Updated 07 July 2014

Types of hypertension

Types of hypertension.


There are two major types of hypertension and four less frequently found types.

The two major types are:

  • Primary or essential hypertension, that has no known cause, is diagnosed in the majority of people.
  • Secondary hypertension is often caused by reversible factors, and is sometimes curable.

The other types include:

  • Malignant Hypertension.
  • Isolated Systolic Hypertension
  • White Coat Hypertension
  • Resistant Hypertension

Primary Hypertension

This type is also called essential hypertension, and it is by far the most common type of hypertension, and is diagnosed in about 95% of cases. Essential hypertension has no obvious or yet identifiable cause.

Secondary Hypertension:

This may be caused by:

  • Kidney damage or impaired function (This accounts for most secondary forms of hypertension.)
  • Tumours or overactivity of the adrenal gland
  • Thyroid dysfunction
  • Coarctation of the aorta
  • Pregnancy-related conditions
  • Sleep Apnea Syndrome
  • Medication, recreational drugs, drinks & food

Malignant Hypertension

This, the most severe form of hypertension, is severe and progressive. It rapidly leads to organ damage. Unless properly treated, it is fatal within five years for the majority of patients.  Death usually comes from heart failure, kidney damage or brain haemorrhage. However, aggressive treatment can reverse the condition, and prevent its’ complications. Malignant hypertension is becoming relatively rare, and is not caused by cancer or malignancy.

Isolated Systolic Hypertension

In this case the systolic blood pressure, (the top number), is consistently above 160 mm Hg, and the diastolic below 90 mm Hg. This may occur in older people, and results from the age-related stiffening of the arteries. The loss of elasticity in arteries, like the aorta, is mostly due to arteriosclerosis. The Western lifestyle and diet is believed to be the root cause.

Latest studies confirm the importance of treating ISH, as it significantly reduces the incidence of stroke and heart disease. Treatment starts with lifestyle modification, and if needed, added drugs.

White coat hypertension

Also called anxiety-induced hypertension, it means blood pressure is only high when tested by a health professional.  If confirmed, with repeat readings outside of the clinical setting, or a 24-hour monitoring device, it does not need to be treated.  However, regular follow-up is recommended to ensure that persistent hypertension has not developed.

Lifestyle changes like more exercise, less salt and alcohol, no nicotine and weight loss, would be wise.  A low fat, high fibre diet, with increased fruit and vegetable intake, will be beneficial.

Resistant Hypertension

If blood pressure cannot be reduced to below 140/90 mmHg, despite a triple-drug regime, resistant hypertension is considered.

(Dr Kathleen Coetzee)


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Hypertension expert

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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