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.

Hypertensive Emergency


Related Terms

  • Accelerated Hypertension
  • High Blood Pressure, Malignant
  • Hypertensive Crisis
  • Hypertensive Urgency

Differential Diagnosis

Specialists

  • Cardiologist, Cardiovascular Physician

Comorbid Conditions

Factors Influencing Duration

The cause of hypertension, degree of damage to the kidneys and other target organs, the response to treatment, or the presence of complications may influence length of disability.

Medical Codes

ICD-9-CM:
401.0 - High Blood Pressure, Malignant

Overview

According to its severity, a hypertensive crisis can be a hypertensive emergency or hypertensive urgency. Hypertensive emergency (formerly called malignant high blood pressure or malignant hypertension) is a rapid, unexplained rise in blood pressure (BP) that is a medical emergency; hypertensive emergency is present when the lower BP reading (diastolic BP) that normally is 80 mmHg rises to over 120 mmHg and the upper BP reading (systolic BP) that normally is 120 mmHg rises to over 180 mmHg with evidence of impending or progressing end organ damage (Chobanian). With hypertensive emergency, there is rapidly progressive, life-threatening organ damage. This differs from hypertensive urgency, in which blood pressure is elevated above 180/110 mmHg but there is no accompanying organ damage. Unless hypertensive emergency is treated quickly to reduce BP, severe damage to the brain, heart, and kidneys may occur, resulting in death (Chobanian).

Although the trigger for hypertensive emergency often is unknown, hypertensive emergency is thought to result from an abrupt narrowing of blood vessels (vasoconstriction) that leads to an acute and severe increase in BP beyond the control of the body's autoregulation system. The result is an acutely reduced blood flow throughout the body that quickly leads to irreversible organ damage (Flanigan).

Incidence and Prevalence: Hypertensive emergency is thought to be a rare complication of hypertension, occurring in less than 1% of individuals with primary hypertension (Epstein). However, 78 million Americans are hypertensive; therefore, we can estimate upwards of three-quarters of a million hypertensive emergencies among American adults each year (Go). The National Institutes of Health estimates that as much as 25% of emergency room visits may be due to severe hypertension (Chobanian); this widely-quoted figure, although still used, is over 30 years old. Since then the incidence and prevalence of hypertension has grown significantly. Our ability to treat the disorder has also improved. An accurate measure of hypertension emergency is not available.

Source: Medical Disability Advisor



Causation and Known Risk Factors

Any hypertensive condition can progress to hypertensive emergency. Individuals with untreated or poorly controlled primary or essential hypertension, or those who have suddenly stopped taking antihypertensive medications are most at risk for hypertensive emergency. Other risk factors associated with hypertensive emergency include underlying renovascular disease, acute and chronic kidney disease (e.g., glomerulonephritis, chronic renal failure, chronic pyelonephritis), atherosclerosis, certain systemic disorders that also affect the kidneys (e.g., systemic lupus erythematosus), endocrine disorders (e.g., Cushing's syndrome, pheochromocytoma), illicit drug use, and a condition in pregnancy characterized by hypertension and proteinuria (pre-eclampsia) sometimes complicated by tonic-clonic seizures (eclampsia) (Chobanian).

Hypertensive emergency can occur at any age and is more common in individuals who are male, black, or who have hypertension from an underlying cause (secondary hypertension) such as kidney disease, diabetes, or cardiovascular disease. Most cases occur among those who have been noncompliant or are inadequately treated (Stewart).

For more information refer to "Disease and Injury Causation," pages 237 to 261.

Source: Medical Disability Advisor



Diagnosis

History: With a hypertensive emergency, the symptoms most commonly seen in the emergency room are chest pain (27% of cases), shortness of breath (dyspnea) (22%), epistaxis, faintness, and various neurologic problems (21%) (Marik). Cardiac complaints also may include angina and palpitations. Neurologic symptoms include severe headache, altered mental status, blurred vision, paresthesias, and dizziness or vertigo. Renal symptoms such as decreased urine production (oliguria) also may be evident. Other symptoms may include nausea, vomiting, malaise, severe anxiety, and agitation. Individuals may report previously diagnosed primary hypertension or secondary hypertension. A history of antihypertensive drug therapy may be reported, or the individual may report recently discontinuing an antihypertensive drug regimen or adding a drug that, as a side effect, elevates blood pressure (Stewart 2006). Surprisingly, in some individuals the condition is discovered without their awareness of any symptoms.

Physical exam: Blood pressure will be elevated to an extreme, often with sudden onset. An exam shows both systolic BP and diastolic BP readings elevating rapidly (usually with a diastolic BP of 120 mmHg or higher). Symptomatic evidence of damage to organ systems may be noted. Examination of the fundus of the eye (ophthalmoscopy or fundoscopy) may reveal damage to the retina at back of the eye (hypertensive retinopathy) and swelling of the head of the optic nerve (papilledema).

