Essential Hypertension – Causes, Symptoms, Diagnosis, Treatment

Essential Hypertension – Causes, Symptoms, Diagnosis, Treatment

Essential hypertension is high blood pressure that doesn’t have a known secondary cause. It’s also referred to as primary hypertension. Blood pressure is the force of blood against your artery walls as your heart pumps blood through your body.

Essential hypertension (also called primary hypertension, or idiopathic hypertension) is the form of hypertension that by definition has no identifiable secondary cause.[rx][rx] It is the most common type affecting 85% of those with high blood pressure.[rx][rx] The remaining 15% is accounted for by various causes of secondary hypertension.[rx] Primary hypertension tends to be familial and is likely to be the consequence of an interaction between environmental and genetic factors.

The current definition of hypertension (HTN) is systolic blood pressure (SBP) values of 130mmHg or more and/or diastolic blood pressure (DBP) more than 80 mmHg. Hypertension ranks among the most common chronic medical condition characterized by a persistent elevation in arterial pressure.

Hypertension has been among the most studied topics of the previous century and has been one of the most significant comorbidities contributing to the development of stroke, myocardial infarction, heart failure, and renal failure.

The definition and categories of hypertension have been evolving over years, but there is a consensus that persistent BP readings of 140/90mmHg or more should undergo treatment with the usual therapeutic target of 130/80mmHg or less.

This article will attempt to review the available knowledge derived from RCTs and the recent updates and guidelines on hypertension put forward by major societies including those from the 8th report of Joint National Committee (JNC-8), American College of Cardiology (ACC), American Society of Hypertension (ASH), European Society of Cardiology (ESC) and European Society of Hypertension (ESH).

Other names for Essential Hypertension

  • High blood pressure
  • Arterial hypertension
  • Hypertension
  • Primary hypertension

Normal blood pressure vs. abnormal blood pressure

Normal blood pressure is less than 120/80 millimeters of mercury (mmHg).

Elevated blood pressure is higher than normal blood pressure, but not quite high enough to be hypertension. Elevated blood pressure is:

  • systolic pressure of 120 to 129 mmHg
  • diastolic pressure less than 80 mmHg

Stage 1 hypertension is:

  • systolic pressure of 130 to 139 mmHg, or
  • diastolic pressure of 80 to 89 mmHg

Stage 2 hypertension is:

  • systolic pressure higher than 140 mmHg, or
  • diastolic pressure higher than 90 mmHg

A recent classification recommends blood pressure criteria for defining normal blood pressure, prehypertension, hypertension (stages I and II), and isolated systolic hypertension, which is a common occurrence among the elderly. These readings are based on the average of seated blood pressure readings that were properly measured during 2 or more office visits. In individuals older than 50 years, hypertension is considered to be present when a person’s blood pressure is consistently at least 140 mmHg systolic or 90 mmHg diastolic. Patients with blood pressures over 130/80 mmHg along with Type 1 or Type 2 diabetes, or kidney disease require further treatment.[rx]

Classification Systolic pressure Diastolic pressure
mmHg kPa (kN/m2) mmHg kPa (kN/m2)
Normal 90–119 12–15.9 60–79 8.0–10.5
Prehypertension 120–139 16.1–18.5 81–89 10.8–11.9
Stage 1 140–159 18.7–21.2 90–99 12.0–13.2
Stage 2 ≥160 ≥21.3 ≥100 ≥13.3
Isolated systolic
≥140 ≥18.7 <90 <12.0
Source: American Heart Association (2003).[rx]

Resistant hypertension is defined as the failure to reduce blood pressure to the appropriate level after taking a three-drug regimen.[rx] Guidelines for treating resistant hypertension have been published in the UK, and US.[rx]

Causes of Essential Hypertension

Most cases of hypertension are idiopathic which is also known as essential hypertension.  It has long been suggested that an increase in salt intake increases the risk of developing hypertension.[rx] One of the described factors for the development of essential hypertension is the patient genetic ability to the salt response.[rx][rx] About 50 to 60% of the patients are salt sensitive and therefore tend to develop hypertension.[rx]

