Hypertension Flashcards
Major forms of CVD
- hypertension
- atherosclerosis
- ischemic heart disease
- peripheral vascular disease
- heart failure
leading cause of death? second one
- Cancer
- diseases of the heart
why cvd is the secod cause of death
better diagnosed and better treatments
who as a higher prevelance of hypertension male or females over the years? and age?
male right now has more hypertension than females
Age: male has more reported hypertension but after 65 years female has more hypertension than male
most people are aware or unaware of their hypertension
aware and controlled however 18% is unaware because this disease is not physically manifestated
what is the #1 visited reason that people go to the doctor
hyperntension
what is the age that normally adults start to have hypertension
55-65
what is the 2 phases of cardiac cycle
contraction and resting
what is the mean arterial pressure based on
cardiac output x peripheral resistance
cardiac output is based on
stroke volume x heart rate
resistance is based on
lenght of vessel x viscocity/ radius ^4
An increase in ____ will increase BP
Heart rate
Stroke volume
Viscosity of blood
Length of vessel
A decrease in ___ will increase BP
radius
what regulate blood pressure
- sympathetic nervous system
- renin angiotensin aldosterone system
- renal function
- hormons
Explain what influences cardiac output (SRC-B)
Primarily determined by heart rate and stroke volume. heart rate influenced by nervous system (sympathetic and parasympathetic), where the stroke volume is influenced by SNS and venous return, Venous return influenced by skeletal muscle, respiratory, cardiac suction and blood volume.
Explain what influences peripheral resistance
Radius is under local metabolic control which is influenced by skeletal muscle, and extrinsic vasoconstriction control which is mediated by SNS and epi, vasporessin, Ang II which will influence RAAS system. Viscosity will be determined by hydration status and # of RBCs.
explain Renin Angiotensin Aldosterone System (RAAS)
a decrease in NaCl, or ECF volume or in the arterial blood pressure will be detcetd by the kidney that will make an enzyme called renin that will convert angiotensinogen into angiotensin 1. The lungs will make an enzyme angiotensin converting enzyme that will convert angiotensin 1 to 2 and there will be an effect in the BP
what is the effect of angiotensin 2
- it will increase vasopressin that will make water reabsorption.
- Increase thrist that will increase fluid intake
- increase vasoconstriction
- make adrenal cortex make aldosterone
what is the primary cause of hypertension
- genetic and env factor
- dietary and behavior factor
what is the secondary cause of hypertension
occurs secondary to another condition such as renal, endocirne or neurological disorders
is hypertension asymptomatic?
yes - silent killer
what are the major non modifiable risk factors
-more than 60y old
-men, postmenopausal women, ethnicity
- family history
what are the modifiable risk of HTN
- smoking
- sedentary lifestyle
- abdominal obesity
- poor diet quality
- stress
how vasopressin and angiotensin 2 impact hypertension
increases vasoconstrcition and fluid retension
what is the mechanism of smoking that interferes with hypertension
it interferes with NO –> impairs endothelial vasodilation
how adrenal disorder impact hypertension? and renal disease
adrenal disorders increase secretion of epinephrine and norepinephrine -> vasoconstriction and increase cardiac output
renal disease - reduced blood flow, increase angiotensis 2, vasoconstriction Na, Cl, water retention and blood volume
what are the target organ damage related to hypertension
- hemorrage, stroke, dementia (brain)
- retinopathy (eye)
- peripheral vascular disease
- renal failure, proteinuria
- heart : LVH, CHD, CHF
How do we measure BP
sphygmamonometer in mmHG
what are the 3 risk regarding hypertension and explain each
- low risk:
no target over damage or cardiovascular risk factor and the risk is 10 years is less than 10% - moderate to high risk
multiple cardiovascular risk factors and 10 year global risk of 10-14% - high risk
50 years and more with 130-180 mmHG and with one of these :clinical cardiovascular disease, chronic kidney disease, estimated 10 year global cvd is more than 15% ad more than 75 years
people with diabetes where are they classified
between moderate and high risk but more for the high risk
when do we initiate antihypertensive therapy (drugs) for high risk patient and what is the target
sbp more than 130
target less 120
when do we initiate antihypertensive therapy (drugs) for diabetes mellitus patients and what is the target
130/80
less than 130/80
when do we initiate antihypertensive therapy (drugs) for moderate to high risk patient and what is the target
more than 140/90
less than 140/90
when do we initiate antihypertensive therapy (drugs) for low risk patient and what is the target
more than 160/100
less than 140/90
what is the preferred way to measure bp and what is advantages
automated office blood presure (AOBP) oscillometric
advanatges: more precise, you can take at home multiple times, the person do it
which device the doctors use to measure bp
non automated office bp auscultatory
how it works the out of office bp measurement methods - ambulatory
it is over 24h and it is a continuois measurement through your daily activities
