1 HYPERTENSION AND IT’S HIDDEN PATHOGENESIS- RANJAN MANNA

HYPERTENSION AND IT’S HIDDEN PATHOGENESIS

Ranjan Manna

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Manuscript info

Abstract:- .
Manuscript Number:- SCI-1006
Now a days hypertension is such a common disease in
Received date:- 23rd june, 2019
people. Theoretical explanation of the pathophysiology of
Final accepted:- 26th june, 2019 the correlation have centre or several possible tragectories,
the most likely being cardiovascular reactivities to stress.
Publishing date:- 1st july, 2019 There are so many causes which can lead hypertension, but
some hidden causes are there according to our life style.

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Introduction:

The pathogenesis of essential hypertension is multifactorial and highly complex. The kidney is both the contributing and the
target organ of the interaction of multiple organ system and numerous mechanism of independent or interdependent pathways.
Factors that play an important role in the pathogenesis of hypertension include genetics , activation of neuro-hormonal system.
Such as the sympathetic nervous system ,renin-angiotensin-aldosterone system, obesity, increased diatary salt intake etc.

About heart and blood vessels

Heart: Our heart is a mascular organ. It sits in the chest, slightly to the left centre.

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Heart pumps blood around the body. It carries deoxygenated blood to the lung where it loads up with oxygen and
unloads carbon-dioxide.

The heart consists four Chamber:

 Right atrium
 Left atrium
 Right ventricle
 Left ventricle

This chambers are separated by a wall of muscle called

septum. Right atrium and right ventricle connected by
tricuspid valve. Left atrium and right ventricle connected
by mitral valve.

The wall of heart consists three layer of tissue:

 Epicardium- protective layer made of connective

tissue.
 Myocardium- the muscle of heart.
 Endocardium- lines the inside of the heart and
protects the valve and chambers.

The right side of the heart receives deoxygenated blood

and sends it to the lung. The left side of the heart receives
oxygenated blood from the lung and pumps it into the
whole body.

Blood vessels: Here is three types of blood vessels in our body.

 Arteries- artery carry oxygenated blood from the heart to

the body ( except pulmonary artery). Arteries are strong
and stretching which helps to push blood through the
circulatory system. It's elastic wall help blood pressure
consistent.
 Veins- they carry deoxygenated blood back to the heart.
Veins have thinner walls than arteries.
 Capillaries- they connect the smallest arteries to the
smallest veins. They have thin walls which allow them to
exchange compounds with tissue, like carbon-dioxide,
water, waste and nutrients.

What is hypertension

Hypertension or high blood pressure is the pressure that blood applies to the inner wall of the blood vessels.

Systolic blood pressure.

It is the pressure of left ventricle of the heart pump the blood through the arteries. This is the top pressure of blood against
the wall of blood vesscle.

It indicates the contractility of heart or heart muscle.

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Diastolic blood pressure.

It happened for flowing of blood through the arteries.

It indicates the condition of blood vessels. If this is resistance , dilated etc.

Physician use following classification:

Normal blood pressure: Systolic blood pressure equal or less than 120 mm/hg.

Diastolic blood pressure equal or less than 80 mm/hg.

Pre-hypertension: Systolic blood pressure 120-139 mm/hg.

Diastolic blood pressure 80-89 mm/hg.

Hypertension: Stage-1 – Systolic blood pressure 140-159 mm/hg.

Diastolic blood pressure 90-99 mm/hg.

Stage-2 – Systolic blood pressure equal or more than 160 mm/hg.

Diastolic blood pressure equal or more than 100 mm/hg.

Types of hypertension

There are mainly two types of hypertension one is essential hypertension or primary hypertension. And the other one is
secondary hypertension. Most people with hypertension have essential hypertension.

Essential hypertension: Essential hypertension is high blood pressure that doesn’t have a known secondary causes.

Essential hypertension is multifactorial and highly complex. The kidney is the both contributing and the target organ of the
hypertensive process, and the disease involved the interaction of multiple organ systems and numerous mechanisms of
independent or interdependent pathways. Essential hypertension is also greatly influenced by diet and lifestyle. Not only
excessive salt intake, there are so many factors that can raise the risk of having essential hypertension also.

The factors are

 Obesity
 Diabetes
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 Stress
 Lack of physical activity
 Chronic alcohol consumption

Secondary hypertension: secondary hypertension is high blood pressure that’s caused by other medical conditions.

Secondary hypertension indicates narrowing of aorta, chronic kidney disease, endocrine disorders as excess aldosterone,
thyroidism etc.

Pulse deficit:-

The difference in a minute's time between the number of beats of the heart and the number of beats of the pulse observed in
disease of heart.

When it occurs?

Pulse deficit occurs when there are fewer pulse than there are heartbeats. Atrial fibrillation and atrial flutter can cause pulse
deficit because they cause the heart to beat so fast and often irregularly, that the force of blood which out of heart is sometime
not very strong enough to create pulse.

