Essential hypertension usually causes no significant symptoms until complications in various organs occur. Symptoms vary widely, depending on the degree of blood pressure elevation and are divided into the following two categories:

• Mild, complicated hypertension: Dizziness, weakness, fatigue, headache, facial flushing
• Severe, complicated hypertension: Stroke, pulmonary edema, renal failure, encephalopathy accompanied by epileptic phenomena and altered mental status, heart failure, myocardial infarction [11] [12].

Essential hypertension is usually diagnosed during a routine check-up, or when a patient experiences mild, persistent symptomatology.

• Resistant Hypertension

  […] in patients with resistant hypertension. [doi.org]

  Pathophysiologically, borderline hypertension is different from established hypertension. A large proportion of such patients have elevated cardiac output and a normal vascular resistance. [care.diabetesjournals.org]

  Additional Hypertension Types: Isolated Systolic, Malignant, and Resistant Isolated systolic hypertension, malignant hypertension, and resistant hypertension are all recognized hypertension types with specific diagnostic criteria. [everydayhealth.com]

  Heart group updates guidelines on resistant hypertension. NEJM Journal Watch. Available at https://www.jwatch.org/fw114569/2018/09/13/heart-group-updates-guidelines-resistant-hypertension. September 13, 2018; Accessed: October 2, 2018. [medscape.com]

• Fatigue

  WebMD notes various symptoms of hypertension, including blood in the urine, chest pain, difficulty breathing, fatigue or confusion, irregular heartbeat, severe headaches and vision problems. [ask.com]

  Over fatigue? Palaging may sakit? Now its the time to try our Cafe Historia LATTE & BUTTERSCOTCH. [findglocal.com]

  Moderate symptoms are dizziness, fatigue, headache and other, whereas more severe symptomatology includes a stroke, heart attack or encephalopathy. [symptoma.com]

  While very few patients may suffer from headache, dizziness and fatigue, many people with hypertension for years are not aware of it because hypertension typically does not give rise to symptoms. [chp.gov.hk]

• Swelling

  Differential Diagnosis III: Complicated Hypertension Rationale: Patient’s description of headaches, swelling of the lower extremities, consecutive uncontrolled hypertensive blood pressures, combined with the potential for chronic hypertensive damage leading [u.osu.edu]

  Corticosteroids are often used to reduce swelling and inflammation. You may be prescribed a high dose of a type of corticosteroid called a glucocorticoid. [hse.ie]

  […] hypertrophy Sleep disorder associated with hypertension Decreased perfusion of lower extremities Coarctation of the aorta Diaphoresis Pheochromocytoma Flushing Pheochromocytoma Growth retardation Chronic renal failure Hirsutism Cushing's syndrome Joint swelling [aafp.org]

  The peritubular capillary blood with less sodium and water develops higher oncotic (i.e., cause by edema, or swelling), pressure and facilitates sodium re-absorption, leading to a higher blood volume and a higher B/P. [rn-journal.com]

• Chills

  Early signs of this condition include weight loss, fevers or chills, frequent infections, bone and joint pain, bleeding and bruising problem, tiredness, and weight and appetite loss. [pchrd.dost.gov.ph]

• Nausea

  If you do experience symptoms, they may include: Headaches Dizziness Nosebleeds Nausea, vomiting Shortness of breath Blurred vision Malignant Hypertension In addition to these types of hypertension, there is a rare, severe form called hypertensive emergency [highbloodpressure.about.com]

  Other forms include: Secondary hypertension – high blood pressure caused by another condition Malignant hypertension – which has obvious and noticeable symptoms, such as chest pain, nausea, and headaches Resistant hypertension – a form that is impervious [mytherapyapp.com]

  If a person experiences vomiting or nausea, severe headaches, vision changes or nosebleeds, it may be a sign of malignant hypertension – a much more dangerous type of high blood pressure.[5] If these symptoms appear, urgent medical attention should be [ada.com]

