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Your blood pressure fluctuates in stressful situations or during physical exertion. However, if it remains high all the time, even during rest or in the absence of stress, you might be suffering from hypertension. High blood pressure (hypertension) is defined as an excessive elevation of pressure in the arteries, which persists over time. It is one of the most common chronic diseases in the world.

Depending on its causes, it is broadly divided into two types: primary or essential, and secondary.

Primary or Essential Hypertension

In most cases, the causes of hypertension remain unidentified or are difficult to identify. This is commonly referred to as essential or primary hypertension. Here are some of the causes:

1. Family history and genes: Studies [1] indicate that genes can have 30-50% impact on your blood pressure. If you have a parent, grandparent or sibling with high blood pressure, you are at risk of developing it too.

2. Age and gender: Arterial hypertension appears earlier in men. Women of childbearing age are less prone to hypertension because of the protective effects of estrogen. At menopause, the chances of hypertension among women are similar to that of men. Ageing is also considered one of the underlying causes of hypertension. It is due to the stiffening of arteries, which contributes to an increase in systolic blood pressure [2].

3. Stress: Studies [3] have linked mental stress with hypertension. Prolonged or chronic mental stress can also lead to hypertension in some cases.

4. Obesity: Since obesity affects body composition, it may have a modifying or damaging influence on the organs too. Studies [4] suggest that obesity contributes approximately 65-78% of the risk of essential hypertension.

5. Lack of physical activity: It is important for adults to engage in at least 30 minutes of exercise daily to stay healthy. Sedentary lifestyle is a major contributor of many health conditions, including hypertension.

6. Hormonal fluctuations: An imbalance in hormones can lead to hypertension [5]. This is why after and during menopause, or during pregnancy, women are prone to high blood pressure. An overactive or underactive thyroid, increased levels of aldosterone or Cushing’s syndrome are some of the underlying causes.

Secondary Hypertension

Secondary hypertension refers to high blood pressure caused by other chronic ailments and factors that are correctable. Approximately 5-10% of adults are diagnosed with secondary hypertension[6]. Some of the major contributing factors include the following:

1. Chronic conditions: Kidney disease, fibromuscular dysplasia, renal artery stenosis, coarctation or narrowing of the aorta, thyroid problems, and sleep apnea are some of the underlying causes of secondary hypertension[6].

2. Pregnancy: Pre-eclampsia or pregnancy-induced hypertension is also very common[7]. This can be attributed to hormonal fluctuations; however, since it appears only during pregnancy, it is categorised as secondary hypertension.

3. Medication: Common medication like certain oral contraceptives, NSAIDs, steroids, herbal remedies like liquorice, and antidepressants increase the chances of hypertension[8-9]. Recreational drugs like cocaine, heroin or amphetamines cause sudden fluctuations in blood pressure. This can lead to chronic hypertension at a young age.

4. Lifestyle: Your lifestyle and environment can contribute to several health problems, with hypertension being one of them. A diet rich in salt and poor in fruits and vegetables; a sedentary lifestyle; smoking; alcohol abuse; and a lack of physical activity can lead to secondary hypertension. It is possible to act on these factors to prevent and reduce hypertension, unlike certain other factors that are not modifiable.


  1. Russo A, Di Gaetano C, Cugliari G, Matullo G. Advances in the Genetics of Hypertension: The Effect of Rare Variants. International Journal of Molecular Sciences. 2018; 19(3):688.
  2. AlGhatrif M1, Strait JB, Morrell CH, Canepa M, Wright J, Elango P, Scuteri A, Najjar SS, Ferrucci L, Lakatta EG. Hypertension. 2013 Nov; 62(5):934-41. doi: 10.1161/HYPERTENSIONAHA.113.01445. Epub 2013 Sep 3.
  3. Esler M1, Eikelis N, Schlaich M, Lambert G, Alvarenga M, Dawood T, Kaye D, Barton D, Pier C, Guo L, Brenchley C, Jennings G, Lambert E. Clin Exp Pharmacol Physiol. 2008 Apr;35(4):498-502. doi: 10.1111/j.1440-1681.2008.04904.x.
  4. do Carmo JM 1 ,  da Silva AA 2, Wang Z 3,  Fang T 3, Aberdein N 3, de Lara Rodriguez CE 3,  Hall JE 3 . Current Hypertension Reports [01 Jul 2016, 18(7):58]. doi: 10.1007/s11906-016-0658-1
  5. Niegowska J1, Sitkiewicz D. Pol Arch Med Wewn. 2004 May;111(5):547-56.
  6. Anthony J. Viera, MD, MPH, and Dana M. Neutze, MD, PhD. Am Fam Physician. 2010 Dec 15;82(12):1471-1478
  7. Braunthal S, Brateanu A. SAGE Open Med. 2019 Apr 10;7:2050312119843700. doi: 10.1177/2050312119843700. eCollection 2019.
  8. Penninkilampi R, Eslick EM, Eslick GD1. J Hum Hypertens. 2017 Nov;31(11):699-707. doi: 10.1038/jhh.2017.45. Epub 2017 Jun 29.
  9. Mir D1, Ardabilygazir A, Afshariyamchlou S, Sachmechi I. Cureus. 2018 Jul 13;10(7):e2978. doi: 10.7759/cureus.2978.

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