What are the signs and symptoms of hypertension?

Signs and Symptoms of Hypertension

Hypertension is typically asymptomatic, and most patients with elevated blood pressure have no specific symptoms directly attributable to the condition itself. 1

Primary Clinical Presentation

Asymptomatic Nature

• The vast majority of hypertensive patients are completely asymptomatic, which is why hypertension is often called the "silent killer" 1
• Symptoms traditionally attributed to hypertension (headache, dizziness, epistaxis, tinnitus) are not reliably associated with elevated blood pressure and are more strongly correlated with awareness of having hypertension rather than the blood pressure level itself 2
• The presence or absence of symptoms should never be used as a criterion for starting treatment or judging treatment efficacy 2

When Symptoms Do Occur

When hypertensive patients develop symptoms, they typically indicate either:

1. Hypertensive complications (end-organ damage)
2. Secondary hypertension (underlying cause)
3. Hypertensive emergency (acute organ injury)

Signs and Symptoms of Hypertensive Complications

Cardiovascular Manifestations

• Chest pain (suggesting coronary ischemia or acute coronary syndrome) 1
• Shortness of breath (indicating heart failure or pulmonary edema) 1
• Palpitations (cardiac arrhythmias) 1
• Peripheral edema (heart failure) 1

Neurological Manifestations

• Headaches (particularly severe or persistent, suggesting hypertensive encephalopathy) 1
• Blurred vision or visual disturbances (hypertensive retinopathy or encephalopathy) 1
• Dizziness (impaired cerebral autoregulation) 1
• Focal neurological symptoms (suggesting stroke or intracranial hemorrhage) 1
• Somnolence, lethargy, seizures, or cortical blindness (hypertensive encephalopathy) 1

Renal Manifestations

• Nocturia (kidney dysfunction) 1
• Hematuria (kidney damage) 1

Vascular Manifestations

• Claudication (peripheral arterial disease) 1

Signs and Symptoms Suggesting Secondary Hypertension

Endocrine Causes

• Muscle weakness, tetany, cramps, arrhythmias (hypokalemia from primary aldosteronism) 1
• Sweating, palpitations, frequent severe headaches (pheochromocytoma) 1
• Symptoms of thyroid disease (hyperthyroidism or hypothyroidism) 1

Renal Causes

• Flash pulmonary edema (renal artery stenosis) 1

Sleep-Related Causes

• Snoring and daytime sleepiness (obstructive sleep apnea) 1

Physical Examination Findings

Cardiovascular Signs

• Abnormal pulse rate, rhythm, or character 1
• Elevated jugular venous pressure 1
• Displaced or abnormal apex beat 1
• Extra heart sounds or basal crackles (heart failure) 1
• Vascular bruits (carotid, abdominal, femoral arteries) 1
• Radio-femoral delay (aortic coarctation) 1

Other Physical Signs

• Enlarged kidneys on palpation (polycystic kidney disease) 1
• Neck circumference >40 cm (obstructive sleep apnea) 1
• Enlarged thyroid (thyroid disease) 1
• Increased BMI/waist circumference (metabolic syndrome) 1
• Fatty deposits and colored striae (Cushing syndrome) 1

Fundoscopic Findings

• Retinal changes, hemorrhages, papilledema, arterial tortuosity, arteriovenous nipping (hypertensive retinopathy or malignant hypertension) 1

Critical Clinical Pitfall

The absence of symptoms does NOT mean blood pressure is controlled or that hypertension is not causing harm. 1 Patients often mistakenly believe they can "feel" when their blood pressure is elevated, leading to poor medication adherence. This is a dangerous misconception that contributes to inadequate blood pressure control and increased cardiovascular risk. Regular blood pressure measurement is the only reliable way to assess hypertension status, regardless of how the patient feels 1, 3.