  These symptoms include: Headache Dizziness Shortness of breath Blurred vision Feeling of pulsations in the neck or head Nausea IMAGES High Blood Pressure (Hypertension) Signs, Causes, Diet, and Treatment See a medical illustration of high blood pressure [medicinenet.com]

  Overall, among the patients who received potassium supplementation, two reported nausea or vomiting, 14 reported change in bowel habits (diarrhea, constipation), 15 reported abdominal pain, 12 reported gas (belching or flatulence), 2 reported headache [journals.plos.org]

• Hypertension

  An accurate measurement of the patient's blood pressure is required in order to diagnose hypertension and, subsequently, essential hypertension. [symptoma.com]

  Essential hypertension accounts for 95% of all cases of hypertension. Essential hypertension is a heterogeneous disorder, with different patients having different causal factors that lead to high BP. [dx.doi.org]

  INTRODUCTION: The renin gene has been suggested as a good candidate in the study of genetic mechanism of essential hypertension. [ncbi.nlm.nih.gov]

• Palpitations

  Proptosis Cause Suggestive Findings Diagnostic Approach Graves disease Eye symptoms: Eye pain, lacrimation, dry eyes, irritation, photophobia, ocular muscle weakness causing diplopia, vision loss caused by optic nerve compression Systemic symptoms: Palpitations [merckmanuals.com]

  Episodic feelings 'as if about to die' or headaches, or paroxysmal sweats or palpitations, suggest phaeochromocytoma. [patient.info]

  Cardiovascular disease Diaphoresis (abnormal) Endocrinopathies Dyspnea on exertion Cardiovascular disease Edema Cardiovascular disease Enuresis Renovascular disease, renal scarring Growth failure Endocrinopathies Heat or cold intolerance Endocrinopathies Heart palpitations [aafp.org]

• Diastolic Hypertension

  After 6 weeks, medication had been discontinued, and his diastolic blood pressure remained within normal levels. The patient was subsequently returned to full flight status without recurrence of diastolic hypertension at followup 6 months later. [ncbi.nlm.nih.gov]

  The blood pressure goals for systolic and diastolic hypertension vary based on the age. [renalandurologynews.com]

  […] totaled near $30 billion. 3 Recent analysis suggests that hypertensive patients fall in two groups: Approximately one-fourth consists of individuals under the age of 50 who are predominantly male and have a diastolic hypertension. [rn-journal.com]

  […] acid was significantly correlated with childhood and adult blood pressure, both systolic and diastolic. [6] Childhood uric acid levels and change in levels of uric acid were significant predictors of adult diastolic blood pressure. [6] Change in uric [ijem.in]

• Wide Pulse Pressure

  Pulse Pressure = Systolic Pressure - Diastolic Pressure A “low” number indicates a narrow pulse pressure. A high number indicates a wide pulse pressure. [realfirstaid.co.uk]

  In older patients with wide pulse pressure, the Korotkoff sounds typically disappear between the phase I and V. This phenomenon is referred to as auscultatory gap and may be indicate of target organ damage (TOD). [renalandurologynews.com]

• Narrow Pulse Pressure

  Pulse Pressure = Systolic Pressure - Diastolic Pressure A “low” number indicates a narrow pulse pressure. A high number indicates a wide pulse pressure. [realfirstaid.co.uk]

• Epistaxis

  Dizziness, facial flushing, headache, fatigue, epistaxis, and nervousness are not caused by uncomplicated hypertension. [merckmanuals.com]

  Examples include upper levels of stage II hypertension associated with severe headache, shortness of breath, epistaxis, or severe anxiety. [doi.org]

• Headache

  Differential Diagnosis I: Primary Hypertension Rationale: Due to patient’s age, BMI, lifestyle, consecutive hypertensive blood pressures, and description of headaches (bilateral temporal throbbing – occurring throughout day with decreased intensity as [u.osu.edu]

  Our cases showed arteriolar involvement and clinical symptoms characterized by headaches, dysesthesias, fleeting paralysis, personality changes, intellectual impairment and a prolonged progressive course. [annals.org]