Tests: Cerebral, renal, cardiac, and vascular function will be evaluated beginning with a chest x-ray, an electrocardiogram (ECG), and laboratory tests to determine the impact severe hypertension may be having on blood flow to the heart, kidneys, and brain. Blood tests include complete blood count (CBC) that will determine red blood cell (RBC), white blood cell, and platelet counts; the proportion of blood volume that is occupied by red blood cells (hematocrit); and hemoglobin level. Blood chemistries include measurements of blood urea nitrogen (BUN), blood glucose, creatinine, renin (a vasoconstrictive kidney enzyme elevated in some forms of hypertension), aldosterone (a hormone elevated in hypertension), electrolytes, and coagulation tests.

These tests will help evaluate organ system response to the acute rise in blood pressure, and may reveal abnormalities indicative of acute organ system dysfunction. CBC may reveal anemia, and hematocrit may show more fluid than cells, indicative of fluid imbalance; platelet count and coagulation tests may reveal coagulation problems. A blood smear may reveal RBC fragments indicative of RBC destruction (hemolysis or hemolytic anemia), which severely affects the oxygen carrying capacity of the blood and causes widespread organ damage. Urinalysis may show microscopic or gross blood in the urine (hematuria) and the abnormal presence of protein (albuminuria); blood and protein in the urine indicate progressive kidney involvement (hypertensive nephropathy). Microscopic analysis of urine sediment may reveal RBCs and RBC casts, indicating kidney dysfunction.

Source: Medical Disability Advisor



Treatment

Hypertensive emergency requires immediate hospitalization, usually to an intensive care unit (ICU) for continuous monitoring of cardiac, neurologic, and renal systems. The goal of treatment is to lower BP and to stabilize and potentially reverse the damage to target organs by attempting to reduce BP by no more than 25% within minutes to the first hour (Stewart). Over the following 2 to 6 hours, antihypertensive drugs slowly reduce BP to a target of 160/100 mmHg, with care to avoid a rapid drop in BP that may result in reduced blood flow to important organ systems (Stewart).

Although intravenous antihypertensive drug therapy usually is indicated, oral drugs also can be used successfully in selected individuals. The type of antihypertensive drug administered will depend on its mode of action and the nature of specific organ dysfunction. Therapy also may include a diuretic to remove excess fluid from the body. If acute renal failure is involved, dialysis may be needed to remove fluid and wastes from the body until kidney function can be restored. When the underlying cause for the hypertensive emergency is known, it can be treated appropriately.

Source: Medical Disability Advisor



Prognosis

The prognosis varies among individuals and depends primarily on the degree of organ damage. Without prompt and aggressive treatment, a hypertensive emergency is rapidly fatal. Before effective treatment was available survival was dismal, 20% at 1 year and 1% at 5 years. Death typically occurs from heart attack (acute myocardial infarction [AMI]), heart failure, stroke (cerebrovascular accident [CVA]), or renal failure. The availability of more effective antihypertensive drug therapies has improved the prognosis for hypertensive crises significantly. With antihypertensive treatment, individuals now have a 10-year survival rate of 70% (Aggarwal).

Source: Medical Disability Advisor



Rehabilitation

Because hypertensive emergency typically requires immediate treatment in the hospital, rehabilitation for this form of hypertension begins after the underlying cause has been identified and treated. As with rehabilitation for other forms of hypertension, an exercise program developed by a healthcare professional will focus on aerobic exercise designed to reduce blood pressure.

Rhythmic forms of moderate exercise are used in the rehabilitation of most forms of hypertension. These exercises include walking, jogging, bicycling, and swimming. The benefits come from the expansion of the blood vessels in the working muscles, decreasing total resistance in blood vessels throughout the body and enhancing blood flow. In the hospital setting, an electrocardiograph (ECG) will be used to record the continuous electrical activity of the heart muscle during these exercises. A physical therapist experienced in cardiac rehabilitation will keep a daily log of the individual's blood pressure, heart rate, and cardiac rhythm.

Throughout the course of rehabilitation for hypertension, patient and family education is necessary to establish a program the individual can successfully continue once discharged from the care of the rehabilitation professional.

Because most individuals who have survived a hypertensive emergency are managed with medication, it is important that the therapist has a medication history for each individual to help understand the individual's acute and chronic response to exercise, which may be altered by specific drugs.

Source: Medical Disability Advisor



Complications

Possible complications include CVA, fluid accumulation in the lungs (pulmonary edema), kidney damage (hypertensive nephropathy), renal failure, damage to the retina at the back of the eye (hypertensive retinopathy), a tear in the inner layer of the aorta (aortic dissection), and insufficient blood supply to the heart muscle resulting in heart failure or AMI.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)


Work restrictions or special accommodations must be determined on an individual basis. They depend on the degree of organ damage or impairment resulting from hypertensive emergency. Employability may be affected if the individual is a commercial driver, pilot, or works in another situation where blood pressure must be controlled.

