowering blood pressure.
Metabolites: In hypertension, certain metabolites in the body can be involved in the regulation and manifestation of the condition. Notable metabolites include angiotensin II, which is part of the renin-angiotensin system and plays a key role in blood pressure regulation by constricting blood vessels and increasing fluid retention. Sodium and potassium levels are also crucial, as imbalances can impact blood pressure. Additionally, high levels of catecholamines like norepinephrine and epinephrine, which are stress-related hormones, can contribute to increased blood pressure by stimulating the heart and narrowing blood vessels.

Regarding "nan," it is unclear what this specifically refers to in the context of hypertension. If "nan" refers to nanotechnology, it is an emerging field in hypertension management, involving the development of nanoparticles for drug delivery systems designed to improve the efficacy and targeting of antihypertensive medications.
Nutraceuticals: Nutraceuticals, such as omega-3 fatty acids, Coenzyme Q10, garlic extract, magnesium, and potassium, are often considered for managing hypertension. These compounds are believed to support cardiovascular health and help lower blood pressure. However, their effectiveness can vary, and they should complement, not replace, conventional treatments as advised by healthcare professionals.
Peptides: Peptides are short chains of amino acids that can play a role in regulating blood pressure. Some bioactive peptides derived from food proteins have been found to inhibit angiotensin-converting enzyme (ACE), which helps relax blood vessels and lower blood pressure, thus offering potential benefits for managing hypertension.

Nanotechnology involves the use of nanoscale materials and devices. In the context of hypertension, nanotechnology can be used to create advanced drug delivery systems. These systems can precisely target hypertensive tissues, improving the efficiency and effectiveness of antihypertensive medications, while potentially reducing side effects.

Combining peptides and nanotechnology could offer novel strategies for treating hypertension, such as peptide-based nanoparticles that specifically target and modulate blood pressure-regulating mechanisms.