Exam Overview

A physical exam for high blood pressure also includes a medical history. 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 physical
exam 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 exam of the retina, the light-sensitive lining at the
    back of the eye.
  • A heart exam.
  • An exam of your legs for
    fluid buildup (edema), and the pulse in several areas, including the
    neck.
  • An exam 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 exam 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:

Results

Blood pressure measurements for adults are classified as
follows.footnote 1

Ideal blood pressure

  • 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

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 2 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.

Other results

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.

Complete the medical test information form (PDF) (What is a PDF document?) to help you prepare for this test.

Related Information

References

Citations

  1. Weber MA, et al. (2013). Clinical practice guidelines for the management of hypertension in the community. Journal of Clinical Hypertension. DOI: 10.1111/jch.12237. Accessed December 19, 2013.
  2. U.S. Preventive Services Task Force. (2015). Hypertension in Adults: Screening and Home Monitoring: Final Recommendation Statement. http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/high-blood-pressure-in-adults-screening. Accessed January 21 , 2016

Credits

ByHealthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD – Internal Medicine
Martin J. Gabica, MD – Family Medicine
Adam Husney, MD – Family Medicine
Specialist Medical Reviewer Adam Husney, MD – Family Medicine

Current as ofOctober 5, 2017