Hypertension
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Hypertension

Two thirds of hypertensive persons are obese. Normally, weight loss can decrease hypertension, as can mild to moderate sodium restriction.

Hypertension is an increase in blood pressure such that the systolic pressure is greater than 140 mmHg and the diastolic pressure is greater than 90 mmHg. Essential hypertension is the most common type, affecting 90% of persons with high blood pressure. The exact origin of essential hypertension is unknown; however, contributing factors include a family history of hypertension, hyperlipidemia, African American background, diabetes, obesity, aging, stress and excessive smoking and alcohol ingestion. Ten percent of hypertension cases are related to renal and endocrine disorders and are classified as secondary hypertension.

The kidneys and the blood vessels strive to regulate and maintain a normal blood pressure. The kidneys regulate blood pressure via the renin-angiotensin system. Renin from the renal cells stimulates procution of angiotensin II (a potent vasoconstrictor), which causes the release of aldosterone (adrenal hormone that promotes sodium retention and thereby water retention). Retention of sodium and water causes fluid volume to increase thus elevating blood pressure. The baroreceptors in the aorta and carotid sinus and the vasomotor center in the medulla also assist in the regulation of blood pressure. Catacholamines such as norepinephrine released from the sympathetic nerve terminals and epinephrine released from the adrenal medulla increase blood pressure through vasoconstriction activity.

Other hormones that contribute to blood pressure regulation are the antidiuretic hormone and atrial natriuretic peptide hormone. ADH is produced by the hyupothalamus and is stored and released by the posterior pituitary gland. This hormone stimulates the kidneys to conserve and retain water when there is a fluid volume deficit, however, when there is a fluid overload, ADH secretion is inhibited, and the kidneys then excrete more water. ANP is released by the atrium of the heart and responds to fluid overload by stimulating the kidneys to increase the glomerular filtration rate, thereby increasing the elimination of sodium and water. In addition, ANP causes vasodilation and inhibits rennin and aldosterone secretions. The hormone brain natriuretic peptide (BNP) is released from the atrium like ANP when volume overload occurs within the heart chambers. ANP and BNP aid in volume homeostasis and are useful for identifying heart failure.

Certain physiologic risk factors contribute to hypertension. A diet with excess fat and carbohydrates can increase blood pressure. Carbohydrates intake can affect sympathetic nervous activity. Alcohol increases rennin secretions, causing the production of angiotensin II. Obesity affects the sympathetic and cardiovascular systems by increasing cardiac output, stroke volume and left ventricular filling. Two thirds of hypertensive persons are obese. Normally, weight loss can decrease hypertension, as can mild to moderate sodium restriction.

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