Focused Assessment in Severe Hypertension
History- Is the patient known to have hypertension? What treatment has been given? What is the compliance with treatment? What investigations have been done to exclude an underlying cause for hypertension? Is there associated cardiac or renal disease?
- Pregnant or within three months of giving birth?
- Drug history? Recent use of drugs that may give hyperadrenergic state (e.g. cocaine, amphetamines, phencyclidine)?
- Any symptoms to suggest stroke or subarachnoid haemorrhage, aortic dissection, acute coronary syndrome, pulmonary oedema?
Examination- Measure the blood pressure in both arms
- Check for signs of heart failure and aortic regurgitation
- Check the presence and symmetry of the major pulses, and for radio-femoral delay
- Listen for carotid, abdominal and femoral bruits
- Examine the abdomen (palpable kidneys?)
- Examine the fundi: are there retinal haemorrhages, exudates or papilloedema (not due to other causes), which define accelerated-phase or ‘malignant’ hypertension?
- Assess the conscious level and for focal neurological signs
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