Dr Carl Shakespeare consultant cardiologist  
       
 
   
Vascular Risk Factors
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Hypertension - Signs and Symptoms:

An obvious question at first, but nonetheless an important one. I am very keen to avoid giving anyone a diagnosis of hypertension unless we are completely sure they have it. This is because blood pressure can be raised for other reasons such as stress, and to be labelled as "hypertensive" may have implications in the future such as when applying for mortgages and insurance policies. Once a diagnosis is made, it sticks to you; rightly or wrongly.

I personally spend a bit of time trying to make the diagnosis or exclude it.

 
Clinical Symptoms:

Hypertension for most people is a pretty silent condition, very rarely giving rise to symptoms. The fact that it is silent can cause problems in diagnosing the condition in the first place, and more importantly, getting people to take treatment for it. Symptoms one could experience include:
  • general tiredness,
  • headaches,
  • nosebleeds,
  • ringing in ears,
Hypertension is slowly progressive, taking years to cause damage that is irreversible, and could have been prevented in the first place. One early indication of underlying vascular risk in men is the presence of erectile dysfunction. This is the development of symptoms of unsatisfactory erection, and can indicate underlying hypertension, diabetes or any other cause of vascular risk.

Clinical Signs:

There may be few features of significant hypertension other than the elevated blood pressure. However as mentioned earlier, the presence of vascular damage (target organ damage- see below) needs to excluded. In cases where there is an underlying secondary cause, clinical features need to be determined, and the relevant tests performed.

Target Organ Damage:

Thickening of blood vessels in eyeHypertrophy - thickening of heart muscleThis involves the assessment of the effects of prolonged elevated blood pressure on body organs. Damage tends to be cumulative and is related to overall 24 hour blood pressure control. Thus for patients with diagnosed hypertension, good 24 hour control is needed to avoid developing target organ damage. In patients with labile blood pressure readings, the presence of target organ damage would confirm the need to treat blood pressure. Target organ damage includes:
  • thickening of the blood vessels at the back of the eye (illustrated right),
  • thickening of heart muscle (hypertrophy - shown left),
  • mild kidney damage with protein in the urine,
  • evidence of previous cerebrovascular disease (stroke),
  • weakening of the central aorta (aortic aneurysm),


   
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