The prime problem in essential hypertension is what?

• A. Increased arteriolar resistance
• B. Decreased venous return
• C. Decreased cardiac output
• D. Low blood volume

Answer: (A)

In essential hypertension, the main issue is increased resistance in the small arteries and arterioles, raising the overall systemic vascular resistance. The arterioles are the vessels that contribute most to resistance, and when their walls undergo structural changes (like smooth muscle thickening) or remain chronically constricted, the luminal radius decreases and resistance climbs a lot (resistance changes dramatically with radius). Because cardiac output is usually normal or only mildly elevated, this higher peripheral resistance pushes the mean arterial pressure up. Venous return and blood volume are typically normal, so they aren’t the primary drivers of the condition. This is why increased arteriolar resistance is the best explanation for essential hypertension.