Editing Hypertension (section)

===Primary hypertension===
{{Main|Essential hypertension}}
Primary (also termed essential) hypertension results from a complex interaction of [[Gene|genes]] and environmental factors. More than 2000 common genetic variants with small effects on blood pressure have been identified in association with high blood pressure,<ref>{{Cite journal |last1=Keaton |first1=Jacob M. |last2=Kamali |first2=Zoha |last3=Xie |first3=Tian |last4=Vaez |first4=Ahmad |last5=Williams |first5=Ariel |last6=Goleva |first6=Slavina B. |last7=Ani |first7=Alireza |last8=Evangelou |first8=Evangelos |last9=Hellwege |first9=Jacklyn N. |last10=Yengo |first10=Loic |last11=Young |first11=William J. |last12=Traylor |first12=Matthew |last13=Giri |first13=Ayush |last14=Zheng |first14=Zhili |last15=Zeng |first15=Jian |date=May 2024 |title=Genome-wide analysis in over 1 million individuals of European ancestry yields improved polygenic risk scores for blood pressure traits |journal=Nature Genetics |language=en |volume=56 |issue=5 |pages=778–791 |doi=10.1038/s41588-024-01714-w |issn=1061-4036 |pmc=11096100 |pmid=38689001}}</ref> as well as some rare genetic variants with large effects on blood pressure.<ref>{{cite journal | vauthors = Lifton RP, Gharavi AG, Geller DS | title = Molecular mechanisms of human hypertension | journal = Cell | volume = 104 | issue = 4 | pages = 545–556 | date = February 2001 | pmid = 11239411 | doi = 10.1016/S0092-8674(01)00241-0 | doi-access = free }}</ref> There is also evidence that [[DNA methylation]] at multiple nearby [[CpG site]]s may link some sequence variation to blood pressure, possibly via effects on vascular or renal function.<ref name="Nor2016">{{cite journal | vauthors = Kato N, Loh M, Takeuchi F, Verweij N, Wang X, Zhang W, etal | title = Trans-ancestry genome-wide association study identifies 12 genetic loci influencing blood pressure and implicates a role for DNA methylation | journal = Nature Genetics | volume = 47 | issue = 11 | pages = 1282–1293 | date = November 2015 | pmid = 26390057 | pmc = 4719169 | doi = 10.1038/ng.3405 }}</ref>

Blood pressure rises with [[aging]] in societies with a [[Western pattern diet|western diet]] and lifestyle,<ref>{{Cite journal| vauthors = Carrera-Bastos P, Fontes-Villalba M, O'Keefe JH, Lindeberg S, Cordain L |date=2011-03-09|title=The western diet and lifestyle and diseases of civilization|url=https://www.dovepress.com/the-western-diet-and-lifestyle-and-diseases-of-civilization-peer-reviewed-article-RRCC|access-date=2021-02-09|journal=Research Reports in Clinical Cardiology|volume=2|pages=15–35|doi=10.2147/RRCC.S16919|s2cid=3231706 |language=English|doi-access=free}}</ref> and the risk of becoming hypertensive in later life is substantial in most such societies.<ref>{{cite journal | vauthors = Vasan RS, [[Alexa Beiser|Beiser A]], Seshadri S, Larson MG, Kannel WB, D'Agostino RB, Levy D | title = Residual lifetime risk for developing hypertension in middle-aged women and men: The Framingham Heart Study | journal = JAMA | volume = 287 | issue = 8 | pages = 1003–1010 | date = February 2002 | pmid = 11866648 | doi = 10.1001/jama.287.8.1003 | doi-access = free }}</ref> Several environmental or lifestyle factors influence blood pressure. Reducing dietary salt intake lowers blood pressure;<ref>{{Cite journal |last1=Filippini |first1=Tommaso |last2=Malavolti |first2=Marcella |last3=Whelton |first3=Paul K. |last4=Naska |first4=Androniki |last5=Orsini |first5=Nicola |last6=Vinceti |first6=Marco |date=2021-04-20 |title=Blood Pressure Effects of Sodium Reduction: Dose–Response Meta-Analysis of Experimental Studies |journal=Circulation |language=en |volume=143 |issue=16 |pages=1542–1567 |doi=10.1161/CIRCULATIONAHA.120.050371 |issn=0009-7322 |pmc=8055199 |pmid=33586450}}</ref> as does weight loss,<ref>{{Cite journal |last1=Hall |first1=Michael E. |last2=Cohen |first2=Jordana B. |last3=Ard |first3=Jamy D. |last4=Egan |first4=Brent M. |last5=Hall |first5=John E. |last6=Lavie |first6=Carl J. |last7=Ma |first7=Jun |last8=Ndumele |first8=Chiadi E. |last9=Schauer |first9=Philip R. |last10=Shimbo |first10=Daichi |last11=on behalf of the American Heart Association Council on Hypertension; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Lifestyle and Cardiometabolic Health; and Stroke Council |date=November 2021 |title=Weight-Loss Strategies for Prevention and Treatment of Hypertension: A Scientific Statement From the American Heart Association |url=https://www.ahajournals.org/doi/10.1161/HYP.0000000000000202 |journal=Hypertension |language=en |volume=78 |issue=5 |pages=e38–e50 |doi=10.1161/HYP.0000000000000202 |pmid=34538096 |issn=0194-911X}}</ref> exercise training,<ref>{{Cite journal |last1=Edwards |first1=Jamie J. |last2=Deenmamode |first2=Algis H. P. |last3=Griffiths |first3=Megan |last4=Arnold |first4=Oliver |last5=Cooper |first5=Nicola J. |last6=Wiles |first6=Jonathan D. |last7=O'Driscoll |first7=Jamie M. |date=October 2023 |title=Exercise training and resting blood pressure: a large-scale pairwise and network meta-analysis of randomised controlled trials |url=https://pubmed.ncbi.nlm.nih.gov/37491419 |journal=British Journal of Sports Medicine |volume=57 |issue=20 |pages=1317–1326 |doi=10.1136/bjsports-2022-106503 |issn=1473-0480 |pmid=37491419}}</ref> vegetarian diets,<ref>{{Cite journal |last1=Lee |first1=Kai Wei |last2=Loh |first2=Hong Chuan |last3=Ching |first3=Siew Mooi |last4=Devaraj |first4=Navin Kumar |last5=Hoo |first5=Fan Kee |date=2020-05-29 |title=Effects of Vegetarian Diets on Blood Pressure Lowering: A Systematic Review with Meta-Analysis and Trial Sequential Analysis |journal=Nutrients |language=en |volume=12 |issue=6 |pages=1604 |doi=10.3390/nu12061604 |doi-access=free |pmc=7352826 |pmid=32486102}}</ref> increased dietary potassium intake<ref>{{Cite journal |last1=Sriperumbuduri |first1=Sriram |last2=Welling |first2=Paul |last3=Ruzicka |first3=Marcel |last4=Hundemer |first4=Gregory L |last5=Hiremath |first5=Swapnil |date=2023-09-29 |title=Potassium and Hypertension: A State-of-the-Art Review |url=https://academic.oup.com/ajh/article-abstract/37/2/91/7286227?redirectedFrom=fulltext |journal=American Journal of Hypertension |volume=37 |issue=2 |pages=91–100 |doi=10.1093/ajh/hpad094 |pmid=37772757 |issn=0895-7061}}</ref> and high dietary calcium supplementation.<ref>{{Cite journal |last1=Cormick |first1=Gabriela |last2=Ciapponi |first2=Agustín |last3=Cafferata |first3=María Luisa |last4=Cormick |first4=María Sol |last5=Belizán |first5=José M |date=2022-01-11 |editor-last=Cochrane Hypertension Group |title=Calcium supplementation for prevention of primary hypertension |journal=Cochrane Database of Systematic Reviews |language=en |volume=2022 |issue=1 |pages=CD010037 |doi=10.1002/14651858.CD010037.pub4 |pmc=8748265 |pmid=35014026}}</ref> Increasing alcohol intake is associated with higher blood pressure,<ref>{{Cite journal |last1=Di Federico |first1=Silvia |last2=Filippini |first2=Tommaso |last3=Whelton |first3=Paul K. |last4=Cecchini |first4=Marta |last5=Iamandii |first5=Inga |last6=Boriani |first6=Giuseppe |last7=Vinceti |first7=Marco |date=October 2023 |title=Alcohol Intake and Blood Pressure Levels: A Dose-Response Meta-Analysis of Nonexperimental Cohort Studies |journal=Hypertension |language=en |volume=80 |issue=10 |pages=1961–1969 |doi=10.1161/HYPERTENSIONAHA.123.21224 |issn=0194-911X |pmc=10510850 |pmid=37522179}}</ref> but