Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Hypertension


Related Terms

  • Benign Hypertension
  • Essential Hypertension
  • High Blood Pressure, Benign
  • Primary Hypertension

Differential Diagnosis

Specialists

  • Cardiovascular Internist
  • Internal Medicine Physician
  • Radiologist

Comorbid Conditions

  • Cardiac arrhythmia
  • Cardiovascular disease
  • Diabetes
  • Kidney disease
  • Obesity

Factors Influencing Duration

Length of disability may be influenced by the cause and severity of the hypertension, response to treatment, and whether or not the individual is compliant with treatment recommendations for lifestyle changes and drug therapy. Complications may produce a period of disability. Certain types of employment, such as those jobs requiring a commercial drivers license (CDL) or pilots license, may require a longer duration.

Medical Codes

ICD-9-CM:
401.1 - High Blood Pressure, Benign

Overview

High blood pressure (hypertension) occurs when smaller blood vessels (arterioles) become narrowed, causing blood to exert excessive pressure against the blood vessel walls and making the heart work harder. Although blood pressure varies during the day and frequently increases as a normal response to stress and physical activity, an individual with hypertension has high blood pressure even at rest. This type of primary, or essential, hypertension does not have an obvious direct cause, although it can be influenced by both heredity and lifestyle factors. Secondary hypertension is the result of an identifiable underlying disorder such as kidney disease, arteriosclerosis, and certain endocrine diseases; it may also be caused by medication side effects.

As many as 90% to 95% of all cases of hypertension are benign (primary, or essential hypertension) ("High Blood Pressure"). The remaining cases of hypertension are secondary hypertension.

Blood pressure (BP) is recorded as two numbers and is measured in millimeters of mercury (mm Hg). The top number (systolic pressure) represents pressure in the arteries when the heart muscle contracts to pump blood. The bottom number (diastolic pressure) represents pressure in the arteries when the heart is relaxed between beats. According to The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC), normal blood pressure and stages of hypertension are categorized by the systolic and diastolic pressure readings taken at rest, based on the average of two or more readings taken on two or more visits after the initial screening measurement ("JNC 7 Express"): Optimal (normal) blood pressure is a systolic BP less than 120 mm Hg and a diastolic BP less than 80 mm Hg (less than 120/80 mm Hg). Prehypertension is a systolic BP between 120 to 139 mm Hg or a diastolic BP between 80 to 89 mm Hg. Stage I hypertension is defined as systolic BP between 140 and 159 mm Hg or diastolic BP between 90 to 99 mm Hg, and Stage II hypertension occurs when systolic BP is greater than 160 mm Hg or diastolic BP is greater than 100 mm Hg.

Incidence and Prevalence: Hypertension is an extremely common disorder affecting approximately one-third of the adult US population; however, 21% of those affected do not know they have the condition (“High Blood Pressure”). Among individuals with high blood pressure, about 45% have it under control while about 55% do not (“High Blood Pressure”).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Several genetic and environmental or lifestyle factors increase the risk of benign hypertension, including obesity, high dietary salt (sodium) intake, tobacco use, high-fat diet, excessive use of alcohol, stressful lifestyle, and lack of exercise. Benign hypertension also may be inherited; specific genetic risk factors include abnormalities in angiotensin-renin genes and inherited abnormalities of the sympathetic nervous system controlling heart rate, blood pressure, and blood vessel diameter.

Men and postmenopausal women have a higher risk of developing hypertension, with more men than women affected under the age of 55, but with more women than men affected after age 55 (Riaz). African Americans have much higher rates of high blood pressure than whites. Diabetes and kidney disease also increase the risk of hypertension. Systolic blood pressure naturally increases with age, and up to 50% of adults over age 65 may have primary hypertension (Patel). Older individuals may also exhibit isolated systolic hypertension, a condition where only the systolic BP is elevated, usually due to stiffening of the aorta with aging.

Source: Medical Disability Advisor



Diagnosis

History: For most individuals, benign hypertension causes no symptoms for years, and is consequently known as the “silent killer.” Symptoms of severe hypertension or its complications may include headache, dizziness, racing or irregular heartbeat (tachycardia or arrhythmias), tiring easily, sexual dysfunction, nosebleeds (epistaxis), chest pain, or shortness of breath (dyspnea). As the disease progresses, damage to the brain, eyes, heart, and kidneys may occur. Family history may reveal high blood pressure, stroke, heart disease, kidney disease, or diabetes. Individuals may present with risk factors for high blood pressure such as tobacco use, high salt intake, obesity, sedentary lifestyle, and elevated cholesterol. Medication history may reveal use of medications that elevate blood pressure. Social history may suggest emotional or environmental factors that could affect blood pressure.

