What is the height and weight of the patient? Where does the patient fit on the growth chart?

Larger and heavier patients will tend to have higher blood pressures.

What is the patient’s weight/height index?

Patients who are heavy for their heights will tend to have higher blood pressures.

Using an appropriate sized cuff, manually obtain the blood pressures in both upper extremities and one lower extremity.

Remember it is always better to use a cuff which might be slightly larger than need than a cuff which is too small. The cuff should cover two thirds of upper arm or the thigh. Elevations of the blood pressures in the upper extremities only could indicate coarctation of the aorta. An elevated blood pressure in the right arm only could indicate stenosis of left ventricular outflow tract.

Assess the skin for any Café-au-lait spots, petechiae, ecchymoses, "butterfly" rash, or generalized rash.

Café-au-lait spots may indicate neurofibromatosis. A petechial rash could indicate Henoch-Schönlein purpura. Ecchymoses could be associated with hemolytic-uremic syndrome. A "butterfly" rash on the face or in fact many generalized rashes may be associated with lupus. Asses the skin, esp. folds of the neck for acanthosis nigricans. This is a sign of insulin resistance and can be seen in syndrome X.

Assess the mucus membranes for lesions.

Lupus can be associated with ulcerations of the mucus membranes.

Perform a careful funduscopic examination.

The eyegrounds may show changes of vessel narrowing, hemorrhages, or exudates in children with significant hypertension.

Assess the heart. Stenosis of the left ventricular outflow tract can result in an elevated blood pressure in the right arm and a systolic murmur.

A PDA or AI can be associated with an elevated systolic pressure and a wide pulse pressure.

Assess the abdomen for masses and bruits.

An obstructed kidney could be palpable. A catecholamine secreting tumor could be palpable. An abdominal bruit could represent a coarctation or a stenotic renal artery.

Assess the genitalia.

A type of adrenogenital syndrome (11ß-Hydroxylase defect) is associated with hypertension and ambiguous genitalia or masculinization.

Assess the quality of the peripheral pulses.

Decreased pulses in the lower extremities and indicate a coarctation of the aorta. An accentuated pulse can indicate a PDA.

Check the extremities for weakness.

Certain neurological diseases such as Guillain-Barré can present with hypertension.