Hypertension for USMLE

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Hypertension pathophysiology, signs and symptoms, complications, and management. Handwritten hypertension full lecture for students taking the USMLE Steps.

PATHOPHYSIOLOGY OF HYPERTENSION
Blood pressure is equal to the cardiac output times the total peripheral resistance. Cardiac output is equal to Stroke Volume times the Heart rate (per minute). Total Peripheral Resistance is determined by the radius of the vessel and compliance.

The primary body systems which help control blood pressure and hypertension is the:

Autonomic Nervous System
alpha1 – vasoconstriction
Beta1 – Increases heart rate
Alpha2 – Decrease sympathetic activity

Renin Aldosterone Angiotensin System

Hormones
Cortisol, Epinephrine, Thyroid and many more.

COMPLICATIONS OF HYPERTENSION
Cardiovascular System complications of hypertension – Left Ventricular Hypertrophy, Confestive Heart Failure, Sudden Cardiac Death

Stroke complcations of hypertension- Infarction, Subarachnoid hemorrhage, Intracerebral hemorrhage, Lacunar infarcts

Renal – Common cause of secondary hypertension, End Stage Renal Disease, Renal Injury, more common in blacks.

Arteries – Atherosclerosis, Claudication

DEFINITION OF HYPERTENSION
Normal Blood pressure is less than 120/80
Pre Hypertension is less than 120-139/80-89
Stage 1 Hypertension is less than 140-159/90-99
Stage 2 Hypertension is greater than 160/100

Isolated Systoilc Hypertension and Isolate Diastolic Hypertension can also occur.

Require minimum of two blood pressure reading over 3 months. Ambulatory Blood Pressure Monitoring is better because can determine night time dip by 10-15%. Also helps distinguish whitecoat hypertension and masked hypertension.

Essential hypertension is when there is no cause identified and is the most common cause. Secondary hypertension can be due to drugs such as OCP, NSAID, TCA, SSRI, Glucocorticoid, EPO, Cyclosporin, Decongestant, Renal causes such as tumor cysts, renal artery stenosis. Adrenal causes of hypertension include high aldosterone, cushings and pheochromocytoma. Endocrine causes of hypertension include hyperthyroidism and hypercalcemia. Aortic coarcation, pre-eclampsia, eclampsia are also other causes of hypertension.

EVALUATION
No specific symptoms can help you diagnose hypertension.
Check BMI, Blood pressure in both arms, Fundoscope, Bruits, Thryoid, murmurs (loud S2 and S4 gallop). Also perform a full Cardiovascular and Neurological examination.

LABS
Renal labs such as urinalysis and albuminuria. ALso rule out metabolic syndrome by checking blood glucose, cholesterol, LDL, HDL, and TAGs. Electrolytes such as Na, K, Calcium.

TREATMENT
Initial treatment for pre hypertension is lifestyle intervention. For hypertension it can help decrease dosage of drug required. Weight reduction alone can decrease blood pressure by 5-20mmHg/10kg. Ideal BMI is less than 25.

Decrease salt intake can also help control hypertension by decrease salt to less than 6g per day.

Dietary Approach to Stop Hypertension (DASH) Diet is high in fruits and vegetables and low in fat can help lower hypertension by 8 to 14mmHg.

Physical activity can also help decrease hypertension by 4-9mmHg.

Pharmacological therapy is used when blood pressure is greater than 140/90. If african american than start with Thiazide and Calcium Channel Blockers, while ACE Inhibitors and ARB are better for patients with Renal disease, Diabetes, Chronic Kidney disease.

Beta Blockers for patients with ischemic heart disease and heart failure. Alpha blocker for patients with

ICD 9 Coding — Coding Hypertension and Chronic Kidney Disease

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ICD 9 Coding — Coding Hypertension and Chronic Kidney Disease

That's Alicia's. I guess I'll bring that answer sheet up.

Alicia: Yeah. And you know what? You guys, I just took a class on this so it's very exciting. I just feel like my little spongy brain has absorbed all kinds of information and it was a lot of fun. I've struggled with this too.

