Primary Hypertension

Chapter

Abstract

A 47-year-old woman presents for establishment of primary care. She has not seen a physician in over 20 years and has been urged to seek medical attention for check up by her children. She is unaware of any medical problems and takes no medications. Her history is notable for four pregnancies, two of which were complicated by hypertension. Her family history is notable for diabetes mellitus, hypertension, and coronary artery disease. She has worked as a data entry technician for the past 25 years, generally eats packaged foods for all meals, and participates in no exercise program. Physical examination shows an overweight woman with BMI 26, BP 150/97, pulse 70/min, respiratory rate 18/min, and temperature 98.6 °F. Her general physical examination is unremarkable. Screening labwork, EKG, and chest radiograph are all unremarkable.

Keywords

Fatigue Obesity Corn Mercury Angiotensin 

References

  1. 1.
    Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Iaao JL, Jones DW, Materson BJ, Oparil S, Wright JT, Roccella EJ. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42:1206–52.PubMedCrossRefGoogle Scholar
  2. 2.
    Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360:1903–13.CrossRefGoogle Scholar
  3. 3.
    Tracy RE. Renal vasculature in essential hypertension: a review of some contrarian evidence. Contrib Nephrol. 2011;269:327–36.CrossRefGoogle Scholar
  4. 4.
    Yang Q, Liu T, Kuklina EV, Flanders D, Hong Yuling H, Gillespie C, Chang M-H, Gwinn M, Dowling N, Khoury MJ, Hu FB. Sodium and potassium intake and mortality among US adults. Arch Intern Med. 2011;171:1183–91.PubMedCrossRefGoogle Scholar
  5. 5.
    Adrogue HJ, Madias NE. Shared primacy of sodium and potassium on cardiovascular risk. Am J Kidney Dis. 2009;54:598–601.PubMedCrossRefGoogle Scholar
  6. 6.
    Adrogue HJ, Madias NE. Sodium and potassium in the pathogenesis of hypertension. N Engl J Med. 2007;356:1966–78.PubMedCrossRefGoogle Scholar
  7. 7.
    Blaustein MP, Leenen FHH, Chen L, Golovina VA, Hamlyn MJ, Pallone TL, Van Huysse JW, Zhang J, Wier WG. How NaCl raises blood pressure: a new paradigm for the pathogenesis of salt-dependent hypertension. Am J Physiol Heart Circ Physiol. 2012;302:H1031–49.PubMedCrossRefGoogle Scholar
  8. 8.
    Brondolo E, Love EE, Pencille M, Schoenthaler A, Ogedegbe G. Racism and hypertension: a review of the empirical evidence and implications for clinical practice. Am J Hypertens. 2011;24:518–29.PubMedCrossRefGoogle Scholar
  9. 9.
    Rostand SG. Vitamin D, blood pressure, and African Americans: toward a unifying hypothesis. Clin J Am Soc Nephrol. 2010;5:1697–703.PubMedCrossRefGoogle Scholar
  10. 10.
    Flack JM, Sica DA, Bakris G, Brown AL, Ferdinand KC, Grimm RH, Hall WD, Jones WE, Kountz DS, Lea JP, Nasser S, Nesbitt SD, Saunders E, Scisney-Matlock M, Jamerson KA. Management of high blood pressure in Blacks: an update of the International Society on Hypertension in Blacks consensus statement. Hypertension. 2010;56:780–800.PubMedCrossRefGoogle Scholar
  11. 11.
    Ventura H, Pina IL, Lavie CJ. Hypertension and antihypertensive therapy in Hispanics and Mexican Americans living in the United States. Postgrad Med. 2011;123:46–57.PubMedCrossRefGoogle Scholar
  12. 12.
    Bertram JF, Douglas-Denton RN, Diouf B, Hughson MD, Hoy WE. Human nephron number: implications for health and disease. Pediatr Nephrol. 2011;26:1529–33.PubMedCrossRefGoogle Scholar
  13. 13.
    Kett MM, Denton KM. Renal programming: cause for concern? Am J Physiol Regul Integr Comp Physiol. 2011;300:R791–803.PubMedCrossRefGoogle Scholar
  14. 14.
    Minor D, Wofford M, Wyatt SB. Does socioeconomic status affect blood pressure goal achievement? Curr Hypertens Rep. 2008;10(5):390–7.PubMedCrossRefGoogle Scholar
  15. 15.