Relationship between pulse deficit and hypertension:

Pulse is mostly controlled by electrical impulses these impulse travel through our heart and telling the chambers to beat in even
time . Exercise, stress, fear and other factors can speed up pulse.

The electrical system stimulates the pumping motion that propels heart's plumbing system.

When the blood vessels are not chocked or blocked blood easily flows through them. But ,if blood vessels are narrow or some
kind of instruction, the heart has to either squeeze harder or beat faster to pump blood. This result in high blood pressure.
When blood pressure and pulse are out of balance , it stains heart . And seems a range of symptoms, including-

 Confusion
 Difficulty exercising
 Dizziness
 Fainting
 Fatigue
 Shortness of breath

Causes of high blood pressure and pulse deficit:

 Thickened heart tissue

 Blood pressure medication
 Traumatic injuries or internal
bleeding

Common cause and relation with hypertension

Hypertension is mainly occur by overloading of fluid , and some

cardio vascular disorders like narrowing of blood vessels,
increase cardiac output. Kidney is the organ which
maintains fluid balance in our body.

 Chronic kidney disease: the relationship between CKD

and hypertension is like a cycle. As chronic kidney disease
contribute to or cause of hypertension. Increasing blood
pressure leads to high intraglomeruler pressure ,
impairing glomerular filtration. It damage to the glomeruli lead to an increase in protine in urine. It increase sodium
lavel in blood .
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Sodium leads the kidney to re absorption of fluid , which help to increase blood pressure.

 Cardiovascular vascular disorders: Hypertension may cause of cardiovascular disorders. High blood pressure may also
bring on heart failure by causing left ventricular hypertrophy. The heart muscle walls may weakend and become unable
to pump as strongly.

In cardiovascular system increase stroke volume helps to increase blood pressure. Narrowing of blood vessels are also
increase blood pressure.

modern life and relation and with hypertension

Life is growing rapidly in modern times with advance technology and social media platforms. There are a multi-faceted
compendium and many sided synthesis of development of human life, technology , and social media in contemporary life.
Lifestyle includes day-to-day behaviours and functions of people in activities , jobs, fun and diet.

The modern lifestyle has a number of advantages which include easing people lifestyle, saving hundreds of people live by the
new development of medicine and vaccine.On the other hand different modern lifestyle patterns have negetive effects on
health physically and psychologically. And hypertension is a symptom of living the modern lifestyle and it can occur from the
psychological and physiological disorders.

In this article we have divided the factors of hypertension in two types.

 Psychological factors
 Physiological factors
 Psychological factors:

Modern lifestyle means internet , face book , what’s app , android mobile. Addiction to technology is making us less efficient our
brains are bursier than ever before . At the same time , we are all doing more pressure in offices , ups and downs in relationship
, and peoples are depriving themselves from family , and friends and social gatherings. And this things are increasing our stress ,
anxiety , depression which are the factors of hypertension.

Stress:

Stress can cause hypertension through repeated blood pressure elevations as well as by stimulation of the nervous system to
produce large ammounts of vaso constricting hormones that increase blood pressure.

Anxiety:

Anxiety doesn’t cause long term high blood pressure. But episodes of anxiety can cause dramatic, temporary spikes in our blood
pressure.

If those temporary spikes occurs frequently, such as every day, thay can cause damage to our blood vessels , heart, and kidney,
which can increase our blood pressure.

Some medication to treat anxiety and mental disorders, such as serotonin and norepinephrine re-up take inhibitors, can also
cause of hypertension.
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Emotion:

Broken hearted people or faliure people suffers from stress and depression . Emotionally weak people get stressed easily. But
there’s no evidence these conditions are Directly linked to hypertension. Instead the hormones our body makes when we are
emotionally stressed may damage our arteries, leading to heart disease. Increases in blood pressure related to stress can be
dramatic.

Hormones:

Our body produces a surge of hormones when we are in a stressful situation. These hormones temporarily increase our blood
pressure by causing our heart to beat faster and our blood vessels to narrow. The production of the stress hormone adrenaline
scrambled thinking.

 Physically factor:

Lifestyle factors are critical determinants of blood pressure levels operating against a background of genetic susceptibility.
Excess body fat is a predominant cause of hypertension with additive effects of dietary salt, alcohol physical inactivity, age ,
pregnancy.

Age::

Hypertension is more common in people aged over 60 years. With age blood pressure can increase as the arteries become siffer
and narrower.

Increasing blood pressure with the age is most associated with structural changes in arteries and especially with large artery
stiffness. In the elderly , the most powerful predictor of risk is increased pulse pressure due to decreased Diastolic blood
pressure and increased Systolic blood pressure.

