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Risk Factors of High Blood Pressure

Age and Weight 

An estimated 50 million Americans (25% of all adults) have high blood pressure. Two-thirds of Americans will experience at least mild high blood pressure before the age of 65. Although the majority have mild hypertension, even this condition requires medical attention. Only 20% of American adults have their blood pressure under control. About one-third of patients with high blood pressure are overweight. Anyone who is overweight has a risk for hypertension that is 50% more than people with normal weight. In fact, the increase in blood pressure as one ages may be due primarily to weight gain. (This is true particularly in America; in other cultures old age does not necessarily coincide with weight gain--or high blood pressure.) Children and adolescents who are obese and babies who are underweight at birth are at greater risk for high blood pressure when they reach adulthood.

Gender and Ethnicity

Women under 60 are 50% to 75% less likely to have hypertension than men of the same age. Between ages 50 and 60, 40% of white men and 30% of white women have high blood pressure. In African Americans of the same age groups over half of men and slightly less than half of women have hypertension. After age 60, half of white men and women have high blood pressure, but the rate in African Americans is 60% in men and leaps to 80% in women. 

Genetic Factors

Some experts believe that essential hypertension may be inherited in 30% to 60% of cases, although several genes, not just one, are probably involved. It is difficult to differentiate between genetic and environmental influences, even in studies of identical twins.

Cholesterol and Stress 

About 40% of people with high blood pressure also have high cholesterol levels, although any causal relationship remains unclear. Stress may play a role in this association; in one study people with high cholesterol levels experienced a steep increase in high blood pressure when given a mental stress test; those with normal cholesterol levels had only a modest increase. When the high-risk group lowered their cholesterol intake, their blood pressure dropped to normal levels during stressful situations. This finding should encourage physicians to test for heart disease risks, particularly unhealthy cholesterol levels, in people with so-called white-coat hypertension--a phenomenon that causes high blood pressure in the physician's office despite normal blood pressure at home.

Emotional Disorders

A number of studies have linked chronic stress, depression, and anxiety with high blood pressure in both men and women. People who are anxious or depressed may have over twice the risk for high blood pressure than those without these problems. It is not clear whether these mood disorders contribute to high blood pressure due to some physiologic effect on blood vessels or if they may lead to behaviors, such as weight gain or alcohol abuse, which are also risk factors for hypertension. Stress caused by discrimination may play a role in the high rate of hypertension in African Americans; in one study, those who experienced discrimination but did not report it suffered higher blood pressure than those who challenged it. Anger does not appear to predict high blood pressure.

Other Factors

People who experience sleep apnea, a disorder in which breathing halts briefly but repeatedly during sleep, also have a higher incidence for hypertension. Many experts believe that a causal relationship exists between the sleep disorder and high blood pressure. Seasonal changes may influence variations in blood pressure, with hypertension increasing during cold months and declining during the summer. This seasonal effect is particularly high in smokers. While cold may narrow blood vessels, another study showed that lack of light was associated with higher blood pressure. A recent study reported that people with normal resting blood pressure that increases to abnormally high levels during treadmill exercises may be at risk for essential hypertension. Oral contraceptives, even low doses, may increase the risk for high blood pressure in African American women.