Hypertension Explained Clearly - Causes, Diagnosis, Medications, Treatment, Pathophysiology
Hypertension Explained Clearly - Causes, Diagnosis, Medications, Treatment, Pathophysiology
Professor Roger Seheult, MD explains hypertension with clear illustrations. IMPORTANT: View our newer video on the updated Hypertension guidelines: • Hypertension Guidelines Explained Cle…
Understand Hypertension and the medications used for treatment with this clear explanation from Dr. Seheult of https://www.medcram.com/?utm_source=Y…
This is video 1 of 2 on hypertension (high blood pressure).
Includes a discussion on the “ABCDs” of antihypertensive medications such as ace inhibitors, angiotensin receptor blockers, beta blockers, ARBs, calcium channel blockers, and diuretics as well as hypertension pathophysiology.
Speaker: Roger Seheult, MD
Clinical and Exam Preparation Instructor
Board Certified in Internal Medicine, Pulmonary Disease, Critical Care, and Sleep Medicine.
MedCram: Medical topics explained clearly including: Asthma, COPD, Acute Renal Failure, Mechanical Ventilation, Oxygen Hemoglobin Dissociation Curve, Hypertension, Secondary Hypertension, Shock, Diabetic Ketoacidosis (DKA), Medical Acid Base, VQ Mismatch, Hyponatremia, Liver Function Tests, Pulmonary Function Tests (PFTs), Adrenal Gland, Pneumonia Treatment, any many others.
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Content
2.36 -> welcome to another MedCram lecture we
could talk about hypertension and
7.46 -> specifically we're going to talk about
the definition why talking about
11.639 -> hypertension is important and then the
treatments and I really want to dedicate
15.9 -> this first video to the treatments
simple treatments of hypertension and
21.21 -> how you choose medications to treat
hypertension so for number one what's
26.07 -> the definition of hypertension well the
a and C seven actually defines this for
31.619 -> us and the definition is simply any
blood pressure that is greater than 140
38.79 -> over 90 now there's different stages
there's stage 1 hypertension and that
46.71 -> would take you from 140 to 159 and then
the diastolic would similarly be 90 to
57.449 -> 99 so this would be stage 1 stage 2
hypertension on the other hand would be
65.25 -> anything greater than or equal to 160
over anything greater than or equal to
72.92 -> 100 this would be stage 2 hypertension
it's just a way of telling you what the
78.18 -> different stages are obviously the
higher the stage the worse the
81.479 -> hypertension is now why this is
important is pretty obvious because we
86.549 -> know that just from studies that high
blood pressure leads to a whole bunch of
92.22 -> things you know things like stroke
97.46 -> things like ischemic cardiomyopathy
things like a hypertensive heart disease
106.009 -> coronary artery disease and these things
are all associated with very bad
111.659 -> outcomes obviously and so if we can
reduce blood pressure we can reduce
116.759 -> these things and studies have shown that
if you reduce blood pressure by even 5
121.969 -> millimeters of mercury so if we just
drop the blood pressure again by 5
128 -> millimeters of mercury
we can see a reduction in stroke
133.66 -> by 34% that's 1/3 that's pretty dramatic
ischemic heart disease can be reduced by
142.17 -> 21% and so that's pretty good
you could also see a decrease in
147.64 -> dementia heart failure mortality from
cardiovascular disease and so forth so
153.46 -> these reductions here are actually
pretty pretty good and doesn't take much
159.37 -> to drop your blood pressure by 5
millimeters of mercury so I really
163.9 -> haven't told you something that you
haven't already known
166.78 -> what's the treatments let's talk about
the treatment and I would be remiss if I
172.78 -> didn't tell you about lifestyle changes
we've got to make sure that we include
177.91 -> lifestyle anytime you have a blood
pressure that's elevated we have so much
183.13 -> evidence now that lifestyle actually
helps with blood pressure we're talking
188.92 -> about dietary changes so diet a low
sodium diet is instructive now we're
196.72 -> talking about physical exercise
205.33 -> there's other things called biofeedback
relaxation meditation but again I think
210.58 -> dietary is key with low sodium they
talked about a - diet you've heard of
219.37 -> the - diet
