Hypertension

Hypertension Case Study Name Institution Course Instructor Date Hypertension Case Study Introduction Also referred to as high blood pressure, hypertension stands as the foremost preventable risk factor for death and cardiovascular disease worldwide. According to the World Health Organization, hypertension affects one in three adults globally. Alarmingly, an almost half of the global population with hypertension are unaware of their condition (Gordon, 2023). Additionally, less than half of the adults diagnosed with high blood pressure (42%) receive suitable medical diagnosis and treatment. This case study aims to explore the causes, risk factors, pathophysiology, clinical manifestations, complications, and diagnostic tests associated with hypertension, the chosen disorder for this case study. Causes Hypertension is primarily caused by the blood volume the heart pumps and the resistance it encounters in the arteries. There are two main types of hypertension: essential and secondary. Essential hypertension typically develops gradually with no identifiable cause, often due to plaque buildup in the arteries (atherosclerosis). Secondary hypertension, on the other hand, arises suddenly and is caused by underlying conditions such as congenital heart defects, kidney disease, adrenal gland tumors, illicit drugs such as cocaine, certain medications like pain relievers or birth control pills, thyroid problems, and obstructive sleep apnea (Mayo Clinic, 2024). Additionally, white coat hypertension may occur when blood pressure elevates simply due to the stress of a medical examination. These factors collectively contribute to the onset and exacerbation of hypertension. Risk Factors Several factors put individuals at risk of developing hypertension. One is age, with individuals at an increased likelihood of developing it as they grow older. According to Mills et al. (2020), at younger ages, men have a higher likelihood than women, but by age 60, women have a higher hypertension prevalence than men. Ethnicity and race are other determinants of the disorder. In a recent study by Aggarwal et al. (2021) analyzing hypertension control rates, they found that the blood pressure control rates for Black, Asian, and Hispanic American adults were lower compared to those of White adults. Another factor is a family history of hypertension, which elevates the risk likely due to shared environmental and genetic factors. If hypertension is present in both grandparents and biological parents, there is an increased likelihood of the same condition manifesting in their offspring and subsequent generations. In addition to the above non-modifiable risk factors, several modifiable factors, including unhealthy diet, lack of physical activity, alcohol consumption, high and low sodium intake, and obesity, are all linked with an elevated risk of hypertension. Pathophysiology A subspecialty of medicine, pathophysiology discusses the working of the body in relation to ailments and illnesses. Hypertension, marked by high blood pressure, arises from pathophysiological mechanisms affecting total peripheral vascular resistance (TPR) and cardiac output (CO). TPR is increased in primary hypertension and certain secondary forms, while CO remains normal or slightly elevated (Bakris, 2024). In specific individuals, however, CO may increase at first due to factors such as venoconstriction in large veins, while TPR remains inappropriately normal. This dysregulation can lead to isolated systolic hypertension or elevated diastolic pressures. Additionally, plasma volume decreases as blood pressure rises, although exceptions exist, such as hypertension resulting from primary aldosteronism. Renal blood flow progressively diminishes with increasing diastolic blood pressure, contributing to arteriolar sclerosis and potentially altering the glomerular filtration rate (GFR) later in the disorder, thereby affecting renal function. At a cellular level, abnormalities in sodium transport play a crucial role in hypertension. Dysfunctions in the sodium-potassium pump or increased sodium permeability across cell walls result in intracellular sodium accumulation, increasing cell sensitivity to sympathetic stimulation. This process is often associated with elevated intracellular calcium levels, further intensifying sympathetic activity and blood pressure elevation. Additionally, defects in sodium transport, even in normotensive individuals, may predispose individuals to hypertension, mainly if there is a familial history of the condition (Bakris, 2024). Moreover, heightened sympathetic nervous system activity raises blood pressure, particularly in hypertensive individuals. Enhanced sympathetic activity can lead to a high resting pulse rate, which is often associated with hypertension. Moreover, higher circulating plasma catecholamine levels are observed in some hypertensive patients, suggesting sympathetic nervous activity dysregulation. Furthermore, the renin-angiotensin-aldosterone system significantly contributes to regulating blood pressure. Released from the juxtaglomerular cells, Renin converts angiotensinogen to angiotensin I. Subsequently, angiotensin II is formed after hydrolysis by angiotensin-converting enzyme (ACE). Angiotensin II exerts potent vasoconstrictive effects, stimulates aldosterone release, and enhances sodium an...