Hypertension

Hypertension, commonly known as high blood pressure, is a chronic condition characterized by elevated arterial pressure, and it is the leading cause of cardiovascular disease and the most common non-communicable condition affecting millions worldwide. ^[1] Its etiology involves a complex interplay of environmental and pathophysiological factors alongside genetics, diet, lifestyle, and other coexisting medical conditions. ^[1]

The pathogenesis of hypertension is linked to endothelial dysfunction, vascular remodelling, sympathetic nervous system activation, and the renin-angiotensin-aldosterone system. ^[1] Clinical and experimental observations strongly support a central role for the kidneys in the long-term regulation of blood pressure, and abnormal renal-pressure natriuresis is present in all forms of chronic hypertension. ^[2] Essential hypertension is caused by increased cardiac output and/or increased peripheral resistance, arising from mechanisms including sympathetic overactivity, excess sodium intake, and endothelial cell dysfunction. ^[3]

Diagnosis is made by measuring blood pressure using a sphygmomanometer, with stages including prehypertension, stage 1 hypertension, and stage 2 hypertension. ^[1] Suboptimal blood pressure control is globally responsible for more than 7 million deaths annually, and its short-term and long-term regulation involves the integrated actions of multiple cardiovascular, renal, neural, endocrine, and local tissue control systems. ^[2] The prevalence of arterial hypertension, particularly systolic hypertension, is constantly rising worldwide, mainly reflecting arterial stiffening as a result of the population's aging. ^[4]

Large cohort studies have demonstrated that high blood pressure is an important risk factor for heart failure, atrial fibrillation, chronic kidney disease, heart valve diseases, aortic syndromes, and dementia, in addition to coronary heart disease and stroke. ^[5] Chronic elevation in blood pressure is a major risk factor not only for cardiovascular morbidity and mortality but also for cognitive decline and loss of autonomy later in life. ^[4] Meta-analysis of blood-pressure-lowering randomized controlled trials has demonstrated a benefit almost identical to that predicted from blood pressure risk relationships in cohort studies. ^[5]