Hypertension Explained Clearly – Causes, Diagnosis, Medications, Treatment
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Hypertension Explained Clearly – Causes, Diagnosis, Medications, Treatment

September 1, 2019

welcome to another MedCram lecture we
could talk about hypertension and specifically we’re going to talk about
the definition why talking about hypertension is important and then the
treatments and I really want to dedicate this first video to the treatments
simple treatments of hypertension and how you choose medications to treat
hypertension so for number one what’s the definition of hypertension well the
a and C seven actually defines this for us and the definition is simply any
blood pressure that is greater than 140 over 90 now there’s different stages
there’s stage 1 hypertension and that would take you from 140 to 159 and then
the diastolic would similarly be 90 to 99 so this would be stage 1 stage 2
hypertension on the other hand would be anything greater than or equal to 160
over anything greater than or equal to 100 this would be stage 2 hypertension
it’s just a way of telling you what the different stages are obviously the
higher the stage the worse the hypertension is now why this is
important is pretty obvious because we know that just from studies that high
blood pressure leads to a whole bunch of things you know things like stroke things like ischemic cardiomyopathy
things like a hypertensive heart disease coronary artery disease and these things
are all associated with very bad outcomes obviously and so if we can
reduce blood pressure we can reduce these things and studies have shown that
if you reduce blood pressure by even 5 millimeters of mercury so if we just
drop the blood pressure again by 5 millimeters of mercury
we can see a reduction in stroke by 34% that’s 1/3 that’s pretty dramatic
ischemic heart disease can be reduced by 21% and so that’s pretty good
you could also see a decrease in dementia heart failure mortality from
cardiovascular disease and so forth so these reductions here are actually
pretty pretty good and doesn’t take much to drop your blood pressure by 5
millimeters of mercury so I really haven’t told you something that you
haven’t already known what’s the treatments let’s talk about
the treatment and I would be remiss if I didn’t tell you about lifestyle changes
we’ve got to make sure that we include lifestyle anytime you have a blood
pressure that’s elevated we have so much evidence now that lifestyle actually
helps with blood pressure we’re talking about dietary changes so diet a low
sodium diet is instructive now we’re talking about physical exercise there’s other things called biofeedback
relaxation meditation but again I think dietary is key with low sodium they
talked about a – diet you’ve heard of the – diet
so things that are rich in nuts whole grains fruits and vegetables okay so vegetarian diet is very good for
reducing blood pressure but of course the thing that we get tested on in
addition to lifestyle is medications and that’s what I kind of want to dedicate
the rest of the talk to because medications have side effects now nuts whole grains fruits and veggies
don’t have side effects so this obviously is a very good thing to do
whereas medications are sometimes you’re forced to use medications and
medications have side effects and so this is the real philosophy when it
comes to starting medications on patients with high blood pressure
because really there are so many different types of blood pressure
medications out there and you don’t start blood pressure medications because
you don’t know whether or not it’s good to reduce blood pressure because you
know that these medications are going to reduce blood pressure that’s what
they’re designed to do so what makes you decide which blood
pressure medication to start it’s based on two things number one what the
underlying diagnosis is because certain blood pressure medications help in
certain diagnoses and number two what are the comorbidities that your patient
has because these medications have side effects and you want to make sure you
get the right side effect profile so that’s what we’re going to talk about
next is these medications and their side effects and how to choose which one to
have so there are many different types of blood pressure medications the way I
want to divide this is in a way that’s easy for you to
remember obviously and so in this first video we’re going to talk about the four
major types of blood-pressure medications and I like to call this the
a B C and D of blood pressure medications so what is a stand for well
a stands for ACE inhibitors and a are B’s B stands for beta blockers C stands
for calcium channel blockers and D stands for diuretics now I know that
there’s other types of medications for instance like alpha blockers nitrates
vasodilators alpha-2 agonist we’re going to talk about that in the next video but
let’s first talk about these major types of medications
okay so ACE inhibitors let’s talk about the diagnoses that make ace inhibitors
useful so we like to use ace inhibitors in patients with blood pressure
elevation who are what well we know that in diabetes this can help with kidney
problems and it protects the kidneys we also know that in congestive heart
failure it can improve ejection fraction so that’s important to know we know that
it helps in post MI it improves survival it also improves survival and CHF so
make sure you know those things because if you’re patient happens to have
diabetes or happens to have congestive heart failure or how it happens to be
post myocardial infarction these are things that help we also like to use ace
inhibitors in patients with connective tissue
disease like scleroderma okay and that also protects the kidneys okay all right
so those are the diagnoses that I would concentrate on what about beta blockers
so beta blockers we like to use beta blockers in again patients with
congestive heart failure if we know that it improves survival we also like to use
beta blockers in post MI again for the same reason it improves survival data
blockers arm can also be used in young and I would also put young here in terms
of ACE inhibitors young people who have problems with blood pressure C’s
these typically work well in young people I’d also put a white here as well
Caucasian young white we find that it seems to be more effective in that
population in terms of congestive heart failure the ones that you should know
are the two special types of beta blockers that should be used in
congestive heart failure is carve a Dalal and metoprolol if that’s what
you’re using it for you need to use those two medications because those are
the only two beta blockers that have been found to improve survival in the
studies for CHF for post mi you can use just about anything but generally
speaking carve a delimit overall should be used in those situations as well all
right what about calcium channel blockers calcium channel blockers really
haven’t been shown to improve survival in any patients and so we don’t really
