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Hypertension

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	- Introduction - Causes - Diagnosis - Treatment
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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 pressure screening.

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.

Complications

• Malignant hypertension
• Hypertensive cardiomyopathy
• Hypertensive retinopathy
• Hypertensive nephropathy
• Atrial fibrillation
• Hypertension of pregnancy:
  • Pre-eclampsia
  • Eclampsia

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Diagnosis

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 disc.

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.

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