    Grotto I, Huerta M, Sharabi Y. Hypertension and socioeconomic status. Curr Opin Cardiol. 2008;23(4):335–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Bale B. Optimizing hypertension management in underserved rural populations. J Natl Med Assoc. 2010;102(1):10–7.PubMedGoogle Scholar
  17. 17.
    Grundy SM, Brewer HB, Cleeman JI, Smith SC, LEnfant C. Definition of metabolic syndrome: report of National Heart, Lung, and Blood Institute/AHA conference on scientific issues related to definition. Circulation. 2004;109:433–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Potenza MV, Mechanick JL. The metabolic syndrome: definition, global impact, and pathophysiology. Nutr Clin Pract. 2009;24:560–77.PubMedCrossRefGoogle Scholar
  19. 19.
    Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Dobnato KA, Fruchart JC, James WP, Loria CM, Smith SC. Harmonizing the metabolic syndrome: a joint interim statement for the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart Lung and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009;120:1640–5.PubMedCrossRefGoogle Scholar
  20. 20.
    Zalesin KC, Franklin BA, Miller WM, Peterson ED, McCullough PA. Impact of obesity on cardiovascular disease. Med Clin North Am. 2011;95(5):919–37.PubMedCrossRefGoogle Scholar
  21. 21.
    Kurukulasaliya LR, Stas S, Lastra G, Manrique C, Sowers JR. Hypertension in obesity. Med Clin North Amr. 2011;95(5):903–17.CrossRefGoogle Scholar
  22. 22.
    Feber J, Ahmed M. Hypertension in children: new trends and challenges. Clin Sci. 2010;119:151–61.PubMedCrossRefGoogle Scholar
  23. 23.
    The 1984 Report of the Joint National Committee on The Detection, Evaluation, and Treatment of High Blood Pressure. Arch Intern Med. 1984;144:1045–1057Google Scholar
  24. 24.
    Clark CE, Talor RS, Shore AC. Association of a difference in SBP between arms with vascular disease and mortality: a systematic review and meta-analysis. Lancet. 2012;11:61710–8.Google Scholar
  25. 25.
    McManus RJ, Mant J. Do differences in blood pressure between arms matter? Lancet. 2012;11:61926–30.Google Scholar
  26. 26.
    White WB. Relating cardiovascular risk to out-of-office blood pressure and the importance of controlling blood pressure 24 hours a day. Am J Med. 2008;121(8 Suppl):S2–7.PubMedCrossRefGoogle Scholar
  27. 27.
    Parati G, Faini A, Valentini M. Blood pressure variability: its measurement and significance in hypertension. Curr Hypertens Rep. 2006;8(3):199–204.PubMedCrossRefGoogle Scholar
  28. 28.
    Powers BJ, Olsen MK, Smith VA, Woolson RF, Bosworth HB, Oddone EZ. Measuring blood pressure decision making and quality reporting: where and how many measures? Ann Intern Med. 2011;154:781–8.PubMedGoogle Scholar
  29. 29.
    Bosworth HB, Powers BJ, Olsen MK, McCant FM, Rubber J, Smith V, Gentry PW, Rose C, Van Houtven C, Wang V, Goldstein MK, Oddone EZ. Home blood pressure management and improved blood pressure control. Arch Intern Med. 2011;171:1173–80.PubMedCrossRefGoogle Scholar
  30. 30.
    Van der Wel MC, Buunk IE, van Weel C, Thien TABM, Bakx JC. A novel approach to office blood pressure measurement: thirty minute office blood pressure vs daytime ambulatory blood pressure. Ann Fam Med. 2011;9:128–35.PubMedCrossRefGoogle Scholar
  31. 31.
    Scherpbier-de Haan N, van der Wel M, Schoenmakers G, Boudewijns S, Peer P, van Weel C, Thien T, Bakx C. Thirty-minute compared to standardised office blood pressure measurement in general practice. Br J Gen Pract. 2011;61(590):e590–7.PubMedCrossRefGoogle Scholar
  32. 32.
    O’Brien E. Twenty-four-hour ambulatory blood pressure measurement in clinical practice and research: a critical review of a technique in need of implementation. J Intern Med. 2011;269:478–95.PubMedCrossRefGoogle Scholar
  33. 33.
