Hypertension, one of the leading risk factors for cardiovascular disease, is a complex condition

influenced by a broad spectrum of developmental, genetic, and environmental factors. Understanding

its manifestations across different life stages and among special populations is critical to improving

prevention, diagnosis, and treatment strategies. This topic explores the multifaceted nature of

hypertension from prenatal development through adulthood, with a particular emphasis on special

populations that require tailored management approaches. It addresses:

- Prenatal and Early-Life Influences on Hypertension: Maternal hypertension and

preeclampsia can impact on fetal vascular development leading to elevated blood pressure in

childhood, increased arterial stiffness, or metabolic dysregulation. Key mechanisms can

include endothelial dysfunction and impaired angiogenesis during fetal development; reduced

renal capacity to manage sodium and fluid balance; epigenetic modifications affecting gene

expression involved in vascular tone and metabolism.

- Pediatric and Adolescent Hypertension: in younger populations hypertension is often

secondary to underlying conditions such as renal or endocrine disorders. However, primary

(essential) hypertension is becoming more common in adolescents, particularly those with a

family history or metabolic risk factors. Early diagnosis is critical, as childhood hypertension

can persist into adulthood and significantly increase the risk of future cardiovascular disease.

- Rare Genetic Disorders and Hypertension: highlights the role of genetic conditions into

the pathophysiology of blood pressure regulation. A key example is Fabry disease, an Xlinked lysosomal storage disorder characterized by deficiency of alpha-galactosidase A,

leading to the accumulation of globotriaosylceramide (GL-3) in vascular endothelium.

Vascular inflammation, fibrosis, increased arterial stiffness and renal dysfunction in Fabry

disease can contribute to the development of hypertension. An effective therapy could

improve blood pressure control and reduce cardiovascular risk.

- Hypertension in the elderly: during aging, hypertension is highly prevalent and presents

unique challenges due to age-related vascular changes, such as increased arterial stiffness,

which often leads to isolated systolic hypertension. Older adults are also more susceptible to

complications like orthostatic hypotension and adverse drug effects due to comorbidities and

polypharmacy. A personalized approach, considering functional status and overall

cardiovascular risk, is essential to optimize outcomes in this population.

- Heritable Vascular Syndromes and Blood Pressure Management: discusses vascular

Ehlers-Danlos syndrome (vEDS) and other connective tissue disorders (e.g., Marfan

syndrome, Loeys-Dietz syndrome), emphasizing their impact on vascular fragility and unique

blood pressure management challenges.

- Secondary Hypertension in Special Populations: Hypertension across the lifespan and in

special populations represents a complex and evolving clinical challenge. Its causes,

manifestations, and management strategies vary significantly depending on age, genetic

background, and coexisting conditions, highlighting the need for personalized and contextspecific approaches. In chronic kidney disease (CKD), hypertension and renal dysfunction

reinforce each other in a harmful cycle of vascular and renal damage. Endocrine disorders

such as primary hyperaldosteronism, Cushing’s syndrome, and pheochromocytoma can lead

to hormone-driven blood pressure elevations, often resistant to standard therapies.

Additionally, obstructive sleep apnea (OSA) is a common but underdiagnosed cause of

secondary hypertension, characterized by intermittent hypoxia and sympathetic overactivity.

Recognizing these specific causes is crucial for effective and personalized management.

Overall, this topic emphasizes the diverse and multifactorial nature of high blood pressure, shaped by

developmental, genetic, and environmental influences. From fetal programming due to maternal

hypertension to complex cases in the elderly or individuals with rare genetic syndromes, the condition

requires tailored diagnostic and therapeutic strategies. Understanding the unique mechanisms and

risks associated with each life stage and special population is essential for effective prevention, risk

stratification, and long-term management. This comprehensive approach aims to improve outcomes

and reduce the burden of hypertension across all patient groups.

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Hypertension Across the Lifespan and Special Populations