What Are The Symptoms And Ways Of Diagnosis Of High Blood Pressure (hypertension)

Hypertension is often called a silent killer, because the condition remains asymptomatic in most people till great damage is done to other systems of the body. Though some symptoms may be present, such as a flushed face, frequent headaches, tiredness and dizziness and bleeding from nose, which are usually considered to be symptoms associated with hypertension, they often do not get the required attention. This is due to the fact that people without hypertension also may have the same symptoms, resulting from some other conditions.

The damage caused by uncontrolled hypertension may be far reaching, severe and progressive in nature as it affects almost all other systems of the body and cause irreversible damage to kidneys, heart, brain and eyes. These damages often become apparent from the symptoms they produce, such as shortness of breath, fatigue, vomiting, nausea and severe headache. Swelling of retina and bleeding caused by very high blood pressure, in those who have malignant hypertension, results in blurring of vision or blindness. This condition requires immediate medical attention as it is fatal, if not treated. Hypertensive encephalopathy is another potentially fatal condition, in which the brain swells due to extreme high pressure, resulting in symptoms such as severe headache that steadily worsens, drowsiness, sleepiness, confusion, nausea and vomiting. It can also cause seizures and the patient may drift into a coma and eventually death, unless emergency medical care is provided.

Since the tumor pheochromocytoma results in overproduction of the fight or flight hormones of the adrenal glands namely, epinephrine and norepinephrine, the secondary hypertension resulting from that condition has characteristic symptoms such as a racing heart, palpitations, tremors, excessive sweating and anxiety.

Hypertension Diagnosis

Diagnosis of hypertension is based on several readings taken at the doctor’s clinic at various intervals. The first reading is taken after a short period of rest either in a sitting position or lying down. After standing up for a short while, the next reading is taken. Blood pressure above 140/90 mm Hg in several readings, may be diagnosed as hypertension. But, if there is a lot of variation between the readings, a few more readings on the same day, of on separate occasions, are taken into consideration before final diagnosis is given.

If the diagnosis still seems inconclusive, a wearable battery-operated blood pressure monitor is worn for 24-hours to take readings throughout the period. The device is attached to the hip and it is connected to a cuff on the arm that reads the blood pressure. It can determine the presence as well as the severity of the condition.

Pseudohypertension is a misdiagnosed hypertension in people who have stiff arteries that do not yield to the pressure applied on the artery by the blood pressure cuff, resulting in a false reading of hypertension. This occurs in older people who are more likely to have stiff arteries.

After hypertension is diagnosed, an effort is made to determine its cause, such as hormonal imbalances or specific disorders of the heart or the kidneys, to see if they can be treated to reduce the blood pressure. Possible damage caused by the high blood pressure to various internal organs may be assessed too. Generally, a thorough physical examination of the heart and the kidneys, including checking for tenderness over the location of the kidneys and listening for bruit (the characteristic sound of blood passing through an artery narrowed by stenosis) in the renal arteries through a stethoscope. It is followed by blood and urine tests to determine kidney function and blood chemistry. Electrocardiography may be done to assess the damage to the heart.

An ophthalmoscope helps doctors to see the damage caused by hypertension to the fine arterioles of the retina, and it is taken as an evidence of similar damage caused to other arteries and arterioles in other organs in the body which cannot be viewed directly. The damage to the retina is termed retinopathy and the severity of hypertension is usually determined on the basis of the extent of retinopathy.

Abnormal heart sounds, resulting from structural changes brought about in the chambers of the heart due to prolonged hypertension, can be detected by a stethoscope placed on the chest. A characteristic sound, termed fourth heart sound, is an indication of the enlargement of the left ventricle which pumps out oxygenated blood to the rest of the body except the lungs. When the left ventricle is enlarged and has become stiff due to the effect of high blood pressure, its elasticity is reduced, and it does not get filled with adequate amount of blood between contractions. To compensate for this, the left atrium contracts harder to fill the left ventricle, producing the typical fourth heart sound.

Electrocardiography can help detect the effects of the damage caused to the heart by hypertension, especially hypertrophy of myocardium or thickening of the heart muscle as well as the enlargement of the chambers of the heart. Echocardiography can provide ultrasound pictures of the heart, to show the exact change in size of the chambers as well as the thickness of the walls.

 When hypertension causes kidney damage, it can be detected by urine tests and blood sample tests for kidney function. If a blood protein called albumin is excreted in the urine, it is often an early indication of kidney damage. So is the presence of blood in the urine. Since the other symptoms of kidney damage such as loss of appetite, weakness and lethargy, appear only after about three fourths of kidney function is lost, the urine and blood tests help to take remedial action much earlier.

Diagnosis of Cause: The search and diagnosis of the exact cause of hypertension is of more significance in younger people with hypertension. Detailed investigations including radionuclide imaging of the renal arteries and the kidneys and measurement of blood levels of adrenal gland hormones as well as cortisol are done in addition to ultrasonography and x-rays. But many routine tests also may help in identifying the cause. For example, bruit in the renal arteries point to stenosis of renal arteries. Excess levels of adrenal hormones adrenalin and norepinephrine, may be diagnosed by the usual symptoms they produce. The occurrence of a tumor in the adrenal gland called pheochromocytoma,  is detected from the urine tests which show traces of the substances formed on the breakdown of the adrenal hormones. Measuring the levels of potassium in the blood may be helpful in detecting hyperaldosteronism or the excessive production of the hormone aldosterone. It may not be always possible to detect the exact cause, in spite of all these tests as hypertension can result from subtle changes involving several systems of the body and hereditary factors also play a role.

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Yasser Elnahas

MD, PHD, Professor Of CardioVascular Surgery
Dr. Yasser Elnahas, Is an associate Professor of Cardiovascular Surgery. Dr. Elnahas was trained as a fellow At Texas Heart Institute And Mayo Clinic Foundation.Dr. Elnahas is dedicated to educating the general public about different disease conditions and simplifying the medical knowledge in an easy to understand terminology.

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