Heart Health

Different Types of High Blood Pressure are Treated Differently

By Kim Crawford, M.D. Last updated: May 8, 2019
types of high blood pressure are detected by her

What is Hypertension?

High blood pressure is a common condition in which the long-term force of the blood against your artery walls is high enough such that it might eventually cause health problems, such as heart disease or strokes. In this article, you’ll see that the causes of hypertension are more varied than you might think. And the two types of high blood pressure that we still classify patients into is still used after decades and decades of the same nomenclature. First, let’s talk about how common this problem actually is-I think you’ll be shocked.

can't detect causes of hypertensionHypertension is a major public health problem. The American Heart Association estimates high blood pressure affects approximately one in three adults in the United States, or about 76.4 million people. Blood pressure is determined both by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. The more blood your heart pumps and the narrower your arteries, the higher your blood pressure. You can have high blood pressure (hypertension) for years without any symptoms. Even without symptoms, damage to blood vessels and your heart continues and can go undetected for quite a while.

Uncontrolled high blood pressure increases your risk of serious health problems, including heart attack and stroke. High blood pressure generally develops over many years, and it affects nearly everyone eventually unless you enhance certain metabolic pathways I’ll be discussing. Fortunately, high blood pressure can be easily detected. And once you know you have high blood pressure, you can generally get it under control.

Symptoms and Types of High Blood Pressure

Most people with high blood pressure have no signs or symptoms, even if blood pressure readings reach dangerously high levels. A few people with high blood pressure may have headaches, shortness of breath or nosebleeds, but these signs and symptoms aren’t specific and usually don’t occur until high blood pressure has reached a severe or life-threatening stage. It’s an urban legend that everyone gets headaches-most people don’t. There are two types of high blood pressure. This is getting antiquated with all of the metabolic knowledge we have but it’s still called either primary or secondary. These describe not only the types of high blood pressure but also the causes. Here’s why.

Causes of hypertension

1. Primary (essential) hypertension

For most adults, there’s no identifiable cause of high blood pressure. This type of high blood pressure, called primary (essential) hypertension, tends to develop gradually over many years. my hunch is that many of these cases are due to the “newly recognized” causes of secondary hypertension I’ll discuss below.

2. Secondary hypertension

Some people have high blood pressure caused by an underlying condition. This type of high blood pressure, called secondary hypertension, tends to appear suddenly and cause higher blood pressure than does primary hypertension. Various conditions and medications can lead to secondary hypertension, including:

  • Obstructive sleep apnea
  • Kidney problems
  • Adrenal gland tumors (pheochromocytomas) or rare middle GI tract tumors (carcinoids)
  • Thyroid problems
  • Certain defects in blood vessels you’re born with (congenital)
  • Certain medications, such as birth control pills, cold remedies, decongestants, over-the-counter pain relievers and some prescription drugs
  • Illegal drugs, such as cocaine and amphetamines
  • Alcohol abuse or chronic alcohol use

Newer recognized causes of secondary hypertension

With many people seeking out functional medicine practitioners; we’re often asked for natural solutions to blood pressure issues. Sometimes we need to use medications until, for example, weight is lost, or when CIRS (see below) is in it’s early stages. However, there are many natural solutions which can be used to combat the three things I’ll discuss next, with articles in this blog dedicated to those topics and behavioral/supplement discussions. Please note that hypertension is always a result of systemic inflammation. Inflammation is caused by eating inflammatory foods, being overweight, even harboring toxins and allergens. That always needs to be addressed first and foremost. Here is a sampling of what else we’re looking for when we detect high blood pressure.

SIRT1 deficiency

Sirtuins are a group of protein enzymes which are decreased in many metabolic disorders such as obesity and metabolic syndrome. An ample amount of  SIRT1 (the most well-studied sirtuin) causes an increase in leptin sensitivity and adiponectin production; both having anti-obesity, anti-metabolic syndrome and thus anti-hypertensive effects. Mitochondrial dysfunction disorders such as neurodegenerative disorders (Alzheimer’s disease), auto-immune disorders (Crohn’s disease), and fatiguing illness (CFS) also are associated with SIRT1 deficiency, with risk for metabolic syndrome, including elevations in blood pressure.

Nitric Oxide deficiency

One of the benefits of nitric oxide is that it protects the lining of blood vessels and vasodilates them. When arteries are damaged by inflammation (obesity, elevated CRP and so on), we see a decrease in nitric oxide near the blood vessel linings. We also see NO levels decrease with age.

