Back to Cardiovascular Diseases
Updated: September 19, 2006
Symptoms and signs
Hypertension can progress without symptoms (silently) to finally
develop any one or more of the several potentially fatal
complications of hypertension such as heart attacks or strokes. As a
matter of fact, uncomplicated hypertension may be present and remain
unnoticed for many years, or even decades. This happens when there
are no symptoms, and those affected fail to undergo periodic blood
Some people with uncomplicated hypertension, however, may
experience symptoms such as headache, dizziness, shortness of
breath, and blurred vision. The presence of symptoms can be a good
thing in that they can prompt people to consult a doctor for
treatment and make them more compliant in taking their medications.
Not infrequently, however, a person's first contact with a physician
may be after significant damage to the end-organs has occurred.
About 1% people with hypertension is diagnosed with severe high
blood pressure (accelerated or malignant hypertension) at their
first visit to the doctor. In these patients, the diastolic blood
pressure (the minimum pressure) exceeds 140 mm Hg! Affected persons
often experience severe headache, nausea, visual symptoms,
dizziness, and sometimes kidney failure. Malignant hypertension is a
medical emergency and requires urgent treatment to prevent a stroke.
- Malignant hypertension
- Hypertensive cardiomyopathy
- Hypertensive retinopathy
- Hypertensive nephropathy
- Atrial fibrillation
- Hypertension of pregnancy:
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Hypertension is diagnosed using a sphygmomanometer according to
the guidelines outlined in the definition above. A
blood pressure of 140/90 or above measured on both arms at two
instances (several weeks apart) is considered high blood pressure.
Chronic high blood pressure can lead to an enlarged heart, kidney
failure, brain or neurological damage, and changes in the retina at
the back of the eyes. Examination of the eyes in patients with
severe hypertension may reveal damage--narrowing of the small
arteries, small hemorrhages in the retina, and swelling of the optic
People with high blood pressure have an increased stiffness or
resistance in the peripheral arteries throughout the tissues of the
body. This increased resistance causes the heart muscle to work
harder to pump the blood through these blood vessels. The increased
workload can put a strain on the heart, which can lead to heart
abnormalities that are usually first seen as enlarged heart muscle.
Enlargement of the heart can be evaluated by chest x-ray,
electrocardiogram, and most accurately by echocardiography.
Ecocardiography is especially useful in determining the enlargement
of the left side of the heart. Heart enlargement may be a forerunner
of heart failure, coronary artery disease, and cardiac arrhythmias.
Proper treatment of the high blood pressure and its complications
can reverse some of these heart abnormalities.
Blood and urine tests may be helpful in detecting kidney
abnormalities in people with high blood pressure, although kidney
damage can itself be the cause or the result of hypertension. An
elevated level of serum creatinine indicates damage to the kidney.
In addition, proteinuria may reflect chronic kidney damage from
hypertension, even if the kidney function (as represented by the
blood creatinine level) is normal. In fact, protein in the urine
alone signals the risk of deterioration in kidney function if the
blood pressure is not controlled. Even small amounts of protein (microalbuminuria)
may be a signal of impending kidney failure and other vascular
complications from uncontrolled hypertension. Recent studies have
also suggested the angiotensin receptor blocking drugs may offer an
additional protective effect against strokes above and beyond
control of blood pressure. Other tests include testing blood glucose
as hypertension co-exists with diabetes in many instances, and
electrolytes (sodium and potassium) in a newly diagnosed
hypertension patient, particularly in young patients when secondary
hypertension is highly suspected.