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SOURCE

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Source: Saseen JJ, MacLaughlin EJ. Hypertension. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill; 2017. http://accesspharmacy.mhmedical.com/content.aspx?bookid=1861&sectionid=146233698. Accessed May 19, 2017.

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CONDITION/DISORDER SYNONYM

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  • High blood pressure.

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DEFINITION

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  • Persistently elevated arterial blood pressure (BP).

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ETIOLOGY

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  • Primary (essential) hypertension: unknown cause (90% patients).

  • Secondary causes of hypertension (10% patients) (Table 1)

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Table Graphic Jump Location
TABLE 1.aSecondary Causes of Hypertension
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PATHOPHYSIOLOGY

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  • Abnormalities involving humoral (ie, the renin–angiotensin–aldosterone system [RAAS]) or vasodepressor mechanisms, abnormal neuronal mechanisms, defects in peripheral autoregulation, and disturbances in sodium, calcium, and natriuretic hormones.

  • Disturbance in the central nervous system (CNS), autonomic nerve fibers, adrenergic receptors, or baroreceptors.

  • Abnormalities in renal or tissue autoregulatory processes for:

    • Sodium excretion.

    • Plasma volume.

    • Arteriolar constriction.

  • Deficiency in synthesis of vasodilators in vascular endothelium (prostacyclin, bradykinin, nitric oxide) or excess vasoconstrictors (angiotensin II, endothelin I).

  • High sodium intake or lack of dietary calcium.

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EPIDEMIOLOGY

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  • Approximately one in three adult (age 20 years or older) Americans have elevated BP.

  • It is projected that by 2030, over 40% of American adults will have hypertension, which is an increase of 8.4% from 2012.

  • Overall incidence is higher in men before the age of 50 and higher in women between the ages of 55 and ...

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