Hypertension: Causes, Mechanisms, and Diagnosis Challenges

Q: Hypertension: Causes, Mechanisms, and Diagnosis Challenges

Hello： In response to your question, 90% of hypertension is primary, related to genetics, and the cause cannot be identified. <br>The remaining 10% of hypertension is secondary, caused by other diseases, and is associated with kidney function, renal artery stenosis, obesity, endo

Regarding hypertension?

Hello, Dr.
Yang.
I would like to ask the following questions:
1.
Is hypertension caused by "poor blood circulation"? Of course, I understand that it is related to diet, lifestyle, and other factors, but I mainly want to know the actual "mechanism" that leads to elevated blood pressure.
2.
Additionally, since hyperthyroidism can also cause palpitations and hypertension, how can we determine whether the hypertension is due to cardiac issues or thyroid problems? I have previously sought medical attention, but neither specialist was able to provide a clear diagnosis.
Are there any specific tests that can clarify this? Thank you very much.

Binggan Mei, 20~29 year old female. Ask Date: 2003/07/24

Dr. Yang Jun reply Internal Medicine

Hello: In response to your question, 90% of hypertension is primary, related to genetics, and the cause cannot be identified.
The remaining 10% of hypertension is secondary, caused by other diseases, and is associated with kidney function, renal artery stenosis, obesity, endocrine disorders, and tumors.
Young individuals with hypertension should first be evaluated by a cardiologist to determine if it is secondary hypertension.
If the cause can be identified and treated, hypertension can be cured.
Hyperthyroidism can cause palpitations, and in some cases, blood pressure may also rise.
However, it is essential to treat the thyroid condition first for both palpitations and hypertension to improve.
Whether hyperthyroidism is present can be determined by an endocrinologist through thyroid function tests.

Reply Date: 2003/07/24

More Info

Hypertension, or high blood pressure, is a complex condition influenced by various factors, and understanding its causes and mechanisms is crucial for effective management.
1. Causes and Mechanisms of Hypertension:
Hypertension is not solely caused by "poor blood circulation." Instead, it is a multifactorial condition that can arise from a combination of genetic, environmental, and lifestyle factors. The majority of hypertension cases (about 90-95%) are classified as primary or essential hypertension, where no specific cause can be identified. This type is often linked to genetic predisposition, age, and lifestyle choices such as diet, physical activity, and stress levels.

Secondary hypertension, which accounts for about 5-10% of cases, is caused by underlying conditions such as kidney disease, hormonal disorders (like hyperthyroidism), or certain medications. The mechanisms behind hypertension involve increased vascular resistance and/or increased cardiac output. Factors that contribute to increased vascular resistance include narrowing of the blood vessels (due to plaque buildup or other reasons), increased blood viscosity, and heightened sympathetic nervous system activity. On the other hand, increased cardiac output can result from factors such as fluid overload or increased heart rate.

2. Thyroid Function and Hypertension:
Hyperthyroidism, a condition characterized by excessive thyroid hormone production, can indeed lead to symptoms such as palpitations and elevated blood pressure. The thyroid hormones increase the heart rate and cardiac output, which can contribute to hypertension. To differentiate whether hypertension is due to cardiac issues or thyroid dysfunction, specific tests are necessary.

Diagnostic Approach:
- Thyroid Function Tests: These tests measure levels of thyroid hormones (T3, T4) and Thyroid Stimulating Hormone (TSH). Elevated levels of T3 and T4 with suppressed TSH indicate hyperthyroidism.

- Cardiac Evaluation: An electrocardiogram (ECG) can help assess heart rhythm and detect any abnormalities. An echocardiogram may be performed to evaluate heart structure and function.

- Blood Pressure Monitoring: Regular monitoring of blood pressure in different settings (home, clinic) can provide insights into whether hypertension is persistent or situational.

- Additional Tests: Depending on the clinical scenario, tests such as renal function tests, urine analysis, and imaging studies (like ultrasound of the kidneys) may be warranted to rule out secondary causes of hypertension.

In conclusion, hypertension is a multifaceted condition that requires a comprehensive approach to diagnosis and management. If you suspect that your hypertension may be related to thyroid dysfunction or other underlying issues, it is essential to work closely with your healthcare provider to undergo the necessary evaluations. Lifestyle modifications, including a balanced diet, regular physical activity, and stress management, are also key components in managing blood pressure effectively. If hypertension persists despite these measures, medication may be necessary to control blood pressure and reduce the risk of cardiovascular complications.

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