Chronic hypertension history and symptoms

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

Hypertension is usually found incidentally by healthcare professionals during a routine checkup. The only test for hypertension is a blood pressure measurement.

History and Symptoms

Hypertension in isolation usually produces no symptoms although some people may report either:

• Blurred vision
• Dizziness
• Facial flushing (suspect pheochromocytoma if this and headaches are present)
• Fatigue
• Headaches
• Tinnitus

Malignant hypertension (or accelerated hypertension) is distinct as a late phase in the condition, and may present with headaches, blurred vision and end-organ damage. Large lunulae (more than 25% of the thumb nail) are also a sign of high blood pressure.

Accelerated hypertension is associated with somnolence, confusion, visual disturbances, and nausea and vomiting (hypertensive encephalopathy).

Hypertensive Urgencies and Emergencies

Hypertension is rarely severe enough to cause symptoms. These typically only surface with a systolic blood pressure over 240 mmHg and/or a diastolic blood pressure over 120 mmHg. These pressures without signs of end-organ damage (such as renal failure) are termed "accelerated" hypertension. When end-organ damage is possible or already ongoing, but in absence of raised intracranial pressure, it is called hypertensive emergency. Hypertension under this circumstance needs to be controlled, but prolonged hospitalization is not necessarily required. When hypertension causes increased intracranial pressure, it is called malignant hypertension. Increased intracranial pressure causes papilledema, which is visible on ophthalmoscopic examination of the retina.

Children and Adolescents

As with adults, blood pressure is a variable parameter in children. It varies between individuals and within individuals from day to day and at various times of the day. The epidemic of childhood obesity, the risk of developing left ventricular hypertrophy, and evidence of the early development of atherosclerosis in children would make the detection of and intervention in childhood hypertension important to reduce long-term health risks; however, supporting data are lacking.

Most childhood hypertension, particularly in preadolescents, is secondary to an underlying disorder. Renal parenchymal disease is the most common (60 to 70 percent) cause of hypertension. Adolescents usually have primary or essential hypertension, making up 85 to 95 percent of cases.

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

History (DO NOT EDIT)

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 OD 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)"