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Clinical Nutrition 1 > Hypertension 1 > Flashcards

Hypertension 1 Flashcards

1
Q

What are the major forms of cardiovascular disease?

A
  • hypertension
  • atherosclerosis
  • ischemic heart disease
  • peripheral vascular disease
  • heart failure
  • cerebrovascular disease
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2
Q

Cardiovascular disease =

A

disease of heart and/or vessels

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3
Q

What are the top leading causes of death in Canada?

A
  1. Cancer
  2. Diseases of the heart
  3. Cerebrovascular disease
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4
Q

What used to be the leading cause of death?

A

Diseases of the heart (but new drugs and understanding)

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5
Q

Between males & females, what is the prevalence of hypertension?
Why is there a difference?

A
  • increasing chance for males versus females

- because of higher obesity and overweight rates among males

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6
Q

Which age category has the highest prevalence of hypertension?

A

75+

bigger prevalence among females (because they live longer)

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7
Q

What is the number 1 reason for visits to physicians in Canada?

A

Hypertension

it is the number 1 reason for taking medication

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8
Q

How many in Canada are affected by hypertension?

A

more than 1/5 = 20% aged +20

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9
Q

What is the % of people unaware they have HTN?

A

18%

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10
Q

What is the % risk of developing HTN between 55-65yo with normal BP?

A

90%

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11
Q

What is the HTN prevalence among adults in the USA?

A

1/3 have hypertension

1/3 have pre-hypertension

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12
Q

HTN increases with/for:

A
  • age
  • males>females
  • African-Americans> whites > hispanic
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13
Q

What are the 2 phases of the cardiac cycle?

A
  • contraction = systolic

- resting = diastolic

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14
Q

MAP =

A

Mean Arterial Pressure
= Cardiac output x peripheral resistance
= the average of systolic and diastolic pressure

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15
Q

MAP is regulated by :

A
  • sympathetic nervous system (autonomous)
  • renin-angiotensin-aldosterone system
  • renal function
  • hormones: epinephrin, vasopressin, angiotensin II
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16
Q

Cardiac output formula

A

CO (L/min)= stroke volume (L/beat) x heart rate (beats/min)

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17
Q

Resistance formula

A

R= (length vessel x viscosity of blood) / (radius^4)

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18
Q

Which has the biggest impact on resistance?

  • viscosity of blood
  • radius of vessel
  • length of vessel
A
  • radius of vessel : a small change has a big impact on the resistance
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19
Q

Vasoconstriction: resistance high/low

A

high

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20
Q

Vasodilation: resistance high/low

A

low

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21
Q

Heart rate is controlled by:

A
  • Parasympathetic NS (decreases HR)

- Sympathetic NS + epinephrine (increases HR)

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22
Q

What controls blood volume on:

  • the short term
  • the long term
A
  • ST: fluid shifts

- LT: salt and water balance in the kidneys

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23
Q

What increases blood viscosity?

A
  • high number of RBCs
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24
Q

Liver releases ->
Kidney releases ->
Lunges release ->
Adrenal cortex releases

A

Liver -> angiotensinogen
Kidney -> renin
Lungs -> angiotensin-converting enzyme
AC -> aldosterone

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25
Q

__ stimulates vasopressin release + thirst + arterial vasoconstriction + aldosterone production

A

Angiotensin II

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26
Q

Vasopressin role

A

increases water reabsorption by kidney tubules

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27
Q

What are the different organs damaged by hypertension?

A
  • heart
  • kidney
  • peripheral vascular system
  • eye
  • brain
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28
Q

What damages does HTN have on heart?

A
  • LVH : left ventricular hypertrophy
  • CHD : coronary heart disease
  • CHF : congestive heart failure
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29
Q

What damages does HTN have on kidneys?

A
  • renal failure

- proteinuria (albumin)

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30
Q

What damages does HTN have on eyes?

A
  • retinopathy
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31
Q

What damages does HTN have on brain?

A
  • hemorrhage
  • stroke
  • vascular dementia
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32
Q

What instruments measure BP?

