When we become ill our body usually sends out signals. We refer to them as symptoms. For example, when our respiratory tract becomes infected we respond by coughing and perhaps run a temperature. A duodenal ulcer announces itself by pain and heartburn. Medical literature lists thousands of such warning signals by which the body notifies us that something has gone wrong. Unfortunately, high blood pressure sends us no such warnings. It can frequently persist for many years undetected and untreated. That is why it is often referred to as the silent disease or "silent killer." There are no typical symptoms or signs. By looking at a person it is impossible to say whether he does or does not suffer from high blood pressure. In the early stages of the disease the patient usually feels quite healthy and happy 1 If there are any complaints they are not necessarily those one might associate with hypertension.

We can differentiate between two categories of complaints and symptoms, and they are related to the length and severity of the disease.

Complaints and Symptoms

1. Non-specific symptoms before any complications of hypertension have set in.

The following list of complaints are those most frequently mentioned by persons suffering from prolonged cases of hypertension. But since they appear just as frequently in persons of the same age group who do not have high blood pressure, they can also be symptomatic of other disorders.

Non-specific complaints in hypertension

Complaint     Frequency (approx.)

Nervousness     35%

Palpitation     32%

Dizziness     30%

Chest pain     26%

Headaches     23%

Depression, lack of drive     7%

The patient with "nervous instability." By this we mean an imbalance of the autonomic nervous system which reacts more labile and more strongly than either required or useful. Younger people with "labile hypertension" often have one or more symptom of nervous instability varying in degree and frequency. They include excessive perspiration, digestive and sleeping problems, fatigue, and excitability. Yet they are not necessarily typical of high blood pressure. Many persons with normal blood pressure have exactly the same symptoms. In some instances the sympathetic nervous system can go into such high gear that cardiovascular complaints will completely dominate the clinical picture.

The older person with "functional deficiency." Men above the age of forty-five years suffering from hypertension often complain of not functioning at their best. They do not perform as well on their jobs, they cannot handle stresses and strains as well as before, they tire more easily, their memory and concentration declines, their sexual drive diminishes. Women in this age group have the additional factor of menopause to cope with.

2. Warning signals of high blood pressure where complications have already set in. Many people with hypertension do not seek medical help until some of the complications have set in. Only then do the" find out that they have high blood pressure.

Here are some of the typical complaints:

Incipient cardiac failure. The first indications are shortness of breath after minimal exertion, often also a persistent cough (pulmonary congestion) as well as urination at night (which may also have other causes.) A more specific symptom of congestive heart failure is swelling of the ankles (so-called edema) at first only during the day, not at night (which explains the urge to urinate) but later turns into a permanent condition involving both lower and upper legs.

Insufficient blood flow through the coronary vessels. Angina pectoris-like pains induced by excitement or stress (see p. 56): tightness in the chest, pressure and pain possibly radiating to the neck, the left shoulder, left arm and left hand.

Insufficient blood flow to the cerebral arteries. Nonspecific early symptoms such as dizziness, memory lapses, inability to concentrate are followed by typical symptoms of intermittent blood shortage in various sections of the brain: fainting, temporary speech problems, difficulties with walking, intermittent weakness of arms and/or legs.

Partial obstruction of the pelvic and leg arteries. Symptoms are leg cramps while walking (intermittent), usually in one leg, rarely in both. As time goes on, the distance a person is able to walk without frequent rest stops becomes progressively shorter. In Europe this is called the "window-shopper's" disease, because the patient needs to stand still before the cramp disappears and he can resume walking.

Occasionally a patient may experience atypical though very disturbing "circulatory attacks," accompanied by palpitation, excessive perspiration, pallor, anxiety, weakness, and vague feelings of discomfort in the region of the heart, all of this triggered by a sudden surge of extremely high pressure. Such sudden attacks may signify a condition known as pheochromocytoma, which stimulates the release of vast quantities of adrenal hormones into the blood stream. Attacks of this type are warning signals of a rare and dangerous but operable type of hypertension.

Some Important Indicators

Even though hypertension does not manifest itself through typical symptoms, important indications of its possible presence nonetheless do exist.

The family history

The personal history

Try to find out whether any members of your immediate family have had hypertension, since heredity is a major factor in essential hypertension, the most common type of high blood pressure. It may not always be easy to find out whether your parents' or grandparents' immediate families have a history of high blood pressure. If you cannot get this information try to learn whether anyone in their families had strokes, congestive heart failure or died of heart attacks—the most common complications of hypertension. These can be important clues to the existence of a hereditary disposition. It would also be important to know whether your family has a history of such crucial risk factors as diabetes, hypercholesterolemia, or gout.

One important warning sign of your personal history is long-standing overweight, especially if you were thin when young and put on anywhere from 30 to 40 pounds or more since then. If that is the case you are a high hypertension risk. Other warning signals are not quite so obvious. As mentioned earlier, kidney disease and hypertension often go hand in hand. Sometimes the patient doesn't even know that his kidneys are affected. Chronic tonsillitis in childhood can be a forerunner of kidney disease. Long-forgotten kidney infections, so-called "harmless" bladder irritations or kidney stones may indicate kidney disease that could lead to high blood pressure.

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