use calcium channel blockers to improve survival and so they don’t get much of
an indication here but you should know that in African American and in the
elderly they could be useful
and that goes the same for diuretics again diuretics really haven’t been
shown to improve survival in any condition and so I would recommend that
you know that african-americans seem to actually respond well to them and also
the elderly okay so those are diagnoses where you’d want to use those
medications in those particular patients what about side effects let’s talk about
side effects okay so we’ll just put a line here and we’ll go over the side
effects so you’d want to know the side effects of these to avoid these problems
so what are the side effects of ACE inhibitors and ARVs
the first thing I want to talk about is angioedema so that’s where the tongue
swells the next swells this could really be a problem so you make sure you know
that the patient knows that if this happens they can go to the emergency
room and we see it both in ACE inhibitors and AR B’s both cough we see
in patients 30% of the time on the Aces and of course if we see that we switch
them to an ARB because we usually don’t see that as much but some of the cut
more common side effects would be hyperkalemia hyponatremia also we see
problems with the creatinine especially in renal artery stenosis so if you have
bilateral renal artery stenosis that’s contraindicated you shouldn’t use it in
those situations obviously you can have increases in creatinine and that can
cause renal failure which is kind of paradoxical because these are
medications that are used especially in problems with the kidneys to protect
from protein area especially in diabetes so be aware that you know what those
side effects are for the ACE inhibitors okay what about side effects for beta
blockers now of course you know that beta blockers can cause the heart rate
to go down that’s almost not even a that’s almost a known response obviously
they’re going to drop blood pressure as well but some of the other things you
may not know is that it could increase your lipids and cholesterol it can
increase depression if they’ve got asthma it can increase asthma and COPD
with bronchospasm so depression hyperlipidemia decreased heart rate
increased asthma bronchospasm these are all side effects of beta blockers it
could also increase potassium as well so that’s something to keep in mind
especially if someone has a hyperkalemia to begin with beta blockers can can do
that calcium channel blockers you really should divide these up into two
different categories there are the dihydropyridine and there are the non
the hydro pyridine x’ okay so what are the dihydropyridine let’s switch to a
different color to highlight what what it is that I’m talking about so the
dihydropyridine x’ or anything that ends in a beam like nifedipine the feta peen
em low to peen and also full-load opine so no feta P&M low doping and falow to
peen these are all dihydropyridine x’ what’s the reason why you should know
about this it’s because they cause peripheral vasodilation whereas the non
dihydropyridine for instance diltiazem and verapamil cause reduction in
inotrope what does that mean that means it reduces contractility of the heart as a result we typically see the heart
rate go down in this non de hydro pyridine x’ and we see the heart rate go
up or stay the same in the dihydropyridine x’ now there is an
exception to that and that is m low to peen that’s kind of like the black sheep
of the family and low to peen tends to make the heart
rate go down which is which is good because this is very good in ischemic
heart disease so if you want to use a dihydropyridine and don’t want to cause
the heart rate to go fast you can actually use a amlodipine which is still
a dihydropyridine but it doesn’t make the heart rate go as fast so that’s a
favorite one to use in ischemic heart disease so what are the other side
effects that you could see from these calcium channel blockers well you could
see edema in the lower extremities you could also see constipation and you
could see heart failure why again because of this negative ion at ro-
contractility this is a really good medicine to use in atrial fibrillation
with rapid ventricular response these non dihydropyridine because they reduce
the response through the AV node and aren’t going to transmit the electrical
conduction of atrial fibrillation which is going so rapidly that the ventricle
can’t keep up and it will block that transmission alright so those are
calcium channel blockers what about diuretics well diuretics is such a broad
term I think what we ought to do is break it down into the two major
diuretics and those are the thighs IDEs so I’ll just abbreviate that as
hydrochlorothiazide and of course lasix now of course the the differences
between these two can be major there are a number of side effects of
hydrochlorothiazide first of all hydrochlorothiazide is an a sending limb
diuretic whereas lasix or furosemide is a loop diuretic okay so what there are
four things that you should know that hydrochlorothiazide increases we know
that diuretics is a general rule decrease potassium so we’ll put that on
both sides but what are four things that hydrochlorothiazide will increase number
one it will increase calcium levels whereas lasix decreases calcium levels
in the blood the second thing that hydrochlorothiazide increases is uric
acid and so that can make gout worse the next thing that it could increase is
lipids and then the last thing that hydrochlorothiazide can increase is
glucose which you have to sometimes worry about in diabetes so the four
things I’ll ask you about is calcium uric acid lipids and glucose of course
hydrochlorothiazide reduces potassium and because it’s a diuretic it can also
increase your cratan and put you into renal failure it can also reduce your
sodium concentration and it’s sometimes the cause for a hypotonic hyponatremia
which is hypovolemic if you want more information on that look at our med
creme lecture on hyponatremia is as a result lasix gets rid of calcium gets
rid of potassium it could also cause hyponatremia and it can also increase
the creatinine and cause renal failure so these are the four basic food groups
if you will of medicines that you can treat patients with hypertension so
let’s just go over these a few just in your mind here if you had a patient with
gout you would not want to put them on hydrochlorothiazide because it could
increase the uric acid level if you had a patient with kidney stones you would
not want to put them on something that’s going to put a lot of calcium into the
urine like lasix because it drops the serum calcium level by dumping
calcium into the urine whereas a thiazide diuretic would be ideal since
it reduces the amount of calcium that is excreted into the urine and thereby
increases the serum calcium concentration now in the next video I’m
going to talk a little bit more about some of these other antihypertensive
medications like alpha blockers alpha-2 agonist s’ nitrates etc so please join
me for that you

