What causes high blood pressure (hypertension)?

Diana Meeks
Diana Meeks on behalf of Sigma Nursing
Family Practitioner

There are two types of hypertension: primary and secondary. Primary hypertension develops slowly over time, and the reasons for this are still unknown. Most cases of hypertension (about 90 percent) fall into this category. Secondary hypertension is hypertension that is caused by another condition, such as kidney disease or adrenal/hormonal disorders, or by the use of some medications. Secondary hypertension tends to develop more quickly.

Tests can be done to find out if there is an underlying medical condition causing your hypertension. Your doctor will give you a thorough physical examination to detect any problems in your abdomen, kidneys and eyes, as conditions in these areas sometimes cause hypertension. Urinalysis is used to check for kidney problems. Blood tests may be done to check levels of potassium, sodium and red blood cells. Electrocardiography can detect any changes to or weaknesses in your heart.

Most times we don't know a few causes that account for less than 1 percent of all high blood pressure are well known such as rare endocrine tumors like pheochromocytoma (I love managing patients with this one personally as it requires the skills of a cardiac anesthesiologist in managing the operating room period and a lot of coaching preoperatively by an internist, and since I am both I love caring for such patients) or adrenal cortical tumors, etc. But the majority we call idiopathic or essential hypertension, which just means we don't know.

That said, a lot of people with high blood pressure end up with normal blood pressure after they loose some omental (belly) fat by going to a Mediterranean diet (see YOU ON A Diet and our waist loss plan on this website), and start doing 10,000 steps a day. We think that is both due to foods that relax blood vessels in this diet (See Go! Foods for YOU on for more info on that) and that fat inside the kidney capsule (like a Tupperware container that the kidney sits in) grows as your belly fat grows, squeezing your kidney and causing it to put out hormones intended to get it more blood flow.

So try more fruits and veggies, more steps in your life and more meditation.

The exact cause of hypertension is not known. However, several factors can contribute to high blood pressure such as:

  • Family history
  • Overweight/obesity 
  • Excessive alcohol intake
  • Inactive lifestyle/lack of exercise
  • A high-salt and/or a high-fat diet
  • High intake of caffeine
  • Smoking
  • Stress

The 90 to 95 percent of hypertension cases in which the cause can't be determined are called essential or primary hypertension cases. Hypertension may also be a symptom of an identified problem (see below) that generally corrects itself when the identified cause is corrected. This type of high blood pressure is called secondary hypertension. Possible causes of secondary hypertension include:

  • renal artery stenosis (narrowing of the arteries leading to your kidneys)
  • adrenal gland disease (Cushing's disease) or adrenal tumors
  • kidney disease
  • preeclampsia (hypertension and increased urine protein levels sometimes caused by pregnancy)
  • thyroid disease
  • a large intake of licorice root extract (equivalent to 25 to 40 licorice candies a day for several years)

Other factors affecting blood pressure include:

  • use of birth control pills
  • psychologic stress
  • severe pain
  • drug or alcohol withdrawal
  • use of amphetamines, cocaine or other stimulants
  • Use of steroids
  • overuse of nicotine nasal sprays, gum, patches and lozenges designed to help smokers kick the habit
  • sleep apnea
Dr. Joel H. Fuhrman, MD
Family Practitioner

High blood pressure is mostly the result of a poor diet, lack of exercise and excessive salt consumption, but according to the Journal of the American College of Cardiology, salt consumption is a significantly bigger risk factor than the other elements.

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High blood pressure (hypertension) affects an estimated 67 million Americans. In most cases, the causes of high blood pressure are not known. However, some things may increase your risk of developing high blood pressure. These include:

  • Heredity: High blood pressure tends to run in families.
  • Race: Black people have high blood pressure more often and more severely than whites.
  • Age: The tendency to develop high blood pressure increases as you age.
  • Obesity: People who are overweight have a greater chance of developing high blood pressure.
  • Lack of exercise: An inactive lifestyle may contribute to being overweight, which is a risk factor for high blood pressure.
  • Excessive alcohol use: Drinking excessive amounts of alcohol can increase blood pressure.
  • Too much dietary salt: Heavy use of salt can increase blood pressure.
  • Oral contraceptives: Women who take the pill have an increased chance of developing high blood pressure, especially if they also smoke.
  • Other diseases: Having chronic kidney disease increases your chance of developing high blood pressure.

High blood pressure is much less common in children than adults. Regular blood pressure checkups should begin during childhood and continue throughout life.

Most cases of hypertension fall into the catagory of "essential hypertension," which means that there is no identifiable direct cause. Many factors can place you at risk which include family history and aging. Blood pressure itself is very dynamic which means it fluctuates throughout the day and is affected by the time of day, position in which it is measured, and your level of activity prior to measuring. Hypertension can not be diagnosed with a single measurement and should be monitored routinely once an official diagnosis is made.

Both your lifestyle and genes, among other factors, can cause high blood pressure.

Essential hypertension, or high blood pressure, that does not result from another medical condition, has an underlying genetic component. In the Southeastern United States, hypertension has been dubbed “The Silent Killer,” because it can have no symptoms, is the number cause of heart attacks and stroke, and a person leading a perfectly healthy lifestyle can develop hypertension at any time simply due to inherited risk.

Aside from a genetic predisposition to developing high blood pressure, the following factors also increase blood pressure: obesity, high alcohol intake, high salt intake, sedentary lifestyle and aging. These factors are additive, meaning if a person is 65, obese and consumes large quantities of alcohol, the risk for hypertension is much higher than if his or her only risk factor was age.

The main hypertensinogenic factor is obesity. Each 10 percent weight gain is associated with a 6.5 mmHg increase in systolic blood pressure. Importantly, high blood pressure can be significantly reduced through healthy weight loss, a moderate exercise program and salt reduction. Talk to your doctor about what makes sense for you.

High blood pressure is caused by genetics, diet and lifestyle. Risk for high blood pressure rises with age.

Dr. Joseph H. Henderson, MD
Cardiologist (Heart Specialist)

High blood pressure is common in westernized countries and tends to trend upward with age. There are many things that aggravate high blood pressure, including excessive sodium consumption, excessive alcohol consumption, sleep apnea (abnormal snoring and breathing at night) and being overweight.

The contents of this website are for informational purposes only and are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Nor does the contents of this website constitute the establishment of a physician patient or therapeutic relationship. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.