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


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