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Essential hypertension

MedGen UID:
88442
Concept ID:
C0085580
Disease or Syndrome
Synonyms: Essential Hypertension; Hypertension, Essential; Hypertension, Primary; Hypertensions, Primary; Primary Hypertension; Primary Hypertensions
SNOMED CT: Essential hypertension (59621000); Idiopathic hypertension (59621000); Systemic primary arterial hypertension (59621000); Primary hypertension (59621000)
 
Related genes: RGS5, PTGIS, NOS3, GNB3, ECE1, CYP3A5, ATP1B1, AGTR1, AGT, ADD1
 
Monarch Initiative: MONDO:0001134
OMIM®: 145500; 601699
Orphanet: ORPHA243761

Definition

The Pickering school held that blood pressure has a continuous distribution, that multiple genes and multiple environmental factors determine the level of one's blood pressure just as the determination of stature and intelligence is multifactorial, and that 'essential hypertension' is merely the upper end of the distribution (Pickering, 1978). In this view the person with essential hypertension is one who happens to inherit an aggregate of genes determining hypertension (and also is exposed to exogenous factors that favor hypertension). The Platt school took the view that essential hypertension is a simple mendelian dominant trait (Platt, 1963). McDonough et al. (1964) defended the monogenic idea. See McKusick (1960) and Kurtz and Spence (1993) for reviews. Swales (1985) reviewed the Platt-Pickering controversy as an 'episode in recent medical history.' The Pickering point of view appears to be more consistent with the observations. [from OMIM]

Additional description

From MedlinePlus Genetics
Hypertension is abnormally high blood pressure in the arteries, which are the blood vessels that carry blood from the heart to the rest of the body. As the heart beats, it forces blood through the arteries to deliver nutrients and oxygen to the rest of the body. The strength of the blood pushing against the artery walls is blood pressure, which is measured in units called millimeters of mercury (mmHg). The top number in a blood pressure reading is the pressure when the heart pumps (systolic blood pressure), and the bottom number is the pressure between heart beats (diastolic blood pressure). In adults, a normal blood pressure measurement is about 120/80 mmHg. Blood pressure is considered high when the measurement is 130/80 mmHg or greater.

Hypertension usually has no symptoms, and many affected individuals do not know they have the condition. However, hypertension is a major risk factor for heart disease, stroke, kidney failure, and eye problems. When blood pressure is elevated, the heart and arteries have to work harder than normal to pump blood through the body. The extra work thickens the muscles of the heart and arteries and hardens or damages artery walls. As a result, the flow of blood and oxygen to the heart and other organs is reduced. Damage to the heart caused by the extra work and a lack of oxygen causes heart disease. In addition, damage to the arteries increases the risk of blood clots that block the flow of blood to the heart, causing a heart attack, or to the brain, causing a type of stroke known as an ischemic stroke. Another type of stroke, called a hemorrhagic stroke, can occur when a weakened blood vessel in the brain bursts. Damage to blood vessels in the kidneys impairs their ability to filter waste and remove fluid, leading to kidney failure. Problems with blood flow in the arteries of the eyes can lead to vision loss.

In rare cases, dangerously high blood pressure can cause severe headaches, confusion, shortness of breath, chest pain, or nosebleeds.

In about 95 percent of cases, the cause of hypertension is unknown. These cases are classified as essential hypertension. When hypertension results from an underlying condition, such as blood vessel defects that reduce blood flow; kidney disorders, which alter the amount of fluids and salts in the body; or problems with hormone-producing glands called the adrenal glands or the thyroid gland, it is classified as secondary hypertension. Hypertension is a key feature of some rare genetic disorders, including familial hyperaldosteronism, pseudohypoaldosteronism type 2, Liddle syndrome, and tumors known as paragangliomas.  https://medlineplus.gov/genetics/condition/hypertension

Clinical features

From HPO
Elevated systolic blood pressure
MedGen UID:
333547
Concept ID:
C1840374
Finding
Abnormal increase in systolic blood pressure.
Elevated diastolic blood pressure
MedGen UID:
374454
Concept ID:
C1840375
Finding
Abnormal increase in diastolic blood pressure.
Elevated mean arterial pressure
MedGen UID:
326719
Concept ID:
C1840376
Finding
An abnormal increase in the average blood pressure in an individual during a single cardiac cycle.

