Hypertension: Know Your Type

04/25/2019 | 6 min. read

Dr. Stephen Sinatra

Dr. Stephen Sinatra

The definition of hypertension has changed considerably over the years. When I trained to become a cardiologist, the medical community set the upper limit for healthy blood pressure at 140/90 mm/Hg—so if your blood pressure crept above 138/88 mm/Hg we intervened.

Then, in 2017 the American Heart Association lowered the hypertension threshold significantly—classifying normal blood pressure as under 120/80 mm/Hg. That’s the “safe zone” to reduce your risk of stroke and other complications.

But knowing your numbers doesn’t tell the whole story. It’s also important to know what type of high blood pressure you have since that affects how you treat it.

What Are the Types of Hypertension?

Ninety percent of all hypertension cases are primary (sometimes called “essential”) hypertension—meaning the exact cause is unknown. It’s the most common type of hypertension and often treated with nutritional supplements, lifestyle interventions, and sometimes medication.

The remaining 10% of hypertension cases are classified as secondary, meaning high blood pressure is “secondary” to something else. Causes can include aging and stiffening of blood vessels, birth control pills (hormones), kidney disease, pregnancy, sleep apnea, and more. With this type of hypertension, blood pressure often returns to normal once the primary cause is treated.

Plus, there are many specific types of hypertension that have unique causes and symptoms. I have listed them here in alphabetical order, which does not imply severity…

Isolated Systolic Hypertension

The top number of your blood pressure, your systolic reading, is the pressure generated when your heart contracts. And the bottom number, your diastolic reading, is the pressure generated when your heart relaxes between beats.

If your top number is elevated and your bottom number is normal, it’s called isolated systolic hypertension (ISH). Since ISH can be a sign of calcification of your aorta, you should ask your doctor for an ultrasound of the aorta to check for this.

The good news about ISH is that the diastolic pressure is normal, so your doctor can take a less aggressive approach to treating it. One of the most important things you can do for ISH is supplementing with potassium. Plus, I've had some patients who experienced good results with 50 mg of nattokinase twice daily.

Malignant Hypertension

What is malignant hypertension? The telltale sign is when the onset is abrupt and blood pressure rises to levels of 180/120 mm/Hg or more very rapidly.

Symptoms of malignant hypertension can include blurry vision, angina, difficulty breathing, dizziness, numbness (arms, legs, and face), and severe headaches. Signs of damage to the eyes and kidneys may also signal to healthcare providers to search for underlying malignant hypertension.

Malignant hypertension is a medical emergency requiring hospitalization, with careful monitoring and intravenous medication to lower blood pressure as soon as possible. Prompt treatment is important since it can cause a heart attack, heart failure, stroke, pulmonary edema (fluid backup in the lung), kidney failure, and even death.

Fortunately, malignant hypertension is extremely rare—occurring in just 1% of people who have a history of hypertension. Possible causes include adrenal tumor(s), illegal drugs like cocaine, kidney disease, medications like birth control pills, scleroderma, and more.

Pregnancy-Induced Hypertension (PIH)

While some women have chronically high blood pressure before conception, others can develop it during pregnancy—called pregnancy-induced hypertension (PIH). Approximately 6-8% of expectant moms develop PIH, which often begins in the second half of pregnancy and disappears after delivery.

You’re at highest risk of PIH if you were hypertensive during a previous pregnancy, have diabetes or kidney disease, are under age 20 or over 40, are expecting a multiples birth, or don’t have access to good healthcare. You’re also at higher risk if you have a family history of PIH or are of African-American descent.

Symptoms of PIH can include fluid retention, swelling and abrupt weight gain, an unrelenting headache, nausea and vomiting, blurry or double vision, and pain in the upper right side of your stomach. Prevention includes good prenatal monitoring by your doctor, including checking your kidneys and liver.

Treatments vary based on the extent of your hypertension, pregnancy duration, and the baby’s health and development. Typically, it’s managed with more frequent prenatal checkups, limiting salt, adequate hydration, diet, and exercise. It’s also important for the mother to be monitored for preeclampsia, which can cause serious complications for both the baby and mother.

Finally, even if your blood pressure normalizes after giving birth, you want to continue to be monitored since you’re at higher risk of developing hypertension in the future.

Pulmonary Hypertension

As its name suggests, pulmonary hypertension (PH) starts in the lungs where freshly oxygenated blood is being brought in from the heart. When the blood vessels in your lung develop arteriosclerosis (stiffening and narrowing), your heart must work harder to pump vital oxygen-rich blood against the resistance in the lung’s circulation. Eventually, your heart can weaken putting you at risk of congestive heart failure.

Signs and symptoms of pulmonary hypertension include fatigue, loss of appetite (as blood shunts from the gut to the organs in need), chest discomfort (angina), pain in the right upper abdominal quadrant, and a racing heart.

This form of hypertension can be genetic, or the result of cardiovascular disease or lung disease. Pulmonary hypertension treatment usually involves medication, oxygen therapy, and in the worst cases a lung transplant.

Renal Hypertension

Most cases of hypertension involve the circulatory system, and renal hypertension is no exception. In this case, the arteries to the kidneys are narrowed and constricted, and therefore compromised by what we call renal artery stenosis of one or both kidneys. Fibromuscular dysplasia is a rarer cause.

The tricky thing about the kidney is that it responds to compromised blood flow by going into a kind of “dehydration mode.” This means it pumps out hormones that tell your body to hold onto water and salt, which can raise your blood pressure.

The secondary effect of renal hypertension is “swelling" of the renal arteries which is a silent symptom. Left unchecked, it can lead to elevated blood pressures and chronic kidney disease. Healthcare providers may go looking for a renal source when hypertension is “resistant” to treatment, which I will explain next.

Renal hypertension is often treated with antihypertension medications, angioplasty, and stenting or surgery of the renal arteries.

Resistant Hypertension

What is resistant hypertension? As its name implies, it’s when your hypertension resists treatment. Even with mindful diet and lifestyle changes, exercise, and medication those elevated pressure readings won’t budge.

When someone’s blood pressure refuses to back down, healthcare providers go looking for clues of secondary causes, such as plaque buildup in the lungs and kidneys, unruly hormones, sleep apnea and snoring, obesity, alcohol or drug use, medications, or psychological stress.

As with all cases of high blood pressure, I recommend treating resistant hypertension by following a Pan-Asian Modified Mediterranean Diet, being mindful of your salt intake, reducing stress, grounding, reducing your EMF exposure, and applying other lifestyle interventions.

White Coat Hypertension

Your high blood pressure could be caused by the stress of seeing your physician, which is called white coat hypertension. This is sometimes the case for people who have “white coat hypertension readings” in the doctor’s office, but normal blood pressure readings when they take their blood pressure at home.

White coat hypertension is very consistent with my own experience with patients, that stress is a more powerful risk factor for high blood pressure than most people realize. And if seeing a doctor can provoke a blood pressure surge, what other stressors may be doing likewise? If you think you might have white coat hypertension, you want to discuss that with your doctor.

You also want to make sure that he or she monitors you for high blood pressure down the road since white coat hypertension is sometimes a precursor to other types of hypertension.

Dr. Stephen Sinatra

Meet Dr. Stephen Sinatra

Dr. Stephen Sinatra is a highly respected and sought-after cardiologist and nutritionist with more than 30 years of clinical practice, research, and study. His integrative approach to heart health focuses on reducing inflammation in the body and maximizing the heart's ability to produce and use energy.

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