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| :: The Causes of Hypertension :: |
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Over 95% of people with elevated blood pressure have "essential hypertension." This means that the specific cause of their hypertension is not known. It is likely that both genetic (inherited) and environmental factors, such as your diet, play a role. The ways that all of the contributing factors interact to elevate blood pressure are not necessarily the same for each person. In addition, most of the genetic causes of hypertension are still a matter of research. Therefore, for the time being, most patients with high blood pressure are considered to have "essential hypertension."
In the remaining 5% or less of people with elevated blood pressure, a specific cause is known, and they are considered to have "secondary hypertension." Examples of causes of secondary hypertension include kidney failure, narrowing of the arteries to the kidneys, and various hormonal conditions. In most cases a general physician can detect these causes, but sometimes a referral to a nephrologist (kidney doctor) who specializes in hypertension is warranted. Many patients are referred to me for evaluation of possible "secondary" causes of their high blood pressure. Only for some of these patients will more detailed blood tests and x-rays be appropriate. For a few patients, if a correctable cause is found the hypertension may be curable.
Does Age Affect a Person's Risk of Having Hypertension?
Hypertension, in particular the type that selectively increases systolic blood pressure (the "top" number), becomes steadily more common with advancing age.
Is Hypertension Genetic?
For the vast majority of hypertensive patients, there is no one gene passed on (inherited) from parent to child that is responsible for high blood pressure. More likely, there are many different genes that interact with each other and the environment to produce high blood pressure. Therefore, inheritance predisposes a person to high blood pressure, but hypertension might only occur with the addition of one or more environmental factors.
In addition, African Americans are more prone as a group to develop hypertension and develop it at a younger age than those of other races or heritage.
Does a High Salt Diet Cause Hypertension?
It has been known for a long time that societies with diets high in salt experience more hypertension and the associated complications of heart attack, stroke, and organ damage. It is not known, however, if increased salt is itself responsible for elevated blood pressure. It might be, for example, that people from societies with increased salt intake may also have some other dietary factors or an inherited factor that is responsible for their hypertension. Most physicians do not believe that high salt intake alone causes hypertension, but they do believe it plays an important role. The most likely explanation is that there are other environmental and genetic factors that along with high salt intake all work together to cause hypertension.
Does Emotional Stress or Caffeine Cause High Blood Pressure?
Emotional stress, in the short term, can elevate the blood pressure. However, it does not cause a persistent elevation in blood pressure and therefore does not cause true hypertension with its associated consequences. Relaxation therapies and biofeedback may offer other benefits, but they have not been shown to prevent the development of hypertension or significantly lower blood pressure. I therefore do not recommend stress management strategies alone without other treatment.
Similarly, caffeine may raise the blood pressure in the short term (and should not be ingested immediately before a doctor checks your blood pressure). However, tolerance to caffeine develops quickly, and any blood pressure elevation is not sustained. I therefore do not routinely recommend caffeine restriction as a means of blood pressure control.
Does Alcohol Consumption Cause High Blood Pressure?
Although the media has widely publicized the beneficial effects of alcohol on the heart, it must be remembered that this applies only to moderate alcohol intake. People who have more than two drinks per day are much more likely to have sustained elevations in blood pressure than nondrinkers. Alcohol may therefore be an unrecognized cause of hypertension in a large number of moderate to heavy drinkers. In my patients with hypertension, I encourage either elimination of alcohol or at least limiting their drinking to two or less drinks per day. This will often lower their blood pressure?sometimes even into a normal range?without medication.
Does Obesity Cause Hypertension?
The reasons why obesity may lead to hypertension are not completely understood, but weight reduction in obese patients definitely lowers blood pressure. The benefits of even a modest reduction in weight are multiple: reduction or elimination of blood pressure medications, improvement in cholesterol levels, and decreased risk of heart attack. Unfortunately, as many patients can attest, weight reduction is easy to recommend but difficult to achieve and maintain. A daily exercise program, a strong social support system, and initially modest goals for weight loss are all required for long-term success.
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