Written by Ada’s Medical Knowledge Team
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, including lifestyle changes and medication. If left untreated, the condition can lead to serious complications, including heart attack and heart failure. People concerned that they may have essential hypertension can use the free Ada app to carry out a symptom assessment.
Whereas essential hypertension is characterized by its lack of identifiable causes, secondary hypertension, another form of hypertension, is directly linked to a variety of vascular, endocrine (related to hormones), 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.
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. 4 People experiencing symptoms that may be linked to hypertension can use the free Ada app 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. 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 puts extra strain on the heart, increasing the risk of high blood pressure.
Those with a family history of essential hypertension are more likely to be at risk of developing the condition themselves. Fifty genes have been identified as linked to high blood pressure.
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
It is thought that long-term or chronic mental stress is linked to the development of essential hypertension. 8
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, which in turn increases the volume of blood and, consequently, blood pressure.
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
Research indicates that hypertension is often more common in people of Afro-Caribbean descent. Hypertension also tends to occur earlier in life, be more severe and be associated with a higher risk of organ damage in people from this group.
Excessive alcohol intake, defined by the U.S. Department of Health as consuming more than one drink per day for women and two drinks per day for men, is associated with hypertension.
A lack of physical activity is associated with hypertension. Exercise is one of the key methods of managing high blood pressure.
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. Multiple readings, including readings taken outside of the hospital or doctor’s office, should be taken. To do 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. These values can be used as a general guide, but it should be noted that the thresholds for healthy and hypertensive blood pressure tend to differ between countries.
People worried about their risk of hypertension should visit a doctor for testing. The free Ada app can also be used to carry out a symptom assessment.
Essential hypertension treatment
Hypertension 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, ideally vegetarian or vegan in nature
- Stress relief techniques
- Reducing alcohol and tobacco use
- Consuming less salt, cheese, bread and processed foods
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
- 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.
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:
Essential hypertension in pregnancy
Essential hypertension is a factor in approximately one percent of pregnancies. 14 To be classed as essential hypertension, the high blood pressure must be pre-existing and have no identifiable cause. Some women develop hypertension during pregnancy; this is a seperate condition called gestational high blood pressure.
Typically, the blood pressure levels of women with essential hypertension during pregnancy will remain stable or fall in the early stages of pregnancy, before accelerating in around the second or third trimester. 14
Essential hypertension in pregnancy may cause complications including: 15
- Intrauterine growth restriction (IUGR)
- Placental abruption
- Premature birth
Women with essential hypertension in pregnancy will have their blood pressure levels monitored regularly by their doctor or midwife. If levels become high, the urine will be checked for protein, and symptoms of preeclampsia will be checked for. If signs of preeclampsia are found, a specialist will be brought in for treatment. 16
If blood pressure levels are high but there are no signs of preeclampsia, treatment will depend on the severity of the hypertension and the risks posed to the pregnancy. To identify potential risks, ensure proper care is given and monitor the health of the baby. Women may be admitted to hospital to undergo blood tests, ultrasounds and other tests. In some cases, medication may be prescribed to lower blood pressure levels. 16
Other names for essential hypertension
- High blood pressure
- Arterial hypertension
- Primary hypertension
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. 17
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. 18
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. 19 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.