History: For most individuals, benign hypertension causes no symptoms for years, and is consequently known as the “silent killer.” Symptoms of severe hypertension or its complications may include headache, dizziness, racing or irregular heartbeat, tiring easily, sexual dysfunction, nosebleeds, chest pain, or shortness of breath. As the disease progresses, damage to the brain, eyes, heart, and kidneys may occur. Family history may reveal high blood pressure, stroke, heart disease, kidney disease, or diabetes. Individuals may present with risk factors for high blood pressure such as tobacco use, high salt intake, obesity, sedentary lifestyle, and elevated cholesterol. Medication history may reveal use of medications that elevate blood pressure. Social history may suggest emotional or environmental factors that could affect blood pressure.
Physical exam: Because early benign hypertension does not cause notable symptoms, it usually is detected during a routine physical examination. Once hypertension is suspected, evaluation may include blood pressure readings recorded in both arms, repeated after the individual sits or lies down for five minutes (and at least 30 minutes after smoking or coffee ingestion). If a person has a high reading, blood pressure is measured again after 10 to 15 minutes, and then twice on at least two other days to make sure the high blood pressure reading is consistent. Readings may need to be repeated at home; some individuals will have elevated blood pressure in the doctor's office because of anxiety (white-coat syndrome). If blood pressure is elevated, the neck veins may be swollen (distended), the thyroid or heart may be enlarged, and heart murmurs may be noted. If characteristic changes in the eyes are evident, the eyes may be further evaluated with an ophthalmoscope.
Tests: Laboratory tests are seldom used to diagnose benign hypertension. After hypertension is diagnosed, however, diagnostic testing such as routine blood and urine tests usually are performed to identify or rule out causes of secondary hypertension (e.g., diabetes, kidney disease, arteriosclerosis). A chest x-ray, echocardiogram, and electrocardiogram may be performed to evaluate heart size and function. A blood test for renin may identify increased production of angiotensin, a chemical that narrows blood vessels. High renin levels may predict heart attacks in individuals with high blood pressure. An exercise stress test performed on individuals with borderline elevated pressure may predict risk of enlargement of the left side of the heart (left ventricular hypertrophy). Cardiac catheterization may be necessary to diagnose underlying coronary artery disease.
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