the possible roles of other factors such as caffeine consumption,<ref>{{cite journal | vauthors = Mesas AE, Leon-Muñoz LM, Rodriguez-Artalejo F, Lopez-Garcia E | title = The effect of coffee on blood pressure and cardiovascular disease in hypertensive individuals: a systematic review and meta-analysis | journal = The American Journal of Clinical Nutrition | volume = 94 | issue = 4 | pages = 1113–1126 | date = October 2011 | pmid = 21880846 | doi = 10.3945/ajcn.111.016667 | doi-access = free }}</ref> and [[vitamin D deficiency]]<ref>{{cite journal | vauthors = Vaidya A, Forman JP | title = Vitamin D and hypertension: current evidence and future directions | journal = Hypertension | volume = 56 | issue = 5 | pages = 774–779 | date = November 2010 | pmid = 20937970 | doi = 10.1161/HYPERTENSIONAHA.109.140160 | doi-access = free }}</ref> are less clear. Average blood pressure is higher in the winter than in the summer.<ref>{{Cite journal |last1=Narita |first1=Keisuke |last2=Hoshide |first2=Satoshi |last3=Kario |first3=Kazuomi |date=November 2021 |title=Seasonal variation in blood pressure: current evidence and recommendations for hypertension management |url=https://www.nature.com/articles/s41440-021-00732-z |journal=Hypertension Research |language=en |volume=44 |issue=11 |pages=1363–1372 |doi=10.1038/s41440-021-00732-z |pmid=34489592 |issn=1348-4214}}</ref>

[[depression (mood)|Depression]] is associated with hypertension<ref>{{cite journal | vauthors = Meng L, Chen D, Yang Y, Zheng Y, Hui R | title = Depression increases the risk of hypertension incidence: a meta-analysis of prospective cohort studies | journal = Journal of Hypertension | volume = 30 | issue = 5 | pages = 842–851 | date = May 2012 | pmid = 22343537 | doi = 10.1097/hjh.0b013e32835080b7 | s2cid = 32187480 }}</ref> and [[loneliness]] is also a risk factor.<ref name="Cacioppo, J 2010 p218-227">{{cite journal | vauthors = Hawkley LC, Cacioppo JT | title = Loneliness matters: a theoretical and empirical review of consequences and mechanisms | journal = Annals of Behavioral Medicine | volume = 40 | issue = 2 | pages = 218–227 | date = October 2010 | pmid = 20652462 | pmc = 3874845 | doi = 10.1007/s12160-010-9210-8 }}</ref> [[Periodontal disease]] is also associated with high blood pressure.<ref>{{cite journal | vauthors = Muñoz Aguilera E, Suvan J, Buti J, Czesnikiewicz-Guzik M, Barbosa Ribeiro A, Orlandi M, Guzik TJ, Hingorani AD, Nart J, D'Aiuto F | display-authors = 6 | title = Periodontitis is associated with hypertension: a systematic review and meta-analysis | journal = Cardiovascular Research | volume = 116 | issue = 1 | pages = 28–39 | date = January 2020 | pmid = 31549149 | doi = 10.1093/cvr/cvz201 | doi-access = free | veditors = Lembo G }}</ref> [[Arsenic]] exposure through drinking water is associated with elevated blood pressure.<ref>{{cite journal | vauthors = Abhyankar LN, Jones MR, Guallar E, Navas-Acien A | title = Arsenic exposure and hypertension: a systematic review | journal = Environmental Health Perspectives | volume = 120 | issue = 4 | pages = 494–500 | date = April 2012 | pmid = 22138666 | pmc = 3339454 | doi = 10.1289/ehp.1103988 }}</ref> [[Air pollution]] is associated with hypertension.