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Aetiology of essential hypertension

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

It is generally agreed that the aetiology of essential hypertension is multifactorial, encompassing both genetic and environmental factors.

Genetic factors

  • hypertension is influenced by many gene and gene combinations (a complex polygenic disorder)
  • several monogenic forms of hypertension have been identified e.g. – glucocorticoid remediable aldosteronism, Liddle’s syndrome, Gordon’s syndrome

Environmental factors

  • overweight and obesity
    • several reports have identified a striking relationship between body weight and high BP and a direct relationship between overweight/obesity and hypertension
    • risk estimates from the Nurses’ Health Study suggest that obesity may be responsible for about 40% of hypertension, and in the Framingham Offspring Study, the corresponding estimates were even higher - 78% in men and 65% in women
    • relationship between obesity at a young age and change in obesity status over time is strongly related to future risk of hypertension
    • becoming normal weight reduced the risk of developing hypertension to a level similar to those who had never been obese

  • sodium intake
    • migrant cross-sectional and prospective cohort studies have shown that sodium intake is positively associated with BP

  • potassium
    • potassium intake is inversely related to BP
    • a higher level of potassium seems to blunt the effect of sodium on BP, with a lower sodium–potassium ratio being associated with a lower level of BP than that noted for corresponding levels of sodium or potassium on their own

  • physical fitness
    • epidemiological studies have demonstrated an inverse relationship between physical activity and physical fitness and level of BP and hypertension
    • even modest levels of physical activity have been associated with a decrease in the risk of incident hypertension

  • alcohol
    • direct relationship between alcohol consumption and BP was first reported in 1915 and has been repeatedly identified in contemporary crosssectional and prospective cohort studies (1)

Reference:


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