    Wexler R. Ambulatory blood pressure monitoring in primary care. South Med J. 2010;103(5):447–52.PubMedCrossRefGoogle Scholar
  34. 34.
    Ashwell M, Gunn P, Gibson S. Waist to height ratio is a better screen tool than waist circumference and BMI in adult cardiometabolic risk factors. Obes Rev. 2012;13:275–86.PubMedCrossRefGoogle Scholar
  35. 35.
    Cepeda-Valery B, Pressman GS, Fiqueredo VM, Romero-Corral A. Impact of obesity on total and cardiovascular mortality—fat or fiction? Nat Rev Cardiol. 2011;8(4):233–7.PubMedCrossRefGoogle Scholar
  36. 36.
    Drost JT, Maas AH, van Eyck J, van der Schouw YT. Preeclampsia as a female-specific risk factor for chronic hypertension. Maturitas. 2010;67(4):321–6.PubMedCrossRefGoogle Scholar
  37. 37.
    Carretero OA, Oparil S. Essential hypertension: part 1: definition and etiology. Circulation. 2000;101:329–35.PubMedCrossRefGoogle Scholar
  38. 38.
    Tarazi RC, Ibrahim MM, Bravo EL. Hemodynamic characteristics of primary hyperaldosteronism. N Engl J Med. 1973;289:1330–5.PubMedCrossRefGoogle Scholar
  39. 39.
    Martinez-Aguayo A, Fardella C. Genetics of hypertensive syndrome. Horm Res. 2009;71:253–9.PubMedCrossRefGoogle Scholar
  40. 40.
    Vehaskari VM. Heritable forms of hypertension. Pediatr Nephrol. 2009;24:1929–37.PubMedCrossRefGoogle Scholar
  41. 41.
    Lifton RP, Gharavi AG, Geller DS. Molecular mechanisms of human hypertension. Cell. 2001;104:545–56.PubMedCrossRefGoogle Scholar
  42. 42.
    Ji W, Foo JN, O’Roak BJ, Zhao H, Larson MG, Simon DB, Newton-Cheh C, State MW, Levy D, Lifton RP. Rare independent mutations in renal salt handling genes contribute to blood pressure variation. Nat Genet. 2008;40(5):592–9.PubMedCrossRefGoogle Scholar
  43. 43.
    Coffman TM. Under pressure: the search for the essential mechanisms of hypertension. Nat Med. 2011;17:1402–9.PubMedCrossRefGoogle Scholar
  44. 44.
    Herrera M, Coffman TM. The kidney and hypertension: novel insights from transgenic models. Curr Opin Nephrol Hypertens. 2012;21:171–8.PubMedCrossRefGoogle Scholar
  45. 45.
    Coffman TM, Crowley SD. Kidney in hypertension. Guyton redux. Hypertension. 2008;51:811–6.PubMedCrossRefGoogle Scholar
  46. 46.
    Johnson RJ, Herrera-Acosta J, Schreiner GF, Rodriguez-Iturbe B. Subtle acquired renal injury as a mechanism of salt-sensitive hypertension. N Engl J Med. 2002;346:913–23.PubMedCrossRefGoogle Scholar
  47. 47.
    Rafiq S, Anand S, Roberts R. Genome-wide association studies of hypertension: have they been fruitful? J Cardiovasc Trans Res. 2010;3:189–96.CrossRefGoogle Scholar
  48. 48.
    Kraja AT, Hunt SC, Rao DC, Davila-Roman VG, Arnett DK, Province MA. Genetics of hypertension and cardiovascular disease and their interconnected pathways: lessons from large studies. Curr Hypertens Rep. 2011;13:46–54.PubMedCrossRefGoogle Scholar
  49. 49.
    Paunovic K, Stansfeld S, Clark C, Belojevic G. Epidemiological studies on noise and blood pressure in children: observations and suggestions. Environ Int. 2011;37:1030–41.PubMedCrossRefGoogle Scholar
  50. 50.
    Carretero OA, Oparil S. Essential hypertension: part 2: treatment. Circulation. 2000;101:446–53.PubMedCrossRefGoogle Scholar
  51. 51.
    Hackam DG, Khan NA, Hemmelgarn BR, et al. The 2010 Canadian Hypertension Education Program recommendations for the management of hypertension: part 2—therapy. Can J Cardiol. 2010;26(5):249–58.PubMedCrossRefGoogle Scholar
  52. 52.
    Egan BM, Zhao Y, Axon RN. US trends in prevalence, awareness, treatment, and control of hypertension, 1988–2008. JAMA. 2010;303:2043–50.PubMedCrossRefGoogle Scholar
  53. 53.
    Daugherty SL, Powers JD, Magid DJ, Tavel HM, Masoudi FA, Margolis KL, O’Connor PJ, Selby JV, Ho PM. Incidence and prognosis of resistant hypertension in hypertensive patients. Circulation. 2012; onlineGoogle Scholar
  54. 54.