  • Obesity – Data from the Nurses’ Health Study showed that a gain of 5 kg above weight at 18 years of age was associated with 60% higher risk of development of hypertension in middle age.[rx] A 4.5 mmHg increase in blood pressure has been associated with each 10 lb (4.5 kg) gain in weight.[rx] One systematic review found that risk of hypertension increased continuously with increasing body mass index (BMI), waist circumference, weight gain, and waist-to-hip and waist-to-height ratio.[rx] It has been postulated that the link between obesity and hypertension is driven by increased circulating volume, leading to increased cardiac output and persistently elevated peripheral vascular resistance.[rx] Obesity is associated with the metabolic syndrome, insulin resistance, and type 2 diabetes. Bariatric treatment of class III obesity (BMI 40 or above) can reduce or eliminate risk factors for cardiovascular disease, with an effect on hypertension, diabetes, and dyslipidemia.[rx][rx]
  • Aerobic exercise <3 times/week – Patients with low level of fitness had a 52% greater relative risk of hypertension at 12-year follow-up compared with those with high levels of fitness.[rx]
  • Moderate/high alcohol intake – Chronic alcohol consumption of more than 1 drink per day in women and more than 2 drinks per day in men has been shown to be associated with an increased risk of blood pressure (BP) elevation.[rx][rx] One Cochrane review of the effect of alcohol on BP found that high-dose alcohol (>30 g) has a biphasic effect, decreasing BP up to 12 hours after consumption and increasing BP after 13 hours.[rx]
  • Metabolic syndrome – Abdominal obesity has been specifically associated with an increased risk of hypertension, as compared with generalized obesity.[rx] Insulin resistance and hyperinsulinemia are thought to contribute to the development of hypertension through a variety of inflammatory mechanisms.[rx]
  • Diabetes mellitus – Hyperglycemia, hyperinsulinemia, and insulin resistance lead to endothelial damage and oxidative stress, and are independently associated with the development of hypertension.[rx]
  • Black ancestry – Highest incidence of hypertension is seen in black non-Hispanic people, at all age levels.[rx]
  • Age >60 years – Incidence of hypertension increases with age in people of all ancestries and both sexes.[rx] family history of hypertension or coronary artery disease – Patient may have family history of hypertension or coronary artery disease risk factors.[rx]
  • Sleep apnea – Obstructive sleep apnea is a risk factor for several cardiovascular diseases, including hypertension.[rx] In addition, there is a possible dose-response relationship between the severity of obstructive sleep apnea and the risk of essential hypertension.[rx] Obstructive sleep apnea is also associated with an increased risk of resistant hypertension.[rx]
  • Sodium intake >1.5 g/day – Individuals show a varied tolerance for sodium intake, and reduced sodium intake has modest effect on blood pressure (BP) lowering.[rx][rx] One meta-analysis has shown the amount of BP lowering achieved with sodium reduction has a dose-response relation and is greater for older populations, nonwhite populations, and those with higher baseline systolic BP.[rx]
  • Low fruit and vegetable intake – Modest reduction in blood pressure with 4 to 6 servings of fruits and vegetables coupled with lower sodium and fat intake (Dietary Approaches to Stop Hypertension [DASH] diet).[rx]
  • Dyslipidemia – Risk of hypertension is increased in the setting of the metabolic syndrome. There are various mechanisms described for the development of hypertension which include increased salt absorption resulting in volume expansion, an impaired response of the renin-angiotensin-aldosterone system (RAAS), increased activation of the sympathetic nervous system.  These changes lead to the development of increased total peripheral resistance and increased afterload which in turn leads to the development of hypertension.

Symptoms of Essential Hypertension

In most cases, there will be no apparent symptoms of essential hypertension, and it will only be discovered during a regular medical examination. If essential hypertension is not diagnosed, the condition has the potential to worsen and create heart or kidney problems.

