Chronic hypertension history and symptoms

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Hypertension Main page

Overview

Causes

Classification

Primary Hypertension
Secondary Hypertension
Hypertensive Emergency
Hypertensive Urgency

Screening

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Assistant Editor-In-Chief: Taylor Palmieri

Overview

Thorough history-taking is crucial for the diagnosis and assessment of hypertension. Not only should history-taking be targeted to identify symptoms consistent with high blood pressure, but more importantly it should address risk factors and target organ damage. History-taking alone may be sufficient to diagnose some causes of secondary hypertension, such as drug-induced hypertension, and may guide healthcare providers towards individualized work-up and tailored management.

History

The vast majority of patients with hypertension are asymptomatic. Nonetheless, a thorough history-taking is still crucial for the diagnosis and assessment of hypertension. History-taking must always address possible risk factors and target organ damage. Additionally, history taking alone may be sufficient to diagnose some causes of secondary hypertension, such as drug-induced hypertension, and may substantially alter work-up and management. However, it is important to note that the diagnosis of hypertension cannot be made on one blood pressure measurement and symptoms alone. Frequent follow-up is thus necessary for appropriate diagnosis.


Symptoms

Most patients with hypertension are asymptomatic at the time of diagnosis. Common symptoms are listed below:

  • Headache
  • Blurry vision
  • Dyspnea
  • Epistaxis
  • Tinnitus
  • Fatigue
  • Drowsiness
  • Other symptoms that might suggest secondary etiologies of hypertension, such as pregnancy, snoring, hair loss, flushing, palpitations, syncope etc.


Blood Pressure History

  • Current blood pressure values outside clinic
  • Previous blood pressure values


Risk Factors

  • Age
  • Ethnicity
  • Tobacco
  • Medications
  • Family history
  • Alcohol
  • Dyslipidemia
  • Diabetes mellitus
  • Known cardiovascular diseases
  • Known kidney diseases
  • Diet
  • Obesity
  • Sedentary lifestyle


Target Organ Damage

Heart

  • Angina
  • Prior MI
  • Prior coronary revascularizations
  • Aneurysm
  • Symptoms of heart failure
  • Symptoms of peripheral vascular disease (PVD)

Brain

  • Stroke
  • Intracranial hemorrhage
  • Transient ischemic attack (TIA)
  • Dementia

Kidneys

  • Proteinuria
  • Hematuria
  • Renal failure

Eyes

  • Retinopathy

2013 ESH/ESC Guidelines For The Management of Arterial Hypertension (DO NOT EDIT)[1]

Summary of Recommendations on History (DO NOT EDIT)[1]

Class I
"1. It is recommended to obtain a comprehensive medical history and physical examination in all patients with hypertension to verify the diagnosis, detect causes of secondary hypertension, record CV risk factors, and to identify organ damage and other CVDs. (Level of Evidence: C)"
"2. Obtaining a family history is recommended to investigate familial predisposition to hypertension and CVDs. (Level of Evidence: B)"

References

  1. 1.0 1.1 Authors/Task Force Members. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A; et al. (2013). "2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)". Eur Heart J. 34 (28): 2159–219. doi:10.1093/eurheartj/eht151. PMID 23771844.

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