Essential hypertension

Alternative names
Hypertension - essential


As blood is pumped through your body, it exerts pressure on the walls of your arteries. The systolic blood pressure is the pressure against these walls when the heart contracts, and the diastolic blood pressure is the pressure when the heart relaxes. When you get a blood pressure reading, you are told the systolic pressure/diastolic pressure.

For example, normal blood pressure is below 120/80.

High blood pressure, also called hypertension, occurs when the systolic pressure is consistently over 140 mm Hg, or the diastolic blood pressure is consistently over 90 mm Hg. “Essential hypertension” refers to high blood pressure with no identifiable cause.

Prehypertension is when your systolic blood pressure is between 120 and 139 or your diastolic blood pressure is between 90 and 99. If you have prehypertension, you are likely to develop high blood pressure at some point. Therefore, your doctor will recommend lifestyle changes to bring your blood pressure down to normal ranges.

Causes, incidence, and risk factors

Blood pressure is determined by the amount of blood pumped, by the actions of the heart, and by the size and condition of the arteries. Many other factors can affect blood pressure including the water volume in the body; salt content of the body; condition of the kidneys, nervous system, or blood vessels; and various hormone levels in the body.

African Americans of both sexes and Caucasian males have a higher rate of significant hypertension. While essential hypertension has no correctable cause, some genetic factors have been identified.


Usually, high blood pressure has no symptoms at all. That is why it is often called the “silent killer.” Millions of people have high blood pressure and many do not even know they have this serious condition.

Rarely, you may experience a mild headache when your blood pressure is elevated. If your headache is severe, or if you experience any of the symptoms below, you must be seen right away because these may be a sign of dangerously high blood pressure (called malignant hypertension) or a serious complication (like a heart attack).

  • Tiredness  
  • Confusion  
  • Visual changes  
  • Nausea, vomiting  
  • Anxiety  
  • Perspiration  
  • Pale skin, or redness  
  • An angina-like pain, crushing chest pain

Note: There are usually no symptoms.

Signs and tests

Blood pressure measurements are repeated over time. Systolic blood pressure consistently over 140, or diastolic blood pressure consistently over 90, is considered hypertension. Your doctor will look for signs of complications to your heart, kidneys, eyes, and other organs in your body.

Multiple systolic blood pressure readings between 130 and 139 or diastolic blood pressure readings between 80 and 89 is called prehypertension. Your doctor will recommend and encourage lifestyle changes including weight loss, exercise, and nutritional changes.

Tests for suspected causes (called secondary hypertension) may be performed. Essential hypertension is diagnosed when NO causes can be found.


As part of your treatment, it is important to have your blood pressure checked by your doctor at regular intervals. Your doctor will tell you how often that needs to be.

You may want to consider a home blood pressure monitor as well. Bring the readings to your doctor when you go for your visits.

Necessary lifestyle changes to help bring your blood pressure down include:

  • Weight loss if you have extra pounds  
  • Regular exercise  
  • Follow a low fat diet rich in fish, chicken, whole grains, fruits and vegetables, and very light on red meats  
  • Limit sodium intake; talk to your doctor or nutritionist about how best to do this

Medications that may be prescribed are listed below. Many people need 2 or more medications to control blood pressure.

  • Diuretics  
  • Beta-blockers  
  • Angiotensin-converting enzyme (ACE) inhibitors, Angiotensin receptor blockers (ARBs)  
  • Calcium channel blockers  
  • Hydralazine, clonidine, doxazosin, and prazosin

Expectations (prognosis)

Essential hypertension is controllable with proper treatment. It requires lifelong monitoring, and treatment may require periodic adjustments.

Untreated hypertension can lead to:

  • Heart attacks  
  • Congestive heart failure  
  • Other heart damage  
  • Blood vessel damage (arteriosclerosis)  
  • Kidney damage  
  • Stroke  
  • Loss of vision

Calling your health care provider

Even if you have not been diagnosed with high blood pressure, it is important to have your blood pressure checked at annual exams, especially if you have a history of high blood pressure in your family.

If you have high blood pressure, you will have regularly scheduled appointments with your doctor.

In between appointments, if you have any of the following symptoms call your health care provider right away:

  • Severe headache  
  • Excessive tiredness  
  • Confusion  
  • Visual changes  
  • Nausea and vomiting  
  • Chest pain  
  • Shortness of breath  
  • Significant sweating

Prevention is based upon lifestyle changes that include:

  • Weight loss, if you are overweight. Excess weight adds to heart strain. In some cases, weight loss may be the only treatment needed to lower your blood pressure.  
  • Exercise to improve cardiac fitness.  
  • Dietary adjustments to lower fat and modify sodium in your diet. Salt, MSG, and baking soda all contain sodium.


Johns Hopkins patient information

Last revised: December 7, 2012
by Mamikon Bozoyan, M.D.

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