Essential Hypertension

What is essential hypertension?

Essential hypertension is a type of high blood pressure that has no clearly identifiable cause, but is thought to be linked to genetics, poor diet, lack of exercise and obesity. It is by far the most common form of high blood pressure, affecting the majority of those who experience hypertension. It is also known as primary hypertension.[1]

As the heart pumps blood through the circulatory system, blood presses against the artery walls. High blood pressure occurs when the walls of the arteries exert a stronger oppositional force, which requires the heart to work harder in order to move blood through the body. This results in an increase in the pressure of blood in the arteries.[2] There are a variety of methods for managing essential hypertension, though there is no cure. If left untreated, the condition can lead to serious complications, including heart attack and heart failure.

Secondary hypertension

Whereas essential hypertension is characterized by its lack of identifiable causes, secondary hypertension, another form of this condition, is directly linked to a variety of vascular, endocrine, heart and kidney conditions. It is far less common than essential hypertension.[3]

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. Rarely, 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.[4]

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.[5] If these symptoms appear, urgent medical attention should be sought.

Causes of essential hypertension

Essential hypertension is defined by its lack of identifiable causes. However, certain risk factors that make the condition more likely have been identified. These include:[6]

Obesity

Obesity puts extra strain on the heart, increasing the risk of high blood pressure.

Genetics

Those with a family history of essential hypertension are more likely to be at risk of developing the condition themselves. 50 genes have been identified as linked to high blood pressure.

Aging

Multiple factors related to aging have been shown to increase the likelihood of essential hypertension. These include the stiffening of the arteries and the onset of certain renal microvascular diseases not yet perceived as a cause.[7]

Stress

It is thought that long-term, or chronic, mental stress is linked to the development of essential hypertension.[8]

Salt

Excessive salt (sodium) consumption, defined by the American Heart Association as eating over 2300 mg per day, can play a role in the onset of essential hypertension. Salt increases retention of water in the body, something which increases the volume of blood and, consequently, blood pressure.

Renin

The enzyme renin, produced by the kidneys, is part of the body’s “renin angiotensin system”, which is responsible for controlling arterial blood pressure and is closely linked to both essential hypertension and hypertension in general. People with both low and high levels of renin are at risk of the condition.

Lack of exercise

The link between leading a sedentary lifestyle and an increased chance of essential hypersensitivity is well studied. To lead a healthy lifestyle and reduce the risk of high blood pressure, it is recommended that adults engage in at least 30 minutes of moderate physical activity five days a week.[9][10]

Diagnosing essential hypertension

Essential hypertension is diagnosed by taking blood pressure measurements using a blood pressure monitor, which is also called a sphygmomanometer or an aneroid device.[11] These tests are routinely carried out as part of a normal medical examination. Stress, anger, physical exercise and other factors can temporarily raise a person’s blood pressure, meaning a diagnosis of essential hypertension can only be made when results are consistently high. To identify this, a doctor may ask people to measure their own blood pressure daily, at home or at a pharmacy.

Blood pressure readings are expressed as two numbers, for example: 120/80. The first number is systolic pressure, which shows the amount of force being exerted on the artery walls as the heart pumps. The second number is diastolic pressure, which shows the amount of force being exerted on the artery walls between beats of the heart.

A healthy systolic reading is 120 or lower.[12] Between 120 and 139 is considered normal, but not optimum, and over 140 is hypertensive. A healthy diastolic reading is 80 or lower. Between 80 and 89 is considered normal, but not optimum, and over 90 is hypertensive.

Essential hypertension treatment

While essential hypertension cannot be cured, it can be managed through a combination of lifestyle changes and medication.

Doctors may recommend a range of lifestyle adjustments that will commonly include:[13]

  • Adopting a healthy, nutritious diet
  • Exercising
  • Stress relief techniques
  • Reducing alcohol and tobacco use
  • Consuming less salt

If lifestyle changes do not produce satisfactory results, a doctor may prescribe medication aimed at lowering blood pressure. These may include:

  • Beta blockers
  • Calcium channel blockers
  • Diuretics
  • Angiotensin-converting enzyme (ACE) inhibitors
  • Angiotensin II receptor blockers
  • Renin inhibitors

Essential hypertension prognosis

People diagnosed with essential hypertension generally stand a good chance of lowering their blood pressure through lifestyle changes, medication or a combination of the two. Lifestyle changes will normally need to be maintained for the rest of one’s life to ensure high blood pressure does not reoccur. Depending on the person, medications may need to be taken indefinitely. In some cases, the use of medication can be stopped after blood pressure has fallen, with these lower levels then maintained through lifestyle alterations.

Complications

If essential hypertension is left untreated, it can lead to a variety of potentially serious complications. The heart, arteries and vascular system can be damaged, leading to:

  • Heart attack
  • Heart failure
  • Kidney damage
  • Eye damage
  • Atherosclerosis (hardening of the arteries)

Other names for essential hypertension

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

Essential hypertension FAQs

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.[14]

Q: What is malignant essential hypertension? A: Malignant essential hypertension is extremely high blood pressure that develops very quickly and causes 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.[15]

Q: Can pregnancy cause essential hypertension? A: Pregnancy can lead to the onset of essential hypertension. Hypertension can lead to a range of maternal, fetal and neonatal problems, and in rare cases, life-threatening complications. Doctors will advise on how to manage essential hypertension if it occurs.


  1. UpToDate. “Patient education: High blood pressure in adults (Beyond the Basics).” November 21, 2017. Accessed April 17, 2018.

  2. Blood Pressure UK. “What is blood pressure?” Accessed July 14, 2017.

  3. Mayo Clinic. “Secondary hypertension.” September 9, 2016. Accessed July 14, 2017.

  4. Patient. “High Blood Pressure (Hypertension) - Symptoms.” December 19, 2016. Accessed September 11, 2017.

  5. NY Times. “Essential Hypertension.” Accessed July 14, 2017.

  6. Hypertension Bloodpressure Center. “Primary Hypertension - Essential Hypertension.” Accessed July 14, 2017.

  7. Hypertension. “Aging, Arterial Stiffness, and Hypertension.” November 3, 2014. Accessed April 17, 2018.

  8. Clinical and experimental pharmacology and physiology. “Chronic mental stress is a cause of essential hypertension: presence of biological markers of stress.” April, 2008. Accessed April 7, 2018.

  9. USA Today. “Most people aren’t meeting exercise guidelines.” May 2, 2013. Accessed July 14, 2017.

  10. Mayo Clinic. “10 ways to control high blood pressure without medication.” May 30, 2015. Accessed April 7, 2018.

  11. The Journal of Family Practice. “The Diagnosis of Essential and Secondary Hypertension in Adults.” August, 2001. Accessed July 14, 2017.

  12. WebMD. “Hypertension/high blood pressure guide.” Accessed July 14, 2017.

  13. BMJ Best Practice. “Essential hypertension.” December 16, 2016. Accessed July 14, 2017.

  14. Treating Hypertension. Benign Essential Hypertension.” Accessed July 14, 2017.

  15. WebMD. “Malignant Hypertension.” November 21, 2015. Accessed July 14, 2017.