Clinical features

Ask patients with known hypertension

• if they have a primary care physician ^b  
• if they take their antihypertensive medication  ^b  

• headaches, palpitations and sweating attacks ^c  
• renal disease

• headache
• psychomotor agitation
• epistaxis
• chest pain
• dyspnoea
• arrhythmias

Concentrate on excluding the following conditions 

• neurological
  • cerebral infarction (see stroke chapter)
  • intracranial haemorrhage or subarachnoid haemorrhage
  • hypertensive encephalopathy
• cardiovascular causes
  • acute pulmonary oedema or acute congestive heart failure
  • myocardial infarction or unstable angina
  • aortic dissection
  • coarctation of the aorta
  • renovascular hypertension ^b 
  • eclampsia 

• fundoscopy ^c  
• auscultate for an abdominal bruit ^a