From the Guidelines
There is no difference between primary hypertension and essential hypertension; they are two different terms used to describe the same condition. This form of high blood pressure develops without an identifiable underlying cause, accounting for approximately 90-95% of all hypertension cases, as noted in the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1. Unlike secondary hypertension, which results from specific identifiable causes such as kidney disease, hormonal disorders, or medication side effects, primary/essential hypertension develops gradually over many years due to a complex interplay of genetic predisposition, lifestyle factors, and environmental influences.
Key Characteristics
- Risk factors include family history, advancing age, obesity, high sodium intake, physical inactivity, excessive alcohol consumption, and chronic stress.
- Management typically involves lifestyle modifications (diet changes, regular exercise, weight management, limiting alcohol, and smoking cessation) along with antihypertensive medications such as thiazide diuretics, ACE inhibitors, ARBs, calcium channel blockers, or beta-blockers, with a preference for agents that have been shown to reduce clinical events, as recommended by Whelton et al in the 2017 High Blood Pressure Clinical Practice Guideline 1.
Treatment Goals
- The goal of treatment is to maintain blood pressure below 130/80 mmHg to reduce the risk of serious complications like heart attack, stroke, kidney damage, and vision problems.
- According to the guideline, primary agents used in the treatment of hypertension include thiazide diuretics, ACE inhibitors, ARBs, and CCBs, due to their proven ability to decrease clinical outcomes 1.
From the Research
Definition of Primary and Essential Hypertension
- Primary hypertension and essential hypertension are often used interchangeably to describe high blood pressure with no identifiable cause 2.
- Essential hypertension, also known as primary or idiopathic hypertension, accounts for at least 95% of all cases of hypertension 2.
Key Characteristics
- Hypertension is arbitrarily defined as diastolic blood pressure (DBP) of 90 mm Hg or higher, systolic blood pressure (SBP) of 140 mm Hg or higher, or both, on 3 separate occasions 2.
- There is no clear distinction between primary and essential hypertension in terms of their definition or characteristics, as they are often considered to be the same condition 2, 3, 4, 5, 6.
Treatment and Management
- The treatment of essential hypertension typically involves lifestyle modifications and medication, such as angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers, and diuretics 3, 4, 5, 6.
- The choice of medication may depend on various factors, including the patient's age, medical history, and other health conditions 3, 4, 5, 6.
Research Findings
- Studies have shown that different medications, such as amlodipine, lisinopril, and chlorthalidone, can be effective in lowering blood pressure and reducing the risk of cardiovascular disease 3, 4, 5.
- However, the effectiveness of these medications can vary depending on the patient's individual characteristics, such as their body mass index (BMI) and other health conditions 5.