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Hypertension: Overview and Risk Factors

Hypertension is a major risk factor for cardiovascular disease, including coronary heart disease and stroke, as well as for end-stage renal disease and peripheral vascular disease. The World Health Organization has identified hypertension as the most important preventable cause of premature death in developed countries.1 Hypertension, obesity, insulin resistance, and lipid abnormalities (hypertriglyceridemia and low HDL-cholesterol levels) make up the metabolic syndrome, a particularly virulent risk profile for cardiovascular disease.

About 65 million people in the United States have hypertension. However, because it is typically asymptomatic, affected individuals often do not know they have the condition. In fact, one third of hypertensive persons are unaware of their disease, and only about half of those who are aware achieve adequate blood pressure control.2

The vast majority of cases are primary or "essential" (ie, the cause is unknown). Approximately 5% to 10% of cases are due to renal or endocrine disease (eg, renovascular disease, thyroid disease, chronic steroid therapy, Cushing's disease, or pheochromocytoma).

Signs and symptoms, when they do occur, include headache, confusion, vision changes, nausea, vomiting, and fatigue.

Risk Factors

African Americans have a higher prevalence of high blood pressure compared with blacks in Africa and with North American whites; the mechanisms for this increased risk are unknown. The following factors increase the likelihood of developing hypertension:

  • Age. About two thirds of Americans over age 65 have high blood pressure.
  • Family history. Having relatives with cardiovascular disease increases risk.
  • Obesity. The prevalence of hypertension in obese adults is double that of normal-weight individuals.
  • Lack of exercise.
  • Dietary factors (discussed in Nutritional Considerations).
  • Renovascular disease/chronic kidney disease.
  • Adrenal gland abnormalities.
  • Hyperthyroidism.
  • Oral contraceptive use.
  • Pheochromocytoma (rare).
  • Smoking.
  • Medications. For example, corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), antihistamines, diet pills, and some antidepressants.


Hypertension: Diagnosis and Treatment >>