Risks for arterial hypertension

Abstract

In this article, the most important risk factors that may predict the transition from borderline to established hypertension are reviewed. Primary prevention has to focus on identifying individuals who are at highest risk and delaying or reversing further elevation of arterial pressure levels. A review of the literature indicates that several environmental and congenital factors can be identified as risk factors for the development of hypertension, including family history of essential hypertension, age, race, obesity, alcohol consumption, salt intake, hormonal status, and some stress factors. Of all diagnostic approaches to predict the development of hypertension, measurements of resting heart rate and responses to dynamic exercise have some predictive value.

PIP: The most important risk factors that may predict the transition from borderline to established hypertension are revised, focusing on those pathological changes that have been investigated for their value as predictors of established hypertension. A patient commonly is diagnosed as a borderline hypertensive if several pressure values are somewhere above as well as below 140/90 mm Hg. Patients in this category generally are regarded as hypertensive when they are younger than age 40. Studies largely favor the hypothesis of polygenic inheritance of essential hypertension, yet the detailed nature of heredity continues to be disputed. Several biochemical markers reflect the hereditary etiology of established hypertension, e.g., a variation in the electrophoretic pattern of plasma proteins, urinary concentration of kallikrein, and an alteration of cell membrane transport of cations. In Western populations, arterial pressure increases throughout life. About 40% of the white population and over 50% of the black population over age 65 have hypertension (blood pressure of 160/95 mm Hg or greater) or isolated systolic hypertension (systolic blood pressure greater than 160 mmHg and diastolic blood pressure less than 95 mm Hg). Essential hypertension is more prevalent and vascular disease more severe in blacks than in whites. There is a well-documented association between obesity and hypertension; obesity increases the prevalence of hypertension 3 to 8 times. Numerous studies have been published about the relationship between arterial hypertension and excessive dietary salt intake, but the results continue to be controversial. In a cross-cultural analysis, a strong relationship was observed between salt intake and the prevalence of hypertension. Also noted was the modifying impact of sodium intake on the increasing prevalence of hypertension with age. Premenopausal women have a lower prevalence of essential hypertension and its risk factors than men of the same age because of the influence of estrogen, but if these women take oral contraceptives, arterial pressure increases and transient hypertension, often severe or even malignant, can be induced. Some behavioral patterns and personality traits appear to be associated with borderline hypertension, but evidence that these factors determine the transition from borderline to established hypertension in later life has not been demonstrated thus far. Measurements of resting heart rate and responses to dynamic exercise have some predictive value in predicting the development of hypertension. Ambulatory monitoring of blood pressure might allow for differentiation of patients with transient elevated blood pressure from those with more sustained hypertension.