Primary hypertension, also known as essential hypertension, is a common condition that accounts for 95% of all cases of hypertension (high blood pressure). More than one billion adults have high blood pressure worldwide. Despite its widespread presence, many people don’t fully understand what primary hypertension is and its impact on a person’s life.

What is primary hypertension?

Primary hypertension is the most common type of hypertension which occurs when someone has high blood pressure without a known underlying medical cause. 

It tends to gradually develop over several years, and often remains hidden, not showing any symptoms. This can allow worsening of the disease without any apparent ill signs, so high blood pressure is therefore also known as a “silent killer”. Regular checkups are crucial in preventing the worsening of primary hypertension, especially with increasing age. 

What causes essential or primary hypertension?

There are several factors at play here, including both genetic and modifiable risk factors. Since none of the factors have been proven the sole cause of the disease, they are referred to as risk factors and not causes. 

Genetic factors include being an older adult (65 years or above), a family history of hypertension, and hereditary aspects of kidney disease or diabetes. It has been suggested by some studies that a person’s natural ability to process salt is one of the risk factors for the development of primary hypertension.

Modifiable risk factors that increase the chances of high blood pressure include a diet high in salt and saturated fat, a sedentary lifestyle, obesity, and consumption of alcohol or tobacco.

Signs and symptoms  

What are the symptoms of primary hypertension?

Early on, the disease shows no symptoms, and therefore blood pressure should be checked several times a year to diagnose someone with hypertension at an early stage.

Over time, blood vessels get damaged due to the constant stress on the vessel walls from the high blood pressure. This leads to symptoms because of damage to vessels supplying different organs.

The symptoms that could result may be fatigue, blurry vision, chest pain, blood in the urine, and severe headache. However, since these symptoms are general and could point to a variety of diseases, the best way to confirm whether someone has primary hypertension is through a thorough medical checkup.

What are the complications of primary hypertension?

If hypertension remains untreated, it may lead to some severe complications over time. Elevated blood pressure levels may cause chest pain, heart attack, heart failure, stroke, or kidney failure in the long run. Through ongoing care, hypertension that has been already been diagnosed rarely goes untreated for long periods and therefore these complications don’t occur that frequently.

How is primary hypertension diagnosed? (diagnosis and tests)

Most cases of hypertension don’t present with symptoms and are diagnosed incidentally during a medical checkup through a blood pressure measurement. 

However, to confirm that the case is primary hypertension and not secondary, medical conditions that lead to secondary hypertension need to be ruled out. This includes checking for thyroid disorders, other endocrine disorders, aortic valve diseases, and other causes of secondary hypertension. Once all such causes are ruled out, a diagnosis of primary hypertension can be made.

Apart from the most common way of taking multiple blood pressure measurements using a sphygmomanometer, a physician may also recommend a 24-hour blood pressure monitoring test which involves monitoring a person’s blood pressure for a whole day to aid in their diagnosis.

Treatment options

What does primary hypertension treatment look like?

The management of primary hypertension involves both pharmacologic and nonpharmacologic treatment. Nonpharmacologic treatment refers to lifestyle management that should be advised to every patient with raised blood pressure.

These include proper instructions regarding salt restriction, smoking and alcohol management, weight loss, and exercise. Trying to reduce the level of stress in a person’s life also helps with lowering blood pressure levels. This is done according to the individual’s needs and current health status. These lifestyle changes alone account for a reduction of about 15% in all cardiovascular-related bad events (such as heart attacks and strokes).

Pharmacologic treatment consists of medications such as ACE (angiotensin-converting enzyme) inhibitors, angiotensin receptor blockers (ARBs), diuretics (such as thiazide), beta-blockers, and calcium channel blockers.

What drug is best for hypertension? 

The drugs to treat primary hypertension consist of different classes of drugs, including ARBs, ACE inhibitors, calcium channel blockers, and so on. 

Whether pharmacologic treatment needs to be begun depends on the blood pressure readings as well as an person’s risk factors, such as their age and existing medical problems. If the hypertension is mild, the patient might be adequately treated with permanent lifestyle modifications.

Polytherapy is normally done, which means prescribing more than one drug at the same time. Although some patients can be treated with a single drug, a combination of drugs is often required for optimal control and lesser side effects. The exact choice of drugs can only be decided after a doctor’s visit.

Can primary hypertension be cured permanently?

There is no permanent cure for primary hypertension, but the treatment options above and regularly checking one’s blood pressure can help control the condition. Keeping blood pressure under control can greatly reduce the chances of developing medical complications related to hypertension.

HealthTap is a great place where a person can get their hypertension questions answered in detail via video. The online clinic is a one-stop solution for general healthcare needs. If someone needs to have their high blood pressure readings reviewed and get a personalized treatment plan, they should schedule an appointment with a HealthTap primary care doctor.