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Updated August 04, 2014.
Written or reviewed by a board-certified physician. See About.com's Medical Review Board.
As a kidney doctor, I see many patients with high blood pressure. Many, in fact, carry the diagnosis of "Essential Hypertension." The term of essential hypertension is supposed to refer to the "run of the mill" hypertension that millions of people in industrialized countries are diagnosed with on a daily basis. This form of high blood pressure usually does not have an identifiable cause or problem that can be pinpointed.
This is in contrast to resistant hypertension where there is usually an identifiable cause.
Over the years, I have come to detest the word "Essential." It implies a sense of finality and "fundamentality," ie, that high blood pressure is as essential to the human condition as is eating and sleeping. That, over the time just as we get older we will all develop high blood pressure.
Nothing could be further from the truth.
While there are many of us who have a genetic predisposition for the development of high blood pressure, the truth is that the science is showing that there are some imbalances in the body that could contribute to the development of high blood pressure. These include: endothelial dysfunction, insulin resistance, increased activity of the sympathetic nervous system, and actvation of a blood pressure hormone system called the renin-angiotension-aldosterone or RAA system.
Endothelial dysfunction: The innermost layer of the blood vessel is an important regulator of blood pressure.
The production of substances including endothelin and nitrous oxide are responsible for narrowing or "constricting" the blood vessel (endothelin) and dilating the blood vessel (nitrous oxide). It is the imbalance between "constrictors" and "dilators" that can contribute to worsening high blood pressure and difficult to treat hypertension. You can read more about the evaluation and management of endothelial dysfunction here.
Insulin resistance: There is a close relationship between insulin resistance and high blood pressure. Insulin is a necessary hormone made by the pancreas responsible for the body's control of blood glucose. While maintaining good blood control is important (ie referring to diabetes), you should be aware of the side effects of taking insulin. Insulin is an "anabolic hormone" meaning that it causes the body to store fat. It causes weight gain. It can also increase blood pressure.
For someone with Type 2 diabetes or the metabolic syndrome and high blood pressure getting control of your own health conditions can sometimes prove difficult. This is because you can enter a vicious cycle: if your blood glucose levels are high you will be more prescribed more insulin to take, which causes increased weight gain which can raise your blood pressure. Increased BMI can also contribute to the increased blood pressure as well.
if you have diabetes and are on insulin, your goal should be on the least amount of insulin possible to maintain good blood glucose control. If you weight more than you should, be aware that insulin resistance is an important contributor to weight gain and high blood pressure. Given that approximately 1/3 of our population is either overweight or obese, this becomes an important health issue.
Did you know that magnesium deficiency is associated with insulin resistance and high blood pressure?
Increased Sympathetic Tone and the RAA System: These two conditions often go hand in hand. Stress, both physical and psychological, as well as lack of sleep can contribute to increase in the body's sympathetic nervous system, or fight or flight response. The production of hormones in the RAA system as a result of increased "sympathetic tone" also contributes to the development of hypertension.
In conclusion, essential hypertension is not "essential" at all, especially when there are "body imbalances" as mentioned above that can contribute to the development of high blood pressure.
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