how much in mmHg does the person needs to have to be considered hypertension
more or equal to 135/85
what are the goals of hypertension therapy
- reduced risk of cvd and renal disease
- lower bp to clinically appropriate level
what the hypertension therapy plan include
- physcial activity
- weight reduction
- nutrition thrapy
- moderation in alcohol, relaxation therapy, smoking cessation
- pharmacological intervention
what are some dietary factors that are involved in hypertension
- high calories, excess weight, obesity
- sodium
- potassium
- calcium
- magnesium
- alcohol
what is the relation between obesity and hypertension
for adults who have more than 55 years old
- direct link between excess weight and hypertension
true or false
60% of adults with excess weight and normal bp will develop hypertension in the next 4 years
true
true or false
abdominal obesity is more associted with hypertension
true
what are the causes of hypertension associated with obesity
- insulin resistance hyperinsulinemia
- overactivity of the sns
- alteration of the raas (major effect)
- leptin increases sympathetic activity
what is the most potent non-pharmacological approach
weight loss
if you lose 10kg how much does it decreases the hypertension
5-20 mmgh
true or false
all overweight patients should achieve a weight loss of 5kg to reduce BP and risk for organ damage
true
what is the effect on sodium intake in systolic blood pressure
for every increase of 100 mmol Na/d there is an increase of 3-6/0-3 mmHg
it is better to measure sodium intake or excretion
excretion because it is hard to measure the intake
when people decrease their consumption of salt who has a bigger impact people who are normal or hypertensives
hypertensives have a greater decrease than people who have a normal bp
high sodium intake increases the risk of which complication compared to people who have a lower sodium intake
- chd Congenital heart defects
- cvd
- all death
decreasing sodium has a higher impact on decreasing blood pressure on people who have a American diet or a dash diet
American diet because people who consumes a dash diet has already lower blood pressure
true or false
there are people that will not respond to an decrease of bp when lowering sodium
sodium
who respond more to a decrease bp when decreasing salt
african american
middle aged
htn, diabetes, renal
factors involved in heterogenous response to sodium reduction
- familial/genetic factors
- age
- severy of hypertension
- degree of restriction
- renin-angiotensin-aldosterone (low renin)
- sympathetic response
- duration of trials
the higher potassium intake the … Na sensitivity
lower
true or false
everyone exceeds the UL (2300 mg) of sodium
true, average intake of sodium is 3400 mg/d
how much do we need to decrease salt to decrease bp
2000 mg Na or 5g of salt
where does the most of the sodium in our diet comes from
comes from processed foods
what are the majors food group that as sodium
- breads
- processed meats
- cheese
- tomato
how can you choose a foods that is low in sodium based on the label
food that have less than 120 mg sodium per serving or 5% or less
benefits of reducing sodium intake
- reduces BP
- prevents hypertension
- has an additive effect to antihypertensive medication (lower doses and better control)
- reduce risk of complications
what is the relation between potassium and blood pressure
there is an inverse relationship between K intake and blood pressure
- decreased mean blood pressure
- decreased prevalence of htn with higher K intake
what are the mechanism of potassium that lower blood pressure
- natriuresis
- suppressed renin
- attenuated vascular contraction (vasodilation)
- reduce sympathetic activity and angiotensin
the lower the potassium intake the … the Na
higher
modern western diet is made of
high sodium intake and low potassium intake which can lead to hypertension
deficit in K in the body causes
retention of Na by the kidneys
explain how potassium depletion can cause the kidneys to retain Na
potassium depletion causes sumpathetic activity that makes angiotensin 2 which will stimulate Na transporter.
Aldosterone will retain Na by the NaCl pump and the K+Na.
THE SODIUM PUMP WILL MAKE 3 Na+ go into the blood and 2 K+ be secreted
how can low K and high Na make the vascular contraction
By the Na/K+ ATPase (sodium pump) Na plus will increase in the cell there will be a depolarization of the membrane and Ca2+ will go out and it will make a vascular contraction that will increase resistance and hypertension
what is the recommendation of potassium
consume more than 2300 mg (decrease stroke mortality)
+ 2000 mg it decreases -3.4/-1.9 BP
when potassium supplements is useful
if you have diuretic induced hypokalemia if not fruits and vegetables will be sufficient for K intake
what are the risk factors for hyperkalemia
- patients using renin-angiotensin-aldosterone inhibitors
- patients receiving other drugs causing hyperkalemia
- chronic kidney disease
- baseline serum potassium more than 45 mmol/l
calcium intake is … associated with bp
inversely
what are the potential mechanism of increased calcium intake
- high sodium excretion
- high sensitivity to NO (vasodilation)
- reduced production of superoxyde and prostanoids (vasoconstrictors)
is supplementation fo ca for normotensive people s recommended ?
no
is supplementation for ca above the daily recommended dietary intake is recommended for treatment for hypertension?
