Everything You Should Know About Essential Hypertension: Causes, Symptoms And Treatment

Essential hypertension is a condition affecting nearly one out of two¹ American adults. The condition – also known as primary hypertension, high blood pressure (HBP), and sometimes just hypertension – is the most common form of HBP.

What is essential hypertension?

Essential hypertension occurs when blood exerts too much force or pressure on the artery walls for long enough to cause health problems. Essential hypertension may lead to health problems such as kidney disease, heart attacks, strokes, or heart failure.

When the heart pumps blood, the blood exerts pressure on the artery walls as a normal part of the body’s circulatory system. However, the opposing forces from the walls of the arteries may be stronger than that of the blood flow. This means the heart has to work harder and, as a result, the pressure of the blood flowing through the arteries increases.

The causes of this condition are unclear, but experts link it to genetics and environmental factors². It requires early treatment to avoid serious complications. Treatment for essential hypertension aims to reduce high blood pressure and protect crucial organs such as the heart, kidneys, and brain from damage.

What is the difference between essential hypertension and secondary hypertension?

People often talk about chronic high blood pressure or hypertension when referring to essential hypertension. Essential hypertension accounts for nearly 95%³ of hypertension cases.

Secondary hypertension is far less common than essential hypertension. Secondary hypertension usually results from taking certain medications (e.g., decongestants) or other medical conditions such as thyroid disease, kidney disease, or obstructive sleep apnea. 

Symptoms of essential hypertension

People with essential hypertension might not realize that they have this condition as high blood pressure often doesn’t have symptoms unless it is very severe. It is often detected by chance, such as during a routine medical check-up or when complications (such as heart attack or stroke) occur.

Some of the  symptoms of more severe hypertension include:

• Severe headaches

• Nosebleed

• Fatigue or confusion

• Vision problems

• Chest pain

• Blood in the urine

• Difficulty breathing

• Irregular heartbeat

• Pounding in the neck, chest, or ears

Risk factors

As mentioned above, essential hypertension has no identifiable causes. But there are risk factors that may put you at a higher risk of developing the disease. These include:

Low levels of physical activity

Being inactive can cause fatty material to build up in the arteries. As a result, the blood vessels may narrow, increasing blood pressure. 

Age

The risk of developing essential hypertension increases as you get older. This is partly because the factors that increase the risk of essential hypertension-  such as hormonal changes or arterial stiffening - become more common as you age.

Hypertension is more common in men than women - until the age of 45. Women may be more likely than men to develop hypertension after 60 years of age.

Diet

Overly salty foods may increase your risk of high blood pressure. Consuming a lot of salt can be harmful in two ways. First, high sodium levels may increase fluid retention in the body, increasing blood volume and elevating blood pressure. Secondly, too much sodium may constrict arteries in the body, increasing the resistance between the arterial walls and blood flow. This can also raise your blood pressure.

Avoiding processed foods and cutting back on your salt intake can help lower sodium levels in your body, reducing the risk of high blood pressure. 

Race

In Black people, essential hypertension is more common⁴ and tends to develop earlier and cause more serious complications.

Obesity

According to estimates, obesity is responsible for about 65–78% of cases of primary hypertension⁵.

Obesity might lead to hypertension and cardiovascular disease by acting as an inflammatory condition that promotes cholesterol and glucose elevation, both of which are risk factors for heart-related problems.  

Family history

Essential hypertension tends to run in families, and people with a family member or close relative with this condition may be more likely to develop it.

Using tobacco

Using tobacco, whether through chewing or smoking, causes narrowing of blood vessels and increases the heart rate, increasing your blood pressure. The chemical substances in tobacco also damage the lining of your artery walls leading to arterial wall narrowing and raised blood pressure.

Drinking too much alcohol

Excessive alcohol consumption increases blood pressure and can lead to heart failure⁶. Women should try not to exceed one drink a day, while men should limit themselves to two drinks a day. A standard drink means 1.5 ounces of 80-proof liquor, five ounces of wine, or 12 ounces of beer.

