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Pathophysiology of hypertension: differences between young and elderly
1Department of Physiology, University of Göteborg, Sweden.
Insights
Primary hypertension involves genetic predisposition, environmental factors, and structural changes. With age, structural adaptations become dominant, leading to irreversible hypertension.
Area of Science:
- Cardiovascular Science
- Hypertension Pathophysiology
Background:
- Primary hypertension arises from a multifactorial background.
- Key elements include polygenic predisposition, environmental triggers, and structural resetting of the cardiovascular system.
- These factors interact, with environmental effects often initiating genetic predisposition and structural changes becoming dominant as hypertension progresses.
Purpose of the Study:
- To elucidate the multifactorial pathogenesis of primary hypertension.
- To describe the progression of hypertension, including early functional changes and later structural dominance.
- To examine the impact of aging on the cardiovascular system in hypertensive individuals.
Main Methods:
- The study synthesizes existing knowledge on hypertension pathogenesis.
- It analyzes the interplay between genetic, environmental, and structural factors in disease progression.
- It reviews the effects of aging on cardiovascular changes in hypertension.
Main Results:
- Hypertension involves polygenic predisposition, environmental factors, and structural resetting.
- Early hypertension shows enhanced neurohormonal activity and reversible hypertrophy.
- Aging exacerbates cardiovascular changes, making structural adaptations dominant and less reversible.
Conclusions:
- Primary hypertension is a complex interplay of genetic, environmental, and structural factors.
- Structural changes become increasingly dominant and irreversible with disease progression and aging.
- Understanding these elements is crucial for managing hypertension effectively.
Abstract:
Pathogenesis of hypertension: Primary hypertension has a multifactorial background, consisting of three main elements, (1) polygenic predisposition, (2) excitatory environmental effects and (3) structural upward resetting of the heart and vessels. These three elements are inter-related, since excitatory environmental effects are usually needed to precipitate the functional expression of genetic predisposition (particularly in man) and structural upward resetting is sometimes genetically facilitated. As hypertension progresses, the structural upward resetting becomes the dominating element, underlying the elevation in both pressure and resistance. Progression of hypertension: In the early phases of both human and animal models of primary hypertension, interactions between the genetic predisposition and excitatory environmental effects are often expressed mainly as mildly enhanced central neurohormonal activity. Not infrequently, cardiac output is increased more than systemic resistance. The structural factor, at this point, is still mainly expressed as a fairly reversible cardiac and vascular muscle hypertrophy (or hyperplasia), and a modest degree of resistance vascular narrowing. Aging effects on hypertension: The normal aging process affects the cardiovascular system to a greater degree in hypertensives than normotensives, implying more pronounced reductions in cardiac and vascular compliance, muscle strength and contractile speed, and in renal functional capacity. With age and a prolonged positive-feedback interaction between genetic/environmental factors and structural adaptation at the systemic resistance level, the structurally based elevation in resistance becomes even more dominant, and is further complicated by increasing interstitial involvement and therefore reduced reversibility.(ABSTRACT TRUNCATED AT 250 WORDS)