Editing Hypertension (section)

==Signs and symptoms==
Hypertension is rarely accompanied by [[Signs and symptoms|symptoms]].<ref name=CDC2024/> Half of all people with hypertension are unaware that they have it.<ref name="WHOreport2023"/> Hypertension is usually identified as part of health [[Screening (medicine)|screening]] or when seeking healthcare for an unrelated problem.

Some people with high blood pressure report [[headache]]s, as well as [[lightheadedness]], [[vertigo]], [[tinnitus]] (buzzing or hissing in the ears), altered vision or [[Syncope (medicine)|fainting episodes]].<ref name=Harrison2005>{{cite book |vauthors=Fisher ND, Williams GH |veditors=Kasper DL, Braunwald E, Fauci AS |title=Harrison's Principles of Internal Medicine|url=https://archive.org/details/harrisonsprincip00kasp |url-access=limited |edition=16th |year=2005 |publisher=McGraw-Hill |location=New York |isbn=978-0-07-139140-5 |pages=[https://archive.org/details/harrisonsprincip00kasp/page/n1491 1463]–1481 |chapter=Hypertensive vascular disease|display-editors=etal}}</ref> These symptoms, however, might be related to associated [[anxiety (mood)|anxiety]] rather than the high blood pressure itself.<ref name=Stress2012>{{cite journal | vauthors = Marshall IJ, Wolfe CD, McKevitt C | title = Lay perspectives on hypertension and drug adherence: systematic review of qualitative research | journal = The BMJ | volume = 345 | pages = e3953 | date = July 2012 | pmid = 22777025 | pmc = 3392078 | doi = 10.1136/bmj.e3953 }}</ref>

Long-standing untreated hypertension can cause organ damage with signs such as changes in the [[optic fundus]] seen by [[ophthalmoscopy]].<ref name=Wong2007>{{cite journal | vauthors = Wong TY, Wong T, Mitchell P | title = The eye in hypertension | journal = Lancet | volume = 369 | issue = 9559 | pages = 425–435 | date = February 2007 | pmid = 17276782 | doi = 10.1016/S0140-6736(07)60198-6 | s2cid = 28579025 }}</ref> The severity of [[hypertensive retinopathy]] correlates roughly with the duration or the severity of the hypertension.<ref name=Harrison2005/> Other hypertension-caused organ damage include [[chronic kidney disease]] and [[left ventricular hypertrophy|thickening of the heart muscle]].<ref name="WHOreport2023"/>

===Secondary hypertension===
{{Main|Secondary hypertension}}
Secondary hypertension is hypertension due to an identifiable cause and may result in certain specific additional signs and symptoms. For example, as well as causing high blood pressure, [[Cushing's syndrome]] frequently causes [[Abdominal obesity|truncal obesity]],<ref>{{Cite web |title=Truncal obesity (Concept Id: C4551560) – MedGen – NCBI |url=https://www.ncbi.nlm.nih.gov/medgen/1637490#Definition |access-date=2022-04-24 |website=ncbi.nlm.nih.gov |language=en}}</ref> [[glucose intolerance]], [[moon face]], a hump of fat behind the neck and shoulders (referred to as a buffalo hump), and purple abdominal [[stretch marks]].<ref name=ABC>{{cite book | vauthors = O'Brien E, Beevers DG, Lip GY |title=ABC of hypertension |publisher=BMJ Books |location=London |year=2007 |isbn=978-1-4051-3061-5 }}</ref> [[Hyperthyroidism]] frequently causes weight loss with increased appetite, [[tachycardia|fast heart rate]], [[exophthalmos|bulging eyes]], and tremor. [[Renal artery stenosis]] may be associated with a localized abdominal [[bruit]] to the left or right of the midline, or in both locations. [[Coarctation of the aorta]] frequently causes a decreased blood pressure in the lower extremities relative to the arms, or delayed or absent [[femoral artery|femoral arterial pulses]]. [[Pheochromocytoma]] may cause abrupt episodes of hypertension accompanied by headache, [[palpitation]]s, [[Pallor|pale appearance]], and [[Diaphoresis|excessive sweating]].<ref name="ABC"/>