A

sphygmomanometer

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33
Q

What is the unit of BP?

A

in mmHG (mercury)

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34
Q

Primary/essential/idiopathic causes of HTN?

A
  • interaction from environmental and genetics factors

- dietary and behavioural factors

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35
Q

Secondary causes of HTN?

A

0ccurs secondary to another condition such as renal, endocrine or neurological disorders

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36
Q

Why is HTN the “silent killer”?

A

It is typically asymptomatic

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37
Q

Non-modifiable risk factors of HTN

A
  • age > 60y
  • men, postmeno women, ethnicity (African-American, Russians, Finns)
  • family history of CVD : women <65y or men <55yo
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38
Q

Modifiable risk factors of HTN

A
  • smoking
  • sedentary lifestyle
  • abdominal obesity, insulin resistance
  • excess sodium intake
  • poor diet quality
  • stress
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39
Q

Which other mechanisms can contribute to HTN?

A
  • excessive sécession of vasopressin + ANG2
  • renal disease
  • adrenal disorders
  • hyperinsulinemia
  • neurological diseases
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40
Q

Reason why smoking contributes to HTN

A

Interferes with nitric oxide (dilates vessels) –> impairs epithelial vasodilation

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41
Q

Reason why renal disease contributes to HTN

A

reduced blood flow -> high ANG2 -> vasoconstriction + sodium, chloride, water retention -> blood volume

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42
Q

Reason why adrenal disorders contribute to HTN

A

increase secretion of epinephrine and norepinephrine -> vasoconstriction / increased cardiac output

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43
Q

Reason why excessive secretion of ANG2 and vasopressin contributes to HTN

A

increase vasoconstriction and fluid retention

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44
Q

Values of NORMAL systolic and diastolic BP

A

SBP: 90-119 mmHG
DBP: 60-79 mmHG

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45
Q

Values of PRE-HTN systolic and diastolic BP

A

SBP: 120-139 mmHg
DBP: 80-89 mmHg

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46
Q

Values of STAGE 1 HTN systolic and diastolic BP

A

SBP: 140-159 mmHg
DBP: 90-99 mmHg

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47
Q

Values of STAGE 2 HTN systolic and diastolic BP

A

SBP: 160-179 mmHg
DBP: 100-109 mmHg

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48
Q

Values of STAGE 3 HTN systolic and diastolic BP

A

SBP: >= 180mmHg
DBP: >=110 mmHg

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49
Q

According to HTN Canada:

LOW risk patients =

A

don’t have target organ damage or cvd risk factors

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50
Q

According to HTN Canada:

MODERATE-HIGH risk patients =

A

multiple cvd risk factors and 10-year global risk <15%

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51
Q

According to HTN Canada:

HIGH risk patients =

A

With 1 or + :

  • clinical or sub-clinical cvd disease
  • chronic kidney disease (non-diabetic nephropathy, proteinuria <1g/d)
  • estimates 10year global cvd risk >=15%
  • Age >= 75yo
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52
Q

Patients with Diabetes Mellitus are at which risk?

A

High risk

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53
Q

Different BP measurement methods

A
  • Office
  • Office Automated (unattended, AOBP)
  • Out of office (ABPM)
54
Q

Office BP measurements (2)

A
  • Automated office BP (AOBP) - oscillometric (electronic)

- Non-automated (manual) office BP -> auscultatory (mercury)

55
Q

Which office measurement is preferred?

56
Q

Office automated BP measurements

A
  • automated unattended (AOBP) -> oscillometric (electronic)
57
Q

Out of office BM measurements

A

Ambulatory (ABPM) : measures over 24h

58
Q

Which value measured in office is considered HTN

A

BP>= 180/110

59
Q

White coat hypertension =

A

increase BP because of stress and intimidation of pt

60
Q

Comprehensive plans to treat HTN include

A
    • physical activity
    • wt reduction
    • nutrition therapy
    • moderation in alcohol, relaxation therapy, smoking cessation
    • pharmacological interventions
61
Q

Pharmacological interventions

A

loop diuretics
thiazides
carbonic anhydrase inhibitors
potassium sparing diuretics