Stress

Chronic stress may lead to an increase in blood pressure. The situation may worsen if you eat more, use tobacco, or drink alcohol to cope with the stress.

Complications caused by essential hypertension

High blood pressure causes damage to the blood vessels and other organs. If you don’t manage high blood pressure, the damage worsens. Some of the complications of unmanaged essential hypertension include:

Aneurysm

Blood vessels may bulge and weaken when blood pressure increases, and this can form an aneurysm. An aneurysm can be life-threatening if it ruptures.

Heart attack or stroke

Essential hypertension can cause damage to artery walls, leading to stroke, heart attack, or other complications.

Kidney damage

Essential hypertension may cause narrowing and weakening of vessels in the kidneys, preventing the organs from functioning optimally.

Heart failure

When the heart strains to pump blood against a high resistance in the blood vessels, the walls of the heart chambers may thicken. Eventually, the heart may not be able to pump the amount of blood our bodies need, causing heart failure.

Remodeling or damage to the blood vessels in the eyes

Blood vessels in the eyes may narrow, thicken or rupture, which can lead to vision loss.

Difficulty with understanding and recall

High blood pressure, if left unmanaged, may affect your ability to learn, think, and remember. People with essential hypertension can have problems understanding and remembering basic concepts.

Dementia

Vascular dementia is a type of dementia caused by decreased blood flow to the brain, leading to strokes. It results from narrowing or blockage of arteries.

Diagnosing essential hypertension

Regular medical check-ups are the best way to determine whether you have essential hypertension since the condition does not show signs in its early stages.

Regular check-ups can also ensure early treatment to prevent complications like a heart attack or stroke if you do have hypertension.

Home monitoring

Home monitoring involves recording blood pressure at home. It will help determine if you actually have high blood pressure and how severe the condition is. It also helps establish whether the blood pressure treatment is working.

The home monitoring kits are inexpensive and widely available, and you will not need a prescription to purchase one. However, home monitoring shouldn’t replace visits to your doctor.

Ensure you use a validated monitoring device and check that the cuff fits. You should bring it to the doctor's office once a year to check its accuracy.

Other tests

Your doctor may recommend other tests to confirm a diagnosis of essential hypertension and check any underlying conditions. These include:

Ambulatory monitoring

This test involves measuring blood pressure regularly (within 24-hour periods) using a special device to get a more precise picture of how it varies.

Kidney and other organ functions tests

These tests, such as urine and blood tests, monitor the function of the kidneys and other organs. Our kidneys help to regulate blood pressure, and a complication of hypertension is renal dysfunction, so it is common for your doctor to monitor kidney function.

Cholesterol tests

The doctor may recommend a cholesterol test or lipid profile test to measure the cholesterol levels in the blood. Cholesterol tests are done to help identify the risk of a heart attack. 

Electrocardiogram

This test provides information about your heart's rate and rhythm by measuring its electrical activity. Additionally, it can detect when high blood pressure causes enlargement of the heart.

Echocardiogram

The doctor may recommend an echocardiogram test to establish any signs of heart disease. This test involves using sound waves to produce images of the heart.

How is essential hypertension treated?

Even if you're diagnosed with essential hypertension, you have a good chance of lowering your blood pressure through medication, lifestyle changes, or a combination of the two.

Medications are often started based on the risk factors, and if lifestyle changes you make can lower blood pressure enough, you may be able to stop taking these medications. 

Lifestyle changes

If you are on blood pressure medication, lifestyle changes can help reduce and manage high blood pressure. The following lifestyle changes can be helpful:

Maintain a healthy weight

If you are overweight or obese, losing weight can help lower blood pressure. Apart from that, maintaining a healthy weight also helps reduce the risk of related health problems.

Increase your daily physical activity

Regular exercise helps reduce stress, keep weight under control, and, most importantly, lower blood pressure.

Limit your alcohol consumption

Drinking alcohol causes blood pressure to rise, even in healthy people. Consider sticking to the recommended range of drinking, with a maximum of two drinks a day for men and one for women.