Physical exam: Because early benign hypertension does not cause notable symptoms, it usually is detected during a routine physical examination. Once hypertension is suspected, evaluation may include blood pressure readings recorded in both arms, repeated after the individual sits or lies down for five minutes (and at least 30 minutes after smoking or coffee ingestion). If a person has a high reading, blood pressure is measured again after 10 to 15 minutes, and then twice on at least two other days to make sure the high blood pressure reading is consistent. Readings may need to be repeated at home; some individuals will have elevated blood pressure in the doctor's office because of anxiety (white-coat syndrome). If blood pressure is elevated, the neck veins may be swollen (distended), the thyroid or heart may be enlarged, and heart murmurs may be noted. The eyes are further evaluated with an ophthalmoscope.

Tests: Laboratory tests are seldom used to diagnose benign hypertension. After hypertension is diagnosed, however, diagnostic testing such as routine blood and urine tests usually are performed to identify or rule out causes of secondary hypertension (e.g., diabetes, kidney disease, arteriosclerosis). A chest x-ray, echocardiogram, and electrocardiogram may be performed to evaluate heart size and function. A blood test for renin may identify increased production of angiotensin, a chemical that narrows blood vessels. High renin levels may predict heart attack (myocardial infarction) in individuals with high blood pressure. An exercise stress test performed on individuals with borderline elevated blood pressure may predict risk of enlargement of the left side of the heart (left ventricular hypertrophy). Cardiac catheterization may be necessary to diagnose underlying coronary artery disease.

Source: Medical Disability Advisor



Treatment

According to current JNC treatment guidelines, goals for individuals with known benign hypertension are to maintain a blood pressure less than 140/90 mm Hg; for those with diabetes or kidney disease, blood pressure should be lower than 130/80 mm Hg (“JNC 7 Express”).

Benign hypertension cannot be cured but can be treated to control the condition and prevent complications. Treatment of hypertension usually follows a progressive approach, each step being slightly more aggressive than the previous one until blood pressure is controlled.

The first step includes lifestyle modifications in order to achieve and maintain a body mass index (BMI) of less than 25, exercise aerobically for an average of 30 minutes/day, restrict alcohol consumption to fewer than 1 to 2 drinks/day, limit non-narcotic pain medications to less than once/week, consume at least 400 micrograms/day of supplemental folic acid, and to follow the Dietary Approaches to Stop Hypertension (DASH) diet (Riaz). The DASH diet is low in saturated fat and cholesterol, rich in whole grains, fruits and vegetables, and contains modest amounts of protein, preferably from fish, poultry, low-fat dairy, nuts, or soy products. This diet contains more than twice the amounts of potassium, calcium, and magnesium than the average American diet, and limits sodium intake (NIH).

If blood pressure is not controlled by lifestyle modifications, the individual will proceed to drug therapy; however, lifestyle modifications should be continued. Drug therapy usually begins with a thiazide diuretic to remove excess fluid or a beta-blocker to reduce the force of the heart's contractions. Angiotensin-receptor blockers (ARBs), angiotensin-converting enzyme (ACE) inhibitors, direct vasodilators, and calcium channel blockers also may be used to reduce the force of the heart's contractions, dilate arteries, and make it easier for the heart to pump blood through the body. The physician choice of drugs depends on the individual's response and comorbid conditions, if any.

Treatment may be fine-tuned by increasing drug dosage, substituting a drug for another in the same class, or switching to a drug in a different class. If blood pressure still is not controlled, then adding a second or third agent to the drug regimen (combination drug therapy) is considered.

Source: Medical Disability Advisor



Prognosis

With appropriate lifestyle changes and the wide variety of drug therapy available, most individuals with high blood pressure can control the condition. A reduction in daily sodium intake to 3 to 6 grams/day results in an average decrease in BP by 2 to 8 mm Hg (Riaz). Regular aerobic exercise for 30 minutes on most days may reduce BP on average by 4 to 9 mm Hg (Riaz). However, because hypertension rarely has symptoms and individuals do not feel sick, they may not feel compelled to make lifestyle changes or follow medication regimens (noncompliance). This can lead to further complications from hypertension.

From 1995 to 2005, the mortality rate from high blood pressure rose 25.2%, with the actual number of deaths rising by 56.4% (“High Blood Pressure”). In 2005, the overall death rate was 18.4% of individuals with hypertension (“High Blood Pressure”). Among African-Americans, death from hypertension occurred in 52.1% of males and 40.3% of females; in whites, death from hypertension occurred in 15.8% of males and 15.1% of females (“High Blood Pressure”).

Source: Medical Disability Advisor



Rehabilitation

The principles of aerobic conditioning in physical therapy are used to develop a hypertension treatment program. Such a rehabilitation program occurs in several phases and follows a progression similar to that for other cardiac diseases because elevated blood pressure is always considered a risk for related cardiovascular disease.

Rehabilitation professionals experienced in cardiac rehabilitation often keep a daily log of the individual's blood pressure, heart rate, and cardiac rhythm. Individuals with significantly high blood pressure typically are monitored using electrocardiography (ECG) to record the continuous electrical activity of the heart muscle. During the initial rehabilitation stage, individuals are monitored for heart rate, heart rhythm, and blood pressure while performing low-demand aerobic activities that use large muscle groups such as the lower extremities. Initial exercises usually include calisthenics of varying intensity such as marching in place or raising both arms overhead.

