Primary Hypertension

Primary hypertension, also called essential hypertension, is blood pressure that stays at 140/90 mmHg or higher without another disease causing it. This type accounts for about 9 in 10 adults with hypertension. Its counterpart is secondary hypertension, which results from a specific disorder such as kidney disease or excess hormones and is covered on the Secondary Hypertension page.

How Primary Hypertension Develops

There is no single mechanism. Many genes, each with a small effect, make a person more prone to rising blood pressure. In some people, the kidneys tend to retain salt and water, so blood volume increases. The nervous system that controls heart rate and blood vessel width can be overactive, for example because of prolonged stress or lack of sleep. The hormones renin, angiotensin, and aldosterone also narrow blood vessels and retain salt. With age, artery walls become stiffer, so the top number tends to rise. The mix of these factors differs from person to person, so responses to salt, exercise, or types of medicine can also differ.

The Role of Lifestyle

An inherited tendency more easily develops into hypertension when it meets less healthy daily habits. High salt intake, too few vegetables and fruits, little physical activity, excess weight, alcohol, and smoking make blood pressure rise little by little over the years. The good news is that these factors can be changed. Cutting salt, eating plenty of vegetables and fruits, exercising regularly, and losing weight can each lower the top number by a few mmHg, and the effect adds up when they are done together.

Long-Term Course

Primary hypertension usually does not go away on its own, but it can be controlled. Without control, high pressure slowly thickens the heart muscle and damages the blood vessels in the brain, kidneys, and eyes. With a healthy lifestyle and medicines when needed, most people with this condition can reach their target and lead an active life. The key is continuous treatment and regular home measurements, because blood pressure usually rises again when medicines or healthy habits are stopped. The ESC 2024 guideline recommends a target top number of 120 to 129 mmHg if tolerated. An overview of all types of hypertension is covered on the Hypertension page.

Primary hypertension is diagnosed in two steps. The first step is to confirm that blood pressure is truly high through repeated measurements in the clinic and, when possible, home measurements over 7 days or 24-hour monitoring. The next step is to make sure no other disease is causing it.

For this, the doctor asks about your medical history, the medicines and herbal remedies you use, snoring habits, and family history, then examines you and orders basic blood and urine tests. If hypertension appears before age 40, blood potassium is low, blood pressure rises suddenly, or it is hard to lower with medicines, testing for secondary causes continues. At the same time, an ECG and urine tests help assess whether high pressure has already affected the heart and kidneys.

Primary hypertension is often found by chance. Make an appointment if:

• Your clinic reading is 140/90 mmHg or higher, or your home average is 135/85 mmHg or higher
• Your blood pressure is in the elevated range and you have diabetes, kidney disease, or a family history of heart disease
• Your target has not been reached after several months of lifestyle changes or treatment
• You have medicine side effects, such as dizziness when standing up, a dry cough, or ankle swelling
• Hypertension appears before age 40, so possible secondary causes need to be looked for

Go to the emergency room right away if your blood pressure is 180/120 mmHg or higher with chest pain, shortness of breath, weakness on one side of the body, slurred speech, or vision problems.