  The following findings are of particular concern: Eye pain or redness Headache Loss of vision Diplopia Fever Pulsating proptosis Neonatal proptosis Proptosis can be confirmed with exophthalmometry, which measures the distance between the lateral angle [merckmanuals.com]

• Irritability

  Fecal transplant is used to treat gut infections and is now being studied as a treatment for obesity, urinary tract infections, irritable bowel syndrome and more. [nytimes.com]

  Some Causes of Proptosis Cause Suggestive Findings Diagnostic Approach Graves disease Eye symptoms: Eye pain, lacrimation, dry eyes, irritation, photophobia, ocular muscle weakness causing diplopia, vision loss caused by optic nerve compression Systemic [merckmanuals.com]

  […] help reduce the inflammation associated with the condition corrective surgery – this may be done to improve the appearance of your eyes once the inflammation is under control Other useful treatments include using eye drops to reduce eye dryness and irritation [nhs.uk]

• Hyperactivity

  It was suggested that, for population that applied TCM diagnostic criteria, RR=1.35,95% CI:1.17-1.56，P CONCLUSIONS: Our review indicated that NHJYP has some beneficial effects in EH patients with liver-yang hyperactivity and abundant phlegm-heat syndrome [ncbi.nlm.nih.gov]

  High-output hypertension results from volume and sodium retention by the kidney, leading to increased stroke volume and, often, with cardiac stimulation by adrenergic hyperactivity. [emedicine.medscape.com]

An accurate measurement of the patient's blood pressure is required in order to diagnose hypertension and, subsequently, essential hypertension. Blood pressure should be measured with a mercurial sphygmomanometer at least three times, with a two-minute interval between each measurement. The pressure should be assessed in both arms and one leg [13] [14].

During auscultation, the presence of a fourth cardiac sound indicates cardiac complications; pulses should also be palpated in the periphery. The region of the neck should be evaluated for the presence of distended jugular veins or carotid bruits.

With a reference to laboratory tests, a complete blood work, followed by a complete biochemical analysis is mandatory and includes the following:

• Hematocrit
• Complete blood count
• Liver function: AST, ALT, γ-GT, ALP
• HbA1c or fasting blood glucose
• Serum electrolytes (Na, K)
• Creatinine, Urea, GFR in order to evaluate renal function
• Complete serum lipid profile: total cholesterol, HDL, LDL, triglycerides
• Urinalysis

Depending on the symptoms a patient presents with, further procedures may be required, in order to eliminate other causes, such as chest X-ray.

In order to establish the diagnosis of essential hypertension, causes that are known to lead to an elevated blood pressure must be investigated. An magnetic resonance angiography (MRA), computed tomographic angiography (CTA) or an invasive renal angiography can help to determine whether the elevated blood pressure can be attributed to renal causes [15] [16]. An electrocardiogram, an echocardiogram and a stress echocardiogram can also provide useful information concerning cardiac involvement [17].

• Insulin Increased

  Thus, although the mechanisms by which obesity and insulin resistance increase BP remain undefined, it is clear that these increases in BP are overlain on the inherited BP. [dx.doi.org]

  Normally, sodium excretion increases when there is an acute increase in blood pressure. [ijem.in]

• Uric Acid Increased

  […] of uric acid in hypertension. [doi.org]

Despite the lack of established causes for essential hypertension, blood pressure can be maintained within the normal or nearly normal range with the daily administration of medications and lifestyle modifications.

Lifestyle modifications refer to the adherence to a more healthy lifestyle, without the factors that pose a threat to the cardiovascular system. Patients are asked to stop smoking, maintain a healthy weight, exercise, increase the consumption of fibers and vitamins and decrease the amount of Na they receive from their diet. Exercise should consist of aerobic training and the optimum BMI is between 18.5- 24.9 for patients diagnosed with hypertension. Food that is low in fat and especially saturated fat, should be preferred and the daily intake of salt should not exceed the limit of 2.4 g/day. The ingestion of alcohol should also be strictly regulated to no more than 29.5 ml per day (men) and 15 ml per day (women). Daily blood pressure measurements at home are advised and individuals affected by hypertension should also control other conditions that exacerbate the condition, such as diabetes and hyperlipidemia.

