TABLE 8.

Examples of Physical Examination Findings Suggestive of Definable Hypertension

Finding*Possible Etiology
Vital signsTachycardiaHyperthyroidism, pheochromocytoma, neuroblastoma, primary hypertension
Decreased lower extremity pulses; drop in BP from upper to lower extremitiesCoarctation of the aorta
EyesRetinal changesSevere hypertension, more likely to be associated with secondary hypertension
Ear, nose, and throatAdenotonsillar hypertrophySuggests association with sleep-disordered breathing (sleep apnea), snoring
Height/weightGrowth retardationChronic renal failure
Obesity (high BMI)Primary hypertension
Truncal obesityCushing syndrome, insulin resistance syndrome
Head and neckMoon faciesCushing syndrome
Elfin faciesWilliams syndrome
Webbed neckTurner syndrome
ThyromegalyHyperthyroidism
SkinPallor, flushing, diaphoresisPheochromocytoma
Acne, hirsutism, striaeCushing syndrome, anabolic steroid abuse
Café-au-lait spotsNeurofibromatosis
Adenoma sebaceumTuberous sclerosis
Malar rashSystemic lupus erythematosus
Acanthrosis nigricansType 2 diabetes
ChestWidely spaced nipplesTurner syndrome
Heart murmurCoarctation of the aorta
Friction rubSystemic lupus erythematosus (pericarditis), collagen-vascular disease, end stage renal disease with uremia
Apical heaveLVH/chronic hypertension
AbdomenMassWilms tumor, neuroblastoma, pheochromocytoma
Epigastric/flank bruitRenal artery stenosis
Palpable kidneysPolycystic kidney disease, hydronephrosis, multicystic-dysplastic kidney, mass (see above)
GenitaliaAmbiguous/virilizationAdrenal hyperplasia
ExtremitiesJoint swellingSystemic lupus erythematosus, collagen vascular disease
Muscle weaknessHyperaldosteronism, Liddle syndrome
  • Adapted from Flynn JT. Prog Pediatr Cardiol. 2001;12:177–188.

  • * Findings listed are examples of physical findings and do not represent all possible physical findings.