Professional guidelines

PubMed

Moiz A, Zolotarova T, Eisenberg MJ
Ann Med 2024 Dec;56(1):2338242. Epub 2024 Apr 11 doi: 10.1080/07853890.2024.2338242. PMID: 38604225Free PMC Article
Ferdinand KC, Nasser SA
Cardiol Clin 2017 May;35(2):231-246. doi: 10.1016/j.ccl.2016.12.005. PMID: 28411897
Sibai BM
Am J Obstet Gynecol 2012 Jun;206(6):470-5. Epub 2011 Sep 16 doi: 10.1016/j.ajog.2011.09.002. PMID: 21963308

Curated

UK NICE Guideline NG136, Hypertension in adults: diagnosis and management, 2023

Recent clinical studies

Etiology

Moiz A, Zolotarova T, Eisenberg MJ
Ann Med 2024 Dec;56(1):2338242. Epub 2024 Apr 11 doi: 10.1080/07853890.2024.2338242. PMID: 38604225Free PMC Article
Wu DF, Yin RX, Deng JL
Eur J Prev Cardiol 2024 Jul 23;31(9):1092-1103. doi: 10.1093/eurjpc/zwae022. PMID: 38236144
Xie M, Tang T, Liang H
Clin Cardiol 2023 Aug;46(8):886-898. Epub 2023 Jul 11 doi: 10.1002/clc.24082. PMID: 37432701Free PMC Article
Monticone S, D'Ascenzo F, Moretti C, Williams TA, Veglio F, Gaita F, Mulatero P
Lancet Diabetes Endocrinol 2018 Jan;6(1):41-50. Epub 2017 Nov 9 doi: 10.1016/S2213-8587(17)30319-4. PMID: 29129575
Garfinkle MA
J Am Soc Hypertens 2017 Jun;11(6):385-391. Epub 2017 Apr 14 doi: 10.1016/j.jash.2017.04.006. PMID: 28479261

Diagnosis

Wu DF, Yin RX, Deng JL
Eur J Prev Cardiol 2024 Jul 23;31(9):1092-1103. doi: 10.1093/eurjpc/zwae022. PMID: 38236144
Xie M, Tang T, Liang H
Clin Cardiol 2023 Aug;46(8):886-898. Epub 2023 Jul 11 doi: 10.1002/clc.24082. PMID: 37432701Free PMC Article
Heidari B, Avenatti E, Nasir K
Methodist Debakey Cardiovasc J 2022;18(5):5-16. Epub 2022 Dec 6 doi: 10.14797/mdcvj.1175. PMID: 36561082Free PMC Article
Monticone S, D'Ascenzo F, Moretti C, Williams TA, Veglio F, Gaita F, Mulatero P
Lancet Diabetes Endocrinol 2018 Jan;6(1):41-50. Epub 2017 Nov 9 doi: 10.1016/S2213-8587(17)30319-4. PMID: 29129575
Messerli FH, Williams B, Ritz E
Lancet 2007 Aug 18;370(9587):591-603. doi: 10.1016/S0140-6736(07)61299-9. PMID: 17707755

Therapy

Chen S, Sun Y, Agrawal DK
J Am Soc Hypertens 2015 Nov;9(11):885-901. Epub 2015 Aug 21 doi: 10.1016/j.jash.2015.08.009. PMID: 26419755Free PMC Article
Xiong XJ, Li SJ, Zhang YQ
J Hum Hypertens 2015 Mar;29(3):143-51. Epub 2014 Jul 3 doi: 10.1038/jhh.2014.52. PMID: 24990417
Wang J, Xiong X, Liu W
Int J Cardiol 2013 Nov 20;169(5):317-26. Epub 2013 Sep 6 doi: 10.1016/j.ijcard.2013.09.001. PMID: 24060112
Hopkins AL, Lamm MG, Funk JL, Ritenbaugh C
Fitoterapia 2013 Mar;85:84-94. Epub 2013 Jan 17 doi: 10.1016/j.fitote.2013.01.003. PMID: 23333908Free PMC Article
Kokkinos PF, Papademetriou V
Coron Artery Dis 2000 Mar;11(2):99-102. doi: 10.1097/00019501-200003000-00002. PMID: 10758809

