Updated 06 October 2014

Symptoms of hypertension

Essential hypertension, which accounts for 95% of all cases of hypertension, rarely has any symptoms.

 Under the heading "Common Hypertension Symptoms" an author of a medical text left the entire page blank – he was emphasising the absence of symptoms seen in most people with hypertension. This highlights the fact that Essential hypertension, which account for 95% of all cases of hypertension, rarely has any symptoms.

Most people with hypertension feel fine (are asymptomatic) and only learn of their hypertension during a routine examination or an examination for some other problem, or unexpectedly have a stroke or heart attack. You could be one of these people. This happens because hypertension may go undetected for years, causing silent damage to your heart, brain, blood vessels and kidneys and quite unexpectedly a person may suffer a heart attack or stroke or be told they have kidney failure. This is why all adults, even those who feel “healthy” and have a healthy lifestyle should be screened for high blood pressure on a regular basis.

Sometimes people who have been diagnosed with hypertension report headaches, dizziness, fatigue, and pounding of the heart. These symptoms may be related to hypertension.

More advanced cases of hypertension - especially with levels greater than 180/110mmHg - may present the following symptoms:
•    Headaches, especially pulsating headaches behind the eyes
•    Visual disturbances
•    Nausea and vomiting
•    Disturbed levels of consciousness, such as sleepiness and even seizures in severe cases

In all these cases patients should seek urgent medical attention, as hypertension may be rapidly fatal. This is called malignant hypertension and is common in young black men.

Once complications have set in, symptoms may be related to this, e.g. shortness of breath and chest pain due to heart disease.

(Reviewed and updated by Prof Brian Rayner, head of the division of nephrology and hypertension, University of Cape Town and Groote Schuur Academic Hospital, November 2010)


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Dr Jacomien de Villiers qualified as a specialist physician at the University of Pretoria in 1995. She worked at various clinics at the Department of Internal Medicine, Steve Biko Hospital, these include General Internal Medicine, Hypertension, Diabetes and Cardiology. She has run a private practice since 2001, as well as a consultant post at the Endocrine Clinic of Steve Biko Hospital.

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