Causes and Risk Factors of Hypertension

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Primary (essential) hypertension, by definition, has no known cause. Medical conditions and lifestyle factors can contribute to the development of secondary hypertension, however, with high blood pressure being a consequence of a separate health concern typically related to the heart, arteries, kidneys, or endocrine system.

Common Causes

Hypertension generally develops without a known cause and gradually worsens over the years. A number of known risk factors are associated with a higher likelihood of developing essential hypertension, and there several health conditions that cause secondary hypertension. 


The risk of hypertension increases as you get older. In general, this is related to a number of the effects of aging, including:  

  • Loss of blood vessel flexibility
  • Hormonal changes, such as menopause
  • Increased sensitivity to salt and other dietary factors

Blood pressure often increases in stages. A person in her thirties may have mild to moderately elevated blood pressure readings. As she ages, blood pressure may continue to slowly rise.

If someone develops high blood pressure before the age of 50, the risk of heart attack and stroke is greatly increased. If untreated, high blood pressure can reduce life expectancy by 10 or more years.


Hypertension is more common in men than women until the age of 45. Thereafter and until age 64, the percentages of men and women with high blood pressure are similar, and women may be more likely to develop hypertension after age 60.

Women often develop hypertension after menopause, as estrogen's protective effects against hypertension decline. 

The increased rates of women who are diagnosed with hypertension after age 55 could be because many men who are prone to hypertension would have already been diagnosed with the condition by that age.


Blacks and Whites are more likely to develop hypertension than Latinos. People of Asian descent are less likely to develop hypertension. The differences in the risk of hypertension between people of different races are believed to be caused by a combination of genetic, dietary, and lifestyle factors.

Kidney Disease

Chronic kidney disease affects fluid and electrolyte volume and concentration in the body, which places excess pressure on the arteries, causing hypertension. 


Diabetes increases the risk of hypertension. This is partially due to the effect of diabetes on kidney function, but people who have diabetes generally develop hypertension before there is a measurable impact on the kidneys. 

Hormone Conditions

Thyroid disease, adrenal disease, and pituitary disease produce hormonal fluctuations that lead to changes in blood pressure, with hypertension being one of the common outcomes of these conditions. 

Sleep Apnea

Sleep apnea is associated with hypertension, though the mechanism is not completely well understood. It is believed that sleep apnea could be the manifestation of other cardiovascular diseases in addition to hypertension, and it may lead to cardiovascular diseases on its own, resulting in a cycle of effects.


A number of medications can contribute to hypertension, including corticosteroids, oral contraceptives, some decongestants, medications that contain caffeine, and many others. In general, it is best to check the label to see if hypertension is one of the side effects of any medications you take, especially if you already have hypertension or if you are at increased risk for it.


Genetics plays a role in hypertension, and much of essential hypertension could ultimately turn out to be genetic in origin.

Genes are believed to have approximately 30 percent to 50 percent impact on blood pressure. Specific genes have not been identified as responsible for hypertension, however.

This may be due to the fact that there are many genes that interact together to influence blood pressure, with some of these genetic variants being more common than others.

Overall, genes that contribute to hypertension are common in the population, as evidenced by the fact that hypertension is one of the most prevalent health conditions. The CDC reports that nearly 50 percent of adults over age 20 have treated or untreated hypertension, and it is believed that essential hypertension is the leading type of hypertension. 

Family History 

There is a link between family history and hypertension. If you have a parent, sibling, or grandparent with hypertension, you are at a higher risk of developing the condition yourself, especially if your family member has essential hypertension. 


If your lifestyle habits are contributing to weight gain, particularly if you have a genetic predisposition to being overweight, commit to making changes that can help you reach an optimal weight and prevent many of the serious adverse health effects of obesity—including hypertension.

Lifestyle Risk Factors

Habits and lifestyle risk factors can cause and contribute to hypertension, regardless of the type.


Among the leading contributors to hypertension, smoking causes narrowing of the blood vessels, as well as atherosclerosis and inflexibility of the arteries. 


Salt in one's diet is a well-recognized contributor to high blood pressure. For some people, a low salt diet can have a substantial impact on blood pressure, while for many people, the effect of dietary salt on blood pressure is minimal. 


Anxiety and stress can raise blood pressure. The body releases epinephrine, norepinephrine, and cortisol, hormones that cause narrowing of the blood vessels, in response to stress. Frequent narrowing and alterations in blood vessel diameter can lead to hypertension over time. 

Sedentary Lifestyle

Lack of regular physical activity is associated with hypertension because weight changes and hormonal responses to physical exercise help maintain optimal blood pressure. 


Chronic, heavy alcohol use is associated with hypertension, although the link is not as strong or as well understood as the link between smoking and hypertension. 

Recreational Drug Use

Several illegal recreational drugs, such as cocaine, heroin, and methamphetamine, cause dramatic shifts in blood pressure. These drugs are more likely to cause a hypertensive emergency than they are to cause chronic hypertension. 

9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Additional Reading

By Mark Stibich, PhD
Mark Stibich, PhD, FIDSA, is a behavior change expert with experience helping individuals make lasting lifestyle improvements.