Types of high blood pressure

High blood pressure is usually defined as primary high blood pressure (essential hypertension) and secondary high blood pressure.

Around 95% of people have primary high blood pressure and the remaining 5% have secondary high blood pressure.

Are there any other types?

Yes there are although these are much rarer and tend to be variations of primary high blood pressure. These include:

• White coat hypertension
• Resistant hypertension
• Pulmonary hypertension
• Malignant hypertension
• Pseudo-hypertension
• Pregnancy-induced hypertension
• Children/teenage hypertension

These are much less common but nevertheless, they do occur so it is important to understand what they are and their effects on your health.

White coat hypertension

White coat hypertension or the ‘white coat effect’ is where a person’s blood pressure is raised when they visit their GP. In other words, they only have high blood pressure at their doctor’s surgery.

This person may be fit and healthy and have normal blood pressure but their blood pressure increases in a medical environment.

This more than likely a case of anxiety or feeling apprehensive about having one’s blood pressure measured. The difference in readings at home and when taken at your GP’s surgery can be quite dramatic. In some cases the systolic reading (the top number) can be as much as 20 to 30mmHg higher in a doctor’s surgery than at home.

If you have high blood pressure readings each time you visit your GP but which are otherwise normal when you are at home then you probably have white coat hypertension.

This can make it difficult to determine if you have high blood pressure or whether you have white coat hypertension as an anxiety reaction.

What causes this form of high blood pressure?

To start with your blood pressure rises and falls throughout the day. This is usually in response to what you are doing, e.g. exercise, what you have consumed, e.g. caffeine or a reaction to events around you, e.g. stress. So if your have been exercising or have drunk a cup of coffee before having your blood pressure measured then this is likely to be higher than normal. But your blood pressure can increase as a reaction to being in a medical environment and undergoing a procedure which many people find stressful. In fact, many people do not always realise that they are nervous when they are in their GP’s surgery.

In most cases it is a sign of anxiety but it can also be an indicator of an underlying problem which must be looked into further.

What can be done about it?

The answer to this is to compare blood pressure readings taken at home with those at a GP’s surgery. This can be done as 24 hour ‘ambulatory’ monitoring or via a home blood pressure monitor.

Both of these are discussed further in our diagnosing high blood pressure section.

Another option is for you to try and relax before you visit your GP. Many people find that their anxiety decreases the more times they have their blood pressure taken which suggests that they have become accustomed to this procedure. The more you are used to something the more relaxed you are about it.

But if you find that you experience this every time you have your blood pressure checked then your GP will look at home monitoring or observation. It is possible to develop high blood pressure as a result of white coat hypertension so you will need to have your blood pressure checked on a regular basis.

Resistant hypertension

This is a form of high blood pressure which fails to respond to treatment - hence the name ‘resistant hypertension’. This occurs in spite of the many forms of treatment available. Resistant hypertension can also occur in people with adrenal gland problems and fluid retention as a side effect of kidney failure. These are both forms of secondary high blood pressure. There is another reason which can be the most difficult to deal with called ‘patient non-compliance’. This means that the patient has not followed the treatment plan although there may be several reasons for not doing so. One possible reason is side effects: if a patient is taking a form of medication for high blood pressure but this causes some unpleasant side effects such as vomiting then they will stop taking this medication.

In this situation, the GP can prescribe another form of medication which is less likely to cause this effect.

If there is an underlying medical condition such as kidney disease then this will need to be investigated further before being treated.

If you experience this form of high blood pressure then your GP will work with you to discover the cause of this non-response to treatment. Rest assured that there are solutions to this.

Pulmonary hypertension

This is a very specific form of hypertension in that it only affects the heart and lungs - which form part of the circulatory system. Over time it affects the heart’s capacity to pump blood around the body and the lung’s ability to transfer oxygen.

It affects the part which connects these two together, known as the pulmonary artery or vein. If blood pressure in either of these is raised, say around 30mmHg then it is classed as high blood pressure.

People suffering from sleep apnoea or chronic liver disease have an increased risk of pulmonary hypertension.

Symptoms of this include shortness of breath and fatigue. These worsen over time to include chest pain, loss of appetite and fainting during exertion. These symptoms appear very similar to those which indicate heart failure.

This is a serious form of hypertension which requires treatment as soon as possible. Treatment options include diuretics to remove any excess fluid (which can put a strain on the heart) and anti-coagulants to prevent blood clots from forming. Exercise is also recommended as this will help to strengthen the heart muscle and the cardiovascular system in general.

Malignant hypertension

A rare but potentially fatal form of high blood pressure. This very high level of pressure causes bleeding in the retinas in both eyes but can also affect other organs in the body, for example the kidneys.

In fact, almost any organ in the body is at risk of serious damage.

No-one is quite sure what causes it but it does appear to affect certain groups of people more than others such as those of African descent, those with kidney failure and pregnant women who have developed complications , e.g. toxaemia of pregnancy.

Younger people are more likely to be affected than older people which are contrary to the normal risk factors for high blood pressure. High blood pressure tends to affect middle aged and older people.

The problem with malignant hypertension is that the symptoms can be very similar to other medical conditions so a prompt diagnosis is needed. Also the symptoms are usually related to which organ of the body has been affected, e.g. the kidneys. So, you may experience a decrease in urine production, headache, and shortness of breath, chest pains and dizziness. Be aware that these symptoms are very similar to those of a heart attack or stroke so seek urgent medical advice.

Pseudo-hypertension

This is an unusual condition in that it people with normal blood pressure appear to have high blood pressure. So, someone who is fit and well with a normal level will show a very high blood pressure reading.

The problem with this is that they are then prescribed medication to treat their ‘high blood pressure’ but this has the opposite effect and results in low blood pressure instead.

This is a rare form of hypertension but it is more likely to develop in older people. The reason for this is that the arteries harden as we age and become narrower as well. This means that they are less elastic and less able to push blood through them and around the body. What can happen is that the patient’s blood pressure appears to be high but there are no signs of organ damage or other related problems.

Attempts to treat this condition often result in low blood pressure which causes dizziness and fainting. If you experience these then your GP will suspect that you have pseudo-hypertension.

Pregnancy-induced hypertension

This is a form of high blood pressure which affects pregnant women. Also known as gestational hypertension, it occurs during pregnancy and along with bleeding and infection is a major risk factor during this time.

It often settles down after pregnancy but in some cases it does not which can be harmful to both mother and baby. This is discussed in greater detail in our women and high blood pressure section.

Children/teenage hypertension

Many people are surprised to learn that young children and teenagers can develop high blood pressure.

We tend to think of this as something which only affects adults but young people can also be affected.

They develop the same type of high blood pressure as adults -primary high blood pressure which affects 95% of cases.

High blood pressure in children and teens is caused by several factors which include a family tendency, poor diet, being overweight or obese and a lack of exercise.

In other words, they develop this for much the same reasons an adult does.

If you are the parent of a child or teenager and want to know more about this then visit our children and high blood pressure section.

These types of high blood pressure tend to be rare and it is more than likely you will have the more common primary high blood pressure.

High blood pressure is a common medical problem, but there are a few myths which surround this condition which are discussed in the next section.