Most people with hypertension experience no symptoms, and as a result the condition may go undetected for many years. Some individuals complain of symptoms, such as headaches, but most often hypertension is discovered during a routine physical examination or, less commonly, when a patient experiences one of the complications of hypertension. These complications include transient ischemic attack (TIA), stroke, visual abnormalities, angina, heart attack, heart failure, intermittent claudication (pain in the leg muscles associated with physical exertion), or kidney disease.
Another situation in which people may experience symptoms from hypertension is a hypertensive crisis. In a hypertensive crisis, blood pressure reaches extremely high levels (diastolic blood pressure above 120 mm Hg). This condition occurs in about 1 percent of people with hypertension—usually around age 40—and may be precipitated by an abrupt cessation of antihypertensive medication. There are two types of hypertensive crises: hypertensive emergency (also called malignant hypertension) and hypertensive urgency.
A hypertensive emergency produces one or more symptoms that indicate major damage is occurring to the body's organs. These symptoms include chest pain, shortness of breath, seizures, back pain, headache with confusion and blurred vision, nausea, vomiting, and unresponsiveness. When a hypertensive emergency is suspected, the affected person should not eat or drink anything and should lie down until he or she can be driven to the hospital or an ambulance arrives.
The more common form of hypertensive crisis—hypertensive urgency—does not result in symptoms indicative of major organ damage. Instead, headache and nosebleed are the two most common symptoms. Although this condition requires medical attention, treatment is not needed immediately. However, within a few hours, a hypertensive urgency could become a hypertensive emergency.
Content excerpted from the Johns Hopkins White Paper on Hypertension & Stroke.