High blood pressure affects more than 1.28 billion adults worldwide. It contributes to around 10 million deaths every year. Often, high blood pressure itself is the main disease, known as essential hypertension. But sometimes, it’s a symptom of another underlying condition. So, how to know when high blood pressure is a disease and when it is a symptom.
Essential Hypertension: A Disease Itself
Essential hypertension accounts for about 90–95% of all hypertension cases. It means the blood pressure is high without a clear underlying medical cause. Essential hypertension typically develops slowly over many years. Lifestyle and genetic factors play crucial roles.
Several risk factors include:
- Age: Nearly 50% of adults over age 50 have hypertension.
- Diet: Consuming more than 2,300 mg of sodium daily increases hypertension risk.
- Weight: Every 2-pound increase in body weight can raise blood pressure by 1 mmHg.
- Stress: Chronic stress can elevate blood pressure by up to 10–20 mmHg.
- Genetics: A family history can double your hypertension risk.
Managing essential hypertension often means lifestyle changes combined with medication. Reducing salt, losing just 5–10 pounds, or increasing physical activity by 30 minutes daily can lower blood pressure significantly—often by 5–15 mmHg.
Secondary Hypertension: When It’s a Symptom
In about 5–10% of hypertension cases, high blood pressure points to another medical condition. This type is called secondary hypertension. It typically appears suddenly and is more severe than essential hypertension.
Common causes of high blood pressure when it is a symptom not a disease itself, include:
- Kidney Disease: Around 20% of secondary hypertension is linked to kidney conditions, as damaged kidneys struggle to filter sodium effectively, increasing fluid retention and raising blood pressure.
- Sleep Apnea: Approximately 50% of people with obstructive sleep apnea develop hypertension. Sleep disruptions trigger stress hormones, elevating blood pressure at night and persistently over time.
- Hormonal Disorders: Conditions like hyperthyroidism or Cushing’s syndrome affect hormone levels, causing blood pressure spikes. For instance, patients with Cushing’s have a nearly 80% chance of developing hypertension.
- Certain Medications: About 10% of secondary hypertension cases are medication-induced. Birth control pills, anti-inflammatory drugs, and even certain antidepressants can increase blood pressure significantly.
Secondary hypertension treatment targets the underlying cause. Resolving the primary condition can often return blood pressure to normal levels without long-term medication. For instance, treating sleep apnea successfully lowers blood pressure by an average of 10–20 mmHg.
How to Tell the Difference
Essential hypertension usually builds up slowly, often without clear symptoms. Most people find out accidentally during routine check-ups. Secondary hypertension often shows up suddenly. It typically doesn’t respond well to standard blood pressure medications alone.
Doctors look for signs pointing to secondary causes:
- Very high blood pressure readings (180/120 mmHg or higher).
- Sudden onset hypertension, especially in younger individuals (under age 30).
- Resistance to standard treatments or lifestyle changes.
- Symptoms such as fatigue, unusual thirst, sudden weight changes, or snoring loudly (suggestive of sleep apnea).
Doctors might use specialized tests like ultrasounds, hormone tests, or sleep studies to identify underlying conditions causing secondary hypertension.
Why Does It Matter?
Understanding if hypertension is primary or secondary greatly impacts treatment strategy. Essential hypertension requires ongoing management through lifestyle and medication. Secondary hypertension demands addressing the underlying disease directly.
Misdiagnosing secondary hypertension as essential can lead to years of ineffective treatment. Identifying secondary causes early significantly reduces long-term cardiovascular risk, potentially adding many healthy years to a patient’s life.
Sources
Primary Hypertension vs Secondary Hypertension – PlushCare
Cleveland Clinic. Secondary Hypertension; Causes, Symptoms, Treatment …
