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      Pathophysiology of essential hypertension: an update.

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          Abstract

          Hypertension is caused by increased cardiac output and/or increased peripheral resistance. Areas covered: The various mechanisms affecting cardiac output/peripheral resistance involved in the development of essential hypertension are covered. These include genetics; sympathetic nervous system overactivity; renal mechanisms: excess sodium intake and pressure natriuresis; vascular mechanisms: endothelial cell dysfunction and the nitric oxide pathway; hormonal mechanisms: the renin-angiotensin-aldosterone system (RAAS); obesity, obstructive sleep apnea (OSA); insulin resistance and metabolic syndrome; uric acid; vitamin D; gender differences; racial, ethnic, and environmental factors; increased left ventricular ejection force and hypertension and its association with increased basal sympathetic activity - cortical connections. Expert commentary: Maximum association of hypertension is found with sympathetic overactivity which is directly or indirectly involved in different mechanisms of hypertension including RAAS, OSA, obesity, etc.. It is not overt sympathetic activity but disturbed basal sympathetic tone. Basal sympathetic tone arises from hypothalamus; possibly affected by cortical influences. Therefore, hypertension is not merely a disease of circulatory system alone. Its pathogenesis involves alteration in ANS (autonomic nervous system) and likely in cortical-hypothalamic connections. Assessment of ANS and cortical-hypothalamic connections may be required for better understanding of hypertension.

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          Author and article information

          Journal
          Expert Rev Cardiovasc Ther
          Expert review of cardiovascular therapy
          Informa UK Limited
          1744-8344
          1477-9072
          Dec 2018
          : 16
          : 12
          Affiliations
          [1 ] a Department of Internal Medicine , Mittal Hospital and Research Centre , Ajmer , India.
          [2 ] b Department Yoga and Physical education , Mittal Hospital and Research Centre , Ajmer , India.
          Article
          10.1080/14779072.2018.1540301
          30354851

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