High Blood Pressure (Arterial Hypertension): Causes

Pathogenesis (development of disease)

Arterial hypertension is characterized by increased cardiac output (CV) and/or peripheral resistance. This results in vessel wall changes and a further increase in blood pressure during the course of the disease.The main feature of elevated isolated systolic blood pressure is arterial stiffness. In primary essential hypertension, the pathogenesis is still unknown. Several factors are thought to interact. These include genetic (gene mutations) and renal as well as endocrine factors, and physical constitution, but also dietary habits, nicotine abuse, and oral contraceptives. This blurs the boundaries between primary and secondary hypertension, in which numerous different triggers are known.

Etiology (causes) of primary hypertension

Biographic causes.

Genetic burden from parents, grandparents

  • Genetic risk depending on gene polymorphisms:
    • Genes/SNPs (single nucleotide polymorphism; English : single nucleotide polymorphism):
      • Genes: ACC, ADD1, AGTR1
      • SNP: rs4343 in the gene ACE
        • Allele constellation: GG (2-fold increase in ACE concentration on a high saturated fat diet compared with AA/AG allele constellation; also higher systolic blood pressure).
      • SNP: rs4961 in the gene ADD1
        • Allele constellation: GT (1.8-fold).
        • Allele constellation: TT (1.8-fold)
      • SNP: rs5186 in the gene AGTR1
        • Allele constellation: AC (1.4-fold).
        • Allele constellation: CC (7.3-fold)
    • Genetic disease
      • Bilginturan syndrome (HTNB, OMIM%112410) – autosomal-dominant inherited hypertension with brachydactyly (short-fingeredness); the inherited trait encodes an enzyme called phosphodiesterase 3A (PDE3A), which regulates both blood pressure and indirectly bone growth.
  • Age – increasing age
  • Occupations – occupations with night shifts, exposure to noise and psychosocial stress.

Behavioral causes

  • Nutrition
    • Chronic overeating
      • High fat diet (animal fats) – as a cofactor.
        • High proportion of saturated fatty acids
      • High sugar consumption
    • Consumption of red meat, i.e. muscle meat of pork, beef, lamb, veal, mutton, horse, sheep, goat.
    • Too low a proportion of complex carbohydrates
    • Low fiber intake
    • High intake of sodium and table salt
    • Excessive consumption of licorice
    • Micronutrient deficiency (vital substances) – see Prevention with micronutrients.
  • Consumption of stimulants
    • Coffee – In patients aged 18-45 years with stage 1 hypertension, regular coffee consumption increases the risk that blood pressure will continue to rise and require therapy; both heavy (>3 cups/d) and moderate (1-2 cups/d) coffee consumption were found to be prognostic factors for a cardiovascular event such as myocardial infarction (heart attack) or apoplexy (stroke), independent of other risk factors.
    • Alcohol (woman: > 20 g/day; man > 30 g/day):
      • “Binge drinking” (high consumption of alcoholic beverages on one occasion):
        • Among young adults who reported massive alcohol consumption on an irregular basis, namely less than once a week, during adolescence: Odds ratio (OR) 1.23; 95% confidence interval (95-% CI] (1,02; 1,49)
        • Intensive alcohol consumption more than once per week: OR 1.64 (1.22, 2.22)
        • Alcohol excesses during teenage years and young adulthood: OR 2.43 (1.13; 5.20)
      • Moderate alcohol consumption may also promote hypertension: average blood pressure at
        • Non-drinkers about 109/67 mmHg.
        • Moderate drinkers 128/79 mmHg
        • Heavy drinkers 153/82 mmHg
    • Tobacco (smoking)
    • Energy drinks (containing 400 mg/100 ml taurine and 32 mg/100 ml caffeine) – significant prolongations of the QTc interval and increase in systolic blood pressure.
  • Drug use
    • Amphetamines (indirect sympathomimetic) and methamphetamine (“crystal meth”).
    • Cannabis (hashish and marijuana).
      • Hypertension, palpitations (heart palpitations), tachycardia (heartbeat too fast: > 100 heartbeats/min); myocardial infarction (heart attack): 4.8 times higher risk within one hour after marijuana use.
      • All-cause mortality (all-cause death rate) was significantly increased by a factor of 1.29 (95% confidence interval: 1.03-1.61) in participants with hypertension who used marijuana; this is assumed to have been predominantly cerebral insults (cerebral infarction) and complications of hypertensive crises.
    • Cocaine
  • Physical activity
    • Physical inactivity
  • Psycho-social situation
    • Stress – stressors in everyday life (time pressure – rushing; too short breaks at work; lack of support at work; lack of social support; anger; fear; worry; excitement; noise) competitive situation pressure to perform).
  • Overweight (BMI ≥ 25; obesity) – 30% of all primary hypertension is contributory to obesity! In adults, systolic blood pressure increases by about 10 mmHg for a weight gain of 10 kg (diastolic blood pressure increases slightly less).

