Hypertension is asymptomatic and also referred to as the "silent killer" until it progresses to a severe stage or causes target organ disease. Patients may experience symptoms stemming from the strain on blood vessels and tissues in various organs or the heart's increased workload.
Physical exams might show no abnormalities other than high blood pressure. Signs of vascular damage, when present, correspond to the organs supplied by the affected vessels, leading to target organ damage. For instance, if the retinal artery is involved, it can include retinal changes like hemorrhages, arteriolar narrowing, cotton-wool spots, or papilledema in severe cases. If a coronary artery is involved, hypertension may also lead to angina and myocardial infarction due to left ventricular hypertrophy, resulting from the heart's adaptation to pumping against a higher systemic pressure. Altered blood urea nitrogen and serum creatinine levels might indicate pathological kidney changes. Furthermore, cerebrovascular involvement could lead to transient ischemic attacks or strokes, with possible symptoms like altered vision, speech, dizziness, or hemiplegia.
Diagnostic Strategies for Hypertension
Identifying hypertension requires a meticulous approach emphasizing variability in blood pressure readings across different settings and times. Key strategies include:
Hypertension is often asymptomatic, typically detected only through elevated blood pressure or BP readings.
However, in advanced stages, it may present specific symptoms indicative of vascular damage associated with organs supplied by affected vessels, known as target organ damage.
For example, cerebrovascular involvement could lead to transient ischemic attacks characterized by changes in vision, speech, dizziness, or hemiplegia.
Renal blood vessel damage might result in chronic kidney disease, while damaged coronary arteries may cause angina.
The diagnostic approach for hypertension typically includes multiple BP measurements.
Ambulatory BP monitoring involves wearing a device for 24-48 hours that records BP periodically to detect white coat hypertension, which shows elevated BP in medical settings that is normal at home, and masked hypertension where BP is normal in clinics and high elsewhere.
Additionally, blood tests evaluate kidney function, electrolytes, blood glucose, and cholesterol levels to identify secondary causes, and electrocardiograms uncover heart abnormalities.
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