From the Guidelines
Hypertension in a previously healthy adult is most commonly caused by primary hypertension, which is often associated with lifestyle factors such as weight gain, high-sodium diet, decreased physical activity, and excessive alcohol consumption 1.
Causes of Hypertension
- Primary Hypertension: accounts for the majority of cases, and is often linked to:
- Lifestyle factors: weight gain, high-sodium diet, decreased physical activity, and excessive alcohol consumption 1
- Family history of hypertension
- Secondary Hypertension: less common, but can be caused by:
- Renal disease: such as chronic kidney disease or kidney failure 1
- Renovascular disease: narrowing of the arteries that supply blood to the kidneys 1
- Endocrine disorders: such as pheochromocytoma, Conn's syndrome, or Cushing's syndrome 1
- Medication or substance use: such as non-steroidal anti-inflammatory drugs, oral contraceptives, or cocaine 1
Risk Factors
- Age: hypertension risk increases with age, with over 75% of people developing hypertension by the eighth decade of life 1
- Family history: a strong family history of hypertension increases an individual's risk of developing primary hypertension 1
- Lifestyle factors: physical inactivity, obesity, high caloric intake, and excessive dietary sodium intake, as well as alcohol consumption, can all contribute to the development of hypertension 1 Regular blood pressure screening is essential to identify individuals who develop elevated blood pressure over time, especially those with elevated ASCVD risk 1.
From the Research
Causes of Hypertension
- Hypertension can be classified into two main categories: essential (primary) hypertension and secondary hypertension 2
- Essential hypertension does not have an obvious pathogenic cause, while secondary hypertension has an identifiable underlying cause 2
- Secondary hypertension can be caused by various factors, including:
- Atherosclerotic renal artery stenosis
- Primary hyperaldosteronism
- Cushing's disease or syndrome
- Parenchymal nephropathy
- Hyperparathyroidism
- Pheochromocytoma and paraganglioma 2
- The most common causes of secondary hypertension include:
- Obstructive sleep apnea (OSA)
- Chronic kidney disease
- Renovascular hypertension
- Primary aldosteronism 3
- Obesity is also considered a potential cause of secondary hypertension, although its recognition as such is still a topic of debate 3
Pathophysiology of Hypertension
- Hypertension is caused by increased cardiac output and/or increased peripheral resistance 4
- The development of essential hypertension involves various mechanisms, including:
- Genetics
- Sympathetic nervous system overactivity
- Renal mechanisms: excess sodium intake and pressure natriuresis
- Vascular mechanisms: endothelial cell dysfunction and the nitric oxide pathway
- Hormonal mechanisms: the renin-angiotensin-aldosterone system (RAAS) 4
- Other factors that can contribute to the development of hypertension include:
- Obesity
- Insulin resistance and metabolic syndrome
- Uric acid
- Vitamin D
- Gender differences
- Racial, ethnic, and environmental factors 4
Diagnosis and Evaluation
- The evaluation of patients with hypertension includes accurate standardized blood pressure measurement, assessment of predicted risk of atherosclerotic cardiovascular disease, and detection of secondary causes of hypertension and presence of comorbidities 5
- Clinical signs suspicious or suggestive of hypertension from endocrine causes, a "reverse dipping" or "non-dipping" profile at 24-hour ambulatory blood pressure monitoring, and signs of obvious organ damage may be helpful clues for diagnosis 2