Physical Examination for High Blood Pressure
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:
- Check if you might 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
High blood pressure is also classified into stages.
- Stage 1 high blood
- Systolic 140-159 mm Hg
- Diastolic 90-99 mm Hg
- Stage 2 high blood
- Systolic 160 mm Hg or higher
- Diastolic 100 mm Hg or higher
If you are over 80 years old and in good health, your doctor may tell you your blood pressure should be 150/90 or less.
If you have diabetes, your blood pressure should be 130/80 or less.
Making sure that blood pressure is actually high
After measuring your blood pressure, your doctor may ask you to test it again when you are home.footnote 1 This is because your blood pressure can change throughout the day. And sometimes blood pressure is high only because you are seeing a doctor. This is called white-coat hypertension. To diagnose high blood pressure, your doctor needs to know if your blood pressure is high throughout the day.
So your doctor may ask you to monitor your blood pressure at home to make sure that it actually is high. You may get an ambulatory blood pressure monitor or a home blood pressure monitor. These devices measure your blood pressure several times throughout the day.
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
High blood pressure means the top number is 140 or higher or the bottom number is 90 or higher, or both.
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Brian D. O'Brien, MD - Internal Medicine
Adam Husney, MD - Family Medicine
Martin J. Gabica, MD - Family Medicine
Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer Stephen Fort, MD, MRCP, FRCPC - Interventional Cardiology
Current as ofJanuary 16, 2018
Current as of: January 16, 2018
Author: Healthwise Staff
Medical Review: E. Gregory Thompson, MD - Internal Medicine & Brian D. O'Brien, MD - Internal Medicine & Adam Husney, MD - Family Medicine & Martin J. Gabica, MD - Family Medicine & Kathleen Romito, MD - Family Medicine & Stephen Fort, MD, MRCP, FRCPC - Interventional Cardiology
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