Only registered users can comment.

  1. why did you not mention exercise is a good treatment for high blood pressure? also where's the evidence that sodium keeps blood pressure high in the long run isn't it true that sodium just increases the blood volume in the short term not actually creating high blood pressure itself?

  2. ok so my brother is a 43 years old african american, who never smoked nor drink and never been sick, all of a sudden just had 2 random seizures within a 15 minute span that lasted 1.5 min each. (ON CHRISTMAS EVE) Earlier that day, he had been complaining about headaches and wooziness. His BP was 224/154 and once we got to the hospital, we later found out that his left lung had collapsed. He is not responding to any of the medications that has been given, and he is only stable when given the cleviprex drip, anything else works temporary or not at all.. plus all of his test come back showing no abnormalities.. what medications should we try..

  3. What a wonderful, concise presentation. As a renal failure patient with uncontrolled hypertension, it gives me more information to discuss the meds that are not working. Thank you

  4. Great concise video ! Thanks so much. Was looking for something like this to refresh my knowledge. As a pharmacist always on the go it's ideal. I don't have to carry big textbooks around!

  5. WAIT – We never asked the question, "WHY IS THE BLOOD PRESSURE HIGH?" Therein lies the answer to why and the solution…LIFESTYLE including diet. Why would you treat the sympton without understanding the problem and solving that? So, it's not just that lifestyle will help the problem. It's that you have the problem because of your lifestyle. Of course, change your lifestyle. This video does not really explain Hypertension. It explains medications. Why would anyone suffer those SIDE effects! Renal Failure? Depression? Heart Failure? Really, that's an ok side effect doc?


  7. Nice and awesome video. It will be more usefull if u give details of drug groups with diagnosis, like u gave in last part of lecture for gout and renal stones. Thankyou…love you a lot

  8. what about the drug treatments available for pregnant women? I think it should be added to the table too 🙂 also, thank you for uploading this!~

  9. Excellent video! Studying for my FNP board certification and experiencing anxiety related to the treatment of hypertension. This video really helps. Thanks!!

  10. Why are the last two recommended for AA patients despite the fact that they don't improve survival? Are they more effective in other ways (for AA patients) than the first two?

  11. See the whole series at www.medcram.com along with other top quality videos including reviews in pulmonary, cardiology, infectious disease, and hematology!

  12. I would like to learn more about blood pressure medications that work better for Mexican-Americans. I know that CCB tend to work better for African Americans. How does renin affect the way some blood pressure medications work is some people and not in others?

  13. i think you switched the MOA on the diuretics. Furosemide at the ascending loop of henle and HCTZ at the dct –> http://www.uptodate.com/contents/mechanism-of-action-of-diuretics?source=search_result&search=loop+diuretics+mechanism&selectedTitle=1~150

  14. Hi!
    Great video!
    In the end you mentioned a scenario in which a pt would have kidney stones, and I found a little confusing why to use HCTZ instead of lasix when Lasix decreases Ca.
    I'd appreciate your help.
    Thank you so much.

