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Essential hypertension

MedGen UID:
88442
Concept ID:
C0085580
Disease or Syndrome
Synonyms: Essential Hypertension; Hypertension, Essential; Hypertension, Primary; Hypertensions, Primary; Primary Hypertension; Primary Hypertensions
SNOMED CT: Essential hypertension (59621000); Idiopathic hypertension (59621000); Systemic primary arterial hypertension (59621000); Primary hypertension (59621000)
 
Related genes: RGS5, PTGIS, NOS3, GNB3, ECE1, CYP3A5, ATP1B1, AGTR1, AGT, ADD1
 
Monarch Initiative: MONDO:0001134
OMIM®: 145500; 601699
Orphanet: ORPHA243761

Definition

The Pickering school held that blood pressure has a continuous distribution, that multiple genes and multiple environmental factors determine the level of one's blood pressure just as the determination of stature and intelligence is multifactorial, and that 'essential hypertension' is merely the upper end of the distribution (Pickering, 1978). In this view the person with essential hypertension is one who happens to inherit an aggregate of genes determining hypertension (and also is exposed to exogenous factors that favor hypertension). The Platt school took the view that essential hypertension is a simple mendelian dominant trait (Platt, 1963). McDonough et al. (1964) defended the monogenic idea. See McKusick (1960) and Kurtz and Spence (1993) for reviews. Swales (1985) reviewed the Platt-Pickering controversy as an 'episode in recent medical history.' The Pickering point of view appears to be more consistent with the observations. [from OMIM]

Additional description

From MedlinePlus Genetics
Hypertension is abnormally high blood pressure in the arteries, which are the blood vessels that carry blood from the heart to the rest of the body. As the heart beats, it forces blood through the arteries to deliver nutrients and oxygen to the rest of the body. The strength of the blood pushing against the artery walls is blood pressure, which is measured in units called millimeters of mercury (mmHg). The top number in a blood pressure reading is the pressure when the heart pumps (systolic blood pressure), and the bottom number is the pressure between heart beats (diastolic blood pressure). In adults, a normal blood pressure measurement is about 120/80 mmHg. Blood pressure is considered high when the measurement is 130/80 mmHg or greater.

Hypertension usually has no symptoms, and many affected individuals do not know they have the condition. However, hypertension is a major risk factor for heart disease, stroke, kidney failure, and eye problems. When blood pressure is elevated, the heart and arteries have to work harder than normal to pump blood through the body. The extra work thickens the muscles of the heart and arteries and hardens or damages artery walls. As a result, the flow of blood and oxygen to the heart and other organs is reduced. Damage to the heart caused by the extra work and a lack of oxygen causes heart disease. In addition, damage to the arteries increases the risk of blood clots that block the flow of blood to the heart, causing a heart attack, or to the brain, causing a type of stroke known as an ischemic stroke. Another type of stroke, called a hemorrhagic stroke, can occur when a weakened blood vessel in the brain bursts. Damage to blood vessels in the kidneys impairs their ability to filter waste and remove fluid, leading to kidney failure. Problems with blood flow in the arteries of the eyes can lead to vision loss.

In rare cases, dangerously high blood pressure can cause severe headaches, confusion, shortness of breath, chest pain, or nosebleeds.

In about 95 percent of cases, the cause of hypertension is unknown. These cases are classified as essential hypertension. When hypertension results from an underlying condition, such as blood vessel defects that reduce blood flow; kidney disorders, which alter the amount of fluids and salts in the body; or problems with hormone-producing glands called the adrenal glands or the thyroid gland, it is classified as secondary hypertension. Hypertension is a key feature of some rare genetic disorders, including familial hyperaldosteronism, pseudohypoaldosteronism type 2, Liddle syndrome, and tumors known as paragangliomas.  https://medlineplus.gov/genetics/condition/hypertension

Clinical features

From HPO
Elevated systolic blood pressure
MedGen UID:
333547
Concept ID:
C1840374
Finding
Abnormal increase in systolic blood pressure.
Elevated diastolic blood pressure
MedGen UID:
374454
Concept ID:
C1840375
Finding
Abnormal increase in diastolic blood pressure.
Elevated mean arterial pressure
MedGen UID:
326719
Concept ID:
C1840376
Finding
An abnormal increase in the average blood pressure in an individual during a single cardiac cycle.

