and Dietary therapy and drugs do not prevent symptoms or signs of congestive heart failure; andThere is evidence from physical examination or laboratory studies of cardiac chamber hypertrophy or dilation, or the pulmonary vascular resistance remains elevated at greater than one-half of the systemic vascular resistance; or the severity of the valvular stenosis or regurgitation is estimated to be moderate to severe; or there is a left-to-right shunt with the pulmonary flow being greater than two times the systemic flow; or there is a left-to-right shunt with the pulmonary vascular resistance being elevated to greater than one-half the systemic vascular resistance; or there is a right-to-left shunt;orThe patient has recovered from heart surgery for the treatment of congenital heart disease and continues to have symptoms or signs of congestive heart failure causing impairment as outlined above.
HYPERTENSIVE CARDIOVASCULAR DISEASE
In the patient in whom a diagnosable disorder causes the hypertension, estimation of permanent impairment should not be undertaken until adequate time has elapsed after treatment of the disorder. If other organs are affected, as with the kidneys in chronic renal disease, then the degree of impairment due to the hypertension should be combined with that due to the other organ system, using the Combined Values Chart.
Drugs are now available with acceptable side effects that can maintain blood pressure in the normal range in most patients with primary hypertension and in most with secondary hypertension and no correctable cause. Ratings of impairment due to hypertension should be delayed until after the drugs have been prescribed and their doses have been adjusted to achieve maximum effect.Before classifying a patient as having hypertensive cardiovascular disease, the physician should make several determinations of the arterial pressure. Hypertensive cardiovascular disease is not necessarily present when a patient exhibits transient or irregular episodes of elevated arterial pressure; these could be associated with an emotional or environmental stimulus or with signs or symptoms of cardiovascular system hyperactivity. Most authorities agree that hypertensive cardiovascular disease is present when the diastolic pressure is repeatedly in excess of 90 mm Hg.
Impairment Classification for Hypertensive Cardiovascular Disease
Class 1 Impairment of the Whole Person, 0—14%
The patient has no symptoms and the diastolic pressures are repeatedly in excess of9Omm Hg; and
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