Updated 08 August 2018

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

Most people with hypertension feel fine (i.e. they are asymptomatic) and only learn of their high blood pressure (BP) during a routine examination, an examination for some other problem, or when they unexpectedly have a stroke or heart attack.

You could be one of these people.

Hypertension may go undetected for years, causing silent damage to your heart, brain, blood vessels and kidneys. Quite unexpectedly, you may suffer a heart attack or stroke, or be told that you have kidney failure. This is why all adults, even those who feel “healthy” and lead a healthy lifestyle, should be screened for high BP 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

All of the above require 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 malignant hypertension (e.g. shortness of breath and chest pain due to heart disease).

Reviewed by Prof Brian Rayner, nephrologist and Director of the Hypertension Clinic, Groote Schuur Hospital. MBChB, FCP, MMed, PhD. May 2018.


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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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