Clinical Presentation

Most patients are asymptomatic early in the disease course due to lack of end-organ damage.

Symptoms generally only occur with severely elevated blood pressure or hypertensive crisis:

• Headache, dizziness, tinnitus
• Epistaxis
• Vision changes
• Chest pain, dyspnea
• Neurologic deficits like confusion, weakness
• Physical exam findings may include:
• Elevated blood pressure
• Retinopathy changes on fundoscopy
• Cardiac murmurs
• Carotid, abdominal, or femoral bruits
• Edema

Risk factors:

• Older age
• Obesity
• Family history
• Black race
• High sodium intake
• Excess alcohol intake
• Sedentary lifestyle
• Dyslipidemia
• Diabetes
• Chronic kidney disease
• Obstructive sleep apnea

It often goes undiagnosed for years until routine screening.

Pseudohypertension can falsely elevate readings in older adults with rigid arteries.

White coat and masked hypertension are common pitfalls that require out-of-office blood pressure monitoring to identify.

Accurate classification requires properly measured average blood pressure from ≥2 occasions.