The Genetic Factors –   

     Some physicians, chemists, and geneticist have called B/P “a quantitative trait” with environmental and genetic determinants;⁸ “essential hypertension” occupies one extreme of B/P distribution only.  Variations in B/P represent the combined effects of multiple genes rather than a single gene disorder with discrete separation. ⁹  A strong family history (e.g., >2  first-degree relatives with hypertension before age 55 years), may predict a future occurrence of hypertension with a relative risk factor (RR) of 3.8. ¹⁰  Obesity, related in hypertension and the associated metabolic syndrome occur from childhood through to adult life, underscoring the importance of early prevention.  ¹¹  In the search, for genetic determinates appear to be handicapped by the absence of a biomarkers to identify pre-hypertensive individuals before the pressure rises because, the initiating factor are rendered unrecognizable at this time. 

The Sodium factors –

     In ancient primitive societies, the diet was indeed characterized by low salt intake (e.g., 10 to 30 mmol per day), but with a high intake of potassium (K₊).  This was due to complete native living and quantitative intake.  In such settings, hypertension was rarely found and documented.  In today’s environment, only a subset of people (20% to 50% appears to be salt sensitive by showing a pressor response when fed a diet of more than 50 mEq sodium per day ¹² (e.g., ≈ ½ tsp. of salt per day, because 1 tsp. of salt = 6 g salt = 2.4 g sodium = 104 mEq sodium = 104 mmol sodium).  The Food and Nutrition Board of the National Academy of Science (FNB-NAS), estimates that an intake of no more than 500 mg of sodium a day is needed for health; the average American diet contains more than 4,500 mg a day. ¹³ That means over 9x’s more sodium intake within the North American diet.  In contrast, the American Heart Association (AHA) recommends that a daily consumption of sodium not exceed 2,400 mg, ¹⁴ Even with this current analyses, Americans are consuming over  47% more salt in there daily diet.  Americans are close to doubling the recommended intake of sodium, + less manual daily exercise, with the added stress of suburbia.  Also, add in the list from convenience of frozen and/or box meals (e.g., sodium is always added as a preservative and/or shelf life stabilizer).  From current medical epidemiology records, over 43 million people in the U.S. have pre-hyperinsulinemia, or have been diagnosed and are taking an anti-hypertensive medication, which is about 1/3^rd or over 25% of the adult population alone. ¹⁵ 

     The Obesity and Morbid Obesity Factors –   

     In the mid 20^th century, the average American diet shifted from one based on fresh, minimally processed vegetable foods to one based on animal products and highly refined, processed foods.  As a result, today Americans consume far more calories, fats, cholesterol, refined sugars, animal protein, sodium, alcohol, and far less fiber and starch than is healthful. 

     In addition, noted from the beginning of the availability for most Americans, the World Wide Web has made environmental changes within our populous, through a sedentary lifestyle, networking, social gathering, and labor force (e.g., includes both blue and white-collar working force).  In the U.S. alone, two out of every three adults are overweight (e.g., defined as body mass index {BMI} of 25 to 30), or obese (BMI > 30), compared with fewer than one in four in the early 1960s. ¹⁶  The consequences include a substantial decrease in life expectancy and an increase in morbidity similar in magnitude to the burden imposed by smoking cessation. ¹⁷

     Obesity as well as morbid obesity conditions is indeed a complex, multifactorial disorder, but a element common to all cases is a positive energy balance in which more calories are consumed than expended through the body.  The amounts of excess calories are stored in body fat; each pound of “adipose tissue” (e.g., tissue containing fat cells), contains 3,500 calories. ¹⁸  Weight loss, can chiefly be accomplished by achieving a negative energy balance.  Before your patients proceed, have the treating clinician (i.e., NP, and/or physician), order a lab panel consisting of creatinine-serum, electrolytes-serum, and bun-serum.  These will R/O abnormalities and raise any suspicion for organ target anomalies.      

The Urinary Excretion of Sodium Factor -

     In healthy individuals, homeostasis (i.e., a state of equilibrium or balance between opposing pressures), will prevail.  When the B/P rises, sodium and water excretion via the kidney increases to return B/P to baseline.  This process is termed “pressure natriuresis.”  A much different story appears among the hypertensive and pre-hypertensive patients.  In addition, renal blood flow (RBF) appears reduced compared to normotensives.  The peritubular capillary blood with less sodium and water develops higher oncotic (i.e., cause by edema, or swelling), pressure and facilitates sodium re-absorption, leading to a higher blood volume and a higher B/P.  Therefore, pressure “natriuresis” occurs but only to sustain B/P at a higher level. 

The Sympathetic Nervous System Factor – 

     In parallel with the renin-angiotensin system, the sympathetic (i.e., denotes a part of the autonomic nervous system), nervous system (SNS) may couple with high sodium intake to raise the B/P.  Often, stress activates the SNS, especially in patients genetically or environmentally predisposed to respond with increased levels of epinephrine, norepinephrine, and neuropeptide. ¹⁹ 

     Increased sympathetic activity serves as an “initiator” (i.e., start of a chemical or enzymatic reaction), and sustainer for hypertension, which promotes the development of left ventricular hypertrophy (LVH), and has been known to predispose to dysrhythmias and sudden death in individuals.  The most common pattern is one of greater anger and hostility, along with a greater suppression of these emotions.  Such hyperreactivity is demonstrable among hypertensive patients and their normotensive offspring when compared to normal controls. ²⁰  The role of psychological stress remains largely undefined.  Possibly, their effect depends on complex interactions among the nature of the stressor, and the individual’s perception of the stress. ²¹ This area of physiology and neuro-psychology remains under investigation. 

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