In the absence of heart failure, hypertension, with or without enlargement of the heart (left ventricular hypertrophy) is usually symptomless.Symptoms, signs and consequences of congestive heart failure can include:

Fatigue
Irregular pulse or palpitations
Swelling of feet and ankles
Weight gain
Nausea
Shortness of breath
Difficulty sleeping flat in bed (orthopnea)
Bloating and abdominal pain
Greater need to urinate at night
An enlarged heart (cardiomegaly)
Left ventricular hypertrophy and left ventricular remodeling
Diminished coronary flow reserve and silent myocardial ischemia
Coronary heart disease and accelerated atherosclerosis
Heart failure with normal left ventricular ejection fraction (HFNEF), often termed diastolic heart failure
Atrial fibrillation, other cardiac arrhythmias, or sudden cardiac deathHeart failure can develop insidiously over time or patients can present acutely with acute heart failure or acute decompensated heart failure and pulmonary edema due to sudden failure of pump function of the heart. Sudden failure can be precipitated by a variety of causes, including myocardial ischemia, marked increases in blood pressure, or cardiac arrhythmias. Diagnosis
Differential diagnosis
Other conditions can share features with hypertensive heart disease and need to be considered in the differential diagnosis. For example:
Coronary artery disease or ischemic heart diseases due to atherosclerosis
Hypertrophic cardiomyopathy
Left ventricular hypertrophy in athletes
Congestive heart failure or heart failure with normal ejection fraction due to other causes
Atrial fibrillation or other disorders of cardiac rhythm due to other causes
Sleep apnea

Prevention
Because there are no symptoms with high blood pressure, people can have the condition without knowing it.
The child typically becomes listless, with repeated episodes of vomiting, and a morning headache, which may lead to a misdiagnosis of gastrointestinal disease or migraine. Soon after, the child will develop a stumbling gait, truncal ataxia, frequent falls, diplopia, papilledema, and sixth cranial nerve palsy. Positional vertigo and nystagmus are also frequent, and facial sensory loss or motor weakness may be present. Decerebrate attacks appear late in the disease. Extraneural metastasis to the rest of the body is rare, and when it occurs, it is in the setting of relapse, more commonly in the era prior to routine chemotherapy. Pathogenesis
Medulloblastomas are usually found in the vicinity of the fourth ventricle, between the brainstem and the cerebellum. Tumors with similar appearance and characteristics originate in other parts of the brain, but they are not identical to medulloblastoma.Although medulloblastomas are thought to originate from immature or embryonal cells at their earliest stage of development, the cell of origin depends on the subgroup of medulloblastoma. WNT tumors originate from the lower rhombic lip of the brainstem, while SHH tumors originate from the external granular layer.Currently, medulloblastomas are thought to arise from cerebellar stem cells that have been prevented from dividing and differentiating into their normal cell types. This accounts for the histologic variants seen on biopsy. Both perivascular pseudorosette and Homer Wright pseudorosette formations are highly characteristic of medulloblastomas and are seen in up to half of cases.