Symptoms are the things which the patient notices and which prompt him to visit the doctor. Signs are the things which the doctor notices or detects on examining the patient.
It is important to realize that the mild to moderate hypertension usually produces no symptoms in the early stages there are usually no abnormal physical findings other than the hypertension. That is why many hypertensives are detected during routine examination for employment or life-insurance.
In the early stages, symptoms which are frequently attributed to the high blood pressure are difficult to differentiate from those associated with general temperament and constitution of the individual especially liable to high blood pressure, i. e. nervousness, irritability, loss of energy, easy fatigue and insomnia. Headache, dizziness and impairment of memory and concentration are later features.
Headache is troublesome and sometimes intractable. It is usually throbbing in nature and felt at the back of head and neck and worse on waking.
Giddiness or dizziness is occasionally felt by the patient and usually he is afraid to walk alone. But fortunately this giddiness is intermittent in nature. In elderly patients giddiness may be due to arteriosclerosis of blood vessels with loss of elasticity of arterioles due to ageing process and also may be due to degenerating vision and arthritic changes in the limbs. It is also important to remember that in individuals who are already taking drugs for their high blood pressure, the drugs themselves can produce giddiness especially on changing their posture suddenly.
Unexplained tiredness is felt by many. This may be due to high blood pressure or may be due to temperament and attitude of the individual towards life.
Changes in the eye sight may necessitate changes in glasses. The one place in the body which serves as a window through which one can see the arteriolar disease is the eye-in the retina the arterioles are directly visible. This is easily seen by the doctor with the help of an instrument called “ophthalmoscope”. The changes in the arterioles with hemorrhages and swelling can be easily seen and these findings are graded into four stages. Stage IV indicates very severe damages and stage I indicates early hypertensive changes. Blindness is rare.
Shortness of breath is due to heart failure. First noticed with exertion such as running or strenuous work and if left untreated will progress to breathlessness at rest. Sometimes acute attacks of breathlessness occur at night.
‘Angina Pectoris’ is a distressing discomfort or pain usually felt over the front of chest. Reduced blood supply to heart muscle due to atherosclerosis with added extra work load on the heart due to hypertension may cause Angina. Like breathlessness, it occurs first with severe exertion and later even with slight exertion like walking, causing the patient to stop until the pain disappears. If coronary artery is completely blocked, the condition is called Coronary Thrombosis, commonly known as a “Heart Attack”.
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