Disease-related causes

  • Diabetes mellitus
  • Dyslipidemia (lipid metabolism disorders)

Etiology (causes) of secondary hypertension (5% of cases)

Disease-related causes

  • Aortic isthmic stenosis (ISTA; synonym: coarctation of the aorta: coarctatio aortae) – narrowing of the aorta (the aorta of the body) in the region of the aortic arch.
  • Aortic valve insufficiency – defective closure of the aortic valve of the heart.
  • Chronic kidney disease*
    • Analgesic nephropathy – kidney damage after overdose of analgesics.
    • Chronic pyelonephritis* (inflammation of the renal pelvis).
    • Diabetic nephropathy – kidney disease caused by diabetes mellitus (diabetes).
    • Glomerulonephritis* * – kidney disease, with inflammation of the kidney filterlets (glomeruli).
    • Renal insufficiency – process leading to a slowly progressive reduction in renal function [also a possible factor in treatment resistance of hypertension].
  • Endocrine and metabolic diseases
    • Acromegaly – endocrinological disorder caused by overproduction of growth hormone (somatotropic hormone (STH), somatotropin), with marked enlargement of the phalanges or acras, such as the hands, feet, lower jaw, chin, nose and eyebrow ridges.
    • Conn syndrome (primary hyperaldosteronism, PH).
      • In its classic (hypokalemic) form, belongs to the rarer causes of hypertension, with a frequency of 0.5-1%; however, up to 10% of patients with hypertension have normokalemic (normal potassium) hyperaldosteronism
      • Overall prevalence (disease incidence) of PA increased with severity of hypertension, from 3.9% in stage I to 11.8% in stage III hypertension
    • Cushing’s syndrome – group of diseases leading to hypercortisolism (hypercortisolism).
    • Gestational diabetes (gestational diabetes).
    • Hyperparathyroidism (parathyroid hyperfunction; hypercalcemia (excess calcium)).
    • Hyperthyroidism (hyperthyroidism)
    • Myxedema – pasty (puffy; bloated) skin showing non-push-in, doughy edema (swelling) that is not positional; facial and peripheral; occurring primarily on the lower legs; especially in the setting of hypothyroidism (underactive thyroid)
    • Pheochromocytoma* – usually benign (benign) tumor (about 90% of cases), which originates mainly from the adrenal gland and can lead to hypertension (hypertensive crisis).
  • Severance of the spinal cord
  • Increased intracranial pressure
  • Renal artery stenosis* /* * – narrowing of the renal artery.
  • Renal infarction – kidney damage due to circulatory problems.
  • Obstructive sleep apnea syndrome (OSAS)* – pauses in breathing during sleep caused by obstruction of the airways.
  • Polycythaemia vera – pathological multiplication of blood cells (particularly affected are: especially erythrocytes/red blood cells, to a lesser extent also platelets (blood platelets) and leukocytes/white blood cells); stinging itching after contact with water (aquagenic pruritus).
  • Polyneuropathy – disease of the peripheral nervous system with disturbances of sensitivity (insensitivity, etc.).
  • Preeclampsia (occurrence of hypertension / hypertension and proteinuria / increased excretion of protein with urine during pregnancy) – quadruples the risk of subsequent arterial hypertension.
  • Sleep apnea syndrome (breathing pauses during sleep) – Sleep apnea syndrome often occurs together with primary hypertension, and 50-90% of all sleep apnea patients have concomitant arterial hypertension. In 5-10% of all patients with primary hypertension can be detected sleep apnea syndrome.In many sleep apnea patients, as in many other secondary forms of hypertension, the physiological nocturnal drop in blood pressure is absent.
  • Vasculitides (inflammatory diseases of the blood vessels).
    • Antiphospholipid syndrome (APS; antiphospholipid antibody syndrome); autoimmune disease; it predominantly affects women (gynecotropia); characterized by the following triad:
    • Cholesterol embolism syndrome – occlusion of small arteries by wash-in (embolism) of cholesterol crystals from ruptured (ulcerated) atherosclerotic plaques.
    • Polyarteritis nodosa (PAN) – autoimmune disease leading to vasculitis (inflammation of blood vessels) with narrowing of the vascular lumen.
    • Scleroderma – group of rare diseases associated with leathery connective tissue hardening of the skin.
    • Systemic lupus erythematosus (SLE).
    • Systemic vasculitides (ANCA-associated vasculitis).
    • Takayasu’s ateritis – granulomatous vasculitis of the aortic arch and outgoing great vessels; almost exclusively in young women.
  • Cystic kidneys – encapsulated fluid accumulation in the kidneys.

* Common causes of secondary arterial hypertension* * Common causes of renal hypertension.

Laboratory diagnoses – laboratory parameters that are considered independent risk factors.

Medication

Environmental pollution – intoxications (poisonings).

  • Bisphenol A (BPA) as well as bisphenol S (BPS) and bisphenol F (BPF).
  • Lead – Increase in relative relative risk by 19% with each 15 μg/g increase in lead (RR 1.19; 95% confidence interval 1.01-1.41; p = 0.04); cumulative lead exposure measured at the vertical bone of the tibia is a risk factor for drug-resistant hypertensionNote: A potential source of lead may be drinking water from lead pipes.
  • Cadmium
  • Carbon monoxide
  • Air pollutants: particulate matter (PM2.5) and nitrogen dioxide (NO2).
  • Pesticides (organophosphates)
  • Thallium
  • Nocturnal aircraft noise (living in flight path; 45 dB during the day and over 55 dB aircraft noise at night).
  • Weather effects:
    • Extreme heat
    • Extreme cold
    • Hot summer
    • Severe winters

Other causes

  • Pregnancy