Essential Hypertension - A Review Article

Nandhini.S /J. Pharm. Sci. & Res. Vol.
6(9), 2014, 305-307
Essential Hypertension A Review Article

Nandhini.S,
BDS Student,Saveetha Dental College
Abstract:
Hypertension (HTN) or high blood pressure, sometimes called arterial hypertension, is a chronic medical condition in which the blood
pressure in the arteries is elevated. Blood pressure is summarised by two measurements, systolic and diastolic, which depend on whether
the heart muscle is contracting (systole) or relaxed between beats (diastole). This equals the maximum and minimum pressure,
respectively. Normal blood pressure at rest is within the range of 100140mmHg systolic and 6090mmHg diastolic. High blood
pressure is said to be present if it is often at or above 140/90 mmHg. Hypertension is classified as either primary (essential)
hypertension or secondary hypertension. Hypertension puts strain on the heart, leading to hypertensive heart disease and coronary artery
disease if not treated. Hypertension is also a major risk factor for stroke, aneurysms of the arteries (e.g. aortic aneurysm), peripheral
arterial disease and is a cause of chronic kidney disease. Dietary and lifestyle changes can improve blood pressure control and decrease
the risk of health complications, although drug treatment is still often necessary in people for whom lifestyle changes are not enough or
not effective.
INTRODUCTION:
Essential
hypertension (also
called primary
hypertension or idiopathic hypertension) is the most
common type of hypertension, affecting 95% of
hypertensive patients,[1][2][3][4] it tends to be familial and is
likely to be the consequence of an interaction
between environmental and genetic factors. Prevalence of
essential hypertension increases with age, and individuals
with relatively high blood pressure at younger ages are at
increased risk for the subsequent development of
hypertension and it makes them suffer a lot. Hypertension
increases the risk of cerebral, cardiac, and renal events.[5]
ETIOLOGY:
Etiological factors correlated with hypertension in adults
have also been associated with blood pressure elevations in
youth. Intrauterine malnutrition, family history of
hypertension ,obesity, particularly excess abdominal fat,
insulin resistance, high dietary sodium intakes, low dietary
intakes of calcium, potassium and magnesium, physical
inactivity, high alcohol intakes, tobacco use, drug use (e.g.,
cocaine, ecstasy, anabolic steroids), emotional stress, diet
pill use, oral contraceptives are the factors associated with
development of hypertension.[6,7,8] An inadequate supply of
nutrients may program changes in foetal structure and
metabolism, increasing the risk of hypertension and other
diseases in later life.[9] Hyperinsulineamia and insulin
resistance are also associated with the development of
hypertension which leads to many problems. The elevated
plasma insulin levels may cause sodium sensitivity.[10,11]
Adequate dietary potassium, calcium, and magnesium
intakes have been associated with lower blood pressure in
youth. Potassium and calcium intakes are below
recommended levels, particularly in adolescent females,
while median intakes of phosphorus and protein, which
promote calcium loss, are high.[12] Lack of physical activity
may increase the risk of developing hypertension by 2050%.
RISK FACTORS:
Having a personal family history of hypertension increases
the
likelihood
that
an
individual
develops
hypertension.[13]Essential hypertension is four times more
common in black than white people, accelerates more
rapidly and is often more severe with higher mortality in
black patients.[14][15][16][17]..Obesity can increase the risk of
hypertension to fivefold as compared with normal weight,
and up to two-thirds of hypertension cases can be attributed
to excess weight. More than 85% of cases occur in those
with a Body mass index greater than 25.[18] .Another risk
factor is salt sensitivity which is an environmental factor
that has received the greatest attention. Approximately one
third of the essential hypertensive population is responsive
to sodium intake.[19] The increased sodium ion
concentration stimulates ADH and thirst mechanisms,
leading to increased reabsorption of water in the kidneys,
concentrated urine, and thirst with higher intake of water.
Also, the water movement between cells and the
interstitium plays a minor role compared to this. The
relationship between sodium intake and blood pressure is
controversial. Reducing sodium intake does reduce blood
pressure, but the magnitude of the effect is insufficient to
recommend a general reduction in salt intake.[20]
Renin elevation is another risk factor. Renin is
an enzyme secreted by the juxtaglomerular apparatus of the
kidney and linked with aldosterone in a negative feedback
loop. 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 white Americans, and
may explain why African Americans tend to respond better
to diuretic therapy than drugs that interfere with the Reninangiotensin system. High renin levels predispose to
hypertension by causing sodium retention through the
following
mechanism:
Increased
renin
Increased angiotensin II Increased vasoconstriction,
thirst/ADH and aldosterone Increased sodium reabsorpti
on in the kidneys (DCT and CD) Increased blood pressure.
Hypertension can also be caused by Insulin resistance and
or hyperinsulinemia, which are components of syndrome
305
Nandhini.S /J. Pharm. Sci. & Res. Vol. 6(9), 2014, 305-307
X, or the metabolic syndrome. Also, some authorities claim

