Hypertension Diagnosis: Three Checks

by Carlo Raj, MD

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    00:01 Hello, everyone. Welcome to cardiovascular disease. Our specific topic here is hypertension.

    00:05 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.

    00:44 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.

    03:04 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 my diastole.

    About the Lecture

    The lecture Hypertension Diagnosis: Three Checks by Carlo Raj, MD is from the course Hypertension.

    Included Quiz Questions

    1. At least 2 measurements of greater than 140/90 mm Hg on 2 separate office visits
    2. At least 4 measurements over 140/90 mm Hg on 4 separate office visits
    3. At least 3 measurements over 160/90 mm Hg taken on both arms in the same office visit
    4. A single measurement over 160/90 mm Hg taken on the right arm
    5. At least 2 measurements over 140/90 mm Hg taken on both arms on separate office visits
    1. Primary hypertension is defined as high blood pressure with no specific cause, unlike secondary hypertension
    2. Primary hypertension is the first presentation of high blood pressure at the office
    3. Primary hypertension is high blood pressure that can be cured by treating the initial medical condition, unlike secondary hypertension, which can only be controlled with diet and exercise
    4. Primary hypertension is high blood pressure in children
    5. Primary hypertension cannot be treated with medication, but only diet and exercise
    1. Greater than or equal to either 210 systolic OR 120 diastolic
    2. Greater than or equal to either 140 systolic or 90 diastolic
    3. Greater than or equal to either 120 systolic or 80 diastolic
    4. Greater than or equal to either 130 systolic or 90 diastolic
    5. Greater than or equal to either 160 systolic or 100 diastolic

    Author of lecture Hypertension Diagnosis: Three Checks

     Carlo Raj, MD

    Carlo Raj, MD

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    By Neuer N. on 10. August 2017 for Hypertension Diagnosis: Three Checks

    Superb explanations in hypertension.very simple logic and scientific explanations