VIP decrease

Vasoactive Intestinal Peptide is a newly “watched” blood test marker. It is helpful for many bodily functions including keeping blood vessels dilated. When it drops too low, blood pressure rises. This is commonly seen in patients with biotoxin illness from mold toxins or lyme disease (CIRS).

When to see a doctor

can detect types of high blood pressureYou’ll likely have your blood pressure taken as part of a routine doctor’s appointment. Ask your doctor for a blood pressure reading annually starting at age 18. Blood pressure generally should be checked in both arms to determine if there is a difference. Your doctor will recommend more frequent readings if you’ve already been diagnosed with high blood pressure or other risk factors for cardiovascular disease.

If you have a biotoxin illness, are overweight or have had other elevations in inflammatory markers your blood pressure should be more closely monitored- every 3 months unless it is super low (110/70 or less).

Children age 3 and older will usually have blood pressure measured as a part of their yearly checkups. If you don’t regularly see your doctor, you may be able to get a free blood pressure screening at a health resource fair or other locations in your community.

You can also find machines in some stores that will measure your blood pressure for free. Common places to look include pharmacies and grocery stores.

Public blood pressure machines, such as those found in pharmacies, may provide helpful information about your blood pressure, but they may have some limitations. The accuracy of these machines depends on several factors, such as a correct cuff size and proper use of the machines. Ask your doctor for advice on using public blood pressure machines.

Blood pressure treatment goals

It’s different, depending on your age. You want it less tightly controlled if you are 75 or older. If this is the case you want it to be equal to or less than 150/90 mm Hg. Why so “high?” Going “too tight” on blood pressure control leads to decreased cerebral (brain) blood flow. In between 60 and 75 we look at what is happening clinically and (In my opinion) should actually do so with healthy 75 year olds.

If you’re 60 or less (or a “young” 70-75) we want your blood pressure to be equal to or less than 115/75 (not the “old” 120/80) with a good bit of evidence that less is better if you’re a healthy adult younger than age 60. Also, people older than 60 commonly have isolated systolic hypertension — when diastolic pressure is normal but systolic pressure is high. That still needs treatment. The category of medication your doctor prescribes depends on your blood pressure measurements and your other medical problems.

Treatment other than pharmaceuticals

1. Eat a healthier and of course I need to add anti-inflammatory diet with less table salt (the Dietary Approaches to Stop Hypertension, or DASH, diet) although “the whole salt thing” is being disproved in many recent studies. It appears that table salt might be an issue for everything from leaky gut to metabolic disease but sea salt doesn’t cause problems. By the way, that wasn’t an endorsement for the DASH diet. You’re better off going anti-inflammatory and switching to sea salt “for taste.”

2. Exercise regularly.

3. Quit smoking – this is a must for all sorts of reasons.

4. Limit the amount of alcohol you drink to 1-2 beverages nightly; tops.

5. Achieve a normal weight. Maintaining a healthy weight or losing weight if you’re overweight or obese might be all you need to do. If this is an issue just know obesity has surpassed smoking as the #1 risk factor for heart disease and cancer so you need to address this ASAP. If you need to lose weight, check out this website for a lot of information to help or ask me for a consult.

6. Supplement to enhance good metabolic pathways. Get rid of oxidative stress with vitamins and anti-oxidant powders. Banish inflammation with weight normalization and DHA, ECGC, and curcumin. Achieve a normal blood sugar with alpha lipoic acid and berberine. Enhance SIRT and leptin pathways. Optimize mitochondrial function. Try natto or take nattokinase supplements. Every bit of information you need is here in this website. Enjoy- and get that blood pressure down for good!



  1. High blood pressure is not a “disease” to be treated, it’s a symptom (inflammation related) that indicates there’s an underlying problem. Treating high blood pressure with medication, is like tying to fix your car from overheating by working on the temperature gauge. Blood pressure medications are dangerous, because they hide and suppress the warning sign of something bigger. Blood pressure meds slow down and put a damper on the metabolic warning process you need to alert you to another issue.

    • Mike-
      You are right about inflammation which I discussed in this article. But have you ever been a doctor faced with a truly inflamed patient who has a BP of 185/115? When it’s this level we must act- we can pontificate all we want about how they need to get their inflammation under control but if they have a stroke while we’re doing so it is malpractice. Of course my goal is to never use pharmaceuticals unless truly needed. Anti-hypertensive medication is something to be used transiently, if at all.

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