From the Guidelines
Essential or primary hypertension is a condition characterized by high blood pressure without an identifiable cause, accounting for about 95% of all hypertension cases. It typically develops gradually over many years due to a complex interplay of genetic factors, lifestyle choices, and environmental influences 1. The risk factors for essential hypertension include family history, advancing age, obesity, physical inactivity, high sodium intake, excessive alcohol consumption, and chronic stress.
Key Characteristics of Essential Hypertension
- Develops without an identifiable cause
- Accounts for about 95% of all hypertension cases
- Typically develops gradually over many years
- Risk factors include family history, advancing age, obesity, physical inactivity, high sodium intake, excessive alcohol consumption, and chronic stress
- Diagnosed when blood pressure readings consistently show systolic pressure ≥130 mmHg or diastolic pressure ≥80 mmHg
- Management typically involves lifestyle modifications and medications such as thiazide diuretics, ACE inhibitors, ARBs, calcium channel blockers, or beta-blockers
- Requires lifelong management to reduce the risk of heart disease, stroke, kidney damage, and other serious health problems if left untreated, as highlighted in the 2021 WHO Guidelines for the Pharmacological Treatment of Hypertension in Adults 1.
Management and Treatment
The management of essential hypertension involves a combination of lifestyle modifications and pharmacological treatment.
- Lifestyle modifications include reduced sodium intake, regular exercise, weight management, and limited alcohol consumption
- Pharmacological treatment may involve the use of thiazide diuretics, ACE inhibitors, ARBs, calcium channel blockers, or beta-blockers, as recommended by the WHO Essential Medicines List 1
- The 2021 WHO hypertension guidelines provide guidance on the BP threshold for the initiation of pharmacological treatment for hypertension, initial and longer-term visit intervals for follow-up of treated patients, treatment target BP levels, and the best use of health care workers for management of hypertension 1. The goal of treatment is to reduce blood pressure to a level that minimizes the risk of cardiovascular disease and other complications, with a target systolic pressure of less than 130 mmHg and a diastolic pressure of less than 80 mmHg, as recommended by the 2017 American College of Cardiology/American Heart Association hypertension guideline 1.
From the Research
Definition of Essential (Primary) Hypertension
- Essential (primary) hypertension is defined as persistently elevated systolic blood pressure (SBP) at least 130 mm Hg or diastolic blood pressure (DBP) at least 80 mm Hg 2
- It is also defined as persistently elevated systolic blood pressure (SBP) >140 mmHg and/or diastolic blood pressure (DBP) at least 90 mmHg 3
Prevalence and Risks
- Hypertension affects approximately 116 million adults in the US and more than 1 billion adults worldwide 2
- It is associated with increased risk of cardiovascular disease (CVD) events (coronary heart disease, heart failure, and stroke) and death 2, 3
Lifestyle Modifications
- Lifestyle modifications are recommended as first-line treatment for hypertension, including weight loss, healthy dietary pattern, physical activity, and moderation or elimination of alcohol consumption 2, 4, 5, 3, 6
- Dietary approaches to stop hypertension (DASH) diet may be considered the most effective treatment for reducing blood pressure 5
- Other lifestyle interventions emphasized by some guidelines include potassium supplementation, smoking cessation, and stress management 5
Management and Treatment
- First-line therapy for hypertension is lifestyle modification, and when drug therapy is required, first-line therapies are thiazide or thiazidelike diuretics, angiotensin-converting enzyme inhibitor or angiotensin receptor blockers, and calcium channel blockers 2
- Lifestyle modifications can also enhance the effects of antihypertensive therapy 5, 3