Hypertension Evaluation Exam

Aka: Hypertension Evaluation Exam

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II. Goals

  1. Identify end organ damage
  2. Identify signs Secondary Hypertension
  3. Identify reversible exacerbating factors
  4. Document progression

III. Exam: Vitals

  1. BP Examination
    1. See Blood Pressure Measurement
    2. Consider arm to leg systolic BP measurements (difference >20 mmHg suggests Aortic Coarctation)
    3. Hypertension Diagnosis
      1. See Hypertension Evaluation
      2. See Blood Pressure
      3. See Hypertension Criteria
      4. See Ambulatory Blood Pressure Monitoring
      5. See Home Blood Pressure Monitor
  2. Pulses
    1. Bilateral radial pulse
  3. Assess for Obesity
    1. Weight and Height
    2. Ideal Body Weight or BMI
    3. Waist Circumference (assess for Metabolic Syndrome)

IV. Exam: Head

  1. Retinal Exam
    1. See Funduscopic Changes in Hypertension
  2. Mouth Exam
    1. Mallampati Score increased in Sleep Apnea

V. Exam: Neck

  1. Thyroid exam
  2. Carotid Bruits
  3. Neck vein exam

VI. Exam: Chest

  1. Congestive Heart Failure signs
  2. Palpable intercostal pulses

VII. Exam: Cardiovascular

  1. S4 Gallop rhythm (decreased LV compliance)
  2. Tachycardia
  3. Accentuated S2 Heart Sound
  4. Aortic Insufficiency murmur
  5. Abnormal EKG or Echocardiogram
  6. Prior Angiography results

VIII. Exam: Abdomen

  1. Renal artery bruit
    1. May be present in Renal Artery Stenosis
  2. Abdominal Aortic Aneurysm
  3. Enlarged or tender Kidneys (CVA pain)

IX. Exam: Genitourinary

  1. Abnormal Sexual Development
  2. Enlarged Prostate

X. Exam: Peripheral Vascular Disease

  1. Femoral bruits
  2. Femoral pulses
    1. Delayed or absent in Aortic Coarctation
  3. Symmetrical pulses
  4. Lower extremity shin Hair Loss

XI. Exam: Neurologic

  1. Peripheral Neuropathy

XII. Exam: Skin

  1. Stigmata of Cirrhosis
  2. Neurofibromata
  3. Chloasma
  4. Signs of Cushing's Disease
    1. Striae
    2. Acne Vulgaris
    3. Hirsutism

XIII. References

  1. Charles (2017) Am Fam Physician 96(7): 453-61 [PubMed]

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