62
Q

Dietary factors involved in HT

A 
!! sodium + potassium 
calcium
magnesium 
alcohol 
high calories, excess wt, obesity
63
Q

Link between obesity + HTN in adults <55y

A

60% of those in excess weight + normal BP will develop HTN in the next 4 years

64
Q

Obesity associated with increased cvd

A

abdominal obesity

65
Q

Causes of HTN associated with obesity (4)

A

insulin resistance/hyperinsulinemia
alterations in RAAS
overactivity of SYMPA NS
leptin increases sympa activity

66
Q

Most effective approach to treat and HTN

A

Weight loss

67
Q

Anthropometric measures aimed for weight loss

A

BMI <= 25 kg/m2

waist circumference <102 cm (men) ; <88 cm (women)

68
Q

Leptin is produced by

A

Adipocytes

69
Q

Per 10 kg weight lost, BP reduction of

A

5-20 mmHg per 10kg lost

70
Q

Overweight patients should achieve a wt loss of __ kg

(a decrease in SPG by __ and DPB by __ mmHg) to reduce Bp and risks for organ damage

A

5 kg
decrease SPB by 4.4
decrease DPB by 3.6

71
Q

If patient uses __ weight loss can be more difficult

A

beta-blockers

72
Q

beta-blockers tend to

A

decrease HR and metabolic rate of the person

73
Q

Weight loss approaches

A

diet education and instruction
increase PA
behavior modification

74
Q

Range of sodium maintained by body

A

135-150mE/L

75
Q

Relation between sodium intake and excretion is _

76
Q

True / False

sodium intake is directly related to blood pressure

77
Q

For every increase of 100 mmol Na/day there is an increase in __ SPB/DBP

A

3-6/0-3 mmHg

78
Q

Lower sodium intake __ systolic BP

79
Q

Impact of decreasing sodium intake on BP is bigger on __ individuals

A

hypertensive (than normotensive)

80
Q

Is the decrease in BP higher in DASH diet or US diet when decreasing sodium form high to medium sodium diet

A

in US diet (unhealthy diet -> less potassium)

81
Q

Individual responses to reduction of sodium intake

A
  • varies among individuals
  • responders: respond to decrease sodium intake by having lower BP
  • non-responders
82
Q

Responders:

A
  • African-american
  • Middle age
  • HTN, diabetes, renal
83
Q

Sodium sensitivity is largely influenced by

A

potassium : high potassium -> low sodium sensitivity

84
Q

Dietary sodium DRI (AI) =

A

1500 mg/day (14-5yo)
1300 mg/day (51-70y)
1200 mg/day (71+y)

85
Q

Upper limit sodium

A

2300 mg Na/day for all adults

86
Q

True / false

Majoriy of Canadians exceed UL

A

True

Males > females (sodium intake)

87
Q

Average total intake of sodium (Canada)

88
Q

CHEP sodium intake recommendations to decrease BP

A

2000mg per day

89
Q

5g salt = __ mmol sodium

90
Q

1/2 tsp salt =

A

1150 mg sodium

91
Q

80% of average sodium intake is where?

A

in processed foods

only 10% added at table or cooking

92
Q

Major food contributors to sodium intake

A
  1. bread
  2. processed meat
  3. vegetable-based dishes, tomato
  4. soups
93
Q

Why is bread in the highest food contributor?

A

Is lower in sodium but eaten in high amounts as opposed to gravies and sauces high in sodium but eaten in low amounts

94
Q

Reading nutrition label advise

A
  • Choose foods with les than 120 mg sodium per serving

- choose foods with sodium <5% DV

95
Q

Reading food packages advise

A
  • by unsalted and lower sodium foods

- look for “sodium-free”, “low sodium”, “reduced sodium”, “no added salt”

96
Q

3 Na controlled diets

A

3000 mg
2000 mg
1000 mg

97
Q

3000 mg Na controlled diet

A
  • eliminate high Na processed foods and beverages

- up to 0.25 tsp salt permitted during cooking or added at table

98
Q

2000 mg Na controlled diet

A
  • eliminate processed and prepared foods + beverages high in Na
  • limit milk + milk products to 2 cups/d
  • no salt in preparation of foods or at table
99
Q

1000 mg Na controlled diet

A
  • like 2000 mg NA but omit canned, frozen, deli goods, cheeses, margarines.
  • limit bread to 2 servings/d
100
Q

Is the 1000 mg Na diet recommended to someone with HTN

A

NO

It could have the opposite effect and lead to massive increase in Na in blood

101
Q

If a patient with hypertension consumes 3500 mg sodium per day what would you advise?

