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Hypertension or High Blood Pressure physiological condition involving increased pressure on the arterial walls Generally both the systolic and diastolic pressure are elevated although diastolic pressure only may be increased Many people have a condition known as labile hypertension in which blood pressure is elevated on initial examination but registers normal on subsequent measurements For this reason a diagnosis of true or sustained hypertension requires elevated blood pressure readings on several occasions Elevated arterial blood pressure indicates increased arterial resistance to blood flow but in 90 percent of patients no cause for this increased resistance can be identified These cases are called primary or essential hypertension Secondary hypertension can be the outcome of pregnancy vascular or kidney diseases or endocrine tumors Essential hypertension remains a major modifiable risk factor for cardiovascular disease CVD despite important advances in our understanding of its pathophysiology and the availability of effective treatment strategies High blood pressure BP increases the risk of CVD for millions of people worldwide and there is evidence that the problem is only getting worse In the past decade age-adjusted rates of stroke incidence have risen and the slope of the age-adjusted rate of decline in coronary disease has leveled off The incidence of end-stage renal disease and the prevalence of heart failure have also increased A major contributor to these trends is inadequate control of BP in the hypertensive population This review of current concepts regarding the definition etiology and treatment of essential hypertension is intended to aid the clinician in identifying those individuals at high risk who need to undergo evaluation and treatment as well as in selecting optimal treatment strategies for hypertensive patients with comorbid conditions andor target organ damage The part of the review that deals with the genetic basis of hypertension and the geneenvironment interaction that may lead to elevated BP is still a work in progress Information gained from the Human Genome Project and from ongoing studies of the
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