High blood pressure (Hypertension) can be associated with numerous non specific symptoms. However, most commonly, raised blood pressure has no symptoms. Therefore, high blood pressure is considered a silent killer, the patient feels totally normal but many organs of the body are slowly damaged by the high blood pressure. This makes screening for hypertension by regular measurement of blood pressure very important.
In a person with hypertension, there can be general high blood pressure symptoms like headache, dizziness, palpitation, easy fatigability, etc. If hypertension is secondary to some other disease, a person may have symptoms of the primary condition. Prolonged hypertension damages many organs of the body, and there may be symptoms due to these complications of long standing hypertension. Finally, hypertension can also result in some serious life-threatening conditions and symptoms in this case vary depending on the specific hypertensive emergency.
Some patients with hypertension may present with symptoms like headache, dizziness, palpitation, blurred vision, nosebleeds, chest pain, breathlessness, impotence and easy fatigability. Headache generally occurs only when the blood pressure is very high. Headache typically occurs in the morning and is commonly localized to the back of the head. Similarly, dizziness is also more frequent in the morning. However, in most of the cases of essential hypertension, symptoms would be totally absent.
Most of the cases of high blood pressure are essential hypertension in which no cause of raised blood pressure could be discovered. However, many disease conditions can result in elevation of blood pressure, and such cases are referred to as secondary hypertension. A person with secondary hypertension may have symptoms of the primary disease condition (which is also causing an elevated blood pressure). Since the list of the causes of secondary hypertension is very big, only the most important ones are mentioned in the table below.
Raised blood pressure over very long duration (many years or decades) damages the various organs of the body. The organs most commonly affected are eyes, kidneys, heart, brain and the peripheral arteries. The various complications and the symptoms are mentioned in the table below.
Long standing hypertension or severe hypertension with extremely high blood pressure can result in various life-threatening hypertensive emergencies that require immediate medical care. Recognizing the symptoms of these conditions is very important so that one can seek immediate medical care. The most common hypertensive emergencies encountered are malignant hypertension, hypertensive encephalopathy, stroke, myocardial infarction (heart attack), acute left ventricular failure (heart failure) and aortic dissection. These are described in more detail in article on risks of hypertension here(can put link here). The symptoms of these conditions are mentioned in the table below.
Table 1: High Blood Pressure Symptoms
| General Symptoms | Headache, Dizziness, Palpitation, Easy Fatigability, Erectile Dysfunction, Blurred Vision, etc. |
| Symptoms in secondary hypertension
| Pheochromocytoma - Panic attacks, occasional headaches, palpitations, abdominal pain, nervousness, irritability, sweating, hand tremors, etc. Chronic pyelonephritis - Back Pain, fever, recurrent urinary tract infection, flank pain, malaise, etc. Polycystic Kidney Disease - Blood in urine, Abdominal and flank pain, excessive urination at night time, etc. Hyperaldosteronism - Headache, fatigue, muscle weakness, numbness, intermittent paralysis Cushing’s Syndrome - Rapid weight gain, central obesity, “moon” face, excessive sweating, stretch marks on skin, sleep disturbances, impotence in men, baldness, etc. Hyperparathyroidism - Abdominal pain, back pain, joint pain, muscle pain, bone pain, weakness, fatigue, fractures, personality changes, nausea and vomiting, increased thirst and urination, blurred vision, depression, etc. Hypothyroidism - Fatigue, joint and muscle pain, constipation, increased susceptibility to cold, depression, weakness, weight gain, etc. Hyperthyroidism - Nervousness, restlessness, difficulty in concentrating, frequent bowel movements, heat intolerance, increased appetite, weight loss, fatigue, irregular menstrual cycle in women, hand tremors, sleeping difficulty etc. Obstructive Sleep Apnea - Snoring during sleep, sleepy during the day, forgetfulness, headaches, fall asleep while working or any other task during daytime |
| Symptoms due to Complications | Retina (Eye) - Visual Field Defects, blindness Heart - Chest pain due to angina, Symptoms due to heart failure (shortness of breath, swelling of feet, fatigue, weakness, cough, increased urination at night, shortness of breath few hours after going to sleep Brain - Variable neurological symptoms depending on the part of brain affected by minor strokes. Transient loss of consciousness or temporary neurological symptoms due to TIA. Kidney - Swelling in the body due to protein loss in urine, Symptoms due to renal failure (nausea, vomiting, weight loss, swelling in various body regions (feet/legs/face/abdomen/generalized swelling), shortness of breath, loss of appetite, weakness, etc. Peripheral Arteries - Pain on walking for a short distance relieved by rest due to PAD. |
| Symptoms due to Hypertensive Emergencies | Malignant Hypertension - Blurred Vision, Headache, Dizziness, Altered Mental State (confusion, sleepiness), seizures, vomiting, chest pain, shortness of breath, swelling in feet Hypertensive Encephalopathy - Speech disturbances, visual disturbances, disorientation, loss of consciousness, seizures, paresthesias (altered sensations) Myocardial Infarction - Chest pain, shortness of breath, sweating, dizziness, fainting, cough, nausea and vomiting. Stroke - Variable neurological symptoms depending on which part of the brain is affected. Symptoms may be altered mental state, changes in hearing/vision/taste, dizziness, difficulty performing tasks (writing, reading, walking swallowing, urination etc.), weakness of arm/leg/face (usually unilateral), altered sensations (paresthesias) or numbness, etc. Acute Left Ventricular Failure - Sudden onset shortness of breath at rest that increases in severity with time. Coughing and wheezing can also occur. Aortic Dissection - Severe Chest pain (usually sudden sharp, stabbing or tearing pain radiating to the back). Other symptoms may include dizziness, sweating, anxiety, nausea and vomiting, shortness of breath. |
* TIA – Transient Ischemic Attacks, PAD – Peripheral Arterial Disease