Essential (primary) hypertension is chronic high blood pressure without preexisting renal disease or another known organic cause. Risk factors for primary hypertension include advanced age, obesity, genetic inheritance, being of African descent, physical inactivity, tobacco use, high-sodium diet, excessive alcohol consumption, diabetes, and dyslipidemia. Unlike most cardiovascular disease, which develops at an earlier age in men compared with women, blood pressure elevation progresses more rapidly in women than in men, with a steeper increase beginning early in life (ie, third decade).

Uncontrolled hypertension can cause complications such as left ventricular hypertrophy, heart failure, ischemic heart disease, ischemic stroke, intracerebral hemorrhage, and chronic kidney disease. Hypertension is the most common concurrent disease in patients with chronic obstructive pulmonary disease (COPD). Long-term cumulative blood pressure exposure has been associated with subsequent cognitive decline, dementia risk, and all-cause mortality in cognitively healthy adults aged 50 years and older.

Hypertension can be classified by stage (stage 1 and stage 2) and, when combined with atherosclerotic cardiovascular disease (ASCVD) risk, the stage can help determine treatment. Lifestyle changes are the cornerstone of therapy, specifically decreasing sodium intake and increasing daily physical activity. Pharmacological intervention may be required in some patients to meet target blood pressure measurements.

Systolic and diastolic hypertension are independent risk factors for cardiovascular disease.

Blood pressure greater than 180/110-120 mm Hg can be a sign of acute severe hypertension and may require emergency therapy.

Hypertension during youth has been shown to increase risk for adult cardiovascular events, including death, before the age of 60.

Related topic: asymptomatic hypertension