What is primary hypertension?

Primary hypertension, also known as essential hypertension, is the most common type of high blood pressure. It has no known cause and cannot be controlled with medication.

It often develops in people who are overweight or over age 40. But it can happen at any age, even in children.

How does primary hypertension affect my body?

Over time, having high blood pressure can lead to serious health problems. Some people may not have any symptoms at first. But eventually, the increased force of blood flow puts stress on your heart and blood vessels. This can damage your kidneys, eyes, heart and brain over time.

What are the symptoms of primary hypertension?

The main sign of primary hypertension is high blood pressure (hypertension) — more than 140/90 millimeters of mercury (mm Hg). The top number represents systolic pressure (the maximum force exerted by your heart each time it beats) while the bottom number represents diastolic pressure (the minimum force between beats). If you have high blood pressure but no signs or symptoms, you may have “silent” or “masked” hypertension.

Why should I be concerned about essential hypertension?

Hypertension is a risk factor for cardiovascular disease. One-third of people with essential hypertension die of heart disease or stroke. The risk of developing heart disease or having a heart attack increases with each 10- or 20-point increase in blood pressure.

High blood pressure also damages the small blood vessels throughout the body (small vessel damage). Small vessel damage can lead to complications such as kidney disease and eye problems, including vision loss and blindness.

The high blood pressure itself can cause serious complications that may be life-threatening if they do not receive treatment. These include:

Stroke — A stroke occurs when an artery in your brain becomes blocked by a clot or ruptures, causing bleeding into the brain. A stroke can cause paralysis, vision loss, memory problems and difficulty speaking or understanding language (aphasia). A stroke usually affects only one side of the body but may also cause death due to other complications related to the brain injury caused by lack of oxygen supply to cells in the brain.

Heart failure — This occurs when your heart cannot pump enough blood through your body because it is enlarged (cardiomyopathy) or has become weakened from previous heart attacks.

What causes essential primary hypertension?

Essential hypertension is the most common type of high blood pressure. It has no underlying cause that doctors can find. The condition usually starts in early adulthood and affects both men and women equally.

Essential hypertension is sometimes called primary high blood pressure or idiopathic (IH) hypertension because it doesn’t have an identifiable cause.

What causes essential primary hypertension?

The exact cause of essential hypertension isn’t known, but there are theories about how it develops:

• Smoking increases blood pressure
• Excess salt intake raises blood pressure
• Lack of exercise makes matters worse

How is primary hypertension different from other forms of hypertension?

Primary hypertension (also called essential hypertension) is a chronic condition that affects the heart and arteries. It’s the most common type of high blood pressure, affecting nearly one-third of American adults.

Primary hypertension is defined as elevated blood pressure with no known cause. This means there are no identifiable symptoms or signs to diagnose primary hypertension.

Other types of high blood pressure include:

• Secondary hypertension, which is caused by an underlying medical condition, such as kidney disease or pregnancy
• Chronic renal disease, which is caused by long-term kidney damage
• Use this guide to learn more about primary hypertension and how it’s treated.

What are the symptoms of essential hypertension (now known as primary hypertension)?

The symptoms of essential hypertension (now known as primary hypertension) are usually mild and nonspecific. The most common symptoms are headache, dizziness, fatigue and shortness of breath. In more severe cases, the patient may also have chest pain, loss of consciousness or fainting episodes.

Classically, these symptoms are accompanied by an increase in blood pressure; however, this is not always the case. One study showed that 50% of patients with high blood pressure did not report any symptoms at all when interviewed by their doctors.

The symptoms of essential hypertension (now known as primary hypertension) may include:

• Headaches
• Nosebleeds
• Fatigue
• Excessive thirst and urination, especially at night
• Blurred vision or the appearance of halos around lights
• Dizziness or fainting spells

How is primary hypertension diagnosed?

The health care provider will take the patient’s blood pressure and ask about medical history, including any family history of cardiovascular disease or high blood pressure.

A 24-hour ambulatory blood pressure monitoring may be ordered to confirm the diagnosis of primary hypertension. This involves taking blood pressure readings at home over 24 hours in a controlled setting. A device called an ambulatory blood pressure monitor is used to measure blood pressure at regular intervals during the day and night.

What happens during a blood pressure check?

A blood pressure test measures the force of blood against the walls of the arteries. This pressure is called systolic pressure and is written as 120 over 80 (120/80 mmHg). The “over” refers to diastolic pressure, which is the pressure in the arteries between heartbeats and is written as 80 over 60 (80/60 mmHg).

Blood pressure can be measured at home, but it requires a special device that inflates a cuff on your arm to temporarily stop blood flow. More often, blood pressure is checked in a doctor’s office or clinic using an automated blood pressure machine. These machines are fairly accurate, but they may not be as reliable as manual measurements taken by trained professionals because they rely on several factors like body position and temperature.

Your doctor will take two readings — one while you’re sitting quietly and another while you’re lying down — then average them together. He or she will also note any abnormal results from previous visits and make sure there aren’t any other signs or symptoms that might indicate a problem with your heart or circulation.

What does primary hypertension treatment look like?

Primary hypertension treatment is not always needed. In most cases, the body will regulate itself. But if you are experiencing some of the symptoms listed above, your doctor may prescribe lifestyle changes or medications to bring your blood pressure back to normal levels.

Lifestyle changes

Your doctor may recommend that you make some simple changes to your lifestyle. These include:

• getting more exercise (30 minutes a day)
• eating a healthy diet (low in saturated fats and high in fruit, vegetables and whole grains)
• avoiding alcohol and smoking

If you have high blood pressure and are overweight, losing as little as 5% of your body weight can help lower blood pressure levels by around 2%.

How can I prevent essential (primary) hypertension from worsening?

The best way to prevent essential (primary) hypertension from worsening is to follow your doctor’s advice and get treatment.

If you have high blood pressure, you may be able to prevent it from getting worse by:

Quitting smoking. Smoking makes high blood pressure worse, so quitting can help keep it under control.

Losing weight if you’re overweight or obese. Losing just 5% to 10% of your body weight can help lower your blood pressure.

Eating a healthy diet that includes fruits and vegetables, whole grains and low-fat dairy products. You should also limit salt (sodium) in the diet — try to eat foods that don’t have added sodium.

Getting regular exercise. Exercise helps lower blood pressure and reduce stress on the heart, which may help keep it healthy and strong over time. Regular exercise can also help you manage your weight if you are overweight or obese. The American Heart Association recommends that adults do at least 150 minutes of moderate aerobic activity such as walking every week plus muscle-strengthening activities two days a week for good health.