The initial treatment plan for patients with essential hypertension and no complications, diabetes, cardiovascular dysfunction or organ damage, solely includes lifestyle adaptations. Failure of these measures to render the patient normotensive indicates the need for anti-hypertensive medication. It should be noted that patients who do not fit the aforementioned profile in terms of comorbidities or present with a blood pressure that exceeds 160/100 mmHg are treated with a combination of lifestyle changes and medications from the beginning.

There are various medications used to control hypertension: β-blockers, ACE inhibitors, aldosterone antagonists, angiotensin receptor blockers, calcium channel blockers and diuretics. Dosages are initiated at a low level and the therapeutic scheme almost invariably starts with the choice of one drug. Failure of the therapy to regulate blood pressure within the next month suggests the need for a second medication or a dosage increase.

Invasive procedures are also an option in cases of essential hypertension that does not respond to conservative treatment. They are primarily used for the treatment of hypertension caused by renal disease or as experimental treatments.

The best prognosis among hypertensive patients is reserved for those with a moderate increase in their blood pressure or those individuals with no hypertension-induced complications, such as cerebral events, cardiovascular events or retinal sequelae. Cerebral events comprise both hemorrhagic and ischemic strokes and carotid artery disease seems to affect hypertensive patients with a greater frequency. Patients who develop papilledema, arterial stenosis and sclerosis of the retina are faced with a poor prognosis.

Essential hypertension has no known causes, yet its etiology is believed to be multifactorial. A certain, non-clarified genetic predisposition has been proposed, alongside flaws in hemodynamics and various physiologic pathways, including the renin-angiotensin activation system.

The risk factors that pose a threat to the cardiovascular system also affect the possibility of developing essential hypertension. Such risk factors are obesity, diabetes, hyperlipidemia and aging. They are thought to trigger hypertension in younger patients with a genetic predisposition. Patients who have exceeded the 60th decade of their lives are believed to be more negatively affected by the increased consumption of sodium, in terms of hypertension occurrence.

Essential hypertension is commonly diagnosed among the American population and affects nearly 1/3 of the latter, simultaneously leading to an elevated risk of cardiovascular and cerebral events [1] [2] [3]. The condition seems to affect non-Hispanic Afro-Americans at increased frequency, when compared with the Caucasian population and Mexican Americans [4] [5] [6].

The unknown and multi-factorial etiology of essential hypertension implies a complex and undefined pathophysiological mechanism [7]. Hypertension is a result of the interaction of many defects in the following physiologic components:

• Blood volume and viscosity
• Reactivity of the vascular system
• Cardiac output
• Neural stimulation
• Humoral mediators
• Vascular elasticity

Various studies have identified the contribution of inflammatory mediators in the pathogenesis of hypertension. The activation of cytokines such as interleukin 17, TNF-α and other molecules have been strongly associated with the occurrence of essential hypertension. The defective activation of the sympathetic nervous system is also believed to promote the clustering of inflammation mediators, thus further exacerbating hypertension: this activation is most likely affected by an abnormal transportation of Na across the cellular wall, by augmented Na permeability or by a dysfunctional Na-K pump [8] [9]. Psychological factors, such as emotional stress, are also known to lead to hypertension episodes, possibly through cortisol reactivity [10].

The renin-angiotensin-aldosterone complex is a system that is known to have the ability to cause the elevation of blood pressure. Renin is an enzyme that induces the conversion of angiotensinogen to angiotensin I; the latter is converted to angiotensin II, which causes vasoconstriction and the release of aldosterone and ADH by the sympathetic nervous system, thus leading to an increased blood pressure. This mechanism underlies secondary hypertension attributed to renal causes and could possibly play a role in primary hypertension as well, although its contribution has not yet been confirmed.