As rehabilitation progresses, more intensive exercises are introduced as tolerated in addition to recreational activities such as swimming and hiking. Light jogging or cycling are appropriate as long as the individual tolerates the rehabilitation program well. The program for benign hypertension then gradually advances to aerobic exercises to increase cardiovascular fitness. These exercises include walking briskly, running, jogging, swimming, climbing stairs, or bicycling. According to the American Heart Association, this type of aerobic activity will help keep high blood pressure under control. Throughout all stages of the rehabilitation program for hypertension, the healthcare team monitors the individual closely to assure that the heart rate slowly returns to normal after exercises.

Source: Medical Disability Advisor



Complications

Hypertension is worsened by uncontrolled lifestyle factors such as obesity, smoking, poor dietary habits, and sedentary habits. Increased blood pressure can damage the inner lining of the arteries leading to atherosclerosis or thickening of the walls of the arteries. This in turn leads to increased hypertension and heart disease as the heart becomes enlarged (hypertrophy).

Complications of untreated hypertension also include injury to vessels in the kidneys, brain, heart, and eyes that may cause kidney failure, stroke, heart failure, aortic aneurysm, heart attack, peripheral artery disease, and impaired vision due to retinal damage at the back of the eye (retinopathy) (Singh). High blood pressure is responsible for 25% of all cases of heart failure (Riaz). Long-term (chronic) high blood pressure may lead to decreased memory and dementia in the elderly. Women of childbearing age who have high blood pressure before they become pregnant are at greater risk for pre-eclampsia, a severe and sudden increase in blood pressure during pregnancy that can have serious consequences for both mother and fetus. If benign hypertension is untreated, it can lead to malignant hypertension with severe blood pressure elevations that can be life threatening.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work restrictions or special accommodations usually are not required for individuals with mild cases of benign primary hypertension. Some individuals, however, may need a less stressful work environment.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Does the individual have a family history of hypertension?
  • Does the individual smoke, use salt generously, or have a sedentary lifestyle?
  • Is the individual overweight? Obese?
  • Does the individual complain of headache, dizziness, irregular heartbeat (arrhythmias), tiring easily, sexual dysfunction, nosebleeds(epistaxis), chest pain, or shortness of breath (dyspnea)?
  • Are medications or emotional or environmental factors contributing to hypertension?
  • Are blood pressure readings elevated consistently?
  • Does the individual have distension of neck veins, enlarged thyroid, heart murmur(s), or eye problems?
  • Has a urine analysis been done?
  • Have blood tests, including a test for renin been done?

Regarding treatment:

  • Has the individual attempted to make lifestyle changes?
  • Does the individual require assistance such as a weight loss program, counseling from a dietitian, an exercise regimen designed for the individual, or a smoking cessation program?
  • Is individual using the DASH diet?
  • What drug(s) has the individual taken? Has the dosage been increased?
  • Is another drug of the same class required?
  • Is a drug in a different class required?
  • Is noncompliance with the treatment regimen an issue?

Regarding prognosis:

  • Is the individual adhering to recommended lifestyle changes and to the prescribed drug regimen?
  • Does the individual understand the potential risks of untreated hypertension, including heart disease, stroke, heart attack, aortic aneurysm, and eye and kidney disease? If not, would education encourage compliance with recommended treatment?

Source: Medical Disability Advisor



References

Cited

"National High Blood Pressure Education Program." National Heart Lung and Blood Institute. Dec. 2003. U.S. National Institutes of Health. 6 Sep. 2009 <http://www.nhlbi.nih.gov/guidelines/hypertension/express.pdf>.

"Your Guide to Lowering your Blood Pressure with DASH." National Heart Lung and Blood Institute. Apr. 2006. U.S. National Institutes of Health. 1 Sep. 2009 <http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf>.

American Heart Association. "High Blood Pressure Statistics." American Heart Association. 29 Mar. 2009. American Heart Association, Inc. 1 Sep. 2009 <http://www.americanheart.org/presenter.jhtml?identifier=2139>.

Patel, Jaqdish, and Stanley J. Swierzewski,. "High Blood Pressure (Hypertension)." Cardiology Channel. 7 Aug. 2007. Healthcommunities.com. 1 Sep. 2009 <http://www.cardiologychannel.com/hypertension/index.shtml>.

Riaz, Kamram, and Ahmed Aqeel. "Hypertensive Heart Disease." eMedicine. Eds. Hanumant Deshmukh, et al. 31 Aug. 2009. Medscape. 1 Sep. 2009 <http://emedicine.medscape.com/article/162449-overview>.

Singh, Vibhuti N. "High Blood Pressure." eMedicine Health. Eds. Alan D. Forker, et al. 9 Apr. 2007. WebMD, LLC. 1 Sep. 2009 <http://www.emedicinehealth.com/high_blood_pressure/article_em.htm>.

Source: Medical Disability Advisor






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