Pathophysiology of Primary Hypertension

As a rule, the pathophysiology of primary hypertension is a complex system of the explanation of the hypertension causes and a number of risk factors that can be developed and influence the patient’s condition with time. Primary hypertension is usually diagnosed in 95% of cases because there is no known medical cause but the impact of some genetic or environmental factors (McCance & Huether, 2015). There are several risk factors that may be identified as the possible causes of primary hypertension. For example, family history of hypertension, age, gender, and race factors cannot be neglected. In the case under analysis, the patient is a 45-year-old African-American man. McCance and Huether (2015) identify that black-race people and men younger than 55 are under a threat of having primary hypertension. The elevation of blood pressure is also possible because of the maintenance of salt and water homeostasis.

Other important factors of primary hypertension are connected with smoking, obesity, alcohol consumption, and poor diet. Besides, regarding the fact that primary hypertension is a result of the interactions that take place between the environment and patient’s genetics, it is possible to say that even if a person does not smoke and promotes a healthy style of life, they may be under a threat of having problems with blood pressure. Besides, different genetic vulnerabilities (like insulin resistance) and environmental risk factors (like inflammation) may lead to the dysfunction of the sympathetic nervous system and rennin-angiotensin-aldosterone system and adducin (McCance & Huether, 2015). These processes result in vasoconstriction and later increased peripheral resistance or renal salt/water retention and later- increased blood volume. Both reactions lead to sustained hypertension. The change of blood pressure that results in primary hypertension depends on the quality and frequency of sodium transportation in renal epithelial cells. In their turn, epithelial cells can be changed and influence the process of sodium transportation because of the presence of some toxins in the organism or even simple and inevitable aging.

Description of Symptoms with the Help of POLDCARTS

In this case, the patient has several symptoms that are used to diagnose primary hypertension and its possible outcomes on the male conditions. To analyze the symptoms in a clear and comprehensive way the POLDCARTS tool is used below.

Hypertension	Dry Cough	Feeling Tired	Constipation	Ten Pound Wt Gain	Dry Skin
P – Previous similar occurrence	Sometimes, a dry cough took place after communication with smoking people. Still, no similar cases before were observed.	The same cases were observed when he was young, but he explained it as an outcome of protracted educational processes.	The patient complains of constipation appears as soon as he starts using OTC Robitussin (Andrews & Storr, 2011). No similar problems have been mentioned before.	The patient was in a good form before and was fond of different kinds of sport.	During all his life, the patient has not complained of the skin problems.
O– Onset	The problems bother the patient during the last three months.	The patient realized that he was constantly tired one month. before	It was one week ago when the patient felt the problems with defecation.	First problems with weight were observed two months before he addressed the doctor.	The problems with skin were first observed one week ago.
L– Location	Throat is the place where the patient feels pain.	Head and legs are the main locators of this kind of pain.	The gut is the source of pain during constipation.	The formation of a little tum and swollen fingers was observed.	The skin of face and hands was changed.
D – Duration	The patient is experiencing a dry cough at night during the last several weeks only and suffers from sleepless nights often.	The patient has been feeling tired during the last few months constantly.	The patient has constipation problems once or two times per day while visiting the toilet.	Overweighting bothers the patient during the last two months.	The skin looks dry during the last week.
C– Characteristics	An excessive and even itchy dry cough bother the patient.	Physical fatigue and dull headache may last during the whole day.	Sharp pain and continuous contractions appear from time to time.	Lack of energy to complete a longitudinal physical task bothers the patient.	Itch is the main characteristic that is connected with
A – Aggravating	As soon as the patient lies on the bed, a cough is aggravating.	Additional physical exercises promote fatigue.	The decision to eat more chocolate may cause additional gut pain.	Eating at nights when it is hard to sleep may lead to overweighting.	Additional scratching may cause more pain or even redness.
R – Relieving	A glass of water or Robitussin could help a bit.	A glass of fresh juice and fresh air walk are helpful.	Regular movements and use of vegetables help to cope with constipation pain.	Water instead of food can be a good source of relief.	A moisturizing cream can be a good solution for pain relief.
T – Temporal	A dry cough bothers at night usually.	The patient feels tired all day and night long.	The patient suffers from constipation in the morning usually.	It is hard to wake up in the morning and walk during a day.	All day long, especially during the heat.
S – Severity*	1	2	5	8	5

* Scale from 1 to 10.

Pathophysiological Origins of Five Symptoms

The evaluation of pathophysiological origins of the symptoms Mr. Irving has should help to analyze his condition and understand the reasons for the identified health problems. As a protective reflex that aims at clearing the airways (McCance & Huether, 2015), a cough may be initiated by inhaled particles, accumulated mucus, or inflammation (the environmental factor). Besides, there can be some foreign bodies that may stimulate irritant receptors that cause a cough. A person is not always able to understand a true reason for a cough, especially for a dry cough, and tries to use the most familiar solutions like a glass of water or fresh air. However, a high blood pressure requires the use of special drugs that may cause a cough.

