High blood pressure is known as a silent killer because by the time symptoms of hypertensive heart disease appear, the condition can be life-threatening. Congestive heart failure is one possible result of hypertensive heart disease. Symptoms of congestive heart failure include:

• Shortness of breath, especially with activity
• Waking at night short of breath
• Need to sleep with the head elevated to avoid shortness of breath
• Rapid or irregular pulse
• Sensation of feeling the heart beat (palpitations)
• Cough, which may produce frothy or blood-tinged mucus
• Fatigue, weakness, faintness
• Swelling of the feet and ankles
• Increased frequency of urination at night

Ischemic heart disease is another possible result of hypertensive heart disease. Symptoms include:

• Chest pain, pressure-type, particularly with exertion
• Chest pain associated with:
  • Nausea
  • Sweating
  • Dizziness
  • Shortness of breath

A third possible result is hypertrophic cardiomyopathy.

Signs of heart disease are found on physical examination. The blood pressure is elevated. Enlargement of the heart may be noted. Listening to the chest with a stethoscope may reveal fluid in the lungs or abnormal heart sounds. Late in the history of the condition, there may be signs of heart failure including pulmonary (lung) congestion.

An ECG may be abnormal, showing an enlarged heart, an irregular heart beat, and/or evidence of ischemia (lack of oxygen to the heart muscle).

Enlargement of the heart or decreased heart functioning may be seen on:

• An echocardiogram
• A chest X-ray
• A chest CT scan (rarely performed for this diagnosis)
• A coronary angiogram