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This occurs in 10-15% of white adults and 20-30% of black adults in the USA.

The onset is usually between ages 25-55 and it is uncommon before age 20.

Sympathetic nervous system hyperactivity- Sympathetic nervous system hyperactivity is most apparent in younger hypertensives, who may exhibit tachycardia and an elevated cardiac output. Renin-angiotensin system- Renin, a proteolytic enzyme, is secreted by the juxtaglomerular cells surrounding afferent arterioles in response to a number of stimuli, including reduced renal perfusion pressure, diminished intravascular volume, circulating catecholamines, increased sympathetic nervous system activity, increased arteriolar stretch, and hypokalemia.

Blood pressures taken by the patient at home or during daily activities using a portable apparatus are often lower than those recorded in the office, clinic, or hospital and may be more reliable in estimating prognosis.Cigarette smoking raises blood pressure, again by increasing plasma norepinephrine..Although the long-term effect of smoking on blood pressure is less clear, the synergistic effects of smoking and high blood pressure on cardiovascular risk are well documented.Hypertension increases with age and is more common in blacks than in whites.The mortality rates for stroke and coronary heart disease, the major complications of hypertension, have declined by up to 60% over the past 30 years but have leveled off.

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Patients with daytime average pressures less than 135/85 mm Hg have a low rate of cardiovascular complications and a low prevalence of left ventricular hypertrophy, suggesting that this is an appropriate ambulatory blood pressure criterion for diagnosing hypertension.

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