Fatigue is another symptom of the disease the patient suffers from. Its peculiar feature is the presence of numerous causes starting from the inability to sleep properly and ending with a wrong reaction to medications. In this particular case, such causes as lack of sleep, wrong medications, and poor physical activities. Not many things should be done or undone to get tired, and Mr. Irving believes that the main reason for him feeling tired is the inability to sleep well during a considerable period of time. The causes of constipation do not depend on primary hypertension directly. Still, it is possible to identify the connection between several symptoms at the same time and find a logical explanation of constipation. Obesity can be the reason for a high blood pressure. Obesity or even a slow gaining of weight also leads to the lack of physical activities. A bowel, as a part of a human organism, also lacks the required portion of activities. It stops working systematically, and constipation is one of the possible outcomes of obesity that is identified as an outcome of hypertension. Among the variety of pathophysiological mechanisms that may develop obesity, the presence of leptin gene is one of the most crucial factors. It participates in interactions that control appetite. As soon as it is mutated, the risks of overweighting may be enlarged, and the risks of the hypertension are developed as well (Bravo et al., 2006).

As for the pathophysiology of origins of the last symptom, dry skin, the researchers fail to discover a single direct cause. There are many internal and external factors that may be considered including the changes in temperature, age, or genetic peculiarities. Dry skin may also be a result of the use of medicines for high blood pressure. It may happen that Mr. Irving takes some drugs to stabilize his pressure and cause the allergy of his skin.

Worth of Lab and Diagnostic Tests

To analyze the condition of the patient, several lab tests and physical examination are conducted. The results of TSH test shows the level of thyroid stimulating hormones in the blood that is responsible for the process of metabolism in the organism (McCance & Huether, 2015). The results should be kept between 0.5 and 5.2. The patient’s results reach 6. T4 reaches 3.2 (regarding the normal results between 4.5 and 14.4). Such results can be interpreted as the sign of evident hypothyroidism. In addition, free T4 test results are also low. It is another sign of hypothyroidism. There are also abnormal results of creatinine that make the doctors pay more attention to the condition of the patient’s kidneys. Malfunctioning of kidneys may also be proved by a high level of blood urea nitrogen. The patient has 24 with normal results between 7 and 20.

Still, the normal results of CMP (Comprehensive metabolic panel) and CBC (complete blood count) provide the doctor and the patient with a chance that there is no terrible kidney disease just its possible malfunctions that can be properly treated, and the conditions of the patient may be improved by means of properly chosen drugs and therapies. The physical examination of the patients does not show any abnormalities as well. Such results mean that the patient is under a threat of having chronic kidney troubles that can be the reason for hypertension. It is required to take medical treatment and protect the organism at its early stage.

Tests’ Meaning and Patient’s Problems

The case of the patient is not complicated. Still, more attention should be paid to the family history and all symptoms that bother the patient. Mr. Irving’s mother died from a stroke, and Mr. Irving’s father died of a heart attack. To avoid similar complications, all tests should be passed again after the treatment is complete. The analysis of kidneys and its connection to hypertension has to be conducted. In this case, hypertension may not be just a disease that has to be treated. It may be a new symptom that leads to a new serious disease that can be characterized by such additional symptoms as dry skin, obesity, sleeping disorders, and fatigue.

Conclusion

The evaluation of the pathopsychological mechanisms of hypertension and its symptoms is helpful indeed. It shows that Mr. Irving’s condition may be explained in a variety of way. Despite the fact that this man supports an active style of life, avoids smoking and alcohol, and wants to control his blood pressure, there are the situations when he fails to meet his goals. There are many external and internal factors that have to be considered. He should also remember the family history and try to protect his organism against various harmful elements connected with poor diets or smoking environment. A dry cough, dry skin, fatigue, overweighting, and constipation may be not the only sings of a disease that doctors call a primary hypertension. More tests and analysis should be taken to clarify the situation and offer an appropriate treatment.

References

Andrews, C.N. & Storr, M. (2011). The pathophysiology of chronic constipation. Canadian Journal of Gastroenterology, 25(B), 16-21.

Bolivar, J.J. (2013). Essential hypertension: An approach to its etiology and neurogenic pathophysiology. International Journal of Hypertension, 2013(3).

Bravo, P.E., Morse, S., Borne, D.M., Aguilar, E.A., & Reisin, E. (2006). Leptin and hypertension in obesity. Vascular Health and Risk Management, 2(2), 163-169.

McCance, K.L. & Huether, S.E. (2015). Pathophysiology: The biologic basis for disease in adults and children. St. Louis, MO: Mosby.

Rapsomaniki, E., Timmis, A., George, J., Pujades-Rodriguez, M., Shah, A.D., Denaxas, S., White, I.R., Caulfield, M.J., Deanfield, J.E., Smeeth, L., Williams, B., Hingorani, A. & Hemingway, H. (2014). Blood pressure and incidence of twelve cardiovascular diseases: Lifetime risks, healthy life-years lost, and age-specific associations in 1.25 million people. The Lancet, 383(9932), 1899-1911.

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Pathophysiology of Primary Hypertension

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Introduction