| History: For most individuals, primary hypertension causes no symptoms for years. 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 problems, kidney disease, or diabetes. Individuals may present with risk factors for high blood pressure such as tobacco use, 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 hypertension does not cause notable symptoms, it is usually 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 immediately measured again, 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 primary hypertension. After hypertension is diagnosed, however, diagnostic testing such as routine blood and urine tests are usually performed to identify or rule out causes of secondary hypertension (diabetes, kidney disease, arteriosclerosis). A chest x-ray and an 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 white males 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). |