So hypertension, abbreviated HTN if you guys didn't know that you know, what is hypertensive disease? And it's so broad that you know, you can't really define it per se. But the main thing about hypertension is you want to know is it essential or primary hypertension? Okay… and it's going to mean, is there no underlying condition that is causing the blood pressure to increase? Okay so what percentage do you think is essential or primary hypertension? In fact, 95% is essential and unless blood pressure readings are very high, efforts to control blood pressure are usually based on things that… you can just change in your lifestyle. You know, you can lose weight. You can exercise. You can you know, reduce your salt. You know, reduce your stress. Only 10% have a secondary hypertension which would be under category 405.

So probably the first code… I always laugh because the first code that most new coders learn is 401.9 because you see it a lot especially if you're coding for Medicare patients. Everybody seems to have hypertension. So let's see, the physician must document if the patient's hypertension is benign or malignant in order to get your 4th digit. Okay so if it doesn't say whether it's benign or malignant then you have to use 401.9 which, by the way, translates in icd 10 as I10 which I think is kind of fun. So now you already know an icd 10 code.

Get more medical coding training, medical coding tips, medical coding certification and free medical coding webinars at

CKD, Diabetes, Hypertension, Heart Disease in CKD (Hindi)

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Risk factors for CKD, Measures to prevent CKD, CKD as a risk factor for Heart Attack.

Diabetes Hypertension | Diabetes Hypoglycemia

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Diabetes Hypertension | Diabetes Hypoglycemia

Top 7 Home Remedies for High Blood Pressure / Hypertension

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Hypertension, also known as high blood pressure. It is the silent killer chronic medical condition. It is a serious health problem that can lead to heart attacks, strokes and kidney failure. Home Remedies for Hypertension/ High blood pressure includes Hibiscus, Coriander leaves, Cucumber, Coconut water, Watermelon and Bhramri pranayam. With help of these wonderful natural home remedies, one can manage his/her blood pressure levels naturally.

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10-20% of strokes are intracerebral hemorrhage and most are caused by hypertension – arteriolar sclerosis. Unlike large vessel lipid deposits (atherosclerosis) small vessel changes include "onion-skin" thickening, vessel weakness, spontaneous occlusion (lacunar infarct) or rupture (hypertensive hematoma). Complications include neurologic deficit, increased intracranial pressure, hydrocephalus, fever, and seizures.

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Guaranteed to work. Natural High Blood Pressure herbal tablets. For All Types of hypertension irregardless of the cause. Fast Acting and gives relief regardless of whether your hypertension is associated with the following:

Heredity
Renal ailment
Heart disease
High Cholesterol
Anxiety & Tension
Insomnia

Ingredients:
Sedge Leaf, Thyme leaf, Aloe Weed, Winter Cherry Root, Climbing staff tree seed

Once your order is received begin by tracking your blood pressure levels. For reading between 120 to 140 for systolic and between 80 to 90 diastolic begin by taking two tablets per day while taking your prescription medication. For reading above 140 systolic and 90 diastolic begin by taking two tablets in the morning and two in the evening.

When the blood pressure has normalized at approximately 120/80 or below take a maintenance dose of two tablets each day. One in the morning and one in the evening. It is important to watch your salt intake, exercise two or three times each week and consume the daily recommended allowance of fruits and vegetables.

For those taking prescription medication. Phase off the prescription after the blood pressure consistently reads below 120/80.

Following the above procedures you will be able to maintain a normal blood pressure reading on just the herbal tablets without any adverse side effects.

Recommendations:

Reduce sodium and increase potassium by using natural salt supplements such as pink himalayan salt, raw celtic sea salt and braggs liquid amino.

Drink pure water each day. (5-8 glasses)

Exercise at least two to three times each week. Preferabley aerobic exercise.

