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Hypertension Jamie Johnston, MD University of Pittsburgh School of Medicine Hypertension: How common in the US? Awareness, Treatment, and Control of High Blood Pressure in Adults* Hypertension - Definition Classification of Blood Pressure for Adults Percent Decline in Age-Adjusted* Mortality Rates for Stroke by Sex and Race: United States, 1972–1994 Percent Decline in Age-Adjusted* Mortality Rates for CHD by Sex and Race: United States, 1972–1994 Incidence of Reported End-Stage Renal Disease Therapy, 1982–1995 Prevalence of Heart Failure,by Age, 1976–1980 and 1988–1991 Hypertension in the 21st Century Improved blood pressure control has helped decrease CVA and MI significantly But most hypertension remains uncontrolled Other HTN diseases are increasing HTN management number one visit for MD office visits in non-pregnant adults Risk of developing hypertension after 50 is 90% Hypertension - Pathogenesis Blood pressure is controlled by a complex combination of processes that influence cardiac output (CO) and total peripheral vascular resistance (TPR) Hypertension is a hemodynamic disorder indicating a disturbance in the ratio between CO and TPR Pathogenesis Rarely is a single factor in the previous diagram found to be the only cause of hypertension. In Primary hypertension (“Essential”) and secondary hypertension, multiple factors play a role Pathogenesis 90-95% of hypertension is primary or essential hypertension. Hypertension requires the participation of the kidney, the heart and blood vessels Pathogenesis of Hypertension - Genetics Genetics Hypertension clusters in families Multiple genes are involved Single gene causes of hypertension are uncommon (Liddle’s syndrome) Candidate Genes Polymorphisms in Renin-angiotensin aldosterone system ACE gene variants Angiotensinogen gene M235T variant Angiotensin 2 Type 1 Receptor variations Pathogenesis of Hypertension - Cardiac Primary increase in cardiac output Guyton et al Animal with reduced renal function Volume expa