    Zampaglione B, Pascale C, Marchisio M, Cavallo-Perin P. Hypertensive urgencies and emergencies. Prevalence and clinical presentation. Hypertension. 1996;27:144–7.PubMedCrossRefGoogle Scholar
  55. 55.
    Moser M. From JNC I to JNC 7—what have we learned? Prog Cardiovasc Dis. 2006;48:303–15.PubMedCrossRefGoogle Scholar
  56. 56.
    Mancia G. Blood pressure reduction and cardiovascular outcomes: past, present, and future. Am J Cardiol. 2007;100(suppl):3J–9.PubMedCrossRefGoogle Scholar
  57. 57.
    Sciarretta S, Palano F, Tocci G, Baldini R, Volpe M. Antihypertensive treatment and development of heart failure in hypertension. Arch Intern Med. 2011;171:384–94.PubMedCrossRefGoogle Scholar
  58. 58.
    Hanratty R, Chonchol M, Havranek EP, Powers JD, Dickinson M, Ho PM, Magid DJ, Steiner JF. Relationship between blood pressure and incident chronic kidney disease in hypertensive patients. Clin J Am Soc Nephrol. 2011;6:2605–11.PubMedCrossRefGoogle Scholar
  59. 59.
    Appel LJ, Wright JT, Greene T, Agodoa LY, Astor BC, Bakris GL, Cleveland WH, Charleston J, Contreras G, Faulkner ML, Gabbai FB, Gassman JJ, Hebert LA, Jamerson KA, Kopple JD, Kusek JW, Lipkowitz MS, Massry SG, Miller ER, Norris K, Phillips RA, Pogue VA, Randall OS, Rostand SG, Smogorzewski MJ, Toto RD, Wang X. Intensive blood pressure control in hypertensive chronic kidney disease. N Engl J Med. 2010;363:918–29.PubMedCrossRefGoogle Scholar
  60. 60.
    Murea M, Freedman BL. Essential hypertension and risk of nephropathy: a reappraisal. Curr Opin Nephrol Hypertens. 2010;19:235–41.PubMedCrossRefGoogle Scholar
  61. 61.
    Veterans Administration Cooperative Study Group on Antihypertensive Agents. Effects of treatment on morbidity in hypertension: results in patients with diastolic blood pressures averaging 115 through 129 mmHg. JAMA. 1967;202:1028–34.CrossRefGoogle Scholar
  62. 62.
    Hansson L, Lindholm LH, Niskanen L, Lanke J, Hedner T, Niklason A, Luomanmaki K, Dahlof B, de Faire U, Morlin C, et al. Effect of angiotensin-converting-enzyme inhibition compared with conventional therapy on cardiovascular morbidity and mortality in hypertension: the Captopril Prevention Project (CAPPP) randomised trial. Lancet. 1999;353:611–6.PubMedCrossRefGoogle Scholar
  63. 63.
    Turnbull F, Blood Pressure Lowering Treatment Triallists’Collaboration. Effects of different blood-pressure-lowering regimens on major cardiovascular events: results of prospectively-designed overviews of randomised trials. Lancet. 2003;362:1527–35.PubMedCrossRefGoogle Scholar
  64. 64.
    Hermida RC, Ayala DE, Fernandez JR, Portaluppi F, Fabbian F, Smolensky MH. Circadian rhythms in blood pressure regulation and optimization of hypertension treatment with ACE inhibitor and ARB medications. Am J Hypertens. 2011;24:383–91.PubMedCrossRefGoogle Scholar
  65. 65.
    Minutolo R, Gabbai FB, Borrelli S, Scigliano R, Trucillo P, Baldanza D, Laurino S, Mascia S, Conte G, De Nicola L. Changing the timing of antihypertensive therapy to reduce nocturnal blood pressure in CKD: an 8-week uncontrolled trial. Am J Kidney Dis. 2007;50:908–17.PubMedCrossRefGoogle Scholar
  66. 66.
    Hedayati SS, Elsayed EF, Reilly RF. Non-pharmacologic aspects of blood pressure management: what are the data? Kidney Int. 2011;79:1061–70.PubMedCrossRefGoogle Scholar
  67. 67.
    Agawal R. Blood pressure goal in chronic kidney disease: what is the evidence? Curr Opin Nephrol Hypertens. 2011;20:229–32.CrossRefGoogle Scholar
  68. 68.
    Hermida RC, Ayala DE, Fernandez JR, Calvo C. Chronotherapy improves blood pressure control and reverts the nondipper pattern in patients with resistant hypertension. Hypertension. 2008;51:69–76.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of Medicine/NephrologyUniversity of LouisvilleLouisvilleUSA
  2. 2.Robley Rex VA Medical CenterLouisvilleUSA

Personalised recommendations