Sometimes, people with essential hypertension may experience headaches, dizziness and blurred vision, but these symptoms are unlikely to occur until blood pressure reaches very high levels. Some people report that their heartbeat seems louder than usual and feels as if it is inside the ear; this may be more prominent the higher the blood pressure is. People experiencing symptoms that may be linked to hypertension can use for a symptom assessment.

If a person experiences vomiting or nausea, severe headaches, vision changes or nosebleeds, it may be a sign of malignant hypertension – a much more dangerous type of high blood pressure. If these symptoms appear, urgent medical attention should be sought.

Diagnosis of Essential Hypertension

Most cases of hypertension are asymptomatic and are diagnosed incidentally on blood pressures recording or measurement.

Some cases present directly with symptoms of end-organ damage as stroke-like symptoms or hypertensive encephalopathy, chest pain, shortness of breath and acute pulmonary edema.

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Physical examination may be unyielding other than occasional pedal edema or raised blood pressure, but one needs to look for signs of:

  • Coarctation of the aorta (radio-radial delay, radio-femoral delay, differences in left and right arm BP or upper and lower limb BP more than 20mmHg)
  • Aortic valve disease (systolic ejection murmur, 4th heart sound)
  • Renovascular disease or fibromuscular dysplasia (FMD) – (renal bruit, carotid bruit)
  • Polycystic kidneys (enlarged kidneys bilaterally)
  • Endocrine disorders [hypercortisolism(thin skin, easy bruising,  hyperglycemia)
  • Thyroid disorders(palpable/ painful or enlarged thyroid] which make up the common treatable causes for secondary hypertension

The presence of a 4th heart sound, which represents a stiff and non-compliant left ventricle, hints towards left ventricular hypertrophy and diastolic dysfunction.

The presence of lung rales and/or peripheral edema suggests cardiac dysfunction and gives a clue to the chronicity of hypertension.

Blood pressure measurements fall into several categories

  • Normal blood pressure. Your blood pressure is normal if it’s below 120/80 mm Hg.
  • Elevated blood pressure. Elevated blood pressure is a systolic pressure ranging from 120 to 129 mm Hg and a diastolic pressure below (not above) 80 mm Hg. Elevated blood pressure tends to get worse over time unless steps are taken to control blood pressure. Elevated blood pressure may also be called prehypertension.
  • Stage 1 hypertension. Stage 1 hypertension is a systolic pressure ranging from 130 to 139 mm Hg or a diastolic pressure ranging from 80 to 89 mm Hg.
  • Stage 2 hypertension. More-severe hypertension, stage 2 hypertension is a systolic pressure of 140 mm Hg or higher or a diastolic pressure of 90 mm Hg or higher.
  • Hypertensive crisis. A blood pressure measurement higher than 180/120 mm Hg is an emergency situation that requires urgent medical care. If you get this result when you take your blood pressure at home, wait five minutes and retest. If your blood pressure is still this high, contact your doctor immediately. If you also have chest pain, vision problems, numbness or weakness, breathing difficulty, or any other signs and symptoms of a stroke or heart attack, call 911 or your local emergency medical number.

Lab Test And Imaging

The ACC recommends at least two office measurements on at least two separate occasions to diagnose hypertension.

  • The ESC/ESH recommends three office BP measurements at least 1 to 2 minutes apart, and additional measurements only if the initial two readings differ by greater than or equal to 10mmHg. BP is then recorded as the average of the last two readings.
  • Both societies endorse the use of higher BP readings and putting patients into a higher stage/grades for adequate medical therapy.
  • The patient should remain seated quietly for at least 5 minutes before taking the blood pressure, and proper technique is necessary. The blood pressure cuff should cover 80% of the arm circumference because larger or smaller pressure cuffs can falsely under-estimate or over-estimate blood pressure readings.

Ambulatory blood pressure measurement is the most accurate method to diagnose hypertension and also aids in identifying individuals with masked hypertension as well as the white coat effect.

