The physical examination should begin with an assessment of the patient's overall appearance, including their comfort level, any shortness of breath, the number of heartbeats per minute, and their complexion, including pallor and estimated age. The physician should then take the patient's blood pressure in both arms and ankles. Generally, the blood pressure is taken while the patient is seated. However, the physician may choose to take the blood pressure while the patient is lying down as well as standing if that patient has reported a history of fainting spells or lightheadedness, or if dehydration or medication toxicity is suspected.

If the examination reveals an asymmetry in the blood pressure between the two arms and/or legs of more than ten millimeters of mercury, or if the overall blood pressure is elevated, the physician should then proceed to check blood pressure in the patient's lower extremities. This asymmetry often provides an early and very reliable sign of arterial disease in the lower extremities or in the aorta itself, the major abdominal artery. It may also serve as a sign of a congenital blockage, called a coarctation of the aorta, which is a surgically reversible cause of high blood pressure. Although frequently diagnosed in young patients, coarctation of the aorta may sometimes only become apparent once the patient reaches 40 to 50 years of age. Coarctation may also be associated with other congenital anomalies such as a bicuspid (two-part) aortic valve—versus the normal tricuspid (three-part) sort—and brain aneurysms.

Blood pressure measurement is an important part of the physical examination.

Next, the physician should confirm that all pulses, from the neck to the ankles, are present, and the physician should observe the veins in the neck. By listening carefully to each pulse for any sign of noise, the physician can identify the presence of a narrowing or arterial cholesterol blockage, an early and very reliable sign of arterial sclerosis. The patient's weight, circumference, and height should be recorded in order to provide an accurate comparison and to help determine the possible influence of treatment measures or dietary regimens. The physician should be particularly alert to any large, unintentional weight loss—approximately 10 to 20 pounds of weight or more—that may indicate a systemic disease, such as cancer or heart failure. Sudden weight gain in the feet and legs due to edema is also a concern, and should be noted as unilateral or bilateral.

Finally, the physician will use a stethoscope to listen to the patient's heart for murmurs, gallops (extra heart sounds), and clicks. He or she will also listen to the patient's major arteries and lungs, as well as palpate the abdominal contents to check for any enlargement of the spleen or liver, and to assess the size of the abdominal aorta. Aneurysms of the aorta, which are often asymptomatic and potentially lethal, can sometimes be identified through a physical examination. The physician will also listen for murmurs. A heart murmur is not a disease but the term used to describe the noise made by blood flowing through the heart. An experienced cardiologist can often identify the origin of the murmur, which may be associated with heart disease. The term will be obsolete when the stethoscope is replaced by hand-held ultrasound or echocardiogram devices.