Chronic hypertension physical examination: Difference between revisions

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Revision as of 00:07, 5 November 2013

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

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. According to JNC 7, physical examination should include:^[1]

Measurement of vital signs (temperature, pulse, respiratory rate, blood pressure). Blood pressure should be measured according to appropriate technique.

Measurement of height, weight, waist and abdominal circumferences. Calculation of BMI is required.

Examination of optic fundi

Auscultation of carotid, abdominal, and femoral bruits

Palpation of thyroid gland

Thorough examination of the heart and lungs

Abdominal examination for enlarged kidneys, masses, distended urinary bladder, and abnormal aortic pulsations

Palpation of lower extremities for edema and pulses

Neurological assessment

2013 ESH/ESC Guidelines For The Management of Arterial Hypertension (DO NOT EDIT)^[2]

Summary of Recommendations on Physical Examination (DO NOT EDIT)^[2]

Class I
"1. It is recommended that all hypertensive patients undergo palpation of the pulse at rest to determine heart rate and to search for arrhythmias, especially atrial fibrillation. (Level of Evidence: B)"

References

↑ Cuddy ML (2005). "Treatment of hypertension: guidelines from JNC 7 (the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure 1)". J Pract Nurs. 55 (4): 17–21, quiz 22-3. PMID 16512265.
↑ ^2.0 ^2.1 Authors/Task Force Members. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A; et al. (2013). "2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)". Eur Heart J. 34 (28): 2159–219. doi:10.1093/eurheartj/eht151. PMID 23771844.

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[pmid16512265-1] Cuddy ML (2005). "Treatment of hypertension: guidelines from JNC 7 (the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure 1)". J Pract Nurs. 55 (4): 17–21, quiz 22-3. PMID 16512265.

[pmid23771844-2] 2.0 ^2.1 Authors/Task Force Members. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A; et al. (2013). "2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)". Eur Heart J. 34 (28): 2159–219. doi:10.1093/eurheartj/eht151. PMID 23771844.

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@@ Line 7: / Line 7: @@
 ==Physical Examination==
-The physical examination should look for end organ disease and underlying causes of hypertension.
+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. According to JNC 7, physical examination should include:<ref name="pmid16512265">{{cite journal| author=Cuddy ML| title=Treatment of hypertension: guidelines from JNC 7 (the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure 1). | journal=J Pract Nurs | year= 2005 | volume= 55 | issue= 4 | pages= 17-21; quiz 22-3 | pmid=16512265 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16512265 }} </ref>
-===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===
+* Measurement of vital signs (temperature, pulse, respiratory rate, blood pressure). Blood pressure should be measured according to appropriate technique.
-* [[Diaphoresis]] would suggest a [[pheochromocytoma]]
-===Head===
+* Measurement of height, weight, waist and abdominal circumferences. Calculation of BMI is required.
-* 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===
+* Examination of optic fundi
-* [[Thyromegaly]] may be present in the setting of [[hyperthyroidism]]
-===Heart===
-* [[S3]] and [[S4]] would suggest [[heart failure]]
-===Lung===
-* [[Rales]] would suggest [[heart failure]]
-===Abdomen===
+* Auscultation of carotid, abdominal, and femoral bruits
-* A [[renal bruit]] suggests the presence of [[renovascular hypertension]]
-===Arteries===
+* Palpation of thyroid gland
-* A carotid, abdominal or femoral bruit might be present
-===Lower Extremities===
+* Thorough examination of the heart and lungs
-* Lower leg [[edema]] suggests cardiac or renal causes of [[hypertension]]
+* Abdominal examination for enlarged kidneys, masses, distended urinary bladder, and abnormal aortic pulsations
+* Palpation of lower extremities for edema and pulses
+* Neurological assessment
 ==2013 ESH/ESC Guidelines For The Management of Arterial Hypertension (DO NOT EDIT)<ref name="pmid23771844">{{cite journal| author=Authors/Task Force Members. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A et al.| title=2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). | journal=Eur Heart J | year= 2013 | volume= 34 | issue= 28 | pages= 2159-219 | pmid=23771844 | doi=10.1093/eurheartj/eht151 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23771844  }} </ref>==