Hypertension 2 Flashcards
How much PA to reduce BP in HTN?
- moderate PA of 30-60 min/d (4-7days/week)
- in addition to daily activities
Would you promote high intensity activities to reduce BP?
No
Tips for a patient to increase PA
- needs to be a GRADUAL increase to 30-60 min/d
For stage 1 HTN, how does resistant training impact BP?
Does not impact negatively
Nutrition Assessment HTN
- identify dietary factors and patterns (contributing to increase BP)
- evaluate need for weight control
- prioritise methods to meet DASH dietary goals
Nutrition Diagnosis HTN
- excessive energy intake
- excessive/inappropriate intake of fats
- excessive sodium intake
- inadequate calcium, fiber, potassium, or magnesium intake
- overweight/obesity
- food & nutrition knowledge deficit
- physical inactivity
Nutrition Intervention HTN
Comprehensive approach that addresses multiple lifestyle factors:
- DASH
- Weight loss
- Low Sodium
- Alcohol in moderation
- Potassium, calcium, magnesium
- Physical activity
- Smoking cessation
- Stress management
DASH diet rich in
F and V, legumes, low-fat dairy, high K, Mg, Ca, fibre; poor T fat, SDA and dietary cholesterol
Benefits of DASH diet according to studies
- average reduction of 5.5mmHg SBP and 3.0mmHg DBP
- further decrease in HTN subjects of 11.4mmHg/5.5mmHg
DASH stands for
Dietary
Approach to
STOP
Hypertension
For a 2,100 kcal diet, how much - sodium - potassium - calcium - magnesium - fiber in a DASH diet
- 2300 mg sodium
- 4700mg potassium
- 1250 mg calcium
- 500mg magnesium
- 30g fiber
What % of Total fat, saturated fat, protein, carb in a DASH diet
- Total fat = 27% (includes 6% sat fat)
- Protein = 18%
- Carbohydrate = 55%
Which diet is most beneficial:
HTN or Mediterranean
DASH
When would you recommend 1500mg Na to HTN patient?
If he has refractory HTN (= BP not controlled)
How much NA do you recommend to a HTN patient?
3000mg
DASH diet improves
BP
LDL
VLDL
TG
DASH diet implies increasing what? and reducing what?
Increasing: potassium, magnesium, calcium, fiber
Reducing saturated FA and sodium
A patient has a blood pressure of 130 (SBP) what is his risk?
HTN high risk
Antihypertensive drugs examples
- thiazide diuretics
- distal tubular diuretics
- angiotensin converting enzyme inhibitors
- ANG2 receptor blockers
- calcium channel blockers
- beta blockers
- single pill combination
First drug to treat HTN in adult without complications
Thiazide/ thiazide-like diuretic
SBP and DBP goal in most HTN pt without diabetes?
SBP < 140 mmHg
DBP < 90 mmHg
SBP and DBP goal in HTN pt with diabetes?
SBP < 130 mmHg
DBP < 80 mmHg
SBP and DBP in high-risk HTN pt
SBP < 120 mmHg
Drug treatment considerations
- Location and drug metabolism and excretion
- Drug/nutrient interactions
- Drug/ drug interaction
- Nutritional status
- Physiological status
Drug/nutrient interaction example
natural liquorice (glycyrrhinic acid)
Drug tx for patient with :
- diabetes (+complications)
ACEi or ARB
Drug tx for patient with :
- diabetes (+ no complications)
ACEi or ARB or CCB or diuretics
Drug tx for patient with :
- coronary artery disease
ACEi or ARB
Drug tx for patient with :
- heart failure
ACEi or ARB + beta blockers
Drug tx for patient with :
- coronary artery disease (+ stable angina)
beta blockers or CCB
Loop diuretics generic name
furosemide (Lasix)
Thiazides generic name
hydrochlorothiazide (Apo-Hydro)
Potassium sparing generic name
spironolactone (Aldactone), triamterene, amiloride
ACE inhibitors generic name
ramipril (Altace)
ANG2 receptor blockers (ARB) generic name
Valsartan (Diovan)
Losartan (Cozaar)
Calcium channel blockers generic name
Amlodipine (Norvasc)
Beta-blockers generic name
Propanolol (Inderal), atenolol, metoprolol
Low albumin affects drug effect how?
Increases drug effect because of more free drug in the blood
2 types of diuretics
- loop and thiazides
- K-sparing
Loop and thiazides mechanism
- decreased reabsorption of Na and K
- production of osmotic diuresis
- increased excretion of Na and K (and H+)
K-sparing mechanism
inhibit action of aldosterone
Loop and thiazides provided with
- potassium rich food
- potassium supplements (side effects)
WIth potassium sparing diuretics avoid
excess dietary potassium and supplements, avoid salt substitues, excess water consumption, natural liquorice
Side effects of loop diuretics
hypokalemia hyperglycemia anorexia nausea/vomiting constipation
SIde effects of thiazides
hypokalemia hyperglycemia anorexia malaise muscle weakness
Side effects of potassium supplements
irritates mucosal lining, increased risk for ulceration, nausea/vomiting/diarrhea
Mechanism of ACE inhibitors
- inhibit conversion of ANG1 to ANG2
- decrease vasoconstriction, vasopressin, inhibit aldosterone release
Side effects of ACE inhibitors
hypotension (older patients)
dry cough
may worsen renal function
With ACE inhibitors avoid
salt substitutes
natural licorice
Side effects of ACE inhibitors are increased in
African Americans
When are ANG2 receptor blockers used
when ACEi are not tolerated
Mechanism of ANG2 receptor blockers
Block ANG2 receptor and decrease its activity –> vasodilation, reduced vasopressin and aldosterone
Side effects ANG2 receptor blockers
hyperkalemia, nausea, dizziness
With ANG2 receptor blockers avoid
salt substitutes
natural licorice
grapefruit
Mechanism of calcium channel blockers
affect movement of Ca through Ca channels causing blood vessel relaxation
Side effects calcium channel blockers
edema, náuseas, heartburn
With calcium channel blockers avoid:
natural liquorice
caffeine
alcohol
grapefruit
Contraindication of calcium channel blockers with
heart failure
Beta-blockers mechanism
block adrenergic beta-receptors in heart –> decrease rate and cardiac output
Side effects beta-blockers
nausea/vomiting, constipation/diarrhea, bloating, masks symptoms of hypoglycaemia, dizziness, fatigue, CHF, hallucination, insomnia
Beta-blockers not recommended if
- diabetes mellitus
- initial therapy if >60y
