Hello, everyone. Welcome to cardiovascular
disease. Our specific topic here is hypertension.
Dr. Raj let us start. We will begin with hypertension.
What are we looking at here? 140/90 that is
the cut off point that you want to pay attention
to. 140 systole, 90 diastole. These are things
that we will then extrapolate from physio
to make sure that you understand the significance
of both systole and diastole. Now, what do
you need to confirm hypertension? Three separate
measurements over three separate office visits.
Pay attention to that phrase, please. Anything
that we do moving forward, you need to make
sure that you confirm your diagnosis always.
That is the type of questions that you
sure will get from every single source. Let it
be rotations, let it be your residency, let
it be any licensing exam. Now, once you go
beyond 140/90, what do you need to do? You
want to make sure that you understand at what
point do you need to administer therapy immediately.
Now we get into blood pressures that are quite
high. Take a look at this systole 210, what
is normal? About 120. As a frame of reference
120 is normal systole. 140 is technical
definition of hypertension and 210 is ridiculously
high. When you have a diastole of 120, what
does that mean? Well as we proceed through
hypertension, we will take a look at the differences
between primary and secondary. We will be
spending a little bit more time on the secondary
because the exact etiology and pathogenesis
become quite obvious in the journey
towards secondary hypertension. It becomes
very relevant. Primary hypertension for the
most, what are you thinking about telling your
patient? "Hey, I want you to lose some weight." Now you not
gonna come out and say that, that wouldn't be
very nice. So what do you say? "What are you
eating? Would you want to cut down on salt
perhaps?" Salt, what is that? Sodium. You start
thinking about sodium and its effects on your
blood pressure. Whenever sodium is present
in your plasma in your blood, guess what is
going to do? It is going to retain some of
that fluid. So all I am doing here is giving
you a better idea and more detailed oriented
pathophys so that you understand how to deal
with something like primary hypertension.
As your blood pressure continues to rise,
we see here 210, you want to start thinking
about "Wow, do I need to administer immediate
therapy?" A diastole of 120. What are you thinking
about diastole? The resting phase. Close your
eyes. Everything that we do in medicine, you
should be able to conceptualize. If you are
just reading what is written here, if you
just look at my mouth and listen what I have
to say, so be it, but you have to be able to picture
it. So that's your resting phase, isn't it?
What is resting? How about your blood vessels?
Well if your blood vessels get constricted,
what happens? What is that called, please? Good.
It is called TPR, total peripheral resistance.
And so therefore if there is increased vasoconstriction
of your blood vessel, what phase of your blood
pressure is going to be affected? The systole
or diastole, please? The diastole. So as we
move forward or any question that you get
in terms of dissecting your blood pressure
further, you want to pay attention to what is the
volume contributing to my systole or is that the
fact that my blood vessels and whether or
not it is vasoconstricting or dilating affecting