===Hypertensive crisis===
{{main|Hypertensive crisis}}
Severely elevated blood pressure (equal to or greater than a systolic of 180 mmHg or diastolic of 120 mmHg) is referred to as a hypertensive crisis.<ref>{{Cite web | work = Center for Drug Evaluation and Research|date=2021-01-21 |title=High Blood Pressure – Understanding the Silent Killer |url=https://www.fda.gov/drugs/special-features/high-blood-pressure-understanding-silent-killer |publisher = U.S. Food and Drug Administration |language=en}}</ref> Hypertensive crisis is categorized as either [[hypertensive urgency]] or [[hypertensive emergency]], according to the absence or presence of end-organ damage, respectively.<ref>{{cite journal | vauthors = Rodriguez MA, Kumar SK, De Caro M | title = Hypertensive crisis | journal = Cardiology in Review | volume = 18 | issue = 2 | pages = 102–107 | date = 2010-04-01 | pmid = 20160537 | doi = 10.1097/CRD.0b013e3181c307b7 | s2cid = 34137590 }}</ref><ref>{{Cite web|title = Hypertensive Crisis|url = http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/AboutHighBloodPressure/Hypertensive-Crisis_UCM_301782_Article.jsp|website = heart.org|access-date = 2015-07-25|url-status = live|archive-url = https://web.archive.org/web/20150725220209/http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/AboutHighBloodPressure/Hypertensive-Crisis_UCM_301782_Article.jsp|archive-date = 25 July 2015}}</ref>

In hypertensive urgency, there is no evidence of end-organ damage resulting from the elevated blood pressure. In these cases, oral medications are used to lower the BP gradually over 24 to 48 hours.<ref name="Marik2007">{{cite journal | vauthors = Marik PE, Varon J | title = Hypertensive crises: challenges and management | journal = Chest | volume = 131 | issue = 6 | pages = 1949–1962 | date = June 2007 | pmid = 17565029 | doi = 10.1378/chest.06-2490 | url = http://chestjournal.chestpubs.org/content/131/6/1949.long | url-status = dead | archive-url = https://archive.today/20121204174126/http://chestjournal.chestpubs.org/content/131/6/1949.long | archive-date = 2012-12-04 }}</ref>

In a hypertensive emergency, there is evidence of direct damage to one or more organs.<ref name=JNC7/><ref name="Perez">{{cite journal | vauthors = Perez MI, Musini VM | title = Pharmacological interventions for hypertensive emergencies | journal = The Cochrane Database of Systematic Reviews | issue = 1 | pages = CD003653 | date = January 2008 | volume = 2008 | pmid = 18254026 | doi = 10.1002/14651858.CD003653.pub3 | pmc = 6991936 }}</ref> The most affected organs include the brain, kidney, heart, and lungs, producing symptoms that may include [[confusion]], drowsiness, chest pain, and breathlessness.<ref name="Marik2007"/> In a hypertensive emergency, the blood pressure must be reduced more rapidly to stop ongoing organ damage;<ref name="Marik2007"/> however, there is a lack of [[randomized controlled trial]] evidence for this approach.<ref name=Perez/>

