Arteriosclerosis with superimposed atherosclerosis is the cause not the consequence of essential hypertension

The arterial system is a closed loop and the pressure within this loop reflects cardiac output, resistance to outflow, volume of fluid within the circulation and stiffness of the arterial wall. Increased resistance to outflow or Bayliss's phenomena cannot be the cause of essential hypertension as it reverses with treatment of hypertension. There is no evidence for increased cardiac output in essential hypertension. Increased blood volume contributes to hypertension in obesity just as it does in hypertension secondary to renal failure. The principle cause of essential hypertension is increasing stiffness of the arterial wall. This is a consequence of arteriosclerosis that commences in utero and progressively increases in severity with increasing age. Arteriosclerotic arterial wall stiffening antedates the onset of essential hypertension by decades. It not only explains the increasing incidence of essential hypertension with increasing age, but it is the only thing that fulfils Koch's first postulate and that is it is present in 100% of individuals with essential hypertension.