Chronic hypertension physical examination

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Classification Primary Hypertension Secondary Hypertension Hypertensive Emergency Hypertensive Urgency
Screening

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Assistant Editor-In-Chief: Taylor Palmieri

Overview

Physical examination of a patient with isolated hypertension in the absence of target organ damage is usually unimpressive with the exception of high blood pressure. Healthcare providers must nonetheless search thoroughly for findings on physical examination that might suggest target organ damage and associated clinical conditions

Physical Examination

The physical examination should look for end organ disease and underlying causes of hypertension.

Appearance

• Obesity may be present which is a risk factor for hypertension. Measurement of height, weight, waist and abdominal circumferences. Calculation of BMI is required.

Skin

• Diaphoresis would suggest a pheochromocytoma

Head

• Moon facies and Hirsutism would suggest Cushing's syndrome

Eyes

• Examination of the optic fundi is required
• Retinal hemorrhage may be seen in malignant hypertension
• Retinalvenous crossing changes

Neck

• Thyromegaly may be present in the setting of hyperthyroidism

Heart

• S3 and S4 would suggest heart failure

Lung

• Rales would suggest heart failure

Abdomen

• A renal bruit suggests the presence of renovascular hypertension

Arteries

• A carotid, abdominal or femoral bruit might be present

Lower Extremities

• Lower leg edema suggests cardiac or renal causes of hypertension