Etiology

Categories: Uncategorized
Sources: Disturbances Of The Heart

One of the most common causes of hypertension is clue to excess of

eating and drinking. The products caused by maldigestion of

proteins, and the toxins formed and absorbed especially from meat

proteins, particularly when the excretions are insufficient, are the

most frequent causes of hypertension. Whatever other element or

condition may have caused increased blood pressure, the first step

toward improving and lowering this pressure is to diminish the

amount of meat eaten or to remove it entirely from the diet. In

pregnancy where there is increased metabolic change, when the

proteins are not well or properly cared for in gout, and when there

is intestinal fermentation or putrefaction, hypertension is likely

to occur. The increased blood pressure in these cases is directly

due to irritation of the toxins on the blood vessel walls.



While alcohol does not tend to raise arterial blood pressure, in

large amounts it may raise the venous pressure. Also, by causing an

abundant appetite and thus increasing the amount of food taken, by

interfering with the activity of the liver, and by impairing the

intestinal digestion, it can indirectly disturb the metabolism and

cause enough toxin to be produced to raise the blood pressure.



Any drug or substance that raises the blood pressure by stimulating

the vasomotor center or the arterioles, when constantly repeated,

will be a cause of hypertension. This is particularly true of

caffein and nicotin. Also, anything that might stimulate, or that

does stimulate, the suprarenal glands will cause a continued high

blood pressure. It is quite probable that in many cases of gout the

suprarenals are hypersecreting and it has been shown by Cannon, Aub

and Binger [Footnote: Cannon, Aub and Binger: Jour. Pharmacol. and

Exper. Therap., March, 1912.] that nicotin in small closes increases

the suprarenal secretion. Therefore, nicotin becomes a decided cause

of hypertension and arteriosclerosis.



Thayer found that heavy work is the cause of about two thirds of all

cases of arteriosclerosis, and one of the functions of the

suprarenals is to destroy the waste products of muscular activity;

hence these glands, in these cases, are hypersecreting. Furthermore,

the reason that many infections are followed later by arterio-

sclerosis may be the fact that the suprarenals have been stimulated

to hypertrophy and hypersecrete.



Many persons in middle life, and especially women at the time of the

menopause, show hypertension without arterial or kidney reason. At

this time of life the thyroid is disturbed, and often, especially if

weight is added, it is not secreting sufficiently. Whether, with the

polyglandular disturbance of the menopause the suprarenals are

excited and hypersecreting, or whether they are simply relatively

secreting more vasopressor substance than is combated by the

vasodilator substance from the thyroid, cannot be determined. These

women are energetic, and look full of health and full of strength,

but their faces frequently flush, sometimes they are dizzy, and the

systolic blood pressure is too high. Reisman has pointed out that

these patients are likely to have very large breasts, and there is

reason to believe that we must begin to study more carefully the

effect of large breasts on the metabolism of girls and women. There

certainly is an internal secretion of some importance furnished by

these glands.



In hyperthyroidism at first the blood pressure may be lowered on

account of the increased physiologic secretion of the thyroid gland.

Later the blood pressure may be raised by stimulation of the

suprarenals, or it may become raised from the irritated and

stimulated heart becoming hypertrophied. If the heart is normal the

ventricles should hypertrophy with the increased work that they are

under; and the blood pressure could increase for this reason. Later

in exophthalmic goiter the heart muscle may become degenerated, a

chronic myocarditis, and the ventricles may slightly dilate. At this

time the blood pressure is lowered. When such a condition has

occurred, the heart bears thyroidectomy badly; hence an operation on

this gland should, if possible, be performed before the heart muscle

has become injured. If the heart shows signs of loss of power, minor

operations to cut off the blood supply of the thyroid should first

be done, and the patient's heart allowed to improve before a

thyroidectomy is performed.



Men with hypertension without kidney or arterial excuse are likely

to have been athletes, or to have done some severe competitive work,

or, as above stated, to have labored hard, or to have worked at high

tension, or in great excitement, or with mental worry, all of which

tend, as long as there is health, to increase the blood pressure.

These men may add weight from the age of 40 on, or they may be thin

and wiry. Besides the hypertension there is likely to be a too

sturdily acting heart, which is often hypertrophied, and there is an

accentuated closure of the aortic valve. There may be dizziness, or

no head symptoms at all. Nicotin is likely to be an etiologic factor

in this class.



These women and these men may all be improved by proper treatment,

and the condition may not develop into arteriosclerosis or

nephritis.



Neurotic conditions, and in some instances neurasthenic conditions,

may show a blood pressure higher than normal. Lead may be a cause of

increased blood pressure, and diabetics occasionally have a high

pressure, although more frequently there is a lowering of blood

pressure in diabetes.



Richman believes that syphilis is the most common cause of

hypertension and arteriosclerosis without renal disease. When

arteriosclerosis and renal disease are combined, of course the

highest systolic readings occur. He thinks that when high tension

occurs under 40 years of age, kidney disease is generally the cause.

Of course it may be the only cause later in life.



High blood pressure due to syphilitic conditions may be greatly

improved by the proper treatment, although some one or more blood

vessels are likely to have been seriously damaged. Although these

patients may live for many years, they are likely to have an

apoplexy, cerebral disease or an aneurysm.



While hypertension is not a disease, and while it often should not

be combated, still, as it is always the forerunner of more serious

trouble, there can be no excuse for not most seriously considering

it and generally attempting its reduction. At the moment high

tension is discovered, there may be no special symptoms; but

troublesome symptoms are always pending, and while the patient need

not be unduly alarmed, there is no excuse for not rearranging the

individual's life so as to prolong it. This is not to state that

every high tension must be lowered, but every hypertension must be

studied and a safer systolic pressure caused if it is possible

without interfering with the person's efficiency. A high diastolic

pressure, one above 105, certainly must receive immediate attention,

and a diastolic pressure of 110 must be lowered, if possible. On the

other hand, a high systolic pressure without a high diastolic

pressure should not be rapidly lowered, else depression will be

caused.