Symptoms

Hypertension is rarely followed by any symptoms, and its identification is typically through screening or when seeking health care for a dissociated problem. A proportion of people with high blood pressure describe headaches especially at the back of the head as well as dizziness, buzzing or hissing in the ears, vertigo, altered vision or fainting episodes.These symptoms of hypertension however are more likely to be related to

associated anxiety than the high blood pressure itself.

On physical examination, hypertension may be suspected on the basis of the presence of hypertensive retinopathy detected by examination of the optic funds found in the back of the eye using ophthalmoscopy. Classically the severity of the hypertensive retinopathy changes grades from grade I–IV, although the milder types may be difficult to distinguish from each other. Ophthalmoscopy findings may also give some indication as to how long a person has been hypertensive.

 Secondary Hypertension 

Some additional symptoms may suggest secondary hypertension, i.e. hypertension due to an identifiable cause such as kidney diseases or endocrine diseases. Thyroid disease and acromegaly can also cause hypertension and have characteristic symptoms and signs. An abdominal bruit may be an indicator of renal artery stenosis, while decreasing blood pressure in the lower extremities and/or delayed or absent femoral arterial pulses may indicate aortic coarctation. Labile or paroxysmal hypertension accompanied by headache, palpitations, pallor, and perspiration should prompt suspicions of pheochromocytoma. A proportion of resistant hypertension appears to be the result of chronic high activity of the autonomic nervous system. This concept is known as "neurogenic hypertension".

 Hypertensive Crisis 

Severely elevated blood pressure is referred to as a "hypertensive crisis", which confer a high risk of complications. People with high blood pressure may have no symptoms, but are more likely to report headaches and dizziness than the general population. Other symptoms accompanying a hypertensive crisis may include visual deterioration or breathlessness due to heart failure or a general feeling of malaise due to renal failure. This may include hypertensive encephalopathy, caused by brain swelling and dysfunction, and characterized by headaches and an altered level of consciousness.Chest pain may indicate and which may create heart muscle damage or a sometimes aortic dissection, the tearing of the inner wall of the aorta. Rapid deterioration of kidney function (acute kidney injury) and microangiopathic hemolytic anemia (destruction of blood cells) may also occur. In these situations, rapid reduction of the blood pressure is mandated to stop ongoing organ damage.

 In Pregnancy 

Hypertension occurs in approximately 10% of pregnancies. Most women with hypertension in pregnancy have pre-existing primary hypertension, but high blood pressure in pregnancy may be the first sign of pre-eclampsia, a serious condition of the second half of pregnancy and puerperium. Pre-eclampsia is characterized by increased blood pressure and the presence of protein in the urine. It occurs in about 5% of pregnancies and is responsible for approximately 16% of all maternal deaths globally. When symptoms of pre-eclampsia occur the most common are headache, vomiting, epigastric pain, visual disturbance often flashing lights and edema. Pre-eclampsia can occasionally progress to a life-threatening condition called eclampsia, which is a hypertensive emergency and has several serious complications including cerebral edema, vision loss, renal failure, seizures or convulsions, disseminated intravascular coagulation and pulmonary edema.

 In Infants and Children 

Failure to thrive, irritability, seizures, lack of energy and difficulty breathing can be associated with hypertension in neonates and young infants. In older infants and children hypertension can cause unexplained irritability, headache, failure to thrive, fatigue, facial paralysis, nosebleeds and blurred vision.