The evaluation consists of looking for signs of end-organ damage and consists of the following,

  • 12 lead ECG (to document left ventricular hypertrophy, cardiac rate, and rhythm)
  • Fundoscopy to look for retinopathy/ maculopathy
  • Blood workup including complete blood count, ESR, creatinine, eGFR, electrolytes, HbA1c, thyroid profile, blood cholesterol levels, and serum uric acid
  • Urine albumin to creatinine ratio
  • Ankle-brachial pressure index – ABI (if symptoms suggestive of peripheral arterial disease)
  • Carotid doppler ultrasound – echocardiography, and brain imaging (where clinically deemed feasible)
  • Cholesterol test. Also called a lipid profile, this will test your blood for your cholesterol levels.
  • Echocardiogram. This test uses sound waves to make a picture of your heart.
  • Electrocardiogram (EKG or ECG). An EKG records the electrical activity of your heart.
  • Kidney and other organ function tests. These can include blood tests, urine tests, or ultrasounds to check how your kidneys and other organs are functioning.

Treatment of Essential Hypertension

The management of hypertension subdivides into pharmacological and nonpharmacological management.

Non-pharmacological and lifestyle management are recommended for all individuals with raised BPs regardless of age, gender, comorbidities or cardiovascular risk status.

Patient education is paramount to effective management and should always include detailed instructions regarding weight management, salt restriction, smoking management, adequate management of obstructive sleep apnea, and exercise. Patients need to be informed and revised at every encounter that these changes are to be continued lifelong for effective disease treatment.

Weight reduction is advisable if obesity is present although optimum BMI and optimal weight range are still unknown. Weight reduction alone can result in decreases of up to 5 to 20mmHg in systolic blood pressure.

Smoking may not have a direct effect on blood pressure but will help in reducing long-term sequelae if the patient quits smoking.

Lifestyle changes alone can account for up to a 15% reduction in all cardiovascular-related events.

Pharmacological therapy consists of angiotensin-converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARBs), diuretics (usual thiazides), calcium channel blockers (CCBs), and beta-blockers (BBs), which are instituted taking into account age, race, and comorbidities such as the presence of renal dysfunction, LV dysfunction, heart failure, and cerebrovascular disease. JNC-8, ACC, and ESC/ ESH have their separate recommendations for pharmacological management.

JNC-8 recommends the following

  • Starting pharmacological therapy for individuals with DM and CKD with BP greater than or equal to 140/90mmHg to therapeutic target BP less than 140/90mmHg
  • Starting pharmacological therapy for individuals 60 years of age and over with BP greater than or equal to 150/90mmHg to therapeutic target BP less than 150/90mmHg
  • Starting pharmacological therapy for individuals 18 to 59years of age with SBP greater than or equal to 140mmHg to therapeutic target SBP less than 140mmHg
  • individuals with DM and non-black population, treatment should include a thiazide diuretic, CCB, and an ACEi/ARB
  • individuals in the black population, including those with DM, treatment should include a thiazide diuretic and CCB
  • individuals with CKD, treatment should be started with or include ACEi/ARB, and this applies to all CKD patients irrespective of race or DM status

ACC recommends the following

  • Ten-year atherosclerotic cardiovascular disease (ASCVD) risk should be estimated
  • Anti-hypertensive medications are usually initiated when BP readings are persistently greater than or equal to 140/90mmHg
  • High-risk populations (diabetics, CKD, individuals with ASCVD) or in those individuals with 10-year ASCVD risk greater than or equal to 10%, therapy can be initiated at lower BP cutoffs
  • The goal of treatment is to keep blood pressures in as close to the normal range as possible, i.e., BP less than or equal to 130/80mmHg. [rx][rx][rx][rx]

ESC/ ESH recommends the following

  • Starting pharmacological therapy for grade 2 or 3 hypertension regardless of the level of risk
  • Starting pharmacological therapy for grade 1 hypertension when there is hypertension mediated end-organ damage (HMOD)
  • Grade 1 hypertension in the absence of HMOD requires either high risk for CVD or failure of lifestyle interventions, for initiating pharmacological therapy
  • Starting pharmacological therapy for individuals greater than or equal to 80 years of age with BP greater than or equal to 160/90mmHg to therapeutic target less than 160/90mmHg regardless of DM, CKD, CAD or TIA/ CVA
  • Starting pharmacological therapy for individuals 18 to 79 years of age with BP greater than or equal to 140/90mmHg to therapeutic target less than 140/90mmHg regardless of DM, CKD, CAD or TIA/ CVA

