Different Types of Hypertension

There are two primary hypertension types. For 95 percent of people with high blood pressure, the
cause of their hypertension is unknown this is called essential, or primary, hypertension.
When a cause can be found, the condition is called secondary hypertension.

Essential hypertension. This type of hypertension is diagnosed after a doctor notices

that your blood pressure is high on three or more visits and eliminates all other causes of
hypertension. Usually people with essential hypertension have no symptoms, but you
may experience frequent headaches, tiredness, dizziness, or nose bleeds. Although the
cause is unknown, researchers do know that obesity, smoking, alcohol, diet, and heredity
all play a role in essential hypertension.

Secondary hypertension. The most common cause of secondary hypertension is an

abnormality in the arteries supplying blood to the kidneys. It results from an identifiable
cause. Renal disease is the most common secondary cause of hypertension.[8]
Hypertension can also be caused by endocrine conditions, such as Cushing's syndrome,
hyperthyroidism, hypothyroidism, acromegaly, Conn's syndrome or hyperaldosteronism,
hyperparathyroidism

and

pheochromocytoma.[8][30]

Other

causes

of

secondary

hypertension include obesity, sleep apnea, pregnancy, coarctation of the aorta, excessive
liquorice consumption and certain prescription medicines, herbal remedies and illegal
drugs, diseases and tumors of the adrenal glands, hormone abnormalities, thyroid disease,
and too much salt or alcohol in the diet. Drugs can cause secondary hypertension,
including over-the-counter medications such as ibuprofen (Motrin, Advil, and others) and
pseudoephedrine (Afrin, Sudafed, and others). The good news is that if the cause is
found, hypertension can often be controlled.

Hypertensive crisis. Severely elevated blood pressure (equal to or greater than a systolic
180 or diastolic of 110sometimes termed malignant or accelerated hypertension) is
referred to as a "hypertensive crisis", as blood pressure at this level confers a high risk of
complications. People with blood pressures in this range may have no symptoms, but are
more likely to report headaches (22% of cases)[9] and dizziness than the general
population.[5] Other symptoms accompanying a hypertensive crisis may include visual
deterioration or breathlessness due to heart failure or a general feeling of malaise due to

renal failure.[8] Most people with a hypertensive crisis are known to have elevated blood
pressure, but additional triggers may have led to a sudden rise.[10]
A "hypertensive emergency", previously "malignant hypertension", is diagnosed when
there is evidence of direct damage to one or more organs as a result of severely elevated
blood pressure greater than 180 systolic or 120 diastolic.[11] This may include
hypertensive encephalopathy, caused by brain swelling and dysfunction, and
characterized by headaches and an altered level of consciousness (confusion or
drowsiness). Retinal papilloedema and/or fundal hemorrhages and exudates are another
sign of target organ damage. Chest pain may indicate heart muscle damage (which may
progress to myocardial infarction) or sometimes aortic dissection, the tearing of the inner
wall of the aorta. Breathlessness, cough, and the expectoration of blood-stained sputum
are characteristic signs of pulmonary edema, the swelling of lung tissue due to left
ventricular failure an inability of the left ventricle of the heart to adequately pump blood
from the lungs into the arterial system.[10] Rapid deterioration of kidney function (acute
kidney injury) and microangiopathic hemolytic anemia (destruction of blood cells) may
also occur.[10] In these situations, rapid reduction of the blood pressure is mandated to
stop ongoing organ damage.[10] In contrast there is no evidence that blood pressure needs
to be lowered rapidly in hypertensive urgencies where there is no evidence of target
organ damage and over aggressive reduction of blood pressure is not without risks.[8] Use
of oral medications to lower the BP gradually over 24 to 48h is advocated in hypertensive
urgencies.

Gestational Hypertension. Hypertension occurs in approximately 810% of

pregnancies.[8] Two blood pressure measurements six hours apart of greater than
140/90 mm Hg is considered diagnostic of hypertension in pregnancy.[12] Most women
with hypertension in pregnancy have pre-existing primary hypertension, but high blood
pressure in pregnancy may be the first sign of pre-eclampsia, a serious condition of the
second half of pregnancy and puerperium.[8] Pre-eclampsia is characterised by increased
blood pressure and the presence of protein in the urine.[8] It occurs in about 5% of
pregnancies and is responsible for approximately 16% of all maternal deaths globally.[8]
Pre-eclampsia also doubles the risk of perinatal mortality.[8] Usually there are no
symptoms in pre-eclampsia and it is detected by routine screening. When symptoms of

pre-eclampsia occur the most common are headache, visual disturbance (often "flashing
lights"), vomiting, epigastric pain, and edema. Pre-eclampsia can occasionally progress to
a life-threatening condition called eclampsia, which is a hypertensive emergency and has
several serious complications including vision loss, cerebral edema, seizures or
convulsions, renal failure, pulmonary edema, and disseminated intravascular coagulation
(a blood clotting disorder).

Whitecoat Hypertension. Whitecoat hypertension is an interesting and fairly common

form of high blood pressure that only occurs during visits to the doctor. People with
whitecoat hypertension may have normal blood pressure at home, but consistently have
elevated readings at the doctor's office. Sometimes this is a type of stress reaction, but it
may signal a more serious underlying problem. Because of this, whitecoat hypertension
should always be evaluated by a doctor.

Resistant hypertension. Resistant hypertension starts out as "regular" hypertension, but

does not respond to treatment. Despite what should be adequate therapy, the blood
pressure remains high. The causes of resistant hypertension are varied. Resistant
hypertension may occur in 20 to 30 percent of high blood pressure cases. Resistant
hypertension may have a genetic component and is more common in people who are
older, obese, female, African American, or have an underlying illness, such as diabetes or
kidney disease.

Isolated systolic hypertension. Blood pressure is recorded in two numbers: The upper,
or first, number is the systolic pressure, which is the pressure exerted during the
heartbeat; the lower, or second, number is the diastolic pressure, which is the pressure as
the heart is resting between beats. Normal blood pressure is considered under 120/80.
With isolated systolic hypertension, the systolic pressure rises above 140, while the lower
number stays near the normal range, below 90. This type of hypertension is most
common in people over the age of 65 and is caused by the loss of elasticity in the arteries.
The systolic pressure is much more important than the diastolic pressure when it comes to
the risk of cardiovascular disease for an older person.

Pulmonary hypertension. Pulmonary hypertension is a unique condition because, unlike

any other form of high blood pressure, it affects only a specific part of the circulatory
system. Despite this, pulmonary hypertension is very dangerous because it affects the part

of the circulatory system that connects the heart and lungs - interfering with the lungs'
ability to transfer oxygen and the heart's ability to pump blood. Pulmonary hypertension
is deadly if left untreated, but those who receive proper treatment have a much better
prognosis.