so things that are rich in nuts whole
227.56 -> grains fruits and vegetables
235.32 -> okay so vegetarian diet is very good for
reducing blood pressure but of course
243.85 -> the thing that we get tested on in
addition to lifestyle is medications and
250.02 -> that's what I kind of want to dedicate
the rest of the talk to because
254.79 -> medications have side effects
263.58 -> now nuts whole grains fruits and veggies
don't have side effects so this
270.04 -> obviously is a very good thing to do
whereas medications are sometimes you're
276.1 -> forced to use medications and
medications have side effects and so
280.24 -> this is the real philosophy when it
comes to starting medications on
284.17 -> patients with high blood pressure
because really there are so many
287.82 -> different types of blood pressure
medications out there and you don't
292.06 -> start blood pressure medications because
you don't know whether or not it's good
295.78 -> to reduce blood pressure because you
know that these medications are going to
299.05 -> reduce blood pressure that's what
they're designed to do
301.63 -> so what makes you decide which blood
pressure medication to start it's based
306.55 -> on two things number one what the
underlying diagnosis is because certain
311.86 -> blood pressure medications help in
certain diagnoses and number two what
317.26 -> are the comorbidities that your patient
has because these medications have side
321.01 -> effects and you want to make sure you
get the right side effect profile so
326.08 -> that's what we're going to talk about
next is these medications and their side
330.16 -> effects and how to choose which one to
have so there are many different types
335.44 -> of blood pressure medications the way I
want to divide this
338.919 -> is in a way that's easy for you to
remember obviously and so in this first
344.65 -> video we're going to talk about the four
major types of blood-pressure
349.33 -> medications and I like to call this the
a B C and D of blood pressure
360.849 -> medications so what is a stand for well
a stands for ACE inhibitors and a are
372.699 -> B's B stands for beta blockers C stands
for calcium channel blockers and D
387.069 -> stands for diuretics now I know that
there's other types of medications for
393.639 -> instance like alpha blockers nitrates
vasodilators alpha-2 agonist we're going
400.81 -> to talk about that in the next video but
let's first talk about these major types
406.029 -> of medications
okay so ACE inhibitors let's talk about
411.46 -> the diagnoses that make ace inhibitors
useful so we like to use ace inhibitors
417.699 -> in patients with blood pressure
elevation who are what well we know that
422.71 -> in diabetes this can help with kidney
problems and it protects the kidneys we
434.169 -> also know that in congestive heart
failure it can improve ejection fraction
440.909 -> so that's important to know we know that
it helps in post MI it improves survival
450.839 -> it also improves survival and CHF so
make sure you know those things because
459.699 -> if you're patient happens to have
diabetes or happens to have congestive
463.779 -> heart failure or how it happens to be
post myocardial infarction these are
468.969 -> things that help we also like to use ace
inhibitors
472.629 -> in patients with connective tissue
disease like scleroderma okay and that
476.979 -> also protects the kidneys okay all right
so those are the diagnoses that I would
486.069 -> concentrate on what about beta blockers
so beta blockers we like to use beta
492.729 -> blockers in again patients with
congestive heart failure if we know that
498.879 -> it improves survival we also like to use
beta blockers in post MI again for the
509.77 -> same reason it improves survival data
blockers arm can also be used in young
519.389 -> and I would also put young here in terms
of ACE inhibitors young people who have
527.05 -> problems with blood pressure C's
these typically work well in young
531.04 -> people I'd also put a white here as well
Caucasian young white we find that it
540.04 -> seems to be more effective in that
population in terms of congestive heart
544.24 -> failure the ones that you should know
are the two special types of beta
550.269 -> blockers that should be used in
congestive heart failure is carve a
554.199 -> Dalal and metoprolol if that's what
