The physical exam on a patient with hypertension includes vital signs, cardiovascular exam, pulmonary exam, neurological exam, and dilated fundoscopy. Vital signs should obviously focus on blood pressure. Key elements of the cardiovascular exam include heart sounds (gallops or murmurs), carotid or renal bruits, and peripheral pulses. Pulmonary exam can identify signs of heart failure if rales are present. Signs of cerebral ischemia can be detected by a good neurological exam.[8] And finally, dilated fundus exam is necessary for staging of hypertensive retinopathy.
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