Limit your salt intake

Consuming too much salt can play a part in essential hypertension. Sodium increases fluid retention in the body, which increases blood volume and, ultimately, pressure. Limit your salt intake and avoid processed foods.

Eat healthy foods

Switch to a healthy diet consisting of whole grains, fish, poultry, low-fat dairy, vegetables, and fruits. Getting enough potassium can also help in controlling high blood pressure.

Manage stress

Practice healthy techniques to cope with stress, such as deep breathing, muscle relaxation, and mindfulness. It is also necessary to ensure you get enough sleep, which can assist in managing blood pressure.

Quit smoking

Tobacco can cause injuries to the blood vessel walls and increase plaque accumulation in the arteries, leading to high blood pressure. If you need help quitting smoking, speak with your doctor.

Medications

The doctor may prescribe medication if lifestyle changes don’t lower your blood pressure.

Possible medications include:

Diuretics

These medications help the kidneys get rid of water and sodium from the body.

Thiazide diuretics are usually the first drugs the doctors recommend to treat essential hypertension. Examples include hydrochlorothiazide (Microzide) and chlorthalidone. However, you may urinate more frequently on these drugs, which may lower your potassium levels. For that reason, your doctor may instead prescribe diuretics along with potassium-sparing diuretics such as spironolactone (Aldactone) and triamterene (Dyazide; Maxide).

Angiotensin-converting enzyme (ACE) inhibitors

These drugs cause relaxation of the blood vessels by hindering the formation of a natural chemical that causes narrowing of blood vessels. Examples include benazepril (Lotensin), captopril, and lisinopril (Zestril; Prinivil).

Calcium channel blockers

These drugs relax blood vessels muscles and may work better than ACE inhibitors in older people. Examples include diltiazem (Tiazac; Cardizem) and amlodipine (Norvasc).

When taking calcium channel blockers, you should avoid eating or drinking any grapefruit products. Grapefruit may interact with some calcium channel blockers and increase their blood levels which may be life-threatening.

Angiotensin II receptor blockers (ARBs)

These drugs relax blood vessels by blocking the natural chemicals that cause them to narrow. Unlike ACE inhibitors that block the formation, ARBSs block the action of the chemicals. Examples of ARBs include losartan (Cozaar) and candesartan (Atacand).

Other essential hypertension medications

Your doctor may recommend other medications if you have trouble lowering your blood pressure with the medications above. These include:

Alpha-blockers

These drugs interfere with the constriction of blood vessels, resulting in a lowering of blood pressure. Examples include prazosin (Minipress) and doxazosin (Cardura).

Central-acting agents

These drugs stop the brain from telling your nervous system to narrow the blood vessels or increase your heart rate. Examples include methyldopa, guanfacine (Intuniv), and clonidine (Kapvay, Catapres).

Renin-inhibitors

The drugs slow the release of the renin enzyme produced by the kidneys, which triggers a chain of chemical steps that cause high blood pressure. An example is Aliskiren (Tekturna).

Alpha-beta blockers

These medications work by blocking nerve signals and slowing the heartbeat to reduce how much blood has to flow through the vessels. Examples include labetalol (Trandate) and carvedilol (Coreg).

Vasodilators

Vasodilators cause blood vessel walls to relax and widen. Examples include minoxidil and hydralazine.

Beta-blockers

Beta-blockers reduce strain on the heart and widen the blood vessels causing the heart to beat slower and with less force. Examples include atenolol (Tenormin) and acebutolol. These drugs are not often the first-line treatment, and will likely be combined with other blood pressure medications.

The lowdown

Essential hypertension is the most common form of high blood pressure. People with essential hypertension often do not know they have it, as symptoms might not appear until high blood pressure reaches a serious or life-threatening stage. For that reason, it is crucial to have regular check-ups to ensure treatment can begin before complications, such as a stroke or heart attack, occur.

Fortunately, an effective treatment plan involving making positive lifestyle changes and, at times, taking medication can help lower blood pressure and maintain your health for years to come.