Table 3: High blood pressure phenotypes according to origin or cause . |
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Phenotype |
Primary or essential |
Secondary |
Pregnancy-related |
Definition |
Permanent elevation of systolic and/or diastolic BP without defined cause |
Permanent elevation of systolic and/or diastolic BP with a defined cause. It is suspected when it begins in childhood or young patients, or patients with refractory or resistant high blood pressure. |
Gestational high blood pressure: Elevated blood pressure during pregnancy. It begins after 20 weeks of pregnancy. Chronic high blood pressure in pregnancy: High blood pressure that begins before the 20th week of pregnancy or before becoming pregnant. Preeclampsia: Sudden increase in blood pressure after the 20th week of pregnancy. In general, it occurs in the last trimester and can continue in the postpartum period. |
Etiology |
Multifactorial: genetic, cultural and environmental causes. |
Frequent: Primary hyperaldosteronism, renal parenchymal diseases and renal artery stenosis. Rare: Aortic coarctation, Pheochromocytoma, Cushing's syndrome, Hyperparathyroidism, Brain tumors, Takayasu's disease and other vasculitides, etc. |
Unknown |
Pathophysiology |
Mainly due to increased vascular resistance and cardiac output |
Depends on the cause |
Generalized inflammation, prothrombosis and proteinuria. |
Prognosis |
High mortality and morbidity. |
Variable |
Premature birth, fetal and maternal death. |
Treatment |
ACEI/ARB combinations, calcium antagonists and thiazide-type diuretics are preferred. |
Depends on the cause |
Acetyl-salicylic acid, Calcium antagonists, alpha-blockers and beta-blockers. |
ESH = European Society high blood pressure; ACEI = Angiotensin-converting enzyme inhibitors; ARB = Angiotensin receptor blockers; BB = Beta-blockers. |