Researchers have also studied renal denervation is a form of interventional treatment where renal sympathetic supply is ablated, via specialized catheter equipment, as a potential treatment for resistant hypertension (where adequate blood pressure control is not achieved despite adequate compliance to two or three anti-hypertensive drugs and lifestyle measures). Multiple randomized trials including SPYRAL, RADIANCE, and SIMPLICITY-HTN trials have shown equivocal results, so this remains an investigational therapy.

Medications for Essential Hypertension

  • Diuretics. Diuretics, sometimes called water pills, are medications that help your kidneys eliminate sodium and water from the body. These drugs are often the first medications tried to treat high blood pressure. There are different classes of diuretics, including thiazide, loop and potassium sparing. Which one your doctor recommends depends on your blood pressure measurements and other health conditions, such a kidney disease or heart failure. Diuretics commonly used to treat blood pressure include chlorthalidone, hydrochlorothiazide (Microzide) and others. A common side effect of diuretics is increased urination, which could reduce potassium levels. If you have a low potassium level, your doctor may add a potassium-sparing diuretic — such as triamterene (Dyazide, Maxide) or spironolactone (Aldactone) — to your treatment.
  • Angiotensin-converting enzyme (ACE) inhibitors. These medications — such as lisinopril (Prinivil, Zestril), benazepril (Lotensin), captopril and others — help relax blood vessels by blocking the formation of a natural chemical that narrows blood vessels.
  • Angiotensin II receptor blockers (ARBs). These medications relax blood vessels by blocking the action, not the formation, of a natural chemical that narrows blood vessels. ARBs include candesartan (Atacand), losartan (Cozaar) and others.
  • Calcium channel blockers. These medications — including amlodipine (Norvasc), diltiazem (Cardizem, Tiazac, others) and others — help relax the muscles of your blood vessels. Some slow your heart rate. Calcium channel blockers may work better for older people and people of African heritage than do ACE inhibitors alone. Don’t eat or drink grapefruit products when taking calcium channel blockers. Grapefruit increases blood levels of certain calcium channel blockers, which can be dangerous. Talk to your doctor or pharmacist if you’re concerned about interactions.
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Additional medications sometimes used to treat high blood pressure

If you’re having trouble reaching your blood pressure goal with combinations of the above medications, your doctor may prescribe:

  • Alpha blockers. These medications reduce nerve signals to blood vessels, lowering the effects of natural chemicals that narrow blood vessels. Alpha blockers include doxazosin (Cardura), prazosin (Minipress) and others.
  • Alpha-beta blockers. Alpha-beta blockers block nerve signals to blood vessels and slow the heartbeat to reduce the amount of blood that must be pumped through the vessels. Alpha-beta blockers include carvedilol (Coreg) and labetalol (Trandate).
  • Beta blockers. These medications reduce the workload on your heart and widen your blood vessels, causing your heart to beat slower and with less force. Beta blockers include acebutolol, atenolol (Tenormin) and others. Beta blockers aren’t usually recommended as the only medication you’re prescribed, but they may be effective when combined with other blood pressure medications.
  • Aldosterone antagonists. These drugs also are considered diuretics. Examples are spironolactone and eplerenone (Inspra). These drugs block the effect of a natural chemical that can lead to salt and fluid buildup, which can contribute to high blood pressure. They may be used to treat resistant hypertension.
  • Renin inhibitors. Aliskiren (Tekturna) slows the production of renin, an enzyme produced by your kidneys that starts a chain of chemical steps that increases blood pressure. Due to a risk of serious complications, including stroke, you shouldn’t take aliskiren with ACE inhibitors or ARBs.
  • Vasodilators. These medications include hydralazine and minoxidil. They work directly on the muscles in the walls of your arteries, preventing the muscles from tightening and your arteries from narrowing.
  • Central-acting agents. These medications prevent your brain from telling your nervous system to increase your heart rate and narrow your blood vessels. Examples include clonidine (Catapres, Kapvay), guanfacine (Intuniv) and methyldopa.

