Diagnosis and Pathophysiology of Hypertension

Hypertension, or high blood pressure, is the leading risk factor associated with death in the world but is largely asymptomatic and often undetected in patients. Hypertension is typically asymptomatic and only detected through opportunistic screening. Once hypertension has been diagnosed, further tests should be conducted, including urine testing, blood tests, an eye examination and a 12-lead electrocardiogram (ECG). Primary hypertension, in which no specific cause is found, affects 95% of patients. Blood pressure is expressed in terms of systolic blood pressure (higher reading), which reflects the blood pressure when the heart is contracted (systole), and diastolic blood pressure (lower reading), which reflects the blood pressure during relaxation (diastole).

Hypertension can be diagnosed when either systolic pressure, diastolic pressure, or both are raised. Blood pressure is determined by the cardiac output balanced against systemic vascular resistance. The process of maintaining blood pressure is complex and involves numerous physiological mechanisms, including arterial baroreceptors, the renin–angiotensin–aldosterone system, atrial natriuretic peptide, endothelin’s, and mineralocorticoid and glucocorticoid steroids.

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