Causes of primary hypertension

Primary hypertension often results from one or more of the following factors:

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Dietary salt. Diets high in salt may raise blood pressure in two ways. One, by causing the body to retain water, salt increases blood volume and thus blood pressure. Two, salt causes vascular smooth muscle to constrict small blood vessels, which produces a greater resistance to blood flow.

Dietary potassium. A diet low in potassium tends to increase blood pressure. Conversely, increased potassium intake blunts the effects of dietary salt on blood pressure.

Other dietary factors. Diets low in fruits, vegetables, and dairy products and high in fat and cholesterol raise blood pressure. Alcohol intake beyond moderate levels (two drinks per day for men and a drink a day for women) raises blood pressure.

Metabolic syndrome. This cluster of health problems--obesity, hypertension, high triglyceride levels, low high-density lipoprotein (HDL) cholesterol levels, and elevated blood glucose (sugar) levels--occurs in about 1 in 4 Americans and in 40 percent of those age 60 and older. Obesity, especially a significant accumulation of fat in the abdomen, initiates the abnormalities of this syndrome by decreasing the body's ability to respond to the actions of insulin, a hormone that regulates blood glucose levels. To overcome this effect, the pancreas increases its production of insulin, and blood levels of insulin rise. Elevated blood insulin levels heighten the activity of the sympathetic nervous system and cause sodium retention by the kidneys--both of which raise blood pressure.

Genetics. Studies of twins and other members of the same family show that primary hypertension has a genetic component. In addition, researchers have identified a number of genetic mutations that result in a small number of cases of hypertension.

Lack of exercise. Physical inactivity can lead to hypertension in several ways. It increases the activity of the sympathetic nervous system, increases the stiffness of the arteries, decreases the release of hormones (such as nitric oxide) that cause arteries to dilate, and reduces the body's ability to respond to insulin.