you're using it for you need to use
566.259 -> those two medications because those are
the only two beta blockers that have
569.92 -> been found to improve survival in the
studies for CHF for post mi you can use
576.04 -> just about anything but generally
speaking carve a delimit overall should
581.47 -> be used in those situations as well all
right what about calcium channel
585.459 -> blockers calcium channel blockers really
haven't been shown to improve survival
590.05 -> in any patients and so we don't really
use calcium channel blockers to improve
594.85 -> survival and so they don't get much of
an indication here but you should know
600.069 -> that in African American and in the
elderly
606.899 -> they could be useful
and that goes the same for diuretics
611.679 -> again diuretics really haven't been
shown to improve survival in any
615.489 -> condition and so I would recommend that
you know that african-americans seem to
621.639 -> actually respond well to them and also
the elderly okay so those are diagnoses
631.54 -> where you'd want to use those
medications in those particular patients
634.899 -> what about side effects let's talk about
side effects okay so we'll just put a
642.369 -> line here and we'll go over the side
effects so you'd want to know the side
646.059 -> effects of these to avoid these problems
so what are the side effects of ACE
650.11 -> inhibitors and ARVs
the first thing I want to talk about is
653.319 -> angioedema so that's where the tongue
swells the next swells this could really
662.439 -> be a problem so you make sure you know
that the patient knows that if this
667.029 -> happens they can go to the emergency
room and we see it both in ACE
670.48 -> inhibitors and AR B's both cough we see
in patients 30% of the time on the Aces
680.559 -> and of course if we see that we switch
them to an ARB because we usually don't
686.29 -> see that as much but some of the cut
more common side effects would be
690.179 -> hyperkalemia hyponatremia also we see
problems with the creatinine especially
698.949 -> in renal artery stenosis so if you have
bilateral renal artery stenosis that's
703.929 -> contraindicated you shouldn't use it in
those situations obviously you can have
709.029 -> increases in creatinine and that can
cause renal failure which is kind of
713.019 -> paradoxical because these are
medications that are used especially in
716.769 -> problems with the kidneys to protect
from protein area especially in diabetes
722.019 -> so be aware that you know what those
side effects are for the ACE inhibitors
728.069 -> okay what about side effects for beta
blockers now of course you know that
732.97 -> beta blockers can cause the heart rate
to go down that's almost not even a
739.57 -> that's almost a known response obviously
they're going to drop blood pressure as
744.82 -> well but some of the other things you
may not know is that it could increase
748.06 -> your lipids and cholesterol it can
increase depression if they've got
758.5 -> asthma it can increase asthma and COPD
with bronchospasm so depression
768.42 -> hyperlipidemia decreased heart rate
increased asthma bronchospasm these are
774.1 -> all side effects of beta blockers it
could also increase potassium as well so
781.45 -> that's something to keep in mind
especially if someone has a hyperkalemia
785.41 -> to begin with beta blockers can can do
that calcium channel blockers you really
791.65 -> should divide these up into two
different categories there are the
799.05 -> dihydropyridine and there are the non
the hydro pyridine x' okay so what are
808.84 -> the dihydropyridine let's switch to a
different color to highlight what what
815.26 -> it is that I'm talking about so the
dihydropyridine x' or anything that ends
818.95 -> in a beam like nifedipine the feta peen
em low to peen and also full-load opine
833.19 -> so no feta P&M low doping and falow to
peen these are all dihydropyridine x'
838.66 -> what's the reason why you should know
about this it's because they cause
842.79 -> peripheral vasodilation whereas the non
dihydropyridine for instance diltiazem
853.06 -> and verapamil cause reduction in
inotrope what does that mean that means
868.03 -> it reduces contractility of the heart
872.38 -> as a result we typically see the heart
rate go down in this non de hydro
