PATHOPHYSIOLOGY OF HYPERTENSION

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Hypertension is a major public health issue in India It is estimated over 1 6 million annual deaths account for 10.8% of the total moralities and 4.6% of disabilityadjusted life years1. Management of Hypertension in Indian Subjects is the management of risk factors through a combination of treatment approaches(2) The fourth National Family Health Survey reported hypertension in 13 8% of men vs 8 8% of women aged 15–49 and 15–54, respectively(3)

Hypertension is the result of many factors that interact to raise blood pressure and cause end organ damage. In 1940 Dr Page proposed the Mosaic Theory of Hypertension which in current concept is modified to a new concepts of oxidative stress, inflammation genetics , sodium homoesostasis and microbiome(4)

Diagram depicting revised Mosaic Theory incorporating a new understanding of environmental, genetic, and cellular mechanisms. This also depicts the interplay of factors like inflammation, oxidative stress, microbiome with PNIE (pituitary, neuro, immune and endocrine) function

With this theory of inflammatory, oxidative, and metabolic stress affecting vascular health, nutritional factors play a large role not only in reducing the risk but also post-diagnosis. Studies state DASH diets (Dietary Approaches to Stop Hypertension), a diet rich in fruits and vegetables can lower the risk of high blood pressure5 Much evidencebased research supports the management of hypertension with diet and lifestyle

Hypertension, usually referred to as high blood pressure, affects a significant percentage of the global populace It is characterized by consistently high blood pressure levels, which can cause several cardiovascular consequences if not managed. It is important to understand the physiology of hypertension, blood pressure regulation, and the pathophysiological factors that contribute to it

Blood pressure regulation

Many different physiological processes interact together to regulate blood pressure. An individual's heart, blood vessels, and kidneys are critical to maintaining normal blood pressure The heart is responsible for pumping blood throughout the body, creating systolic pressure as the heart muscle contracts and diastolic pressure when the heart is at rest. Blood pressure, which is the pressure of the blood on the walls of the arteries (blood vessels), is affected by factors such as peripheral resistance and heck lood and m to

System of Sympathetic Nerves (SNS)

The sympathetic and parasympathetic branches of the nervous system are responsible to control blood pressure. The sympathetic branch is activated during times of stress or physical exertion, which results in vasoconstriction (narrowing of the blood vessels) and an increase in heart rate In contrast, the parasympathetic branch provides relaxation and vasodilatation (widening of the blood vessels) helping to lower blood pressure. The SNS comes into play for short-term blood pressure regulation like when faced with stress or other stimuli The SNS releases norepinephrine, which binds to receptors on blood vessels causing vasoconstriction and raising blood pressure Additionally, the SNS prompts the heart to beat faster and contract more forcefully, boosting cardiac output.

Renin-Angiotensin-Aldosterone System (RAAS):

The RAAS is a vital player in blood pressure regulation When the blood pressure falls, special cells in the kidney release an enzyme called renin. Renin acts upon angiotensinogen, a protein, converting it into angiotensin I.