What types of hypertension are there?

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In 2017, the American College of Cardiology (ACC) and the American Heart Association (AHA) revised their hypertension guidelines. This changed the definition of high blood pressure.

Under the new guidelines, a blood pressure reading between 120 and 129 millimeters of mercury (mm Hg) for the top (systolic) number and more than 80 mm Hg for the bottom (diastolic) number is considered elevated. Additionally, any blood pressure reading above 130/80 mm Hg classifies as hypertension.

Learn more about diastole and systole in blood pressure.

Since 2017, the ACC and AHA categorize blood pressure measurements as follows:

• Normal: Systolic pressure is below 120 mm Hg and diastolic is below 80 mm Hg.
• Elevated: Systolic pressure is between 120 and 129 mm Hg and diastolic pressure is below 80 mm Hg.
• Stage 1: Systolic pressure is between 130 and 139 mm Hg or diastolic pressure is between 80 and 89 mm Hg.
• Stage 2: Systolic pressure is a minimum of 140 mm Hg or diastolic pressure is a minimum 90 mm Hg.

This system categorizes more people as having hypertension than the previous system. Previously, many of these people would classify as having prehypertension. Healthcare professionals no longer use prehypertension as a classification.

Under the current categories, up to 46% of American adults may qualify as having hypertension.

Anyone with a blood pressure reading in the elevated category should consult with their doctor. A doctor can provide advice about lifestyle modifications or treatments that may help manage the condition.

There are two main types of hypertension: primary hypertension and secondary hypertension.

Primary hypertension

Primary hypertension is the most common type of hypertension. It is also referred to as essential hypertension. This type describes hypertension with no obvious cause.

The AHA suggests that a combination of genetics, age, and lifestyle factors cause primary hypertension. Lifestyle factors that may contribute include smoking, excessive alcohol consumption, and lack of exercise.

Making modifications to diet and lifestyle may help a person lower their blood pressure and reduce their risk of complications from hypertension.

Secondary hypertension

Secondary hypertension describes high blood pressure that has an identifiable cause or underlying condition.

According to the American Academy of Family Physicians (AAFP), around 5–10% of hypertension cases classify as secondary hypertension. This type tends to be more common in younger people.

Up to 30% of people ages 18–40 who have high blood pressure have secondary hypertension.

Some possible underlying causes of secondary hypertension include:

• renal artery stenosis, or a narrowing of the arteries that supply blood to the kidneys
• diseases of the adrenal glands, such as:
  • Cushing syndrome
  • hyperaldosteronism
  • pheochromocytoma
• obstructive sleep apnea
• thyroid disorders
• congenital heart defects, such as coarctation of the aorta

Clinicians further classify primary and secondary hypertension into the following sub-types:

Resistant hypertension

Resistant hypertension is hypertension that may not respond to treatment or requires multiple medications to control.

Doctors consider a person to have resistant hypertension when their blood pressure remains above target levels and they are taking three different blood pressure-lowering medications, such as a diuretic.

According to a 2015 review of studies, around 10% of people living with hypertension in Western cultures have the resistant type.

Isolated systolic hypertension

Isolated systolic hypertension is when a person’s systolic blood pressure rises above 140 mm Hg and their diastolic blood pressure drops below 90 mm Hg.

Up to 15% of people age 60 years or older may be living with isolated systolic hypertension. Experts do not know the exact cause of isolated systolic hypertension. However, many believe it is due to stiffening of the artery walls as a result of aging.

It is possible for younger people to develop isolated systolic hypertension. A 2016 study notes that isolated systolic hypertension occurs in 2–8% of younger people.

A 2015 study looked at cardiovascular health in younger people and adults living with isolated systolic hypertension. After a 31-year average follow up, researchers found they had a higher risk of heart attacks and strokes than those whose blood pressure fell within a healthy range.

Malignant hypertension

Malignant hypertension refers to hypertension that damages a person’s organs. This is a medical emergency that requires immediate treatment. It is the most severe type of hypertension and a form of hypertensive emergency.

The main characteristics of malignant hypertension are:

• systolic blood pressure at or over 180 mm Hg
• diastolic blood pressure at or above 120 mm Hg
• damage to multiple organs

Malignant hypertension is very uncommon, occurring in approximately 1–2 cases out of 100,000. A person should call 911 immediately if they suspect they may have malignant hypertension.

A hypertensive emergency refers to when a person’s blood pressure suddenly rises to 180/120 mm Hg or above. As discussed in the previous section, one example of a hypertensive emergency is malignant hypertension.

People should call 911 immediately if they experience any of these symptoms:

• chest pain
• dizziness
• changes in vision
• difficulty speaking
• shortness of breath

Hypertensive emergency is a potentially life threatening condition. It can damage essential organs and cause severe complications, such as heart attack, stroke, and loss of kidney function.

Hypertensive urgency describes when a person’s blood pressure rises to 180/120 mm HG or more, but they do not have any of the other symptoms of hypertensive emergency.

Doctors typically treat hypertensive urgency by adjusting a person’s medications. However, a person should still seek immediate medical attention for hypertensive urgency to prevent it from becoming a hypertensive emergency.

The main types of hypertension are primary hypertension and secondary hypertension. Primary hypertension is hypertension without an obvious cause, while secondary hypertension occurs due to an underlying health condition.

Other types of hypertension include resistant hypertension, isolated systolic hypertension, and malignant hypertension.

A person should speak with a doctor if they think they may have any form of hypertension.

People should call 911 if they suspect they are experiencing a hypertensive emergency. This may involve symptoms such as shortness of breath, dizziness, and chest pain.