Prognosis

Hundemer GL, Curhan GC, Yozamp N, Wang M, Vaidya A
Lancet Diabetes Endocrinol 2018 Jan;6(1):51-59. Epub 2017 Nov 9 doi: 10.1016/S2213-8587(17)30367-4. PMID: 29129576Free PMC Article
Ogunsua AA, Shaikh AY, Ahmed M, McManus DD
Methodist Debakey Cardiovasc J 2015 Oct-Dec;11(4):228-34. doi: 10.14797/mdcj-11-4-228. PMID: 27057292Free PMC Article
Chen S, Sun Y, Agrawal DK
J Am Soc Hypertens 2015 Nov;9(11):885-901. Epub 2015 Aug 21 doi: 10.1016/j.jash.2015.08.009. PMID: 26419755Free PMC Article
Kulkarni S, O'Farrell I, Erasi M, Kochar MS
WMJ 1998 Dec;97(11):34-8. PMID: 9894438
Svensson A
Clin Exp Hypertens 1993 Nov;15(6):1353-61. doi: 10.3109/10641969309037117. PMID: 8268895

Clinical prediction guides

Cesario V, Presta V, Figliuzzi I, Citoni B, Battistoni A, Miceli F, Volpe M, Tocci G
High Blood Press Cardiovasc Prev 2020 Jun;27(3):195-201. Epub 2020 May 2 doi: 10.1007/s40292-020-00382-1. PMID: 32361899
Loscalzo J
Circ Res 2019 Mar 29;124(7):987-989. doi: 10.1161/CIRCRESAHA.119.314403. PMID: 30920923Free PMC Article
Rizzoni D, Agabiti Rosei C, De Ciuceis C, Semeraro F, Rizzoni M, Docchio F
Am J Hypertens 2018 Feb 9;31(3):265-273. doi: 10.1093/ajh/hpx211. PMID: 29228086
Gkaliagkousi E, Gavriilaki E, Triantafyllou A, Douma S
Curr Hypertens Rep 2015 Nov;17(11):85. doi: 10.1007/s11906-015-0596-3. PMID: 26371063
Iimura O, Shimamoto K
Ann N Y Acad Sci 1993 Mar 15;676:105-21. doi: 10.1111/j.1749-6632.1993.tb38729.x. PMID: 8489125

Recent systematic reviews

Xie M, Tang T, Liang H
Clin Cardiol 2023 Aug;46(8):886-898. Epub 2023 Jul 11 doi: 10.1002/clc.24082. PMID: 37432701Free PMC Article
Richards EMF, Giorgione V, Stevens O, Thilaganathan B
Am J Obstet Gynecol 2023 Apr;228(4):395-408. Epub 2022 Oct 7 doi: 10.1016/j.ajog.2022.09.046. PMID: 36209937
González-González JG, Violante-Cumpa JR, Zambrano-Lucio M, Burciaga-Jimenez E, Castillo-Morales PL, Garcia-Campa M, Solis RC, González-Colmenero AD, Rodríguez-Gutiérrez R
High Blood Press Cardiovasc Prev 2022 Nov;29(6):547-564. Epub 2022 Oct 1 doi: 10.1007/s40292-022-00542-5. PMID: 36181637
Monticone S, D'Ascenzo F, Moretti C, Williams TA, Veglio F, Gaita F, Mulatero P
Lancet Diabetes Endocrinol 2018 Jan;6(1):41-50. Epub 2017 Nov 9 doi: 10.1016/S2213-8587(17)30319-4. PMID: 29129575
Tam TS, Wu MH, Masson SC, Tsang MP, Stabler SN, Kinkade A, Tung A, Tejani AM
Cochrane Database Syst Rev 2017 Feb 28;2(2):CD008996. doi: 10.1002/14651858.CD008996.pub2. PMID: 28245343Free PMC Article

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    Clinical resources

    Practice guidelines

    • PubMed
      See practice and clinical guidelines in PubMed. The search results may include broader topics and may not capture all published guidelines. See the FAQ for details.
    • Bookshelf
      See practice and clinical guidelines in NCBI Bookshelf. The search results may include broader topics and may not capture all published guidelines. See the FAQ for details.

    Curated

    • NICE, 2023
      UK NICE Guideline NG136, Hypertension in adults: diagnosis and management, 2023

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