Here Are the 15 Most Common Causes and Risk Factors for Hypertension

An estimated 47% of U.S. adults have hypertension, also called high blood pressure. Hypertension can raise your risk of heart disease and stroke. Since it usually does not cause symptoms until problems arise, it is often called the “silent killer.” Here, we’ll look at the causes of hypertension, including risk factors, and address what you can do to lower your risk.

What causes high blood pressure? 

There are many things that can affect your blood pressure. Some may be under your control, while others may not. Ninety-five percent of the time, hypertension is the result of multiple risk factors combined. Many people may share the same risk factors, but their blood pressure may react in different ways. In only about 5% of cases, one clear and reversible medical cause can be found.

The American Heart Association’s (AHA) most recent blood pressure guidelines address the causes and risk factors for hypertension in great detail. We’ll review these below, but rare causes of high blood pressure are not addressed in this article.

Common causes and risk factors for hypertension 

1. Gender

Men under the age of 60 are more likely to have hypertension than women. After 60, women start to take the lead.

2. Older age

Older people tend to experience higher rates of hypertension. For example, nearly 75% of people ages 65 and older are estimated to have hypertension. In contrast, only about 27% of men and 12% of women in their 20s have hypertension. 

3. Race 

Black and South Asian Americans are more likely to have hypertension compared with other racial groups. About 45% of people in these groups have high blood pressure compared with 27% of Caucasians and 33% of Hispanics. 

4. Genetics

Certain genes in your DNA are linked to a higher risk for hypertension. Although there is little we can do to change our genetics, it’s important to know about your family history. If your family members have hypertension, you may also be at greater risk. There are also certain physical conditions that you may be born with that can raise your blood pressure. These include problems with the aorta and other blood vessels, which are usually diagnosed in childhood.

5. Having overweight or obesity

People who have overweight or obesity tend to have higher blood pressure than those who do not. In fact, excess weight may be responsible for up to 75% of all cases of hypertension. Scientists are still trying to understand why, but evidence suggests that excessive weight may: 

• Cause fluid retention

• Harm the kidneys

• Affect hormone balance

• Cause inflammation and injury to the blood vessels

• Contribute to sleep apnea, which is another risk factor for hypertension

6. Eating too much sodium

Americans tend to overeat salt, often known as sodium chloride. And too much of it in your diet may raise your risk of hypertension. Processed foods and restaurant food are the most salt-heavy sources. The latest CDC guidelines recommend less than 2300 mg of sodium a day. On average, Americans eat over 3400 mg daily. Lowering that amount by just 1000 mg can have great benefits.

This is because too much salt can raise your risk of stroke, heart problems, and other health issues. 

Plus, certain people may have greater sensitivity to salt. These include:

• Adults over 65

• Black Americans

• People with obesity 

• People living with diabetes

• Those with kidney problems 

For more tips, you can read the CDC’s guide to lower salt in your diet. 

7. Eating too little potassium

Not enough potassium can also be a problem. We get potassium from fruits and vegetables, so it’s important to include these foods in your diet. The AHA recommends eating 4700 mg of potassium a day. 

Some health conditions and medications can affect how your body processes potassium. Make sure to talk to your provider before you make a big change in your diet. And unless you and your provider watch your health on a regular basis, try to avoid potassium supplements. 

8. Sedentary (inactive) lifestyle

The less active you are, the higher your risk of developing hypertension. This seems to be especially true for Black men. To lower your risk, a regular exercise program or even a daily walk, may help. 

9. Chronic, excessive alcohol consumption

Excessive alcohol use is a known cause of high blood pressure. Drinking too much alcohol can also raise your cholesterol and triglyceride levels. Alcohol can have other harmful effects on your health as well. For these reasons, it’s best to keep your alcohol intake to less than two drinks a day for men and less than one drink a day for women*.

*One drink is defined as 12 oz beer, 4 oz of wine, 1.5 oz of 80-proof spirits, or 1 oz of 100-proof spirits.

