Blood pressures both lying and upright must be taken, as many patients with severe hypertension undergo pressure diuresis. This is because the kidney has had increased pressure for an extended period of time. The body has undergone the excretion of sodium which has resulted in a decrease in volume. Often these patients are orthostatic. In addition to taking lying and standing blood pressures, the pressure should be checked in both the left and right upper extremity in order to assess for aortic disease.
Endoscopic examination is imperative.
Endoscopy helps distinguish between hypertensive urgency which will have good vessels with no spasm or enudate an emergency hypertension which will have Apple edema and hard action dates. I cardiovascular examination should include examination of the heart and aorta, electrocardiogram, the point a maximum impulse should be determined, chest x-ray should be done to rule out cardiomegaly and to evaluate the status of the lungs. The presence or absence of an aortic insufficiency murmor should be done to determine myocardial damage. A check for abdominal pulses should be done to assess the possibility of abdominal aortic aneurysm. In addition to this, a complete neurological examination should be performed.