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In 90 to 95 percent of high blood pressure cases, the cause is unknown. In fact, you can have high blood pressure for years without knowing it. That's why it is called "the silent killer.” When the cause is unknown, you have what is called "essential" or "primary hypertension." Factors that may lead to high blood pressure in the remaining 5–10 percent of cases, which are known as secondary hypertension, include:

• Kidney abnormality
• A structural abnormality of the aorta (the large blood vessel leaving the heart) existing since birth
• Narrowing of certain arteries
• These problems can usually be corrected. For example, doctors can repair a narrowed artery that supplies blood to a kidney. Most of these problems can be ruled out by a careful history, a physical examination, and a few tests. Special tests are sometimes needed, but these don't usually require a hospital stay.

Additional Resources:
http://edis.ifas.ufl.edu/fy199
http://edis.ifas.ufl.edu/fy305