Lifestyle Modification

Lifestyle modification is a very important aspect of the treatment of diabetes and hypertension. It is generally agreed that lifestyle modification has a modest antihypertensive effect resulting in an effective blood pressure reduction of 5-10 mmHg. Changes to lifestyle which appear to have health benefits include:

  • Maintain a healthy weight – Strive for a body mass index (BMI) between 18.5 and 24.9.
  • Eat healthier – Eat lots of fruit, veggies and low-fat dairy, and less saturated and total fat.
  • Reduce sodium – Ideally, stay under 1,500 mg a day, but aim for at least a 1,000 mg per day reduction.
  • Get active – Aim for at least 90 to 150 minutes of aerobic and/or dynamic resistance exercise per week and/or three sessions of isometric resistance exercises per week.
  • Limit alcohol – Drink no more than 1-2 drinks a day. (One for most women, two for most men.)
  • Reducing salt intake to less than 1.5 g/day
  • Increasing consumption of fruits and vegetables (8-10 servings per day)
  • Increasing consumption of low-fat dairy products (2-3 servings per day)
  • Increasing activity levels/ engaging in regular aerobic physical activity (e.g. brisk walking 30 min/day)
  • Losing excess weight
  • Avoiding excessive alcohol consumption (less than 2 drinks (30 ml ethanol)/day for men and less than 1 drink/day for women)
  • Lifestyle modification may be used as a sole treatment modality in patients with blood pressure <140/80, but ideally should be combined with pharmacotherapy in patients with systolic blood pressure (SBP) ≥ 140 and or diastolic blood pressure (DBP) ≥ 80

Home Remedies for Essential Hypertension

Lifestyle changes can help you control and prevent high blood pressure, even if you’re taking blood pressure medication. Here’s what you can do:

  • Eat healthy foods. Eat a heart-healthy diet. Try the Dietary Approaches to Stop Hypertension (DASH) diet, which emphasizes fruits, vegetables, whole grains, poultry, fish and low-fat dairy foods. Get plenty of potassium, which can help prevent and control high blood pressure. Eat less saturated fat and trans fat.
  • Decrease the salt in your diet. Aim to limit sodium to less than 2,300 milligrams (mg) a day or less. However, a lower sodium intake — 1,500 mg a day or less — is ideal for most adults. While you can reduce the amount of salt you eat by putting down the saltshaker, you generally should also pay attention to the amount of salt that’s in the processed foods you eat, such as canned soups or frozen dinners.
  • Maintain a healthy weight. Keeping a healthy weight, or losing weight if you’re overweight or obese, can help you control your high blood pressure and lower your risk of related health problems. In general, you may reduce your blood pressure by about 1 mm Hg with each kilogram (about 2.2 pounds) of weight you lose.
  • Increase physical activity. Regular physical activity can help lower your blood pressure, manage stress, keep your weight under control and reduce your risk of many health conditions. If you have high blood pressure, consistent moderate- to high-intensity workouts can lower your top blood pressure reading by about 11 mm Hg and the bottom number by about 5 mm Hg. Aim for at least 150 minutes a week of moderate aerobic activity or 75 minutes a week of vigorous aerobic activity, or a combination of moderate and vigorous activity. For example, try brisk walking for about 30 minutes most days of the week. Or try interval training, in which you alternate short bursts of intense activity with short recovery periods of lighter activity. Aim to do muscle-strengthening exercises at least two days a week.
  • Limit alcohol. Even if you’re healthy, alcohol can raise your blood pressure. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women, and up to two drinks a day for men. One drink equals 12 ounces of beer, 5 ounces of wine or 1.5 ounces of 80-proof liquor.
  • Don’t smoke. Tobacco can injure blood vessel walls and speed up the process of buildup of plaque in the arteries. If you smoke, ask your doctor to help you quit.
  • Manage stress. Reduce stress as much as possible. Practice healthy coping techniques, such as muscle relaxation, deep breathing or mindfulness. Getting regular physical activity and plenty of sleep can help, too.
  • Monitor your blood pressure at home. Home blood pressure monitoring allows you to keep a daily log of blood pressure measurements. Your doctor can review the information to determine if your medication is working or if you’re having complications. Home blood pressure monitoring isn’t a substitute for visits to your doctor. Even if you get normal readings, don’t stop or change your medications or alter your diet without talking to your doctor first. If your blood pressure is under control, ask your doctor about how often you need to check it.
  • Practice relaxation or slow, deep breathing. Practice taking deep, slow breaths to help relax. Some research shows that slow, paced breathing (five to seven deep breaths per minute) combined with mindfulness techniques can reduce blood pressure. There also are some devices available that promote slow, deep breathing. According to the American Heart Association, device-guided breathing may be a reasonable nondrug option for lowering blood pressure, especially if you have anxiety with high blood pressure or can’t tolerate standard treatments well.
  • Control blood pressure during pregnancy. Women with high blood pressure should discuss with their doctors how to control their blood pressure during pregnancy.