===Pregnancy===
{{main|Gestational hypertension|Pre-eclampsia}}

Hypertension occurs in approximately 8–10% of pregnancies.<ref name="ABC"/> Two blood pressure measurements six hours apart of greater than 140/90 mmHg are diagnostic of hypertension in pregnancy.<ref name="Harrison2011">{{cite book|title=Harrison's principles of internal medicine.|publisher=McGraw-Hill|location=New York|isbn=978-0-07-174889-6|year=2011|pages=55–61|edition=18th}}</ref> High blood pressure in pregnancy can be classified as pre-existing hypertension, [[gestational hypertension]], or [[pre-eclampsia]].<ref name="uptodate.com">{{Cite web|title = Management of hypertension in pregnant and postpartum women|url = http://www.uptodate.com/contents/management-of-hypertension-in-pregnant-and-postpartum-women|website = uptodate.com|access-date = 2015-07-30|url-status = live|archive-url = https://web.archive.org/web/20160304070333/http://www.uptodate.com/contents/management-of-hypertension-in-pregnant-and-postpartum-women|archive-date = 4 March 2016}}</ref> Women who have chronic hypertension before their pregnancy are at increased risk of complications such as [[Preterm birth|premature birth]], [[Small for gestational age|low birthweight]] or [[stillbirth]].<ref>{{cite journal | vauthors = Al Khalaf SY, O'Reilly ÉJ, Barrett PM, B Leite DF, Pawley LC, McCarthy FP, Khashan AS | title = Impact of Chronic Hypertension and Antihypertensive Treatment on Adverse Perinatal Outcomes: Systematic Review and Meta-Analysis | journal = Journal of the American Heart Association | volume = 10 | issue = 9 | pages = e018494 | date = May 2021 | pmid = 33870708 | pmc = 8200761 | doi = 10.1161/JAHA.120.018494 }}</ref> Women who have high blood pressure and had complications in their pregnancy have three times the risk of developing [[cardiovascular disease]] compared to women with normal blood pressure who had no complications in pregnancy.<ref>{{Cite journal |date=2023-11-21 |title=Pregnancy complications increase the risk of heart attacks and stroke in women with high blood pressure |url=https://evidence.nihr.ac.uk/alert/pregnancy-complications-increase-the-risk-of-heart-attacks-and-stroke-in-women-with-high-blood-pressure/ |journal=NIHR Evidence |type=Plain English summary |publisher=National Institute for Health and Care Research |doi=10.3310/nihrevidence_60660|s2cid=265356623 }}</ref><ref>{{cite journal | vauthors = Al Khalaf S, Chappell LC, Khashan AS, McCarthy FP, O'Reilly ÉJ | title = Association Between Chronic Hypertension and the Risk of 12 Cardiovascular Diseases Among Parous Women: The Role of Adverse Pregnancy Outcomes | journal = Hypertension | volume = 80 | issue = 7 | pages = 1427–1438 | date = July 2023 | pmid = 37170819 | doi = 10.1161/HYPERTENSIONAHA.122.20628 | doi-access = free }}</ref>

Pre-eclampsia is a serious condition in the second half of pregnancy and [[puerperium|following delivery]] characterised by increased blood pressure and the presence of [[proteinuria|protein in the urine]].<ref name="ABC"/> It occurs in about 5% of pregnancies and is responsible for approximately 16% of all [[maternal death]]s globally.<ref name="ABC"/> Pre-eclampsia also doubles the risk of [[perinatal mortality|death of the baby around the time of birth]].<ref name="ABC"/> Usually there are no symptoms in pre-eclampsia and it is detected by routine screening. When symptoms of pre-eclampsia occur the most common are headache, visual disturbance (often "flashing lights"), vomiting, pain over the stomach, and [[edema|swelling]]. Pre-eclampsia can occasionally progress to a life-threatening condition called [[eclampsia]], which is a [[hypertensive emergency]] and has several serious complications including [[blindness|vision loss]], [[cerebral edema|brain swelling]], [[tonic-clonic seizures|seizures]], [[kidney failure]], [[pulmonary edema]], and [[disseminated intravascular coagulation]] (a blood clotting disorder).<ref name="ABC"/><ref name="urlHypertension and Pregnancy: eMedicine Obstetrics and Gynecology">{{cite web |url=http://emedicine.medscape.com/article/261435-overview |title=Hypertension and Pregnancy | vauthors = Gibson P |date=30 July 2009 |work=eMedicine Obstetrics and Gynecology |publisher=Medscape |access-date=16 June 2009 |url-status=live |archive-url=https://web.archive.org/web/20090724065747/http://emedicine.medscape.com/article/261435-overview |archive-date=24 July 2009 }}</ref>

In contrast, [[gestational hypertension]] is defined as new-onset hypertension during pregnancy without protein in the urine.<ref name="uptodate.com"/>

There have been significant findings on how exercising can help reduce the effects of hypertension just after one bout of exercise. Exercising can help reduce hypertension as well as pre-eclampsia and eclampsia. 

