Elevated blood pressure is generally asymptomatic, that is, without symptoms, and the patient has no complaints. Sometimes patients may complain of a morning headache-preferably occipital (“toward the back of the head“)-that disappears immediately after getting out of bed.In the setting of hypertension (high blood pressure), the following nonspecific complaints may occur:
- Dizziness
- Headache
- Nervousness
- Visual disturbances
- Tinnitus (ringing in the ears)
- Epistaxis (nosebleeds)
- Palpitations
- Sweating
- Resting dyspnea (shortness of breath at rest)
- Feeling of anxiety, angina pectoris (“chest tightness”; sudden pain in the heart area).
- Cramps, paralysis symptoms
- Nausea (nausea)
- Vomiting
The following symptoms and complaints may indicate hypertension:
Symptoms of mild to moderate hypertension
- Dizziness/fainting spells
- Palpitations (heart palpitations)
- Easy fatigability
- Impotence
- Nervousness
- Ringing in the ears
- Epistaxis (nosebleed)
- Hematuria (blood in the urine)
- Sweating
- Nausea (nausea)
- Vomiting
Symptoms that occur mainly in severe hypertension or long course with organ damage:
- Headache (occur mainly in the morning).
- Visual disturbances
- Dyspnea (shortness of breath)
- Angina pectoris (chest tightness, heart pain)
- Cramps, paralysis symptoms
- Nocturia – urination at night
- Oliguria – decreased amount of urine.
- Polyuria – increased amount of urine
Outpatient versus inpatient treatment for hypertensive crises without symptoms (hypertensive urgency/danger)
Study rationale: retrospective analysis of six-month data from nearly 60,000 patients with hypertensive urgency. MACE (major adverse cardiovascular event; incidence of combined clinical end points cardiac death, myocardial infarction (heart attack) [Q-wave and non-Q-wave]) rates showed that initial hospital care was not associated with a better outcome compared with outpatients with identical risk profiles who received only ambulatory care: MACE rates were not significantly different: in the first 7 days (0 vs. 2), between days 8 and 30 (0 vs. 2), and in the first six months (8 vs. 4).
Hypertensive crisis
| Hypertensive crisis | >180/120 mmHg |
| Hypertensive emergency | > 230/120 m mHg or any elevated value with life-threatening organ damage |
| Malignant hypertension | Diastolic blood pressure > 120 mmHg* . |
* With abolished day-night rhythm, hypertensive retinopathy (blood pressure-related retinal disease), and development of renal insufficiency (kidney weakness).
Possible symptoms:
- Nausea (nausea)/vomiting.
- Cephalgia (headache)
- Vertigo (dizziness)
- Dyspnea
- Thoracic discomfort (as a sign of myocardial ischemia/angina pectoris (chest tightness, heart pain) or aortic dissection/acute splitting (dissection) of the wall layers of the aorta (main artery)).
- Neurological symptoms (agitation/sick agitation in which there are violent and hasty movements of the patient, clouding of consciousness, visual disturbances, etc.).
The following acute life-threatening situation may develop: hypertensive encephalopathy (increase in intracranial pressure (intracranial pressure) with consecutive intracranial pressure signs), pulmonary edema (accumulation of water in the lungs) or aortic dissection.
