SYMPTOMS
In hypertension, as long as the heart, which is probably hypertrophied, remains perfectly competent, there are few symptoms, and the person does not seek advice until he notices one or more of several possible conditions. He may be dizzy, his head may feel full and tight, he may have headaches, or he may have some cardiac pain or distress. Other persons do not seek advice until there is a slight weakening of the heart, showing the strain under which it is laboring. In most of these high tension cases, the patients have rather a slow heart, provided the heart is sufficient. Eyster and Hooker [Footnote: Eyster and Hooker: Am. Jour. Physiol., May, 1908.] found that the slowing of the heart in high blood pressure is due to action through the vagus nerves either from the inhibitory center in the medulla or reflexly by stimulation of the peripheral nerves of the vessels.
Another symptom for which the patient frequently seeks advice is that he is unable to relax from his business cares, when off duty. He also finds that he works at a higher tension, and that coffee and tea, alcohol and tobacco stimulate him more than usual. He sleeps restlessly, and dreams at night. He has an increased frequency of urination in the morning, especially after taking coffee, and sometimes gets up once or twice at night to urinate. He is irritable at times; short breathed on exertion, and sometimes has indigestion. He may have pains or aches in his heart. He may find that he dislikes to lie on his left side.
However much it may upset the patient and render him more nervous to inform him that his blood pressure is too high, it is necessary to give him this information. People now suspect the condition, and they frequently seek their physicians to determine if the blood pressure is too high and, from reading health journals, more or less realize some of the things, at least, that must be done to decrease the pressure. Consequently, the very things that are advised or ordered give the patient the diagnosis, whether he is told directly or not. Hence, we must talk freely with the patient, much as we do in heart defects, and get his cooperation, stating how frequent the condition is, how often it is readily improved, and how little it may interfere with long life.
Wiener and Wolfner [Footnote: Wiener, Meyer, and Wolfner, M. L.: A Reaction of the Pupil, Strongly Suggestive of Arteriosclerosis with Increased Blood Pressure, THE JOURNAL A. M. A., July 17, 1915, p. 214.] state that they have found with blood pressure that the pupils of the eyes are larger than normal, and that they readily contract to the stimulus of light, but immediately return to their previous size.