Causes of Hypertension

Primary (Essential) Hypertension

• The American College of Cardiology notes that hypertension is a complex polygenic disorder where multiple genes influence blood pressure, though genetic variants collectively account for only about 3.5% of blood pressure variability 4, 5, 6
• The European Heart Journal states that primary hypertension results from complex interactions between genetic predisposition, environmental factors, and behavioral influences, with approximately 90% of cases being primary (essential) hypertension of unknown exact cause and 10% being secondary hypertension with identifiable causes 1, 2, 3
• Obesity may be responsible for 40% of hypertension cases and up to 78% in men and 65% in women, according to the Journal of the American College of Cardiology 4, 5
• The relationship between body mass index and blood pressure is continuous and almost linear, with no threshold, as reported by the Journal of the American College of Cardiology 4, 5
• Sodium intake is positively associated with blood pressure and accounts for much of the age-related increase in blood pressure, according to the Journal of the American College of Cardiology 4, 5
• Excessive sodium consumption is independently associated with increased risk of stroke, cardiovascular disease, and other adverse outcomes beyond its blood pressure effects, as stated by the Journal of the American College of Cardiology 4, 5
• Insufficient intake of potassium, calcium, magnesium, protein, fiber, and fish fats are associated with high blood pressure, according to the Journal of the American College of Cardiology 4, 5, 6
• Poor diet, physical inactivity, and excess alcohol consumption, alone or in combination, are the underlying cause of a large proportion of hypertension, as reported by the Journal of the American College of Cardiology 4, 5, 6
• Excessive alcohol intake contributes to hypertension development, according to the Journal of the American College of Cardiology 4, 8

Secondary Hypertension

• Secondary hypertension accounts for approximately 10% of cases and has identifiable causes, including renal disease, endocrine disorders, obstructive sleep apnea, drug-induced hypertension, and vascular causes, as stated by the European Heart Journal 1, 2, 3
• Chronic kidney disease and renal parenchymal disease are common secondary causes of hypertension, according to Hypertension 9 and the Journal of the American College of Cardiology 8
• Primary aldosteronism presents with hypokalemia, muscle cramps, and weakness, as reported by the Journal of the American College of Cardiology 8
• Pheochromocytoma causes blood pressure lability, episodic pallor, and dizziness, according to the Journal of the American College of Cardiology 8
• Cushing's syndrome presents with central obesity, facial rounding, and easy bruisability, as stated by the Journal of the American College of Cardiology 8
• Hyperthyroidism causes weight loss, palpitations, and heat intolerance, according to the Journal of the American College of Cardiology 8
• Obstructive sleep apnea presents with snoring and hypersomnolence, and requires continuous positive airway pressure therapy to improve blood pressure control, as reported by the European Heart Journal 10
• Over-the-counter medications, prescribed drugs, and recreational substances can cause hypertension, according to the European Heart Journal 10
• Nonsteroidal anti-inflammatory drugs, cocaine, amphetamines, corticosteroids, and calcineurin inhibitors elevate blood pressure, as stated by the Journal of the American College of Cardiology 8 and the European Heart Journal 10

Clinical Approach to Identifying Causes

• Historical features suggesting primary hypertension include gradual blood pressure increase with slow rate of rise, lifestyle factors favoring higher blood pressure, and strong family history of hypertension, as reported by the Journal of the American College of Cardiology 8
• Historical features suggesting secondary hypertension include absence of family history of hypertension, sudden onset or rapid progression of hypertension, and specific symptoms pointing to underlying causes, according to the Journal of the American College of Cardiology 8