Arterial hypertension

Hypertension is a complex, multifactorial and multisystem disorder and a leading cause of morbidity and premature death globally. Major guidelines define it as systolic blood pressure > 130 mmHg and/or diastolic blood pressure > 80 mmHg. Hypertension is a very common disease with prevalence rates of about 30% in adults worldwide. The incidence of hypertension is age-related. At younger ages, hypertension is more prevalent in males than females, but this trend is reversed by age 65. Gender-related differences in hypertension may relate to cardiovascular effects of sex hormones. The underlying cause of the disease is identified in only ∼ 5% of patients (secondary hypertension), while in 95% of patients, no etiology is found (primary or essential hypertension). Multiple factors including genetics, environmental factors and interacting physiological systems contribute to the pathophysiology of hypertension. High blood pressure is a major preventable risk factor for heart failure, ischemic heart disease, chronic kidney disease, stroke and vascular dementia. The risk of hypertension-related complications and target organ admage increases as blood pressure increases. Hypertension is typically associated with vascular dysfunction, cardiovascular remodeling, renal dysfunction, and stimulation of the sympathetic nervous system. Growing evidence indicates that the immune system is also important and that activated immune cells promote inflammation, fibrosis, and target-organ damage. Common to these processes is oxidative stress, defined as an imbalance between oxidants and antioxidants in favor of the oxidants, which cause disruption of oxidation-reduction (redox) signaling and promotion of molecular and cell damage. This chapter provides a comprehensive review on hypertension and highlights some new concepts on molecular mechanisms and pathophysiological processes underlying hypertension and approaches to diagnosing and managing hypertension in the clinic.