Understanding the Different Types of Hypertension

Nearly half of adults in the United States have hypertension, also known as high blood pressure. Left untreated, hypertension increases the risk of?stroke and heart attack, which are two of the leading causes of death in the United States.

High blood pressure is sometimes called “the silent killer.” That’s because it frequently doesn’t have any symptoms, particularly in the early stages. It’s often first detected during a routine wellness visit, when a provider measures your blood pressure levels with a monitor.

Normal blood pressure is defined as less than 120/80 mmHg. The top number is a measure of your systolic pressure, which is the pressure in the arteries when the heart beats. The bottom number is a measure of your diastolic pressure, which is the pressure in the arteries in between heartbeats.

Here's a breakdown of all the ranges and numbers.

2 Main Types of Hypertension

There are two types of high blood pressure: primary (essential) hypertension and secondary hypertension.

Primary (Essential) Hypertension

Primary hypertension, also known as essential hypertension, is a type of high blood pressure that doesn’t have a singular cause, and it develops gradually over time. It’s also referred to as high blood pressure.

Left unchecked, primary hypertension puts extra pressure on the artery walls, which can damage blood vessels and other organs in the body. This, in turn, can increase the risk of cardiovascular, kidney, and vision problems, among others.

Those with a higher risk for primary hypertension include people who:

Are 65 and older
Are obese
Have been diagnosed with diabetes
Eat a diet that’s high in salt
Drink too much alcohol

If your blood pressure is 130/80, you’ll be diagnosed with hypertension.

Sometimes, high blood pressure can be managed with lifestyle changes such as avoiding alcohol, exercising more often, or lowering your salt intake. In other cases, you may need to take medication to lower your blood pressure. Some of these drugs include:

Alpha blockers, which relax the muscles in the arteries
Angiotensin-converting enzyme (ACE) inhibitors, which help the body produce less angiotensin (a chemical that causes the arteries to narrow)
Angiotensin II receptor blockers (ARBs), which blocks the effects of angiotensin
Beta-blockers, which lower heart rate
Calcium channel blockers, which prevent calcium from entering the heart and arteries
Central alpha-2 receptor agonists, which block brain signals that increase the heart rate and tell the blood vessels to narrow
Combined alpha-and-beta-blockers, which are both alpha-blockers and beta-blockers
Diuretics, also called water pills, which help the body flush out excess salt and water
Vasodilators, which cause the muscles in the blood vessels to widen

Secondary Hypertension

Secondary hypertension is high blood pressure that’s caused by another medical condition. It’s estimated that about 10 percent of people who have high blood pressure have this type of hypertension.

Some of the health issues that can cause secondary hypertension include:

Diabetes
Kidney disease
Adrenal gland disorders
Thyroid problems
Coarctation of the aorta, a birth defect that narrows the body’s largest artery
Sleep apnea

If you have secondary hypertension, you may have difficulty managing your blood pressure even when taking medications. The treatment for secondary hypertension usually involves treating the underlying cause of your high blood pressure.

Other Types of Hypertension

Beyond the two common types explained above, there are several other reasons why someone’s blood pressure may run high.

White Coat Hypertension

White coat hypertension is a condition where a person’s blood pressure rises during a medical appointment — the “white coat” refers to the usual attire of doctors — but it runs normal otherwise. It’s estimated that up to 30 percent of people who get a high blood pressure result at a doctor’s office have white coat hypertension.

It's thought that the stress of a doctor’s appointment contributes to the phenomenon, but some experts also suspect that people who have white coat hypertension may also be more likely to develop high blood pressure later on.

If you have at least three in-office readings that are higher than 130/80 mmHg, but your at-home readings are less than 130/80 mmHg, your doctor may diagnose you with white coat hypertension. You may also need to keep tabs on your blood pressure at home using an at-home blood pressure monitor. If your numbers start rising to 130/80 mmHg or higher while you’re at home, you may be developing high blood pressure.

Resistant Hypertension

Resistant hypertension is a type of high blood pressure that doesn’t go down after you make lifestyle changes or take medications. In this case, an underlying medical condition — such as obesity, sleep apnea, or even certain over-the-counter or prescription meds like painkillers, birth control pills, or nasal decongestants — may be to blame.

To combat resistant hypertension, your doctor may want to make sure you’re taking the medication correctly. If you aren’t taking the right dose at the right time, you may not see a positive effect. Or you may need to add another drug to your existing regimen. Sometimes people need to take multiple medications, such as a diuretic and a calcium channel blocker, to lower their blood pressure.

Isolated Systolic Hypertension

Isolated systolic hypertension is a condition where the systolic (top) number is elevated — 130 mmHg or higher — but the diastolic (bottom) number is in a normal range. Older adults are especially at risk for this, in part because the condition develops as the arteries lose their elasticity with age. An estimated 15 percent of people over the age of 60 have isolated systolic hypertension.

