Symptoms of Hypertension
Most patients with hypertension are completely asymptomatic, which is why it is often called the "silent killer." 1
Primary Presentation
Hypertension typically produces no symptoms in the vast majority of cases, and elevated blood pressure is usually discovered incidentally during routine medical visits or screening. 1
The absence of symptoms does not indicate absence of disease or reduced cardiovascular risk—asymptomatic hypertension still causes progressive organ damage and increases mortality. 1
Symptoms That May Suggest Hypertension or Coexistent Conditions
When symptoms do occur, they are often nonspecific and may indicate either longstanding hypertension with complications or coexistent cardiovascular disease: 1
- Headaches (particularly occipital, though this is nonspecific) 1
- Blurred vision or visual disturbances 1
- Dizziness 1
- Chest pain (suggesting coronary artery disease) 1
- Shortness of breath (suggesting heart failure or pulmonary involvement) 1
- Palpitations 1
- Nocturia (nighttime urination, suggesting renal involvement) 1
- Hematuria (blood in urine, suggesting renal damage) 1
- Peripheral edema (swelling, suggesting heart failure) 1
- Claudication (leg pain with walking, suggesting peripheral artery disease) 1
Symptoms Suggesting Secondary Hypertension
Specific symptom patterns may point to an underlying secondary cause of hypertension: 1
- Muscle weakness, tetany, cramps, or arrhythmias suggest hypokalemia from primary aldosteronism 1
- Flash pulmonary edema (sudden severe shortness of breath) suggests renal artery stenosis 1
- Sweating, palpitations, and frequent severe headaches suggest pheochromocytoma 1
- Snoring and daytime sleepiness suggest obstructive sleep apnea 1
- Symptoms of thyroid disease (weight changes, heat/cold intolerance, tremor) 1
Symptoms of Hypertensive Emergency (Acute Target-Organ Damage)
These symptoms indicate a hypertensive emergency requiring immediate ICU admission and IV therapy: 1, 2
- Severe headache with vomiting (suggesting hypertensive encephalopathy) 1, 2
- Altered mental status, lethargy, seizures, or coma (hypertensive encephalopathy) 1, 2
- Visual disturbances or cortical blindness (hypertensive encephalopathy or malignant hypertension) 1, 2
- Severe chest pain (suggesting acute coronary syndrome or aortic dissection) 1, 2
- Acute dyspnea (suggesting cardiogenic pulmonary edema) 1, 2
- Focal neurologic deficits (suggesting stroke) 1, 2
- Abdominal pain, nausea, vomiting, and low urinary output in pregnancy (suggesting eclampsia) 1
Critical Clinical Pitfall
Do not wait for symptoms to diagnose or treat hypertension—the disease causes silent, progressive cardiovascular, renal, and cerebrovascular damage long before symptoms appear. 1 Regular blood pressure screening is essential because symptoms are an unreliable indicator of disease presence or severity. 1