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Aetiology of essential hypertension

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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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)


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