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(4) High Blood Pressure

Symptoms

High blood pressure, as will be discussed later in this chapter, is a risk factor for heart disease and stroke. Having high blood pressure generally causes no symptoms for most people. It is only in the very rare situation of ‘malignant’ high blood pressure that symptoms may occur, usually in the form of headaches.

Do people with high BP feel any different from people with normal BP?

Usually no. By itself, before it has caused organ damage, high BP causes no symptoms at all. Symptoms may not be noticeable even after organ damage has started. Even very high pressures, very dangerous and already causing serious kidney damage, may sometimes be present for several months before they cause any symptoms. The only way to know if you have high BP (and how high it is) is to have it measured with a sphygmomanometer.

I have suffered from headaches and breathlessness lately – do you think these are caused by my high BP?

When BP reaches about 180/120 mmHg, some symptoms can occur: chiefly headache and breathlessness on slight exertion, such as going upstairs. Of course, both these symptoms are common anyway, but they happen more often in people with high BP, and increasingly so as BP rises. Some of these headaches can be a warning of early damage to arteries in the brain or retina, requiring urgent control of BP to prevent serious complications.

Higher levels of BP also often occur with other factors that increase the likelihood of breathlessness, for example being overweight. So it may be difficult to attribute symptoms to a single cause. Breathlessness in people with high BP is usually simply a result of being overweight but, if your BP has either risen out of control or unaccountably started to fall without any change in your medication, breathlessness may be the main symptom of early heart failure.

As lots of people get headaches from anxiety, tension, or minor virus infections, such innocent headaches are equally common in people with high BP, but a careful doctor will always check BP first, before dismissing associated headaches as insignificant; they could occasionally signal sudden dangerous loss of control in your BP. Do visit your doctor to make sure that your BP is being adequately controlled.

I would have thought that increased BP would sometimes cause bleeding. Isn’t this so?

Risk of bleeding from arteries into the brain (causing stroke) or into the retina (the back of the eye, causing patchy loss of vision if the bleed is large) is increased by high BP, particularly in people over 50, and is one of the main reasons why high BP needs treatment.

Nosebleeds and small bleeds into the white of the eye (‘subconjunctival haemorrhages’) can occur in people with high BP, although both are common in people with normal BP and need not necessarily be a cause for alarm. Subconjunctival haemorrhage sounds alarming, but the word ‘haemorrhage’ is simply a posh word for bleeding of any extent, large or small.

Subconjunctival haemorrhages appear, often after coughing, sneezing or straining on the toilet, and disappear slowly over the next 6 weeks. They are completely harmless and have nothing to do with retinal haemorrhages.

Heavy periods and other menopausal symptoms, including palpitations, sweats and the sensation with or without the appearance of flushing, all occur commonly in women with high BP, simply because high BP is common at this age. None of these symptoms is caused by high BP, or cured by lowering it.

Since I was told I had high BP, I’ve had awful palpitations. Is this one of the symptoms, and why didn’t I notice it before?

Palpitations (feeling or hearing your own heart beating fast), tension headaches and over breathing are common in people who are anxious or frightened. If they have these symptoms already, and are then found to have high BP, this may confirm their fears and reinforce the symptoms. People without such symptoms, after they have been told that they have high BP, often get palpitations for the first time, not because of high BP, but because of fear of high BP. With sufficient explanation of what this diagnosis actually means, symptoms usually disappear, although not always immediately.

Although I’m only 35, my doctor says I have unusually high BP. I’ve noticed that my heart often seems to miss a beat and, if I count my pulse, it’s often irregular. Has this got something to do with high BP?

Almost certainly not. There are two common causes of an irregular pulse in young adults such as yourself.

• If you take long, deep breaths, you may find that your wrist pulse slows down as you breathe in, and speeds up as you breathe out. This is not a sign of disease, but of youth. It is caused by a link between the nerves controlling breathing movements of the diaphragm and the point of origin of heartbeats, the ‘atrial sinus’; it is therefore called ‘sinus arrhythmia’. Older people lose this link, but some still have it well into their 50s.

• The second common cause, at all ages, is extra heart beats (‘extrasystoles’). These are smaller, relatively ineffective heartbeats, too small to reach the wrist, but they cause an apparent delay before the next beat that is big enough to feel. They are completely normal and harmless, and always disappear if you start any vigorous activity.

Irregular heartbeats in older people may be more complicated, and be due to irregular movement of the upper chambers of the heart (‘atrial fibrillation’). They can occur when BP is poorly controlled, and need to be confirmed by an electrocardiograph (ECG), an electronic tracing of the heart. As atrial fibrillation is a strong risk factor for suffering a stroke, treatment with bloodthinning drugs (usually warfarin or aspirin) is needed. 

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