<ref>{{cite journal | vauthors = Yang BY, Qian Z, Howard SW, Vaughn MG, Fan SJ, Liu KK, Dong GH | title = Global association between ambient air pollution and blood pressure: A systematic review and meta-analysis | journal = Environmental Pollution | volume = 235 | pages = 576–588 | date = April 2018 | pmid = 29331891 | doi = 10.1016/j.envpol.2018.01.001 | bibcode = 2018EPoll.235..576Y }}</ref> Whether these associations are causal is unknown. [[Gout]] and elevated blood [[hyperuricemia|uric acid]] are associated with hypertension<ref>{{Cite journal |last1=Sandoval-Plata |first1=Gabriela |last2=Nakafero |first2=Georgina |last3=Chakravorty |first3=Mithun |last4=Morgan |first4=Kevin |last5=Abhishek |first5=Abhishek |date=2021-07-01 |title=Association between serum urate, gout and comorbidities: a case–control study using data from the UK Biobank |url=https://academic.oup.com/rheumatology/article/60/7/3243/6032841 |journal=Rheumatology |language=en |volume=60 |issue=7 |pages=3243–3251 |doi=10.1093/rheumatology/keaa773 |pmid=33313843 |issn=1462-0324}}</ref> and evidence from genetic ([[Mendelian randomization|Mendelian Randomization]]) studies and clinical trials indicate this relationship is likely to be causal.<ref>{{Cite journal |last1=Gill |first1=Dipender |last2=Cameron |first2=Alan C. |last3=Burgess |first3=Stephen |last4=Li |first4=Xue |last5=Doherty |first5=Daniel J. |last6=Karhunen |first6=Ville |last7=Abdul-Rahim |first7=Azmil H. |last8=Taylor-Rowan |first8=Martin |last9=Zuber |first9=Verena |last10=Tsao |first10=Philip S. |last11=Klarin |first11=Derek |last12=VA Million Veteran Program |last13=Evangelou |first13=Evangelos |last14=Elliott |first14=Paul |last15=Damrauer |first15=Scott M. |date=February 2021 |title=Urate, Blood Pressure, and Cardiovascular Disease: Evidence From Mendelian Randomization and Meta-Analysis of Clinical Trials |journal=Hypertension |language=en |volume=77 |issue=2 |pages=383–392 |doi=10.1161/HYPERTENSIONAHA.120.16547 |issn=0194-911X |pmc=7803439 |pmid=33356394}}</ref> [[Insulin resistance]], which is common in obesity and is a component of [[metabolic syndrome|syndrome X]] (or [[metabolic syndrome]]), can cause hyperuricemia and gout<ref>{{Cite journal |last1=McCormick |first1=Natalie |last2=O'Connor |first2=Mark J. |last3=Yokose |first3=Chio |last4=Merriman |first4=Tony R. |last5=Mount |first5=David B. |last6=Leong |first6=Aaron |last7=Choi |first7=Hyon K. |date=November 2021 |title=Assessing the Causal Relationships Between Insulin Resistance and Hyperuricemia and Gout Using Bidirectional Mendelian Randomization |journal=Arthritis & Rheumatology |volume=73 |issue=11 |pages=2096–2104 |doi=10.1002/art.41779 |issn=2326-5205 |pmc=8568618 |pmid=33982892}}</ref> and is also associated with elevated blood pressure.<ref>{{Cite journal |last1=Quesada |first1=Odayme |last2=Claggett |first2=Brian |last3=Rodriguez |first3=Fatima |last4=Cai |first4=Jianwen |last5=Moncrieft |first5=Ashley E. |last6=Garcia |first6=Karin |last7=Del Rios Rivera |first7=Marina |last8=Hanna |first8=David B. |last9=Daviglus |first9=Martha L. |last10=Talavera |first10=Gregory A. |last11=Bairey Merz |first11=C. Noel |last12=Solomon |first12=Scott D. |last13=Cheng |first13=Susan |last14=Bello |first14=Natalie A. |date=September 2021 |title=Associations of Insulin Resistance With Systolic and Diastolic Blood Pressure: A Study From the HCHS/SOL |journal=Hypertension |language=en |volume=78 |issue=3 |pages=716–725 |doi=10.1161/HYPERTENSIONAHA.120.16905 |issn=0194-911X |pmc=8650976 |pmid=34379440}}</ref> 

Events in early life, such as [[low birth weight]], [[Smoking and pregnancy|maternal smoking]], and lack of [[breastfeeding]] may be risk factors for adult essential hypertension, although the strength of the relationships is weak and the mechanisms linking these exposures to adult hypertension remain unclear.<ref name="Lawlor 2005">{{cite journal | vauthors = Lawlor DA, Smith GD | title = Early life determinants of adult blood pressure | journal = Current Opinion in Nephrology and Hypertension | volume = 14 | issue = 3 | pages = 259–264 | date = May 2005 | pmid = 15821420 | doi = 10.1097/01.mnh.0000165893.13620.2b | s2cid = 10646150 }}</ref>