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etiology of arterial hypertension

Etiology: 1) systolic hypertension with wide pulse pressure a) decreased compliance of aorta (arteriosclerosis) b) increased stroke volume - aortic regurgitation - thyrotoxicosis - hyperkinetic heart syndrome - fever - arteriovenous fistula - patent ductus arteriosus 2) systolic & diastolic hypertension (increased PVR*) a) renal - chronic pyelonephritis - acute & chronic glomerulonephritis - polycystic renal disease - renovascular stenosis or renal infarction - most other chronic renal failure - diabetic nephropathy - arteriolar nephrosclerosis - poor sleep hygiene due to increased sympathetic activity [5,6] b) endocrine - oral contraceptives - adrenocortical hypertension - Cushing's disease & syndrome - primary hyperaldosteronism - congenital or hereditary adrenogenital syndromes - 17-alpha & 11-beta hydroxylase defects - pheochromocytoma - hypothyroidism, myxedema - acromegaly - hyperparathyroidism c) neurogenic - psychogenic - diencephalic syndrome - familial dysautosomia (Riley-Day syndrome) - polyneuritis - acute porphyria - lead poisoning - increased intracranial pressure (acute) - spinal cord section (acute) d) other - coarctation of the aorta - increased intravascular volume - excessive transfusion - polycythemia vera - polyarteritis nodosa - hypercalcemia - sleep apnea [7] - pharmaceutical agents - clonidine withdrawal - corticotropin (ACTH) - cyclosporin - glucocorticoids - monoamine oxidase (MAO) inhibitors with sympathomimetics - sympathomimetics - amphetamine - cocaine - erythropoietin - birth control pills - SSRI [7] - antiretroviral agents - VEGF antagonists (bevacizumab) - over the counter agents - non-steroidal anti-inflammatory agent (NSAIDs) [3,4] - RR= 1.38 (1.26 with aspirin) with frequent use [4] - antagonism of beta-blockers & Ca+2 channel blockers - tylenol [3], RR = 1.34 with frequent use - sympathomimetics in over-the-counter cold remedies - pseudoephedrine - phenylpropanolamine - caffeine ? (see Nurses' Health Study) - black licorice [7] - alcoholic beverages - exposure to high levels of aircraft noise at night [9] e) idiopathic - essential hypertension (> 90% of all cases) - toxemia of pregnancy - acute intermittent porphyria f) inflammation ? - increased C-reactive protein (RR# 2.5) [2] g) diet - high-salt diet - potatoes & other foods of high glycemic index [7] - high glycemic load itself ? [7] 3) expansion of intravascular volume - salt-sensitive hypertension * peripheral vascular resistance # relative risk for CRP > 3.5 vs < 0.43 mg/dL

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hypertension (HTN, high blood pressure, HBP)

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References

  1. Harrison's Principles of Internal Medicine, 13th ed. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1994, pg 1117
  2. Journal Watch 24(3):22, 2004 Sesso HD et al C-reactive protein and the risk of developing hypertension. JAMA 290:2945, 2003 PMID: 14665655 - Grundy SM et al Inflammation, hypertension, and the metabolic syndrome. JAMA 290:3000, 2003 PMID: 14665663
  3. Prescriber's Letter 12(9): 2005 Non-narcotic Analgesics and the Risk of Hypertension in Women Detail-Document#: 210915 (subscription needed) http://www.prescribersletter.com
  4. Forman JP et al, Frequency of analgesic use and risk of hypertension among men. Arch Intern Med 2007, 167:394 PMID: 17325302
  5. Knutson KL et al Association Between Sleep and Blood Pressure in Midlife The CARDIA Sleep Study Arch Intern Med. 2009;169(11):1055-1061 PMID: 19506175
  6. Cappuccio FP et al, Gender-specific associations of short sleep duration with prevalent and incident hypertension: The Whitehall II Study. Hypertension 2007, 50:693 PMID: 17785629
  7. Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015
  8. Borgi L et al. Potato intake and incidence of hypertension: Results from three prospective US cohort studies. BMJ 2016 May 17; 353:i2351. PMID: 27189229 Free PMC Article - Harris MF and Laws RA. Are there bad foods or just bad diets? BMJ 2016 May 17; 353:i2442. PMID: 27188599
  9. Dimakopoulou K, Koutentakis K, Papageorgiou I et al Is aircraft noise exposure associated with cardiovascular disease and hypertension? Results from a cohort study in Athens, Greece. Occupational & Environmental Medicine. June 13, 2017 PMID: 28611191 http://oem.bmj.com/content/early/2017/05/08/oemed-2016-104180