that potassium might both prevent and treat
hypertension.[21]Cigarette smoking, a known risk factor for
other cardiovascular disease, may also be a risk factor for
the development of hypertension.[22] Several studies have
shown that hypertensive patients and their children handle
salt differently. It is suggested that due to the presence of a
sodium transport inhibitor, leucocytes of hypertensive
patients are found to have a reduced sodium pump
activity.[23]This results in increased intracellular sodium
leading to high intracellular calcium which is responsible
for increased vascular tone. Due to abnormal sodium
handling, renal sodium excretion is affected which leads to
increase in extracellular fluid volume, an increased venous
return and increased cardiac output. Autoregulation to
achieve tissue perfusion leads to vasoconstriction and
raised peripheral vascular resistance. Salt restriction
interrupts pathophysiologic chain of events by lowering
extracellular fluid volume and lowers blood pressure
similar to diuretic therapy. [24]
PREVENTION:
It is therefore recommended that all cases of hypertension
should restrict their sodium intake to approximately 6 Gms
of sodium chloride salt or 2.4 Gms of sodium per day. In
order to achieve that much sodium restriction, following
measures should be adopted. [25] a) Reduce salt for cooking
by 50%.b) Substitute natural foods for processed foods. c)
Avoid salty snacks such as pickles, chutneys, pappad,
salted nuts. d) Use salt substitutes containing potassium. f)
Avoid medications such as antacids as these are rich in salt.
It is now agreed that reducing salt intake is an essential1.
The universal recommendation is to consume less than 10
Gms of NaCl per day. WHO recommends 5 Gms or less
especially in populations known to have a high salt intake
or a high prevalence of blood pressure. [26]Chain smokers
have a sustained increase in blood pressure. So prevention
from smoking is must here. These are widely practised for
stress reduction. So far no substantial evidence in support
of benefits of yoga, meditation is available. Yet the
availability of some controlled research, its overall costeffectiveness and its lack of side effects make further
investigations of yoga a topmost priority. Clinically several
clinical trials are in progress. [27]Epidemiological studies
have revealed a strong relation between obesity and
hypertension. So maintaining the body fitness and
preventing the body from obesity is very necessary. [28]
Maintaining a good health and exercising regularly
prevents hypertension. Eating a balanced diet and
monitoring the blood pressure is very must.
TREATMENT:
Beta-blocker is one of a drug used to reduce hypertension.
It works by making our heart beat more slowly and with
less force, thereby reducing blood pressure. But
they are found to be less effective than other treatments.
Calcium channel blockers are very helpful because they
keep calcium from entering the muscle cells of the heart
and blood vessels. This method widens the arteries and
reduces the blood pressure.
CONCLUSION
Adopting a healthy lifestyle is critical for the prevention of
HBP and an indispensable part of managing it. We must
think of these changes as a "lifestyle prescription" and
make every effort to comply with them. If we have
been diagnosed with high blood pressure, also called
hypertension, or are concerned because we have some of
the risk factors for the disease, we must understand this:
while there is no cure, high blood pressure is manageable.
Maintaining a healthy life style is necessary.
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Nandhini.S /J. Pharm. Sci. & Res. Vol.

6(9), 2014, 305-307

Essential Hypertension A Review Article

X, or the metabolic syndrome. Also, some authorities claim

18. Haslam DW, James WP (2005). "Obesity". Lancet 366 (9492):

Older Men". American Journal of Hypertension 21 (2): 148

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