Professional guidelines

PubMed

Naruse M, Katabami T, Shibata H, Sone M, Takahashi K, Tanabe A, Izawa S, Ichijo T, Otsuki M, Omura M, Ogawa Y, Oki Y, Kurihara I, Kobayashi H, Sakamoto R, Satoh F, Takeda Y, Tanaka T, Tamura K, Tsuiki M, Hashimoto S, Hasegawa T, Yoshimoto T, Yoneda T, Yamamoto K, Rakugi H, Wada N, Saiki A, Ohno Y, Haze T
Endocr J 2022 Apr 28;69(4):327-359. Epub 2022 Apr 12 doi: 10.1507/endocrj.EJ21-0508. PMID: 35418526
Ferdinand KC, Nasser SA
Cardiol Clin 2017 May;35(2):231-246. doi: 10.1016/j.ccl.2016.12.005. PMID: 28411897
Sibai BM
Am J Obstet Gynecol 2012 Jun;206(6):470-5. Epub 2011 Sep 16 doi: 10.1016/j.ajog.2011.09.002. PMID: 21963308

Curated

UK NICE Guideline NG136, Hypertension in adults: diagnosis and management, 2023

Recent clinical studies

Etiology

Xie M, Tang T, Liang H
Clin Cardiol 2023 Aug;46(8):886-898. Epub 2023 Jul 11 doi: 10.1002/clc.24082. PMID: 37432701Free PMC Article
Can Çiçek S, Demir Ş, Yılmaz D, Açıkgöz A, Yıldız S, Yis ÖM
Holist Nurs Pract 2022 Jul-Aug 01;36(4):209-222. doi: 10.1097/HNP.0000000000000526. PMID: 35708557
Louca P, Menni C, Padmanabhan S
Am J Hypertens 2020 May 21;33(6):473-481. doi: 10.1093/ajh/hpaa022. PMID: 32060494Free PMC Article
Bruno RM, Masi S, Taddei M, Taddei S, Virdis A
High Blood Press Cardiovasc Prev 2018 Mar;25(1):35-40. Epub 2018 Jan 9 doi: 10.1007/s40292-017-0245-9. PMID: 29313304
Monticone S, D'Ascenzo F, Moretti C, Williams TA, Veglio F, Gaita F, Mulatero P
Lancet Diabetes Endocrinol 2018 Jan;6(1):41-50. Epub 2017 Nov 9 doi: 10.1016/S2213-8587(17)30319-4. PMID: 29129575

Diagnosis

Xie M, Tang T, Liang H
Clin Cardiol 2023 Aug;46(8):886-898. Epub 2023 Jul 11 doi: 10.1002/clc.24082. PMID: 37432701Free PMC Article
Heidari B, Avenatti E, Nasir K
Methodist Debakey Cardiovasc J 2022;18(5):5-16. Epub 2022 Dec 6 doi: 10.14797/mdcvj.1175. PMID: 36561082Free PMC Article
Ito S, Itoh H, Rakugi H, Okuda Y, Yoshimura M, Yamakawa S
Hypertension 2020 Jan;75(1):51-58. Epub 2019 Dec 2 doi: 10.1161/HYPERTENSIONAHA.119.13569. PMID: 31786983
Monticone S, D'Ascenzo F, Moretti C, Williams TA, Veglio F, Gaita F, Mulatero P
Lancet Diabetes Endocrinol 2018 Jan;6(1):41-50. Epub 2017 Nov 9 doi: 10.1016/S2213-8587(17)30319-4. PMID: 29129575
Messerli FH, Williams B, Ritz E
Lancet 2007 Aug 18;370(9587):591-603. doi: 10.1016/S0140-6736(07)61299-9. PMID: 17707755

Therapy

Chen S, Sun Y, Agrawal DK
J Am Soc Hypertens 2015 Nov;9(11):885-901. Epub 2015 Aug 21 doi: 10.1016/j.jash.2015.08.009. PMID: 26419755Free PMC Article
Xiong XJ, Li SJ, Zhang YQ
J Hum Hypertens 2015 Mar;29(3):143-51. Epub 2014 Jul 3 doi: 10.1038/jhh.2014.52. PMID: 24990417
Wang J, Xiong X, Liu W
Int J Cardiol 2013 Nov 20;169(5):317-26. Epub 2013 Sep 6 doi: 10.1016/j.ijcard.2013.09.001. PMID: 24060112
Hopkins AL, Lamm MG, Funk JL, Ritenbaugh C
Fitoterapia 2013 Mar;85:84-94. Epub 2013 Jan 17 doi: 10.1016/j.fitote.2013.01.003. PMID: 23333908Free PMC Article
Kokkinos PF, Papademetriou V
Coron Artery Dis 2000 Mar;11(2):99-102. doi: 10.1097/00019501-200003000-00002. PMID: 10758809