TESTIMONIALS

I've been on prescription medication for over 10 years and decided to try your herbal tablets even though I was skeptical. I took two in the morning and two in the evening. After two weeks my pressure was 115/75 while taking both medication and herbal tablets. On just the prescription it was 155/89. I then took only the herbal tablets and the pressure jumped up as high as 132/85 for about a week. I called your office and was told to continue with just the herbal tablet unless the pressure went up above 140/90.

I followed your advice and today 6 weeks later my reading on just the herbal tablets is consistently below 130 for the top number and below 80 for the bottom number.

I thank you so much as I was beginning to deal with side effects from the prescription medication. I will tell my friends about your website. Thanks again.

High Blood Pressure : Eat this AMAZING Fruit to Lower Your High Blood Pressure

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Learn how to lower your high blood pressure quickly. Eating this Wonder FRUIT will help lower your high blood pressure naturally. This is one of Grandmother's tricks!

Explained as simple as possible, blood pressure is what you get when you measure the rate at which your heart works when it comes to circulating blood throughout the body. Blood pressure is usually affected by two main factors: how much blood does the heart pump out and how much resistance appears when the heart tries to pump the blood in general circulation. If you want to get a better idea of how this works, think of a narrow hose and how it lets water through, when compared with a wide hose. The pressure needed to pump the water through a wide hose is smaller than the pressure needed for a small hose.

Diet For High Blood Pressure If you want to go on a diet for high blood pressure, you need to learn the truth about the foods that are good and those that are bad. There are a lot of misconceptions when it comes to the diet for high blood pressure, so you need to inform yourself properly. Just because food is healthy, people seem to think that it will taste bad. Obviously, this is not true, as there are many wonderful and delicious meals out there are that are very healthy for your heart. Below I’ll try to tell you about some of the best foods you can consume if you’re on a diet for high blood pressure.

When it comes to including meat in your diet, you should go with lean meats. That’s right, you can eat meat in a diet for high blood pressure, as long as you choose something without a lot of fat in it. To find out if something has a lot of fat, look at it, and if it has many white parts and lines, then go with a piece that doesn’t have them. Cooking the meat is also an important part of the diet, as frying it isn’t ideal. Instead, you can barbecue the meat, or you can go with baking, so you keep the juices that come out of the meat. Ideally, you should use barbecues when it comes to cooking meat. The fat is drained this way, the meat becomes tender and the flavor is very nice.

One other type of meat that you’re allowed to eat is the frozen or fresh fish. Again, baking is better than frying. The baking process should be done until it becomes flaky, and the taste will be very good. You can use some lemon splash and thyme to get a better taste. Fish based meals are very good for high blood pressure, so make sure you include them in your diet.

There is one other thing about fish to consider. You should always avoid getting fish which comes from a can. They come with a lot of salt and preservatives inside, both things you should avoid if you’re on a diet for high blood pressure. Just say no to canned fish and go with something fresh or frozen, that you cook yourself.

One of the most important meals of the day is breakfast, and cereals should be an important part of it. Just get a cereal that doesn’t have too much sodium in it. Most people believe that cereals can’t have salt, since they’re sweet, but they do contain large quantities of salt, so it’s better to be picky about the brand you’re eating.

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How to control High blood pressure naturally

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The cheapest & easiest way to control hypertension/high blood pressure naturally. For better result after following the video instructions decrease your salt intake as far as possible. Information on this video is provided on a "best efforts" basis for interest only and does not constitute any medical advice.

NATURAL REMEDIES TO GET OFF HIGH BLOOD PRESSURE, CHOLESTEROL MEDS -DR JOE BROWN

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DR JOE BROWN TELLS YOU NATURAL REMEDIES TO GET OFF YOUR BLOOD PRESSURE / HYPERTENSION AND CHOLESTEROL MEDICATIONS NATURALLY. ALSO THE DANGERS OF TAKING CONVENTIONAL MEDICATIONS AND THEIR SIDE EFFECTS. HERBAL AND NATURAL PRODUCTS TO REPLACE YOUR PHARMACEUTICAL DRUGS.

Visit: Dr. Joe Brown at