Updated 06 October 2014

Risk factors for hypertension

Here are a few examples of people who have a major risk of developing hypertension, followed by complications and organ damage due to high blood pressure: smokers, diabetics, people over 50, overweight people.

 In 90 to 95% of cases there is no known cause of hypertension. However, there are factors that contribute to the problem, called risk factors. If you have two or more of these risk factors, your risk for hypertension can be classified as “high”.
Risk factors can be divided into three main categories:

1. Those you cannot control. These include your parents (determining your ethnicity, your genes and thus your family history) and your age.

2. Risk factors you can control. These include overweight, lack of exercise , smoking, wrong food choices, use of the contraceptive pill and several recreational drugs.

3. Associated diseases or organ damage that can also increase your total risk. These include high blood cholesterol levels, existing heart disease, angina, heart failure, diabetes, previous stroke (including so-called mini-strokes), kidney damage, damage to the retina of the eye, damage to the blood vessels.

Risk factors and associated conditions create a double-edged sword. Some risk factors will not only increases your chances of developing high blood pressure, but as soon as your are indeed hypertensive, some associated factors will increase your risk of developing complications such as cardiovascular disease and kidney failure. This, in turn, can increase blood pressure and a vicious cycle is the end result.

In summary, the following people display a major risk of developing hypertension, followed by complications and organ damage due to high blood pressure:

•    Smokers (controllable factor)
•    Those with high blood cholesterol levels (controllable factor)
•    Those with a family history, i.e. brother/sister, father/mother with high blood pressure, diabetes, heart problems or a stroke (uncontrollable factor)
•    Those with diabetes (uncontrollable factor)
•    People older than 50 years (uncontrollable factor)
•    African ethnicity (uncontrollable factor)
•    Those who are overweight, especially around the abdomen (controllable factor)
•    Those with a family history of early coronary artery disease in a parent or sibling. i.e. before age 45 for men or 55 for women (uncontrollable factor)
•    Those with bad eating habits, particularly sensitivity to sodium (salt) intake and low intake of potassium, magnesium and calcium
•    Those with a high intake of alcohol, i.e. more than two drinks daily (controllable factors)
•    Those with an inactive lifestyle (controllable factor)
•    The use of the Pill, steroids such as cortisone and anti-inflammatory drugs can all contribute to higher blood pressure. (controllable factor)
•    Abusers of drugs like “tik”, cocaine and other amphetamine-like drugs. Hypertension can be very dangerous in these circumstances.

Your doctor will take all your risk factors into account in an individualised management plan. It will influence decisions of when to start drug treatment, as well as the choice of medication. Special examinations and regular follow-up treatment will be needed to optimise your health.

Special note: Since hypertension often has no symptoms and may go undetected for years (it is often referred to as the silent killer), all adults, even if feeling healthy, should be screened for high blood pressure on an annual basis. Contrary to popular opinion, high blood pressure often occurs in younger people. Health care professionals should also routinely measure blood pressure in this group, especially if overweight or obese and there is a family history of hypertension.

(Reviewed and updated by Prof Brian Rayner, head of the division of nephrology and hypertension, University of Cape Town and Groote Schuur Academic Hospital, November 2010)


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Dr Jacomien de Villiers qualified as a specialist physician at the University of Pretoria in 1995. She worked at various clinics at the Department of Internal Medicine, Steve Biko Hospital, these include General Internal Medicine, Hypertension, Diabetes and Cardiology. She has run a private practice since 2001, as well as a consultant post at the Endocrine Clinic of Steve Biko Hospital.

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