A

The 3000 mg Na diet and then the 2000 mg

102
Q

Reducing sodium intake:

A

reduces BP
prevents HTN
additive effect to antihypertensive medications

103
Q

Relationship between potassium and BP is __

104
Q

With a higher potassium intake, there is a decreased

A

prevalence of HTN

105
Q

Mechanisms of potassium

A
  • natriuresis
106
Q

Mechanisms of potassium

A
  • natriuresis (increase Na excretion)
  • suppressed renin
  • vasodilation
  • reduces sympathetic activity + ANG2
107
Q

Why is the effect of potassium inter-dependent with sodium

A

the greater the increase in BP with Na, the greater the decrease with supplemental K

108
Q

True / false

Having high potassium reduces BP

A

False:
Is for salt-sensitive
Potassium protects against familial susceptibility

109
Q

Deficit in K in body causes

A

Retention of Na by kidneys

110
Q

Average totale potassium intake in Canadian adults

A

2800 mg/d (women)

3300 mg/d (men)

111
Q

Potassium DRI

112
Q

Daily dietary K recommendations associated with decreased risk of stroke mortality

A

> = 60 mol (2300 mg)

113
Q

K supplementation recommendation

A
  • above daily dietary intake of 60 mol/d ≠ recommended to treat HTN
  • may be useful if diuretic-induced hypokalaemia
114
Q

K supplementation recommendation

A
  • > 60 mol/d NOT recommended to treat HTN

- may be useful if diuretic-induced hypokalaemia

115
Q

CFG recommendation for K

A

emphasising fruits + veg for sufficient K intake

116
Q

Patients at risk for hyperkalemia

A
  • using RAAS inhibitors
  • receiving other drugs causing hyperkalemia
  • chronic kidney disease filtration rate
  • baseline serum potassium > 4.5 mol/L
117
Q

Blood pressure and calcium relationship : _

A

inversely associated

118
Q

Increased calcium leads to :

A

increase sodium excretion
increase sensitivity to nitric oxide -> vasodilation
reduced production of superoxide and prostanoids (vasoconstriction)

119
Q

CFG recommendation for calcium

A

2-3 servings of milk products daily

120
Q

Calcium supplementations or HTN

A

NOT recommended if consume + daily recommendations

Does not prevent high BP for normosensitive

121
Q

Blood pressure and magnesium relationship:

A

Inverse relationship

122
Q

Magnesium regulates

A

vascular structure and function : regulates vascular reactivity and contractility

123
Q

Magnesium DRI

A

420 mg/d (men)

320 mg/d (women)

124
Q

Magnesium recommendation for hypertensive patients

A

To increase DIETARY Mg to reach DRI

125
Q

Relationship between alcohol and blood pressure

A

dose-response relationship : over 2 drinks/d increases BP

126
Q

Alcohol effect

A

immediate: decrease BP
following: elevated BP in next 10-15h

127
Q

Mechanisms of alcohol

A
  • stimulates cortisol
  • stimulates SYMPA NS
  • increased Ca uptake by cell membranes
128
Q

Moderate consumption of alcohol effects on BP

A

cardio protective effects, does not raise BP

129
Q

Alcohol recommendations

A

2 drinks per day - men

1 drink per day - women

130
Q

standard drinks :
beer =
wine =
spirits =

A 
beer = 360 mL (5%)
wine = 150 mL (12%)
spirits = 45 mL (40%)

Clinical Nutrition 1 (13 decks)

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