The acute physiological responses include an increase in cardiac output (CO) of the individual (increased heart rate and stroke volume). This increase in CO can inadvertently maintain the amount of blood going into the muscles, improving the functionality of the muscle later. Exercising can also improve systolic and diastolic blood pressure making it easier for blood to pump to the body. Through regular bouts of physical activity, blood pressure can reduce the incidence of hypertension.<ref>{{Cite journal |last1=Ruivo |first1=Jorge A. |last2=Alcântara |first2=Paula |date=February 2012 |title=Hipertensão arterial e exercício físico |url=https://linkinghub.elsevier.com/retrieve/pii/S0870255111001107 |journal=Revista Portuguesa de Cardiologia |language=pt |volume=31 |issue=2 |pages=151–158 |doi=10.1016/j.repc.2011.12.012|pmid=22237005 |doi-access=free }}</ref> 

Aerobic exercise has been shown to regulate blood pressure more effectively than resistance training. It is recommended to see the effects of exercising, that a person should aim for 5-7 days/ week of aerobic exercise. This type of exercise should have an intensity of light to moderate, utilizing ~85% of max heart rate (220-age). Aerobic has shown a decrease in SBP by 5-15mmHg, versus resistance training showing a decrease of only 3-5mmHg. Aerobic exercises such as jogging, rowing, dancing, or hiking can decrease SBP the greatest. The decrease in SBP can regulate the effect of hypertension ensuring the baby will not be harmed. Resistance training takes a toll on the cardiovascular system in untrained individuals, leading to a reluctance in the prescription of resistance training for hypertensive reduction purposes.<ref>{{Cite report |url=http://www.scivee.tv/node/9522 |archive-url=https://web.archive.org/web/20100515142447/http://www.scivee.tv/node/9522 |url-status=dead |archive-date=15 May 2010 |title=ResearchGATE |date=2009-01-13 |publisher=SciVee |doi=10.4016/9522.01 |doi-broken-date=12 November 2024 |language=en}}</ref><ref>{{Cite journal |last1=Kokkinos |first1=Peter F. |last2=Narayan |first2=Puneet |last3=Papademetriou |first3=Vasilios |date=2001-08-01 |title=Exercise as Hypertension Therapy |url=https://www.sciencedirect.com/science/article/abs/pii/S0733865105702320 |journal=Cardiology Clinics |volume=19 |issue=3 |pages=507–516 |doi=10.1016/S0733-8651(05)70232-0 |pmid=11570120 |issn=0733-8651}}</ref>

===Children===
[[Failure to thrive]], [[seizures]], [[irritability]], [[lethargy|lack of energy]], and [[Infant respiratory distress syndrome|difficulty in breathing]]<ref name="urlHypertension: eMedicine Pediatrics: Cardiac Disease and Critical Care Medicine">{{cite web |url=http://emedicine.medscape.com/article/889877-overview |title=Hypertension | vauthors = Rodriguez-Cruz E, Ettinger LM |date=6 April 2010 |work=eMedicine Pediatrics: Cardiac Disease and Critical Care Medicine |publisher=Medscape |access-date=16 June 2009 |url-status=live |archive-url=https://web.archive.org/web/20090815113248/http://emedicine.medscape.com/article/889877-overview |archive-date=15 August 2009 }}</ref> can be associated with hypertension in newborns and young infants. In older infants and children, hypertension can cause headache, unexplained irritability, [[fatigue (medical)|fatigue]], failure to thrive, [[blurred vision]], [[epistaxis|nosebleeds]], and [[Bell's palsy|facial paralysis]].<ref name="urlHypertension: eMedicine Pediatrics: Cardiac Disease and Critical Care Medicine"/><ref name=Dionne/>