no consuming 2-3 serving of milk products is sufficient
… relationship between Mg intake and bp
inverse
mechanism of Mg and bp
regulate vascular reactivity and contractility
is supplement above DRIs recommend for Mg
no
what are the dose-response relationship between alcohol intake and bp
over 2 drinks increase bp
what are the first effects of alcohol? what happens after
there is a decrease of bp and then there is an elevated BP for the next 10-15h
what are the potential mechanism of alcohol
- stimulated sns
- cortisol secretion
- increase Ca uptake by cell membranes
what is the problem with the public and alcohol
they don’t know the amounts so it is important to explain to them
what is the global assessment that needs to be done
- lab testing
- ECG
- target organ damage
- cardiovascular risk score
- physical activity
what is the nutritional assessment when people have hypertension
- identify dietary factors and patterns, specifically with nutrients of interest
- evaluate the need for weight control
- alcohol intake
- prioritize methods t meet dahs dietary goals
possible nutrition diagnoses
- excessive energy intake
- excessive or inappropriate intake of fats
- excessive sodium intake
- inadequate calcium, fiber, potassium or mg intake
- overweight/obese
- food and nutr deficit
what are the behaviours recommendation and how much they decrease bp
- more physically active (4-9mmHg)
- weight reduction (5-20 mmhg) : healthy bmi + waist circumference
- moderation of alcohol intake (2-4 mmHg): limit consumption of less than 2 drinks per day to lower bp
- eating healthier (8-14 mmg) : dash diet - high in fruits, beg, low fat and low sat fat and cholesterol. High K
- relaxation therapies
- smoking cessation
how can physical activity decrease hypertension
accumualtion of moderate physical activity 30-60 min/d + daily activities = reduces bp by 4-9 mmHg
increase PA has an impact on
decreasing the relative workload on the heart ( goof for all CVD) and may help reduce weight
what are the benefits of the dietary approach to stop hypertension (DASH) diet
- average decrease of 5.5/3 mmHg vs control
what is the daily nutrient goals used in the dash studies
- low sodium
- high potassium
- high calcium
- high mag
- high fiber
what are the food that have a good source of potassium, mg and fiber
broccoli, carrots, spinach, tomatoes, sweet potatoes etc
what is the benefit of having a dash low sodium diet
- greater combined effects on BP
- recommended when there is a refractory hypertension
there is a greater effect in dash diet or Mediterranean diet in bp
dash
A study made with comparing dash diet + rich in CHO or rich in protein or rich in unsaturated fatty acids. What was their result
- They found that all diets reduced blood pressure, LDL and cardiovascular risk
- diet high in proteins and unsaturated fatty acids decreased further blood pressure in hypertensive individuals
higher fat/low cho dash diet vs dash diet
- similar decrease in bp
- decrease triglycerides and large and medium VLDL particle concentrations
- increase LDL diameter
what is the changes in nutrients and improvements of the DASH diet
- increase K, Mg, Ca, fiber
- reduce sat fa, sodium
- improve bp, LDL, VLDL, triglycerides
what are the antihypertensive drugs
- thiazide diuretics
- distal tubular diuretics
- angiotensin converting enzyme (ACE) inhibitors
- angiotensin II receptor blockers (ARB)
- calcium channel blockers (CCB)
- beta blockers
- single pill combinations (SPC)
Diuretic mechanism
- decreased reabsorption of Na and K
- production of osmotic diuresis
- increased excretion of NA and K
- inhibit action of aldosterone
what are some diuretics drugs
- loop diuretics (K losing): furosemide (lasix)
- thiazide : hydrochlorothiazide (apo-hydro)
- potassium sparing : spironolactone (aldactone)
side effects of furosemide (lasix)
hypokalemia, hyperglacemia, constipation
side effects hydrochlorothiazide (apo-hydro)
hypokalemia, hyperglacemia
for lasix and apo hydro what is nutritional needed
potassium rich foods and potassium supplements
what is the important to avoid when taking spironolactone (aldactone)
- avoid excess potasium and supplements
- avoid salt substitutes
- avoid excess water consumption
- avoid natural licorice
example of ACE inhibitor drug
ramipril (altace)
what is the mechanism of ACE inhibitor (altace)
inhibit conversion of angiotensin 1 to 2
decreases vasoconstriction, vasopressin, inhibits aldosterone release
side effects of altace
- hypotension, dry cough (side effects are increases in African Americans)
examples of angiotensin 2 receptors blockers (ARB)
valsartan (diovan), losartan (cozaar)
what is the mechanism of ARB
block angiotensin 2 and therefore decrease its activity
side effects of ARB
hyperkalemia, nausea, dizziness
what it needs to be avoid when taking ARB
avoid salt substitues
avoid natural licorice
caution with grapefruit
examples of calcium channel blockers
amlodipine (norvasc)
what is the mechanism of calcium channel blockers
affect the mvt of Ca through Ca channel causing blood vessel relaxation
side effects of norvasc
- edema, nause, heartburn
what needs to be avoid when taking norvasc
limit caffeine, alcohol and grapefruit
what is the contraindication for taking norvasc
heart failure
example of drugs for beta blockers
propanolol (inderal)
what is the mechanism of beta blockers
block adrenergic beta receptors in the eart -> decrease rate and CO
what is the side effects of beta blockers
diziness, fatigue, insimnia
beta blcokers is not recommended as
as an initial therapy for those over 60 years old
diabetes, coronary and heart faiure cannot use
ACEi or ARB and b-blockers for heart failure
