Which of the following is a sign of cardiac stress in hypertension?

Chest pain is a significant indicator of cardiac stress in patients with hypertension. When blood pressure is consistently elevated, it places additional strain on the heart. This stress can lead to ischemia, where the heart muscle does not receive enough oxygen and nutrients due to narrowed or blocked coronary arteries. As a result, individuals may experience chest pain, known as angina, which is a clear signal that the heart is under duress.

While fatigue can be a symptom associated with various conditions, increased appetite typically does not correlate with cardiac stress, and an elevated heart rate can occur due to numerous factors unrelated to heart strain alone. Thus, chest pain stands out as a specific, concerning sign related to the cardiovascular system in the context of hypertension.