Hypertension Symptoms: Signs of High Blood Pressure and What They Mean

Why hypertension usually has no symptoms

Blood pressure rises slowly over years, and the body adapts. Arteries, the heart and the kidneys are damaged quietly, without pain. Nearly half of US adults have high blood pressure by current guidelines, and many of them do not know it. Most people find out at a routine check, at a pharmacy, or after a complication such as a stroke or heart attack.

This is why doctors say you cannot use how you feel to judge your blood pressure. Feeling well does not mean your pressure is normal, and feeling tense or flushed does not mean it is high.

Symptoms that can come with very high blood pressure

When blood pressure climbs to very high levels, usually around 180/120 or above, or rises quickly, symptoms can appear:

Any of these with a very high reading is a hypertensive emergency. Call 911 or your local emergency number.

Does high blood pressure cause headaches?

Usually not at the levels most people have. A headache is linked to blood pressure mainly when readings are in the crisis range, and a sudden severe headache with a very high reading can signal hypertensive encephalopathy or a brain bleed. Ordinary tension headaches are far more common, and the pain of a headache can itself push a reading up for a while. Morning headaches in someone who snores loudly may point to sleep apnea, which also raises blood pressure.

Dizziness and nosebleeds

Dizziness is more often caused by blood pressure medicines lowering pressure too far, especially on standing, than by high blood pressure itself. Nosebleeds are common and usually caused by dry air or nose picking; high blood pressure can make an existing bleed harder to stop but rarely starts one.

Symptoms often blamed on blood pressure

Facial flushing, feeling nervous or "wound up", sweating, poor sleep and a pounding heartbeat are often put down to high blood pressure, but studies show they are poor predictors of the actual reading. If you have them, check your pressure rather than assume.

Symptoms of long-term damage

Years of untreated hypertension can damage organs. The symptoms are those of the complication, not of the blood pressure itself:

• Heart: breathlessness on exertion or when lying flat, ankle swelling and tiredness from heart failure; chest pain from coronary artery disease
• Brain: sudden face drooping, arm weakness or speech problems from stroke; gradual memory problems from vascular dementia
• Kidneys: usually silent until advanced, then swelling, tiredness and changes in urination
• Eyes: usually no symptoms early; hypertensive retinopathy is often first seen at an eye exam
• Legs: cramping pain in the calves when walking, from narrowed arteries

High blood pressure symptoms in women

Hypertension causes the same lack of symptoms in women as in men, but some situations are specific to women:

• Pregnancy: blood pressure of 140/90 or higher needs prompt assessment. A severe headache, vision changes, pain under the ribs on the right, or sudden swelling of the face and hands can be signs of preeclampsia, which can also start in the weeks after birth.
• Birth control pills containing estrogen can raise blood pressure in some women.
• Menopause: blood pressure tends to rise after menopause. Hot flashes and palpitations at this time are usually hormonal, not a sign of high pressure.

How to find out if you have hypertension

The only way to know is to measure it. A diagnosis of hypertension needs raised readings, 130/80 or higher by US guidelines, on at least two separate occasions, ideally confirmed with home readings or 24-hour monitoring.

If you have just seen a high number on a monitor and want to know whether it is dangerous and how to recheck it properly, see our step-by-step guide to what to do after a high blood pressure reading.

Frequently asked questions

What are the symptoms of high blood pressure?

Most people with high blood pressure have no symptoms. At very high levels it may cause a severe headache, blurred vision, chest pain, shortness of breath, confusion or weakness, which need emergency care. Because it is usually silent, regular checks are the only reliable way to find it.

Can you feel high blood pressure?

Usually not. Most people feel completely normal even with readings well above the healthy range. Some people believe they can tell by a flushed face, tension or a headache, but these are poor guides. Measure your blood pressure rather than relying on how you feel.

Why is high blood pressure called the silent killer?

Because it damages the arteries, heart, brain, kidneys and eyes for years without causing symptoms. Many people find out only after a stroke, heart attack or kidney problem. Treating it lowers these risks substantially, which is why routine checks matter.

Can high blood pressure make you tired?

High blood pressure itself rarely causes tiredness. Fatigue is more often due to blood pressure medicines, poor sleep, sleep apnea, or complications such as heart failure or kidney disease. If you feel tired after starting a new medicine, talk to your doctor rather than stopping it.

What are the warning signs of a hypertensive crisis?

A reading of 180/120 or higher with a severe headache, chest pain, shortness of breath, back pain, numbness or weakness, vision changes, trouble speaking or confusion. These signal possible organ damage. Call 911 or your local emergency number straight away.