For more information refer to "Work Ability and Return to Work," pages 267 to 271.

Risk: Risk is dependent on the individual’s compliance with lifestyle modifications and antihypertensive medications. Individuals working as commercial drivers or pilots may need reassignment.

Capacity: Compliance with lifestyle modifications and antihypertensive medications will improve capacity. Increased activity is of benefit to the individual. Capacity is dependent on the degree of organ damage resulting from the hypertensive emergency. Contact physician for details.

Tolerance: Hypertension does not typically cause symptoms. Individuals may need to monitor their blood pressure at the workplace.

Source: Medical Disability Advisor



Maximum Medical Improvement

60 days.

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:

  • Has diagnosis of hypertensive emergency been confirmed?
  • Have other conditions with similar symptoms been ruled out?
  • Has the underlying cause of hypertensive emergency been identified?
  • Did individual suddenly stop taking antihypertensive medications?
  • Does individual have hypertension from an underlying cause such as kidney disease, diabetes, or cardiovascular disease (secondary hypertension)?

Regarding treatment:

  • Has blood pressure been stabilized? Was blood pressure successfully sustained at acceptable levels?
  • Has individual sustained organ damage? Is damage reversible?
  • If renal failure was involved, was dialysis necessary? Are kidneys again functional?
  • If the underlying cause for the condition is known, has it responded favorably to treatment?
  • Has individual initiated a rehabilitation program that focuses on aerobic exercise designed to reduce blood pressure?

Regarding prognosis:

  • Does individual's condition continue to be monitored by a physician?
  • Has individual responded favorably to antihypertensive treatment?
  • Is individual compliant with taking antihypertensive medications?
  • Has blood pressure remained within acceptable limits?
  • Did individual sustain permanent organ damage?
  • Does individual have a coexisting condition, such as coronary artery disease or renovascular disease that may complicate treatment or impact recovery?
  • Has individual experienced any complications related to the hypertensive emergency?
  • Is individual actively participating in a comprehensive rehabilitation program?

Source: Medical Disability Advisor



References

Cited

Aggarwal, Monica, and Ijaz A. Khan. "Hypertensive Crisis: Hypertensive Emergencies and Urgencies." Cardiology Clinics 24 1 (2006): 135-146.

Bisognano, John D. "Malignant Hypertension." eMedicine. Eds. Vecihi Batuman, et al. 24 Jan. 2013. Medscape. 21 Jun. 2014 <http://emedicine.medscape.com/article/241640-overview>.

Chobanian, A. V. , et al. "Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure." Hypertension 42 6 (2003): 1206-1252.

Epstein, M. "Diagnosis and Management of Hypertensive Emergencies." Clinical Cornerstone 2 (1999): 41-54.

Flanigan, John S. , and David Vitberg. "Hypertensive Emergency and Severe Hypertension: What to Treat, Who to Treat, and How to Treat." Medical Clinics of North America 90 3 (2006): 439-451.

Go, A. S. , et al. "Heart Disease and Stroke Statistics--2013 Update: A Report from the American Heart Association." Circulation 127 (2013): e6-e245.

Herbert, Christopher J., and Donald G. Vidt. "Hypertensive Crises." Primary Care 35 3 (2008): 475-487.

Hopkins, Christy. "Hypertensive Emergencies." eMedicine. Eds. David F.M. Brown, et al. 2 Apr. 2013. Medscape. 21 Jun. 2014 <http://emedicine.medscape.com/article/758544-overview>.

Marik, Paul E., and Joseph Varon. "Hypertensive Crises Challenges and Management." Chest 131 6 (2007): 1949-1962. PubMed. 21 Jun. 2014 <http://www.ncbi.nlm.nih.gov/pubmed/17565029>.

Melhorn, J. Mark, and William Ackerman, eds. "Causation in Common Cardiovascular Problems." Disease and Injury Causation, Guides to the Evaluation of. AMA Press, 2008. 237-261.

Stewart, D. L. , S. E. Feinstein, and R. Colgan. "Hypertensive Urgencies and Emergencies." Primary Care 33 (2006): 613-623.

Talmage, J. B. , J. M. Melhorn, and M. H. Hyman, eds. "Working with Common Cardiovascular Problems." Work Ability and Return to Work, AMA Guides to the Evaluation of. Second ed. Chicago: AMA Press, 2011. 274-277.

Source: Medical Disability Advisor






Feedback
Send us comments, suggestions, corrections, or anything you would like us to hear. If you are not logged in, you must include your email address, in order for us to respond. We cannot, unfortunately, respond to every comment. If you are seeking medical advice, please contact your physician. Thank you!
Send this comment to:
Sales Customer Support Content Development
 
This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is published with the understanding that the author, editors, and publisher are not engaged in rendering medical, legal, accounting or other professional service. If medical, legal, or other expert assistance is required, the service of a competent professional should be sought. We are unable to respond to requests for advice. Any Sales inquiries should include an email address or other means of communication.