Risk factors

High blood pressure has many risk factors, including:

  • Age. The risk of high blood pressure increases as you age. Until about age 64, high blood pressure is more common in men. Women are more likely to develop high blood pressure after age 65.
  • Race. High blood pressure is particularly common among people of African heritage, often developing at an earlier age than it does in whites. Serious complications, such as stroke, heart attack and kidney failure, also are more common in people of African heritage.
  • Family history. High blood pressure tends to run in families.
  • Being overweight or obese. The more you weigh, the more blood you need to supply oxygen and nutrients to your tissues. As the amount of blood flow through your blood vessels increases, so does the pressure on your artery walls.
  • Not being physically active. People who are inactive tend to have higher heart rates. The higher your heart rate, the harder your heart must work with each contraction and the stronger the force on your arteries. Lack of physical activity also increases the risk of being overweight.
  • Using tobacco. Not only does smoking or chewing tobacco immediately raise your blood pressure temporarily, but the chemicals in tobacco can damage the lining of your artery walls. This can cause your arteries to narrow and increase your risk of heart disease. Secondhand smoke also can increase your heart disease risk.
  • Too much salt (sodium) in your diet. Too much sodium in your diet can cause your body to retain fluid, which increases blood pressure.
  • Too little potassium in your diet. Potassium helps balance the amount of sodium in your cells. A proper balance of potassium is critical for good heart health. If you don’t get enough potassium in your diet, or you lose too much potassium due to dehydration or other health conditions, sodium can build up in your blood.
  • Drinking too much alcohol. Over time, heavy drinking can damage your heart. Having more than one drink a day for women and more than two drinks a day for men may affect your blood pressure. If you drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women and two drinks a day for men. One drink equals 12 ounces of beer, 5 ounces of wine or 1.5 ounces of 80-proof liquor.
  • Stress. High levels of stress can lead to a temporary increase in blood pressure. Stress-related habits such as eating more, using tobacco or drinking alcohol can lead to further increases in blood pressure.
  • Certain chronic conditions. Certain chronic conditions also may increase your risk of high blood pressure, including kidney disease, diabetes and sleep apnea.
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Sometimes pregnancy contributes to high blood pressure as well.

Although high blood pressure is most common in adults, children may be at risk, too. For some children, high blood pressure is caused by problems with the kidneys or heart. But for a growing number of kids, poor lifestyle habits — such as an unhealthy diet and lack of exercise — contribute to high blood pressure.


The excessive pressure on your artery walls caused by high blood pressure can damage your blood vessels as well as your organs. The higher your blood pressure and the longer it goes uncontrolled, the greater the damage.

