Classification of Hypertension - By: Robert Baird

Hypertension is also classified based on whether or not the underlying cause is known.

Primary Hypertension

More than 90% of hypertensive patients have primary hypertension (also called essential or idiopathic hypertension), with the onset generally occurring between ages 30 and 50. Although the cause of primary hypertension isn't known, certain risk factors may contribute to the disease.

Advanced Age

A patient's chances of developing hypertension increase as he ages because of structural and functional changes in the peripheral vascular system. These changes include atherosclerosis, the loss of connective tissue elasticity, and a decreased relaxation of vascular smooth muscle, which reduces the ability of the vessels to distend and recoil. With advanced age, a patient's heart becomes stiffer and less efficient. Additional peripheral vascular resistance increases the work required to pump blood throughout his body.

Sex

Hypertension occurs more commonly in men until middle age; after middle age, it occurs more in women. The disease is more likely to cause complications and death in men.

Ethnic Group

In the United States, whites are less likely to have hypertension than African-Americans, Cubans, Puerto Ricans, and Mexican-Americans. AfricanAmericans are at greatest risk because they tend to have low plasma renin levels and a decreased ability to rid the body of excess sodium. AfricanAmericans have twice the risk of developing hypertension, a greater tendency to develop severe hypertension, and a higher death rate from hypertension.

Family History

Genetics seems to be a risk factor for some hypertensive patients. Although the inherited traits leading to high blood pressure haven't been determined, certain families have elevated intracellular sodium levels and lowered potassium-tosodium ratios. Also, studies show a relationship between blood pressure and environment for genetically similar family members. From these studies, researchers estimate that 25% to 61 % of all hypertension cases are linked to genetics.

Obesity

Generally, the greater a person's weight, the higher his blood pressure. Just a 10-pound weight loss can significantly decrease a person's blood pressure and may reduce the dose of antihypertensive drug needed.

Upper-body fat is more dangerous than fat in the hips and thighs. In particular, patients with increased intraabdominal fat are at risk for devel oping hypertension. Also, women with a waist-tohip ratio greater than 0.85 and men with a waistto-hip ratio greater than 0.95 have an increased risk of developing hypertension.

Tobacco Use

Although smoking and hypertension haven't been conclusively linked, patients who stop smoking decrease their risk of developing cardiovascular disease. In fact, a hypertensive patient who does not smoke is three to five times less likely to suffer a myocardial infarction (MI) or eVA than a patient with hypertension who does smoke. Also, smoking interferes with the action of some antihypertensive drugs such as propranolol.

High-Sodium Diet

For patients with primary hypertension, ingesting high-sodium foods or beverages may trigger an excessive release of natriuretic hormone, which indirectly increases blood pressure. Also, sodium intake may stimulate vasopressor mechanisms within the central nervous system (ENS), causing water retention and high blood pressure. Usually, blood pressure decreases when sodium intake is restricted.

Although almost everyone in Western countries consumes a high-sodium diet, only about 20% develop hypertension. Thus, a person must be sensitive to sodium to some degree for highsodium intake to trigger the development of hypertension.

High-Fat Diet

Foods with a high fat content have an indirect effect on blood pressure. A high-fat diet contributes to obesity and hyperlipidemia, which increase a patient's risk of cardiovascular complications. Hyperlipidemia, an excess of lipids in the plasma, increases the risk of atherosclerosis. Thus, hypertensive patients should be encouraged to eat a low-fat diet to reduce the risk of cardiovascular complications.

Heavy Alcohol Consumption

Alcohol consumption increases blood pressure; the greater a patient's daily consumption, the higher his blood pressure. Patients who drink excessive amounts of alcohol may be twice as likely to develop hypertension as patients who drink very little. Between 5% and 11 % of all cases of hypertension result from excessive alcohol consumption.

Sedentary Lifestyle

A patient's risk of developing hypertension increases by as much as 25% with a sedentary lifestyle. A hypertensive patient should be encouraged to exercise as a way to better his overall cardiovascular health. The activity doesn't need to be strenuous; moderate activity, such as a brisk 3D-minute to 45-minute walk three to five times a week, is sufficient. By maintaining regular aerobic activity, a hypertensive patient can decrease his systolic blood pressure by about 10 mm Hg.

Stress

A patient's blood pressure can temporarily increase as part of a normal protective, physiologic response to stressors such as anger, fear, and physical pain. However, if such stressors persist, increased vasoconstriction, an increased heart rate, and stimulation of renin release can cause continued high blood pressure. Thus, patients who are exposed to repeated stress have an increased risk of hypertension.

Excess Renin

In some patients with primary hypertension, the kidneys secrete excess quantities of renin, resulting in the conversion of angiotensinogen to angiotensin. Angiotensin causes arteriole constriction and an increase in aldosterone levels, followed by electrolyte and water retention and, subsequently, hypertension. Between 10% and 17% of hypertensive patients have elevated plasma renin levels and are classified as having highrenin primary hypertension.

Mineral Deficiencies

Patients with potassium, calcium, and magnesium deficiencies may experience increased blood pressure. A person can maintain normal potassium levels by changing his diet. Taking calcium supplements may reduce blood pressure in some patients, but it's not recommended to prevent hypertension. Taking magnesium supplements to control hypertension isn't recommended either.

Diabetes

Diabetic patients commonly develop hypertension, and they do so at an early age. In patients with both diabetes and hypertension, complications are severe.

About the Author

For more information on hypertension go to http://www.hypertensionblog.org/ for specialized information on blood pressure and coronary artery diseases .

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