Physical Examination for High Blood Pressure
British Columbia Specific Information
High blood pressure, also called hypertension, can damage your blood vessels, heart and kidneys. This damage can cause a heart attack, stroke or other health problems. Your blood pressure reading is based on two measurements called systolic (the top number) and diastolic (the bottom number) written as a ratio, for example (120/80 mmHg). Generally if your blood pressure is more than 140/90 mmHg when measured in your healthcare provider’s office, it may be high blood pressure. This figure is different for the very elderly (more than 80 years old) whose blood pressure should be below 150/90 mmHg, and for people with diabetes whose blood pressure should be below 130/80 mmHg. People suffering from other illnesses will have different target normal values. For more information on hypertension, visit the Heart & Stroke Foundation and Hypertension Canada.
Making healthy lifestyle choices can help lower your blood pressure and improve your health. For information on healthy eating for lowering your blood pressure, see HealthLink BC File #68b Lifestyle Steps to Lower Your Blood Pressure, our Heart Health resources, or visit Eating Well with Canada's Food Guide.
You may also call 8-1-1 to speak to a registered dietitian, Monday to Friday 9:00 a.m. to 5:00 p.m., or you can Email a HealthLinkBC Dietitian.
A physical examination for high blood pressure also includes a medical history. The extent of the physical examination 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 physical examination and medical history includes:
- Your medical history, to evaluate risk factors such as smoking or family history of high blood pressure.
- 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, height, and waist.
- An examination of the retina, the light-sensitive lining at the back of the eye.
- A heart examination.
- An examination of your legs for fluid buildup (edema), and the pulse in several areas, including the neck.
- An 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 blood flow through a narrowed artery in the abdomen (abdominal bruits).
- An examination of your neck for an enlarged thyroid, distended neck veins, and bruits in the carotid arteries.
Why It Is Done
The physical examination 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 high blood pressure), such as medicines or other medical conditions.
Blood pressure measurements are classified as follows.footnote 1
Low risk or ideal
- Systolic 120 millimetres of mercury (mm Hg) or below
- Diastolic 80 mm Hg or below
Medium risk or high-normal blood pressure
- Systolic 121–139 mm Hg
- Diastolic 80–89 mm Hg
High risk or high blood pressure (hypertension)
- Systolic 140 mm Hg or above
- Diastolic 90 mm Hg or above
Your doctor might check for signs that high blood pressure has already caused damage to your blood vessels, heart, or eyes. Your doctor might check for:
- Extra heart sounds caused by enlargement of the heart.
- Swollen (distended) neck veins, which may point to possible heart failure.
- Abnormal sounds when the doctor listens to the blood vessels in the abdomen using a stethoscope. These sounds may be caused by blood flow through a narrowed artery in the abdomen (abdominal bruits) or a narrowed artery leading to the kidney (renal artery stenosis) or by abnormal movement of blood through the aorta, the main artery that carries blood from the heart to the rest of the body.
- Abnormal sound of blood flow (bruit) or diminished or absent blood flow (pulses) in the blood vessels of the arms and legs.
- Abnormal buildup of fluid in the abdomen or legs (edema).
- Abnormalities of the blood vessels in the back of the eye.
What To Think About
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.
Adaptation Date: 7/13/2016
Adapted By: HealthLink BC
Adaptation Reviewed By: HealthLink BC
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