Overweight or obesity::

Obesity and hypertension are intimately connected. Obesity increase cardiovascular disorders risk by increasing LDL- cholesterol
levels ( bad cholesterol) and refusing HDL-cholesterol levels ( good cholesterol). This produces Harding of the heart arteries and
other arteries which leads to hypertension. Obesity is also increase the risk of diabetes by diminishing glucose tolerance and
predisposing to the development of left ventricular hypertrophy.

The most important issue to remember is that obesity is associated with hypertension and hypertension is associated with
numerous other disease that can effect overall health and life expectancy.

Dietary salt intake::

Salt is an ionic compound composed of sodium chloride, which is 40% sodium and 60% chloride. Salt crystals are readily soluble
in water and dissolved in water, it separates into Na+ and Cl- ions. Over the past century , sodium chloride has been the subject
of intence scientific research related to blood pressure elevations and cardiovascular mortalities.

Sodium has a big role in increasing blood pressure. Our body removes unwanted fluid by filtering our blood through the
kidneys. Here extra fluid is sucked out as urine from our body. Kidney do this using osmosis process. This process uses a delicate
balance of sodium and potassium to pull the water across the wall of cell from the blood stream to the collecting channel.

Eating salt raises the amount of sodium in our blood stream and wreck the delicate balance, refusing the ability of kidney to
remove water. It’s lead to hypertension due to extra fluid.

To cope with this extra strain, the tiny muscle in the artery walls become stronger and thicker. This made the space of inside
the arteries smaller and raises blood pressure.

An adult eat no more than 5-6g of salt a day, but most of us eat much more than this.

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Some patients having high blood pressure intake no amount of salt in a day which leads to other health problems, like rough
skin, heir falling etc. Sodium is essential for nerve and muscle function.

Less potassium intake- potassium is a key mineral that the body relies on heavily to function properly. It balancing out the
negative effects of salt to control blood pressure.

Blood sodium and wreck the delicate balance, reducing the ability of kidney to remove fluid. Eating more fruit and vegetables
will increase the potassium levels and help to restore the delicate balance. Which is help to kidney to work efficiently. And help
to lower blood pressure to a healthy level.

Renin- angiotensin system- the renin-angiotensin system regulates blood pressure and fluid balance in the body when blood
volume or sodium levels in the body are low, or blood potassium is high then the kidney cells release enzyme called renin. Renin
converts angiotensinogen. Which is produced in liver, to the hormone angiotensin- I into angiotensin- ii . So blood pressure is
increased.

Angiotensin -ii also stimulates the release of the hormone aldosterone in the adrenal glands, which causes the renal tubules to
retain sodium and water and excrete potassium. Angiotensin-ii and aldosterone work together to raise volume of blood, so
blood pressure is increased.

Lack of Physical activity::

Now a days in advance lifestyle less physical activity is a common thing. Due to less physical activity fat is growing in body. This
is a chance of obesity, bad cholesterol levels is also increase in this situation. Causing hypertension is happens.

Eating fast food::

Over weight and high cholesterol is happens during eat fast food. This lead to hypertension.

Intake tobacco and too much alcohol::

Smoking , chewing tobacco, drink alcohol immediately rise blood pressure temporarily. Due to vaso construction. It also damage
the lining of arteries walls. It can cause arteries narrowing and increased risk of heart disease.

What to do?

Changing the lifestyle can controling the high blood pressure. Make changes lifestyle including :

 Eating heart healthy diet with less salt.

 Getting regular physical activity.
 Maintaining a healthy weight or losing weight from over weight.
 Limited ammount of alcohol drinking.

Medication to treat high blood pressure:

 Angiotensin converting enzyme inhibitors.

 Angiotensin-ii receptor blockers.
 Calcium channel blockers.
 Alpha, Beta, Alpha-Beta blockers.
 Renin inhibitors.
 Aldosterone antagonist.
 Vasodilator.

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Conclusion

From this study, it can ba concluded that the prevalence of both prehypertension and hypertension is very high urban.

Increasing age is proved to be an independent risk factor for hypertension. But the hidden pathogenesis of hypertension is
lurked in our lifestyle.

We can prevent this by increasing the awareness about hypertension and it’s factors, but it can take more time. Interventions
like weight management, increased physical activity, increased fruits and vegetables consumption, and reduction in tobacco and
alcohol use are required and recommended.

Acknowledgement

I would like to thanks my teacher respected Dr. Sinchan Das sir to give this opportunity and this topic to me and helping me to
complete this article.

Reference

https://www.medicalnewstoday.com/article

https://www.webmd.com/hypertension-high-blood-pressure

https://scholargoogle.co.in/scholar

https://www.ncbi.nlm.nih.gov/pcm/article

https://en.m.wikipedia.org/wiki/hypertension

www.bloodpressureuk.org/..

Corresponding author- Ranjan Manna