10. Medication side effects

Certain medications can raise your blood pressure as a side effect. This includes both prescription drugs and over-the-counter pills and supplements. Check in with your healthcare provider or pharmacist if your blood pressure goes up suddenly. Sometimes, a simple change in your medications can make a difference.

11. Smoking

The AHA report did not specifically list smoking as a risk factor for high blood pressure. But it did mention the importance of quitting. Some studies have found that smoking may contribute to hypertension, especially in men over the age of 45.

12. High blood sugar

Diabetes, or high blood sugar, is another risk factor that has a less clear effect on blood pressure. For that reason, it was not part of the AHA list of risk factors. Yet, there is good evidence that if you have chronically high blood sugar, you may be at risk for developing hypertension later in life.

Several medical conditions can cause blood pressure to rise, too. In some cases, treating these problems can reverse hypertension. Below are a few examples.

13. Kidney problems

The kidneys are responsible for getting rid of many waste products through the urine. When the kidneys don’t work well, they are less able to flush out fluid and toxins. This can lead to hypertension. Many things can cause trouble for the kidneys, and the cause is not always obvious. For example, narrowed arteries to the kidneys can lead to hypertension. But blood and urine tests can help find the source of the trouble. In some cases, specialized imaging testing is needed.

14. Obstructive sleep apnea

Many people with sleep apnea will develop hypertension. If you experience disrupted sleep or heavy snoring, it is important to talk to your healthcare provider. A sleep study can help you determine if you have sleep apnea. If so, you may need a breathing device (known as a CPAP machine) or a special mouth guard to use at night. Treating sleep apnea may help to lower your blood pressure and improve your quality of life.

15. Hormonal changes

Many hormones in your body work together to control your blood pressure. When the balance of these hormones is off, you might experience a change in your blood pressure. For instance, trouble with the thyroid gland and adrenals can lead to high blood pressure. With a few simple blood tests, your provider can help you confirm if your hormone levels are out of balance. 

Pregnancy and birth control pills may also affect blood pressure for some women, especially when other risk factors are present.

How do I know if my blood pressure is too high?

High blood pressure can happen without causing any symptoms. That’s why the best way to know if you have hypertension is to check your blood pressure periodically. 

If you’re under the age of 40, have a low risk based on the above list, and have normal blood pressure currently, you should get screened every 3 to 5 years. If you’re 40 or older, you should be screened yearly. 

Symptoms that are sometimes associated with hypertension include: 

• Headaches

• Nosebleeds

• Heart palpitations

More worrisome symptoms need urgent evaluation in an ER or urgent care. These include: 

• Blurry vision

• Chest pain

• Shortness of breath 

• Confusion 

• Numbness or weakness on one side of the body

Why trust our experts?

Written by:

Sarah A. Samaan, MD

Sarah Samaan, MD, FACC, FACP, FASE is a board-certified cardiologist who practiced clinical cardiology for nearly 30 years. She is a member of the American College of Cardiology, the American College of Physicians, and the American Society of Echocardiography.

Edited by:

Samvida Patel, MNSP, INHC

Samvida Patel, MNSP, INHC, is a health editor at GoodRx. She is a nutritionist and integrative nutrition health coach with over 8 years of experience in health communications.

Reviewed by:

Mandy Armitage, MD

Mandy Armitage, MD, has combined her interests in clinical medicine with her passion for education and content development for many years. She served as medical director for the health technology companies HealthLoop (now Get Well) and Doximity.

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Are you at high risk for high blood pressure?

Certain genetic and lifestyle factors can put you at greater risk for developing high blood pressure (also known as hypertension), which can lead to heart disease, stroke, and kidney disease. Understand your risk so you can take steps now to help prevent future health problems. This is for informational use only. It’s not a substitute for professional medical advice, a diagnosis, or endorsement of treatment. Always consult a doctor. By continuing, you agree to our privacy policy and terms of use.

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