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Difference between Primary and Secondary Hypertension

Key Takeaways

  • Primary hypertension is more common and has no identifiable cause, while secondary hypertension results from an underlying condition or medication use.
  • Both types of hypertension require regular monitoring and appropriate management to prevent complications.
  • Lifestyle modifications and medications are used to manage primary hypertension, while secondary hypertension management focuses on addressing the underlying cause and managing blood pressure.
  • Regular blood pressure monitoring and following healthcare providers’ recommendations are crucial in maintaining overall health.


Hypertension, also known as high blood pressure, is a prevalent health condition that affects millions of people worldwide. Understanding the difference between primary and secondary hypertension is crucial for proper diagnosis and treatment. In this article, we will discuss the differences between primary and secondary hypertension, their causes, diagnosis, and management. We will also provide a table summarizing the key differences between the two types of hypertension.

Difference between primary and secondary hypertension
Primary hypertension accounts for 90-95% of cases

Causes of Primary and Secondary Hypertension

Primary Hypertension: Essential or Idiopathic

Primary hypertension, also known as essential or idiopathic hypertension, is the most common form of high blood pressure, accounting for approximately 90-95% of cases[1]. The exact cause of primary hypertension is unknown, but it is believed to result from a combination of genetic, environmental, and lifestyle factors. These factors may include obesity, high salt intake, excessive alcohol consumption, sedentary lifestyle, and family history of hypertension[2].

Secondary Hypertension: Identifiable Cause

Secondary hypertension, on the other hand, accounts for about 5-10% of cases and is caused by an identifiable underlying condition[3]. Several medical conditions and medications can lead to secondary hypertension, including kidney disease, hormonal disorders, sleep apnea, and the use of certain medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) and oral contraceptives[4].

Diagnosis and Management

Diagnosing Primary Hypertension

Diagnosing primary hypertension is usually based on the measurement of blood pressure over time. If a healthcare provider finds that a patient has consistently elevated blood pressure without an identifiable cause, they may diagnose the patient with primary hypertension. It is essential to monitor blood pressure regularly and follow a healthcare provider’s recommendations for lifestyle modifications and medication if needed[5].

Diagnosing Secondary Hypertension

To diagnose secondary hypertension, healthcare providers will first rule out primary hypertension and then search for an underlying cause. They may order blood tests, kidney function tests, hormone level tests, or imaging studies to identify the specific cause of high blood pressure[6]. Once the underlying cause is identified, treatment will focus on addressing that specific condition in addition to managing blood pressure.

Managing Primary and Secondary Hypertension

Managing both primary and secondary hypertension typically involves lifestyle modifications and, if necessary, medication. Lifestyle changes may include weight loss, increased physical activity, reduced salt intake, stress management, and limiting alcohol consumption[7]. Medications prescribed for hypertension may include diuretics, beta-blockers, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors, and angiotensin II receptor blockers (ARBs)[8].

Key Differences between Primary and Secondary Hypertension

Primary Hypertension Secondary Hypertension
Most common form (90-95% of cases) Less common form (5-10% of cases)
Unknown cause Identifiable underlying cause
Result of genetic, environmental, and lifestyle factors Result of medical conditions or medications
Diagnosed based on consistently elevated blood pressure Diagnosed by ruling out primary hypertension and identifying the specific cause
Treatment focuses on lifestyle modifications and medication Treatment focuses on addressing the underlying cause and managing blood pressure


Understanding the difference between primary and secondary hypertension is essential for proper diagnosis, treatment, and management. While primary hypertension is more common and has no identifiable cause, secondary hypertension results from an underlying condition or medication use. Healthcare providers diagnose and manage these two types of hypertension differently, with primary hypertension focusing on lifestyle modifications and medications, and secondary hypertension targeting the specific cause in addition to managing blood pressure. Regular monitoring of blood pressure and adherence to healthcare providers’ recommendations are crucial for preventing complications and maintaining overall health.

Early detection and intervention can make a significant difference in managing hypertension and reducing the risk of complications such as heart disease, stroke, and kidney disease.


  1. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289(19):2560-72. Link
  2. Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71(6):e13-e115. Link
  3. James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507-20. Link
  4. Rimoldi SF, Scherrer U, Messerli FH. Secondary arterial hypertension: when, who, and how to screen? Eur Heart J. 2014;35(19):1245-54. Link
  5. Tomaszewski M, White C, Patel P, Masca N, Damani R, Hepworth J, et al. High rates of non-adherence to antihypertensive treatment revealed by high-performance liquid chromatography-tandem mass spectrometry (HP LC-MS/MS) urine analysis. Heart. 2014;100(11):855-61. Link
  6. Viera AJ, Neutze DM. Diagnosis of secondary hypertension: an age-based approach. Am Fam Physician. 2010;82(12):1471-8. Link
  7. Gavras I, Gavras H. Benefits and side effects of blood pressure lowering treatment: what was wrong with doxazosin in the ALLHAT? Curr Control Trials Cardiovasc Med. 2001;2(6):257-259. Link
  8. Weber MA, Schiffrin EL, White WB, Mann S, Lindholm LH, Kenerson JG, et al. Clinical practice guidelines for the management of hypertension in the community: a statement by the American Society of Hypertension and the International Society of Hypertension. Journal of Clinical Hypertension. 2014;16(1):14-26. Link

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