Hypertension II: Pathophysiology

The RAAS activates when kidney blood flow decreases, triggering renin release. Renin converts angiotensinogen into angiotensin I, which the lungs convert to angiotensin II. Angiotensin II narrows blood vessels and stimulates aldosterone release, increasing sodium and water retention. This dual mechanism elevates blood pressure significantly.

Chronic stress activates the sympathetic nervous system, causing vasoconstriction, increased heart rate, and renin release. This heightened SNS activity triggers RAAS activation and contributes to arterial stiffness, reducing blood vessels' ability to dilate. Persistent sympathetic activation perpetuates elevated blood pressure.

Endothelial dysfunction reduces production of vasodilators like nitric oxide while increasing vasoconstrictors such as angiotensin II. This imbalance elevates peripheral resistance and blood pressure. The endothelium's compromised ability to regulate vascular smooth muscle tone directly contributes to hypertension development and progression.

Aldosterone stimulates the kidneys to conserve sodium and water, increasing blood volume in arteries. Excessive dietary sodium compounds this effect by further expanding fluid volume. Elevated blood volume directly increases the force exerted against artery walls, raising systemic blood pressure.

Chronic hypertension causes arterial hypertrophy and atherosclerosis, thickening artery walls and narrowing the vessel lumen. These structural changes increase vascular resistance, perpetuating elevated blood pressure. Understanding these changes is essential for developing effective drug therapy and lifestyle modifications to manage the condition.

Reduced kidney blood flow, as in renal artery stenosis, activates the RAAS by stimulating renin release. This cascade produces angiotensin II, a potent vasoconstrictor that narrows blood vessels and increases blood pressure. The kidneys' impaired perfusion initiates a self-perpetuating cycle of hypertension.

Nitric oxide, produced by blood vessel linings, normally relaxes arterial smooth muscle and maintains vascular tone. Hypertension involves nitric oxide shortage or diminished response, increasing vascular resistance. This deficiency contributes to endothelial dysfunction and elevated peripheral resistance, worsening blood pressure control.