The physical examination may be normal (other than the elevated blood pressure), but signs of hypertension and / or its causes are sometimes present and should be specifically sought, including Eyes: Proptosis (hyperthyroidism), hypertensive retinopathy (arteriolar spasm, hemorrhages, exudates, and rarely papilledema) Head and face: Moon facies (corticosteroid excess, such as Cushing syndrome), tonsillar hypertrophy (sleep apnea) Neck: Thyroid enlargement and / or tenderness (hyperthyroidism) Heart: Murmur (coarctation of the aorta), friction rub (collagen vascular disease), apical heave (left ventricular hypertrophy) Abdomen: Mass (tumor, cystic kidney disease, hydronephrosis), bruit (renovascular disease) Extremities: Edema (kidney disease), joint swelling (collagen vascular disease), lower extremity traction or cast (orthopedic-related hypertension) Genitalia: Ambiguous / virilization (adrenal hyperplasia), advanced puberty (intracranial tumor) Skin: Pallor / flushing (catecholamine excess), acne / hirsutism / striae (Cushing syndrome, corticosteroid therapy), café-au-lait spots / neurofibromas (neurofibromatosis), ash-leaf spots / adenoma sebaceum (tuberous sclerosis complex), rash (systemic lupus erythematosus, immunoglobulin A-associated vasculitis) Neurologic: Muscle weakness (hyperaldosteronism, Liddle syndrome) General: Obesity (primary / essential hypertension), growth retardation (chronic kidney disease) Vital signs: Tachycardia (hyperthyroidism, catecholamine excess), blood pressure difference between the extremities (coarctation of the aorta, mid-aortic syndromes [1]) Symptoms and signs reference 1.