Left untreated, isolated systolic hypertension can also lead to conditions such as heart attack and stroke, so it’s important to talk to your doctor about ways to manage it. This may include making lifestyle changes such as reducing your sodium or alcohol intake or taking medications such as diuretics, calcium channel blockers, ACE inhibitors, or ARBs.

Malignant Hypertension

Malignant hypertension occurs when there’s a sudden spike in a person’s blood pressure. It’s also known as a hypertensive crisis, and can be classified two ways:

A hypertensive emergency happens when blood pressure rises and a person shows signs of severe organ damage.
Hypertensive urgency occurs when blood pressure is very high, but a person doesn’t have signs of severe organ damage.

Malignant hypertension is defined as systolic blood pressure that’s greater than 180 mmHg and diastolic blood pressure that’s greater than 120 mmHg. Hypertensive emergencies are relatively rare, with about 1 to 2 cases per million.

Some causes of malignant hypertension include preexisting health conditions such as adrenal disorders and thyroid problems. Some of the symptoms, which can vary based on which organs are affected, include chest pain, delirium, headaches, lower back pain, nausea, shortness of breath, and vision changes.

Those experiencing malignant hypertension need to seek immediate medical care. At the emergency room, doctors will likely perform a series of tests to determine whether you’re having hypertensive urgency or hypertensive emergency. People who have hypertensive urgency will likely receive oral blood pressure medications. Those experiencing a hypertensive emergency may need to stay in the hospital, where they may be given medication through an IV until their blood pressure numbers come back down.

Understand Your Type of Blood Pressure

If you’ve been diagnosed with any type of hypertension, your doctor may ask you to check your blood pressure at home with an at-home monitor. These monitors are available at local stores and pharmacies. You should use one that has a cuff that goes around your upper arm rather than devices that go on your wrist or finger, since those tend to be less accurate.

Your provider may also suggest these lifestyle changes:

Take your medications as instructed.
Schedule regular checkups with your doctor.
Stick to a healthy diet, which may include limiting your salt intake.
Cut down on or avoid alcohol.
Quit smoking.

The Takeaway

Primary hypertension, also known as high blood pressure, is very common but doesn’t have a singular cause. Secondary hypertension develops because of an underlying health condition, such as diabetes, obstructive sleep apnea, or kidney disease.
If you have high blood pressure, your doctor will likely suggest lifestyle changes or medications such as ACE inhibitors, beta-blockers, or calcium channel blockers.
Rarely, high blood pressure can cause a hypertensive emergency, which is a spike in blood pressure along with signs of organ damage.

Chung Yoon, MD

Medical Reviewer

Castle Connolly

Chung Yoon, MD, is a noninvasive cardiologist with a passion for diagnosis, prevention, intervention, and treatment of a wide range of heart and cardiovascular disorders. He enjoys clinical decision-making and providing patient care in both hospital and outpatient settings. He excels at analytical and decision-making skills and building connection and trust with patients and their families.

See full bio

Maria Masters

Author

Maria Masters is a contributing editor and writer for Everyday Health and?What to Expect, and she has held positions at Men's Health and Family Circle. Her work has appeared in Health, on Prevention.com, on MensJournal.com, and in?HGTV Magazine, among numerous other print and digital publications.

See full bio

Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.

Resources

Estimated Hypertension Prevalence, Treatment, and Control Among U.S. Adults. Centers for Disease Control and Prevention. May 12, 2023.
Primary Hypertension (Formerly Known as Essential Hypertension). Cleveland Clinic. October 26, 2021.
Understanding Blood Pressure Readings. American Heart Association. May 17, 2024.
High Blood Pressure (Hypertension). Mayo Clinic. February 29, 2024.
Types of Blood Pressure Medication. American Heart Association. May 24, 2024.
Hegde S et al. Secondary Hypertension. StatPearls. July 30, 2023.
Secondary Hypertension. Cleveland Clinic. May 3, 2019.
Franklin SS et al. White-Coat Hypertension: New Insight From Recent Studies. Hypertension. September 2013.
White Coat Hypertension: When Blood Pressure Rises in a Medical Setting. Mayo Clinic. June 13, 2024.
White Coat Syndrome. Cleveland Clinic. August 3, 2022.
High Blood Pressure That’s Hard to Treat. American Heart Association. May 6, 2024.
Resistant Hypertension. Cleveland Clinic. August 30, 2023.
Liang Tan J et al. Systolic Hypertension. StatPearls. January 23, 2023.
Isolated Systolic Hypertension. Cleveland Clinic. January 31, 2023.
Malignant Hypertension. Cleveland Clinic. December 23, 2021.
Naranjo M et al. Malignant Hypertension. StatPearls. June 19, 2023.
High Blood Pressure (Hypertension). Mayo Clinic. February 29, 2024.