Rethinking arterial hypertension: the need for a paradigm shift

Essential (primary or idiopathic) hypertension is presented as the most prevalent 'cause' of arterial hypertension, which is a paradoxical statement for a condition whose causes are unknown. The consequence of this description is that secondary hypertension is held to be exceptional and, therefore, very rarely sought for in current clinical practice. Labelling a hypertensive patient as 'essential' means that no further investigations will be undertaken to discover the cause of hypertension, therefore neglecting the possibility of long-term cure of hypertension and sentencing the patient to a life-long drug treatment.

We will describe how the notion of essential hypertension has developed and whether scientific evidence from the most recent studies still support the conclusion that it is highly prevalent. The concept of secondary hypertension along with the criteria to be used to define it as such are also being examined.

The evidence that secondary hypertension is highly prevalent, when systematically sought for, should increase the awareness of this condition and lead to a broader search for it, which are fundamental steps to achieve cure or a better control of high blood pressure, thus improving patients' outcome and quality of life.