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Three-Way Classification of Hypertension: Gene Hypertension, Environment Hypertension, and Disease Hypertension

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Essential Hypertension 2

Summary

Bright described in 1827 [1] a patient in whom urine protein was associated with edema and hypertrophy of the heart, which greatly progressed the research of renal hypertension. In 1872, Gull and Sutton [2] demonstrated arterio-capillary fibrosis in patients with hypertension and separated the hypertensive disease from kidney disease. Frank designated in 1911 [3] this hypertensive disease as “essentielle Hypertonie”, which has been translated into English as essential hypertension and recognized as an arterial disease. In 1914, Volhard and Fahr [4] classified hypertension quantitatively into benign and malignant depending on the severity of hypertension. Pickering in 1955 [5] qualitatively differentiated hypertension into essential hypertension and secondary hypertension, which is a two class classification. Essential hypertension was characterized by high blood pressure and hypertensive cardiovascular hypertrophy of the heart and arteries. Secondary hypertension was defined as hypertension occuring as the prominent phenomenon of a disease. Renovascular hypertension, primary aldosteronism hypertension, pheochromocytoma hypertension, and others are considered as secondary hypertension. Aoki proposed in 1985 [6], an etiological classification of hypertension, the following three-way classification: (1) gene (essential) hypertension, (2) environment (accessory gene) hypertension, and (3) disease (non-gene) hypertension. Gene hypertension, inherited through the major hypertension gene, may correspond to Frank’s essential hypertension. Environment hypertension is characterized by the development of hypertension due to an interaction of environmental factors on an accessory hypertension genes. Salt-sensitive hypertension, obesity-sensitive hypertension, alcohol hypertension, and others of environment hypertension are considered. Disease hypertension, defined as high blood pressure resulting from a disease, corresponds to Pickering’s secondary hypertension. This three-way classification according to hypertension gene, applicable to both experimental and clinical cases of hypertensive disease, may open the door to a wide range of further research on the mechanisms, therapy, and prevention of hypertensive diseases.

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  1. Second Department of Internal Medicine, Nagoya City University Medical School, Mizuho-ku, Nagoya 467, Japan

    Kyuzo Aoki

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  1. 2nd Department of Internal Medicine, Nagoya City University Medical School, Nagoya 467, Japan

    Kyuzo Aoki

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Aoki, K. (1989). Three-Way Classification of Hypertension: Gene Hypertension, Environment Hypertension, and Disease Hypertension. In: Aoki, K. (eds) Essential Hypertension 2. Springer, Tokyo. https://doi.org/10.1007/978-4-431-68090-1_2

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  • DOI: https://doi.org/10.1007/978-4-431-68090-1_2

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