Pathophysiology of essential hypertension: an update

Area of Science:

• Cardiovascular Medicine
• Neuroendocrinology
• Renal Physiology

Background:

• Essential hypertension arises from increased cardiac output or peripheral resistance.
• Multiple factors contribute, including genetics, autonomic nervous system activity, and renal, vascular, and hormonal mechanisms.
• Obesity, sleep apnea, metabolic syndrome, and environmental factors also play significant roles.

Purpose of the Study:

• To review the diverse mechanisms contributing to essential hypertension.
• To highlight the central role of sympathetic nervous system overactivity.
• To explore the involvement of autonomic nervous system and central nervous system connections in hypertension.

Main Methods:

• Comprehensive review of literature on hypertension pathogenesis.
• Analysis of genetic, physiological, and environmental factors.
• Examination of the interplay between sympathetic activity, hormonal systems, and central neural pathways.

Main Results:

• Sympathetic overactivity, particularly disturbed basal sympathetic tone, is strongly associated with hypertension.
• Mechanisms like the renin-angiotensin-aldosterone system (RAAS), obesity, and obstructive sleep apnea (OSA) are linked to sympathetic overactivity.
• Hypertension pathogenesis involves alterations in the autonomic nervous system (ANS) and potentially cortical-hypothalamic connections.

Conclusions:

• Hypertension is a complex condition influenced by numerous interconnected factors.
• Disturbed basal sympathetic tone, originating from the hypothalamus and possibly cortical influences, is a critical element.
• Further assessment of ANS and cortical-hypothalamic connections may be necessary for a comprehensive understanding and management of hypertension.