Precipitating causes such as pregnancy, illicit drug use (cocaine and methamphetamines), or decongestants should be considered. Patients should be asked about central nervous system symptoms (headaches, visual changes, weakness, seizures, and confusion), cardiovascular symptoms (chest pain, palpitations, dyspnea, syncope, pedal edema, or tearing pain radiating to the back or abdomen), and renal symptoms (anuria, edema, or hematuria). The patient should be examined for evidence of papilledema, retinal exudates, neurologic deficits, seizures, or encephalopathy; the presence of these findings may constitute a hypertensive emergency in the setting of elevated blood pressure. The patient also should be assessed for carotid bruits, heart murmurs, gallops, asymmetrical pulses or unequal blood pressures (coarctation vs aortic dissection), pulsatile abdominal masses, and pulmonary rales. Hypertensive encephalopathy is characterized by altered mental status in the setting of acute hypertension, and may be accompanied by headache, vomiting, seizures, visual disturbances, papilledema, or hematuria. In the pregnant (or postpartum) patient, the clinician should look for hyperreflexia and peripheral edema, suggesting preeclampsia.