Hypertension and Blood Pressure Regulation: Pathophysiology, Risk Factors, and Advanced Therapeutic Strategies for Cardiovascular Health

Abstract

Hypertension remains a leading contributor to global cardiovascular morbidity and mortality, affecting over 1.28 billion adults worldwide, with nearly half remaining undiagnosed or undertreated. This study investigated the pathophysiology, risk factors, and therapeutic strategies for blood pressure regulation by integrating molecular, clinical, and therapeutic evidence. A cohort of 200 participants (120 males, 80 females; mean age 49.6 ± 11.3 years) was assessed through standardized blood pressure measurement, biochemical profiling, and lifestyle evaluation. Statistical analyses, including logistic regression and ANOVA, were performed with p < 0.05 as the significance threshold. The prevalence of uncontrolled hypertension was 42.5%. Obesity (OR = 2.13, 95% CI: 1.54–2.96, p < 0.001), high sodium intake (>5 g/day; OR = 1.87, 95% CI: 1.33–2.61, p = 0.002), sedentary lifestyle (OR = 1.65, 95% CI: 1.12–2.41, p = 0.014), age >50 years (OR = 1.92, 95% CI: 1.38–2.66, p < 0.001), and family history (OR = 1.58, 95% CI: 1.11–2.23, p = 0.011) emerged as significant predictors. Lifestyle interventions such as the DASH diet and physical activity lowered systolic blood pressure by –8.7 mmHg (95% CI: –10.4 to –6.9, p < 0.001), similar to pharmacological therapies (–10.2 mmHg, 95% CI: –12.8 to –7.5, p < 0.001). Renal denervation achieved an additional –6.5 mmHg reduction (95% CI: –8.1 to –4.8, p < 0.001) in resistant cases. Combination therapy (lifestyle + pharmacological) achieved the highest control rate (72.4%) compared with monotherapy (56.3%; p = 0.009). These findings emphasize that hypertension is driven by multifactorial mechanisms—vascular, renal, neurohormonal, and genetic—yet remains strongly modifiable through targeted interventions. Integrating lifestyle modifications with pharmacological and advanced strategies, such as renal denervation, represents the most effective pathway for reducing the burden of hypertension and improving cardiovascular health outcomes globally.