Prognosis

Hung CS, Sung SH, Liao CW, Pan CT, Chang CC, Chen ZW, Wu VC, Chen CH, Cheng HM, Lin YH; TAIPAI Study Group
Hypertension 2019 Sep;74(3):623-629. Epub 2019 Jul 29 doi: 10.1161/HYPERTENSIONAHA.118.12342. PMID: 31352825
Hundemer GL, Curhan GC, Yozamp N, Wang M, Vaidya A
Lancet Diabetes Endocrinol 2018 Jan;6(1):51-59. Epub 2017 Nov 9 doi: 10.1016/S2213-8587(17)30367-4. PMID: 29129576Free PMC Article
Chen S, Sun Y, Agrawal DK
J Am Soc Hypertens 2015 Nov;9(11):885-901. Epub 2015 Aug 21 doi: 10.1016/j.jash.2015.08.009. PMID: 26419755Free PMC Article
Sibai BM
Am J Obstet Gynecol 2012 Jun;206(6):470-5. Epub 2011 Sep 16 doi: 10.1016/j.ajog.2011.09.002. PMID: 21963308
Kulkarni S, O'Farrell I, Erasi M, Kochar MS
WMJ 1998 Dec;97(11):34-8. PMID: 9894438

Clinical prediction guides

Olczak KJ, Taylor-Bateman V, Nicholls HL, Traylor M, Cabrera CP, Munroe PB
J Intern Med 2021 Dec;290(6):1130-1152. Epub 2021 Jul 8 doi: 10.1111/joim.13352. PMID: 34166551
Loscalzo J
Circ Res 2019 Mar 29;124(7):987-989. doi: 10.1161/CIRCRESAHA.119.314403. PMID: 30920923Free PMC Article
Rizzoni D, Agabiti Rosei C, De Ciuceis C, Semeraro F, Rizzoni M, Docchio F
Am J Hypertens 2018 Feb 9;31(3):265-273. doi: 10.1093/ajh/hpx211. PMID: 29228086
Gkaliagkousi E, Gavriilaki E, Triantafyllou A, Douma S
Curr Hypertens Rep 2015 Nov;17(11):85. doi: 10.1007/s11906-015-0596-3. PMID: 26371063
Bear RA, Erenrich N
Can Med Assoc J 1978 Apr 22;118(8):936-40. PMID: 348289Free PMC Article

Recent systematic reviews

Xie M, Tang T, Liang H
Clin Cardiol 2023 Aug;46(8):886-898. Epub 2023 Jul 11 doi: 10.1002/clc.24082. PMID: 37432701Free PMC Article
Richards EMF, Giorgione V, Stevens O, Thilaganathan B
Am J Obstet Gynecol 2023 Apr;228(4):395-408. Epub 2022 Oct 7 doi: 10.1016/j.ajog.2022.09.046. PMID: 36209937
González-González JG, Violante-Cumpa JR, Zambrano-Lucio M, Burciaga-Jimenez E, Castillo-Morales PL, Garcia-Campa M, Solis RC, González-Colmenero AD, Rodríguez-Gutiérrez R
High Blood Press Cardiovasc Prev 2022 Nov;29(6):547-564. Epub 2022 Oct 1 doi: 10.1007/s40292-022-00542-5. PMID: 36181637
Monticone S, D'Ascenzo F, Moretti C, Williams TA, Veglio F, Gaita F, Mulatero P
Lancet Diabetes Endocrinol 2018 Jan;6(1):41-50. Epub 2017 Nov 9 doi: 10.1016/S2213-8587(17)30319-4. PMID: 29129575
Li EC, Heran BS, Wright JM
Cochrane Database Syst Rev 2014 Aug 22;2014(8):CD009096. doi: 10.1002/14651858.CD009096.pub2. PMID: 25148386Free PMC Article

Supplemental Content

Table of contents

    Clinical resources

    Practice guidelines

    • PubMed
      See practice and clinical guidelines in PubMed. The search results may include broader topics and may not capture all published guidelines. See the FAQ for details.
    • Bookshelf
      See practice and clinical guidelines in NCBI Bookshelf. The search results may include broader topics and may not capture all published guidelines. See the FAQ for details.

    Curated

    • NICE, 2023
      UK NICE Guideline NG136, Hypertension in adults: diagnosis and management, 2023

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