Lastly, hypertension is not solely caused by the abundance of a vasoconstricting agent, but can also be induced by the decreased concentration of a vasodilator. Various renal pathologies are associated with decreased production of vasodilators, but the potential mechanism in terms of essential hypertension has also not yet been definitively clarified.

Hypertension can be prevented to a significant degree, by means of adopting a more healthy lifestyle. The following recommendations can, in many cases, help an individual to avoid the onset of the condition:

• Avoiding food that is rich in saturated fat
• Consumption of alcohol that does not exceed one drink per day for women and two drinks per day for men
• Aerobic exercise, approximately for 30 min., most days of the week
• Cessation of smoking
• Reduction of daily sodium ingestion
• Consumption of fiber-rich foods, such as fruits and vegetables
• Reduction of emotional stress
• Healthy body weight

Hypertension is a condition which involves a persistently increased systolic blood pressure ≥ 140 mm Hg, diastolic blood pressure ≥ 90 mm Hg, or both, with the measurement performed at rest. Secondary hypertension can arise as a complication of another pre-existing condition, most commonly chronic kidney disease or primary aldosteronism, whereas essential hypertension occurs idiopathically, with no known etiology. Essential hypertension is otherwise referred to as primary hypertension.

Essential hypertension is a condition that affects the vast majority of the late-adult population of the western world, since the risk of being affected by it reaches 90%. It should be medically addressed and regulated, since elevated blood pressure can lead to various sequelae of cerebral, cardiac or renal nature. Even though its causes remain unknown, individuals at a high risk of developing hypertension are those who share the following risk factors:

• Advanced age
• Diabetes mellitus
• Obesity
• Insulin resistance
• Hyperlipidemia

Essential hypertension usually does not cause acute, life-threatening events; nevertheless, prolonged periods of elevated blood pressure can eventually lead to major complications, including a stroke, kidney failure or myocardial infarction.

Primary hypertension is treated with daily ingestion of antihypertensive drugs, which do not cure the condition but help to maintain blood pressure either within a normal range or within a range that does not constitute a cardiovascular, renal or cerebral threat. In spite of the extensive availability and variety of antihypertensive medication used to control the condition in patients with various comorbidities and characteristics, essential hypertension very often remains unregulated.

Hypertension is a condition in which the blood pressure is constantly elevated above normal limits while an individual is resting. It can arise as a complication of other conditions, primarily renal conditions (secondary hypertension) or occur spontaneously, without any known cause referred to as primary or essential hypertension.

Essential hypertension is indeed a frequent condition, estimated to affect nearly 30% of the population of the industrialized world. Even though the medical community has not yet discovered its exact causes and mechanisms, these are certain risk factors believed to increase a person's chances of developing essential hypertension. These risk factors include an increased body weight, progressed age, diabetes, smoking, high serum cholesterol, lack of exercise and an increased intake of sodium (salt) through one's diet. Hypertension is believed to have some genetic background and people who are genetically more prone to develop it might do so at a younger age, if their lifestyle features some of the previously mentioned risk factors.

Hypertension is a condition that cannot be cured, but the blood pressure can be kept within a normal range or within a range that does not pose a threat to other organs, such as the brain, heart, retina or kidneys. It does not cause symptoms, unless a complication has occurred, whether mild or severe. Moderate symptoms are dizziness, fatigue, headache and other, whereas more severe symptomatology includes a stroke, heart attack or encephalopathy. Severe complications usually arise if blood pressure has been too high for a long period of time, with no treatment.

Hypertension can be treated with lifestyle modifications that include less sodium in one's diet, the cessation of smoking, exercising regularly, keeping one's weight within healthy limits and reducing the amount of alcohol one consumes. If these changes are not enough to normalize the blood pressure, a patient is in need of medication. These drugs help to regulate blood pressure and must be ingested for the rest of the individual's life.

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