Uncontrolled high blood pressure can lead to complications including:

  • Heart attack or stroke. High blood pressure can cause hardening and thickening of the arteries (atherosclerosis), which can lead to a heart attack, stroke or other complications.
  • Aneurysm. Increased blood pressure can cause your blood vessels to weaken and bulge, forming an aneurysm. If an aneurysm ruptures, it can be life-threatening.
  • Heart failure. To pump blood against the higher pressure in your vessels, the heart has to work harder. This causes the walls of the heart’s pumping chamber to thicken (left ventricular hypertrophy). Eventually, the thickened muscle may have a hard time pumping enough blood to meet your body’s needs, which can lead to heart failure.
  • Weakened and narrowed blood vessels in your kidneys. This can prevent these organs from functioning normally.
  • Thickened, narrowed or torn blood vessels in the eyes. This can result in vision loss.
  • Metabolic syndrome. This syndrome is a group of disorders of your body’s metabolism, including increased waist size, high triglycerides, decreased high-density lipoprotein (HDL) cholesterol (the “good” cholesterol), high blood pressure and high insulin levels. These conditions make you more likely to develop diabetes, heart disease and stroke.
  • Trouble with memory or understanding. Uncontrolled high blood pressure may also affect your ability to think, remember and learn. Trouble with memory or understanding concepts is more common in people with high blood pressure.
  • Dementia. Narrowed or blocked arteries can limit blood flow to the brain, leading to a certain type of dementia (vascular dementia). A stroke that interrupts blood flow to the brain also can cause vascular dementia.

Essential hypertension FAQs

Q: Can essential hypertension be treated successfully?
A: Yes, in many cases, there is a good chance that blood pressure can be lowered if the appropriate treatment methods are followed. To ensure blood pressure remains at a healthy level, most people will be required to maintain lifestyle changes and, if required, take medication, possibly for the rest of their lives.

Q: What is malignant essential hypertension?
A: Malignant essential hypertension, sometimes called accelerated hypertension, is a form of hypertensive emergency. It involves high blood pressure that develops very quickly, causing serious complications. The malignant variety is extremely rare, affecting roughly one percent of those with high blood pressure, but if it is suspected, it should be treated as a medical emergency.

Q: What is benign essential hypertension?
A: When essential hypertension remains in its early stages for a prolonged period of time and without a specific known cause, it is known as benign essential hypertension. In this state, the condition will generally be symptomless and develop very slowly. It is still important to seek treatment after a diagnosis of benign essential hypertension.

What is non-essential hypertension?
A: Non-essential hypertension is an alternative name for secondary hypertension. Essential hypertension is characterized by a lack of clearly attributable causes, whereas secondary hypertension is directly linked to a variety of vascular, endocrine, heart and kidney conditions.

Q: Can pregnancy cause essential hypertension?
A: Essential hypertension is defined by its lack of a clearly attributable cause, meaning that pregnancy cannot be said to cause the condition. However, pregnancy can cause a form of hypertension known as gestational hypertension. By definition, this form of hypertension must occur after 20 weeks of pregnancy in a previously not hypertensive person and disappear after the delivery of the baby Longer lasting hypertension, detected either before pregnancy or before the 20th week of pregnancy, and which remains after delivery of the baby, is defined as chronic hypertension and can be a kind of essential hypertension. Both gestational and chronic hypertension can lead to preeclampsia, a potentially serious but treatable complication of pregnancy. For more information, take a look at this resource on preeclampsia.

Q: What is hypertensive heart disease?
A: Hypertensive heart disease is an umbrella term for various heart conditions that are caused by chronically or prolonged high blood pressure levels. High blood pressure puts extra strain on the heart and the vessels surrounding and supplying the heart, something which can lead to the development of a variety of heart disorders. These include heart failure, coronary artery disease and the thickening of the heart muscle, among others. People at risk of hypertensive heart disease should talk to their doctor about methods of preventing potential complications, e.g. attending regular check-ups and taking medication regularly as required by their prescription. This will typically also include getting plenty of exercise, eating a balanced, nutritious diet and losing weight, if the person in question is considerably overweight or obese.



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