881.89 -> pyridine x' and we see the heart rate go
up or stay the same in the
887.92 -> dihydropyridine x' now there is an
exception to that and that is m low to
894.19 -> peen that's kind of like the black sheep
of the family
896.74 -> and low to peen tends to make the heart
rate go down which is which is good
902.2 -> because this is very good in ischemic
heart disease so if you want to use a
908.2 -> dihydropyridine and don't want to cause
the heart rate to go fast you can
913.57 -> actually use a amlodipine which is still
a dihydropyridine but it doesn't make
918.52 -> the heart rate go as fast so that's a
favorite one to use in ischemic heart
923.2 -> disease so what are the other side
effects that you could see from these
928.26 -> calcium channel blockers well you could
see edema in the lower extremities you
936.67 -> could also see constipation and you
could see heart failure why again
948.52 -> because of this negative ion at ro-
contractility this is a really good
955.15 -> medicine to use in atrial fibrillation
with rapid ventricular response these
960.58 -> non dihydropyridine because they reduce
the response through the AV node and
967.29 -> aren't going to transmit the electrical
conduction of atrial fibrillation which
973.63 -> is going so rapidly that the ventricle
can't keep up and it will block that
978.04 -> transmission alright so those are
calcium channel blockers what about
982.06 -> diuretics well diuretics is such a broad
term I think what we ought to do is
986.59 -> break it down into the two major
diuretics and those are the thighs IDEs
991.24 -> so I'll just abbreviate that as
hydrochlorothiazide and of course lasix
997 -> now of course the the differences
between these two can be major there are
1002.25 -> a number of side effects of
hydrochlorothiazide first of all
1006.24 -> hydrochlorothiazide is an a sending limb
diuretic whereas lasix or furosemide is
1014.31 -> a loop diuretic okay so what there are
four things that you should know that
1019.68 -> hydrochlorothiazide increases we know
that diuretics is a general rule
1025.98 -> decrease potassium so we'll put that on
both sides but what are four things that
1030.839 -> hydrochlorothiazide will increase number
one it will increase calcium levels
1035.61 -> whereas lasix decreases calcium levels
in the blood the second thing that
1042.78 -> hydrochlorothiazide increases is uric
acid and so that can make gout worse the
1048.75 -> next thing that it could increase is
lipids and then the last thing that
1057.059 -> hydrochlorothiazide can increase is
glucose which you have to sometimes
1062.04 -> worry about in diabetes so the four
things I'll ask you about is calcium
1067.47 -> uric acid lipids and glucose of course
hydrochlorothiazide reduces potassium
1073.35 -> and because it's a diuretic it can also
increase your cratan and put you into
1076.89 -> renal failure it can also reduce your
sodium concentration and it's sometimes
1081.87 -> the cause for a hypotonic hyponatremia
which is hypovolemic if you want more
1087.75 -> information on that look at our med
creme lecture on hyponatremia is as a
1091.8 -> result lasix gets rid of calcium gets
rid of potassium it could also cause
1097.46 -> hyponatremia and it can also increase
the creatinine and cause renal failure
1103.97 -> so these are the four basic food groups
if you will of medicines that you can
1110.52 -> treat patients with hypertension so
let's just go over these a few just in
1115.65 -> your mind here if you had a patient with
gout you would not want to put them on
1122.4 -> hydrochlorothiazide because it could
increase the uric acid level if you had
1127.05 -> a patient with kidney stones you would
not want to put them on something that's
1134.52 -> going to put a lot of calcium into the
urine like lasix because it drops
1139.66 -> the serum calcium level by dumping
calcium into the urine whereas a
1144.309 -> thiazide diuretic would be ideal since
it reduces the amount of calcium that is
1149.08 -> excreted into the urine and thereby
increases the serum calcium
1154.26 -> concentration now in the next video I'm
going to talk a little bit more about
1159.58 -> some of these other antihypertensive
medications like alpha blockers alpha-2
1165.789 -> agonist s' nitrates etc so please join
me for that
1190.59 -> you
Source: https://www.youtube.com/watch?v=OmKVteeuQj0