Physical exam for high blood pressure

Exam Overview

The extent of the physical exam and the level of detail in your doctor's questions depend on how high your blood pressure is and whether you have other risk factors for heart disease. People who have many risk factors may have a more detailed evaluation.

The exam includes:

• Your medical history to evaluate risk factors.
• Two or more blood pressure measurements. Measurements may be taken from both the left and right arms and legs and may be taken in more than one position, such as lying down, standing, or sitting. Multiple measurements may be taken and averaged.
• Measurement of your weight and height.
• Examination of the retina, the light-sensitive lining at the back of the eye.
• A heart exam.
• Examination of your torso, arms, and legs for fluid buildup (edema), and the pulse in several areas, including the neck.
• Examination of your abdomen using a stethoscope. A doctor will listen to the blood vessels in the abdomen for abnormal sounds. These sounds may be caused by rapid blood flow through a narrowed artery in the abdomen (abdominal bruits).
• Examination of your neck for an enlarged thyroid, distended neck veins, and bruits in the carotid arteries.

Why It Is Done

The physical exam and medical history are done to:

• Confirm that you have high blood pressure.
• Check for effects of high blood pressure on organs such as the kidneys and heart.
• Determine whether you have risk factors for heart disease or stroke.
• Rule out other causes of high blood pressure (secondary hypertension), such as medicines or other medical conditions.

Results

Blood pressure measurements are classified as follows.

Normal (optimal)

• Systolic 119 millimeters of mercury (mm Hg) or below
• Diastolic 79 mm Hg or below

Prehypertension

• Systolic 120–139 mm Hg
• Diastolic 80–89 mm Hg

High blood pressure (hypertension)

• Systolic 140 mm Hg or above
• Diastolic 90 mm Hg or above

High blood pressure is also classified into stages.

• Stage 1 high blood pressure:
  • Systolic 140–159 mm Hg
  • Diastolic 90–99 mm Hg

• Stage 2 high blood pressure:
  • Systolic 160 mm Hg or higher
  • Diastolic 100 mm Hg or higher

Other exams

The physical exam may look for evidence that high blood pressure has already caused damage to blood vessels or other organs or for signs of other disease. Your health professional may examine your:

• Eyes.
• Heart, torso, arms, and legs.

If prehypertension or high blood pressure is diagnosed, lifestyle changes and/or drug treatment may be started.

You may need more tests to check for secondary high blood pressure or damage to other organs, such as the kidneys, if:

• You are young and your blood pressure is 160/100 or higher.
• You had many treatments and medicines but your blood pressure is still 160/100 or higher.

What To Think About

In most cases of high blood pressure, the person does not have any signs of complications or secondary causes of high blood pressure.

Note: A diagnosis of high blood pressure usually is based on an average of two or more readings taken during two or more visits after an initial screening.

• Except in very severe cases, the diagnosis is not based on a single reading.
• Two or more blood pressure measurements, taken at follow-up doctor visits, may be needed to confirm an initial high blood pressure reading.
• Single blood pressure readings taken a week apart may vary, due to normal changes in blood pressure and to differences in how it is measured.

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