  15. I am taking amoldipine to fight off essential HTN. I wonder if amoldipine can also cause drowsiness and probably constipation as side effects?

  16. EXCELLENT ..keep on ading more topics of medicine..just to make this huge (medicine) the easiest thing:-)


  18. http://www.sandiegouniontribune.com/business/biotech/sd-me-salt-diet-20170425-story.html

    its currently being proved low sodium diet has very little evidence to reduce hypertension or prevent it

  19. Discuss the caveat side effect of impotency caused by Beta Blockers and Ace Inhibitors. Is this preventable? …or require still more drugs to restore virility while on bp medications?

  20. Great video! Is there any video explains technically why and how blood pressure increased? Few years ago, I had bad fatty liver and high blood pressure (150-160/100-110) at the same time, i "accidentally fixed" my liver by using chinese herb medication in one to two months. My blood pressure back to normal since then !!

  21. I believe these programs are very useful for Doctor to follow or check for diagnosis or answers
    for regular person it,s nice to go to these videos when you are concerned about your health. Thank you.

  22. Thanks for the informative video. One correction: thiazide diuretics have their effect on the early distal tubule (inhibiting Na-Cl symporters), not the loop of Henle.

  23. Great video. I have a question. My doctor recently prescribed me Metoprolol ER succinate 25 mg for borderline high blood pressure. I also take 4 mg a day of xanax for anxiety. I am apprehensive about taking the beta blocker for blood pressure in conjunction with the xanax because I'm worried that my heart rate will drop to low. My pulse varies from 90 to 67 depending on my activity level and anxiety. So I don't know if an ACE inhibitor is better for me. I'm a 45 year old Caucasian male. I also have crohn's disease and to much fruits, vegetables, and grains cause me to flare. What is your opinion? I would like to speak with my doctor once I have more information.

  24. I really enjoyed watching this video. I was diagnose with hypertension a few months ago. My physician has prescribed a diuretic to help with my hypertension. It's great to know all the side effects that comes along with each blood pressure medication.. It's good to know what also work well with every situation a patient or person may have that's being treated for this condition. Great job and keep the information coming.

  25. does amlodipine significantly reduce HR? as I recall study findings which patient on amlo shows significant increase in serum norepinephrine level, hence higher risk of palpitation?

  26. I feel so much more confident for my Med Surgical Exam this evening. The ABCD’s Of HTN has never been so simply put. You are an amazing instructor. I haven’t had a chance to see the other videos on other illnesses, but for sure you will be my guide throughout this phase of my nursing education. I have learned from in one hour more than I have from my instructors in two weeks of class

  27. In what way would a vegetarian dietary habit filled with carbohydrates and sugar in the form of whole grains, mixed with carbs and sugar coming from fruit make sense for someone with hypertension. That's an unneeded insulin response and an unneeded glucose rise in the blood stream mixed with what I would guess to be other ailments following or coexisting with the hypertension; type 2 diabetes, etc. Red meat with carb exclusion while being counterintuitive for the mainstream, would seem to fix the issues here. The whole grains addition makes no sense to me.

  28. Stop using drugs and go on a low carb high fat diet! Food is your medicine. No side effects like the drugs. Medical students need to study more on nutrition

  29. Can you please include medications for those who wants to stay away from animal source and use a vegan diet- those medication that has a vegetable magnesium stearate? Also please include the pharmacy or compound pharmacy that may have drugs available that does not have pork or a pork-by product. Thank you so much for your presentation.

  30. Probably wise to change the title and/or add brackets to show that these recommendations are old and then redirect to the new video. Thanks for all the great content! Also, where are your Allreds from?


  32. What if instead Reducing the dietary Sodium we increased the dietary potassium from Avocado, spinach and bananas?

  33. if you lower blood pressure, will this put more risk of stroke to a patient? just thinking, because blood carries oxyen to the brain.

  34. Oh thank you so very much. I wish I could talk to you in person or on the phone for a couple of other questions I have.

  35. Plz like and subscribe my YouTube channel for hand written medical notes on different topics.


  36. Could you please tell me if concor 2.5 and norvasc 5 wich tip A , B, c, D . I take one concor 2.5 + novasc 5 morning and evening. Thanks

  37. Why is your information so different from Dr John Bergman and Dr Peter Gliddens et al?
    One of you is gonna shorten my life if I take your advice. Bergman so much sense. He suggests we look for the cause and fix it, You sell tablets that mostly have significant side effects. You seem totally aligned with 'Big Pharma'.
    What do you prescribe to treat the side effects?

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