42. Cardiovascular & Nutrition Flashcards
Define
Systemic hypertension
high blood pressure in the systemic arteries - the vessels that carry blood from the heart to the body’s tissues (other than the lungs)
Define
Resistant hypertension
hypertension that is poorly responsive to treatment and requires the use of multiple medications to achieve acceptable blood pressure ranges
Define
Minoxidil
a peripheral vasodilator C9H15N5O used orally to treat hypertension and topically in a propylene glycol solution to promote hair regrowth in male-pattern baldness
Define
Renal denervation
a minimally invasive procedure to treat resistant hypertension. The procedure uses radiofrequency ablation to burn the nerves in the renal arteries. This process causes a reduction in the nerve activity, which decreases blood pressure
Definition
high blood pressure in the systemic arteries - the vessels that carry blood from the heart to the body’s tissues (other than the lungs)
Systemic hypertension
Definition
hypertension that is poorly responsive to treatment and requires the use of multiple medications to achieve acceptable blood pressure ranges
Resistant hypertension
Definition
a peripheral vasodilator C9H15N5O used orally to treat hypertension and topically in a propylene glycol solution to promote hair regrowth in male-pattern baldness
Minoxidil
Definition
a minimally invasive procedure to treat resistant hypertension. The procedure uses radiofrequency ablation to burn the nerves in the renal arteries. This process causes a reduction in the nerve activity, which decreases blood pressure
Renal denervation
Uncontrolled hypertension causes increased risk of what?
Stroke
Heart attack
Kidney failure
Blindness
Other complications
What are the risk factors of hypertension?
Genetics
Smoking
Stress
Environment
Diet
The cause of what percentage of primary hypertension is unknown?
90%
How does diet lead to cardiovascular disease?
- Dietary intake
- Altered gut bacteria
- Metabolism and immune system response
- Cardiovascular disease
What effects does a Western, Gluten-free and Mediterranean diet have on GIT integrity?
Both Western and Gluten free diets cause a decrease in good bacteria and an increase in bad
Mediterranean causes an increase in good bacteria
What have we found when administering AngII to both normal and germ free mice with regards to blood pressue? What can we conclude?
AngII causes a significant increase in BP in the normal mice
AngII has less of an effect on the BP of GF mice
Therefore, gut bacteria contribute to hypertension
Why is it important to understand how gut bacteria modulate metabolites?
Some metabolites, such as short chain fatty acids can reduce BP. Different metabolites are produced by difference bacteria and the composition of the gut microbiota is controlled by diet
How does eating more fibre lead to decrease BP?
Fibre leads to the production of more short-chain fatty acids by the bacteria in the gut which act to reduce blood pressure (and even neuroinflammation)
Which short-chain fatty acids have been investigated for their effects on BP?
Acetate
Propionate
Butyrate
Based on what we know about how diet effects BP, what are the potential treatmenst to prevent/reverse systemic hypertension?
Mediterranean/high fibre diet
Short chain fatty acids (SFCAs)
What is the first line treatment for hypertension?
Control weight
Physical activity/exercise
Diet
Cease smoking
Decrease alcohol
What are the pharmacological treatment options for hypertension?
Angiotensin converting enzyme inhibitors & angiotensin antagonists
Beta blockers
Calcium channel blockers (NOT for HF)
Diuretics (thiazides, loop, K+ sparing)
What is resistant hypertension?
Blood pressure not under 140/90
3 BP lowering drugs used (1 is a diuretic)
At optimal dosage
What risk factors are associated with resistant hypertension?
Obesity
Sleep apnea
Female
Diabetes
Black
Kidney disease
Age
Salt intake
Alcohol
What are the patient related causes of resistant hypertension?
High Salt diet
Medications that raise BP
Life style choices
Not adhering BP medication plan
What are the physician related causes of resistant hypertension?
Unsuspected secondary cause
Inadequate use of diuretics
Progressive renal insufficiency
What needs to be considered when evaluating resistant hypertension?
- Good Blood pressure recording technique – cuff size
- Strict compliance with treatment recommendation
- Evaluation of secondary causes of resistant hypertension
- Ambulatory BP monitoring – exclude ”white coat” hypertension
- History of drug intake that can cause resistant hypertension
- Signs of sleep apnoea – snoring, daytime sleepiness
What medications can interfere with BP control?
- NSAIDS and aspirin
- Sympathomimetic agents (decongestants)
- Diet pills
- Excessive alcohol
- Licorice
- Oral contraceptive pills
- Erythropoietin
What are the treatment options for resistant hypertension?
- Optimise the current treatment plan
- Treat identifiable cause if found
- Mineralcorticoid receptor antagonists ie spironolactone
- Effective diuresis ie furosemide
- Minoxidil
How can Minoxidil treat resistant hypertension?
Opening of KATP channels leads to vasodilation of resistance arteries and lowering of blood pressure (in resistant hypertension)
What are some future pharmocological options for treating resistant hypertension?
Novel aldosterone antagonists
Aldosterone synthase inhibitors
Endothelin antagonists
Direct renin inhibitors
What are some future non-pharmocological options for treating resistant hypertension?
Renal denervation – especially for patients in which kidneys contribute to the cause
Neurovascular decompensation
Implantable pulse generators
How does high BP contribute to Alzheimer’s?
High blood pressure can damage small cerebral arteries in the frontal lobe
______________ reduced the risk of Alzheimer’s approximately 75%
Potassium-sparing diuretics reduced the risk of Alzheimer’s approximately 75%
What lifestyle factors can you use to lower the risk of Alzheimer’s?
Eat a healthy diet
Maintain a healthy weight
Stop smoking and reduce alcohol intake
Check blood pressure at home
