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6-Clinical Nutrition 1 > Hypertension Part 1 > Flashcards

Hypertension Part 1 Flashcards

1
Q

What are the major forms of CVD?

A
  • HTN
  • Atherosclerosis
  • Ischemic Heart
  • Peripheral Vascular Disease
  • Heart Failure
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2
Q

What are the trends in prevalence of reported HTN?

A
  • 28%
  • increasing for both from 2011
  • pretty much the same for men and women and seems to go up for men
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3
Q

What is the reported prevalence in 2014 of HTN?

A

there are more women than men

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4
Q

What is the percentage of ppl who are unaware of HTN?

A

18%

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5
Q

What is the percentage of ppl who are aware and not treated of HTN?

A

4%

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6
Q

What is the percentage of ppl who are treated by medication and not controlled of HTN?

A

65%

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7
Q

What is the percentage of ppl who are treated by medication and not controlled of HTN?

A

14%

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8
Q

The lifetime risk for developing HTN among adults age 55-65 years with normal blood pressure is ___

A

90%

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9
Q

What is the epidemiology of HTN?

A
  • 1 in 3 adults Americans have
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10
Q

Which ethnicity is more prone to have HTN?

A

African Americans

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11
Q

What is blood pressure?

A

cardiac output x peripheral resistance

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12
Q

What is cardiac output?

A

2 phases:

  • contraction (systolic)
  • resting (diastolic)

stroke volume x heart rate

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13
Q

What is resistance?

A

(length of vessel x viscosity of the blood)/radiusˆ4

** even a small change in radium will greatly affect the resistance and thus the blood pressure

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14
Q

How is mean arterial blood pressure determined?

A

determines by cardiac output and total peripheral resistance

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15
Q

What are the 4 factors that regulate bp?

A
  • sympathetic nervous system
  • RAAS
  • Renal function
  • Hormones involved: epinephrine, ADH, angiotensin II
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16
Q

HTN can cause…

A 
hemorrhage
stroke
Left ventricular hypertrophy 
CHD
CHF 
Renal failure 
Proteinuria 
Peripheral vascular disease 
Retinopathy
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17
Q

What is the device used to measure BP?

A

Sphyngomanometer

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18
Q

What is systolic blood pressure?

A

max. pressure the heart exerts while beating

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19
Q

What is diastolic BP?

A

amount of pressure in the arteries between beats

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20
Q

What type of HTN is benign?

A

family history of higher BP than normal –> not harmful

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21
Q

What type of HTN is malignant?

A

occurring for other reasons (disease, diet, lifestyle)

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22
Q

What is the primary cause of HTN?

A
  • unknown etiology

- influenced by dietary and behavioral factors

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23
Q

What is the secondary cause of HTN?

A
  • occurs secondary to a condition such as renal, endocrine or neurological disorders.
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24
Q

What is the nickname of HTN?

A

silent killer

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25
Q

What is the etiology of HTN?

A

the exact etiology is not known but very likely of mixture of a lot of risk factors. Largely influenced bu diet, exercise, stress and smoking…

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26
Q

What is a normal BP level?

A

SBP –> 90-119

DBP –> 60-79

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27
Q

What is considered pre-HTN?

A

SBP –> 120-139

DBP –> 80-89

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28
Q

What is considered Stage I HTN?

A

SBP –> 140-159

DBP –> 90-99

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29
Q

What is considered Stage II HTN?

A

SBP –> 160-179

DBP –> 100-109

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30
Q

What is considered Stage III HTN?

A

SBP –> >180

DBP –> >110

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31
Q

What are non-modifiable risk factors for HTN?

A
  • age >60
  • men, premenopausal women, ethnicity (African American, Russian, Finns)
  • Family history of CVD: women <65, men <55
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32
Q

What are modifiable risk factors of HTN?

A
  • smoking
  • sendentary lifestyle
  • abdominal obesity, insulin resistance
  • excess sodium intake
  • poor diet quality
  • stress
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33
Q

How does excessive secretion of vasopressin and angiotensin II affect BP?

A

increases vasoconstriction and fluid retention

34
Q

How does smoking affect BP?

A

interferes with NO (nitric oxide) –> impairs endothelial vasodilation

35
Q

How does renal disease affect BP?

A

reduced blood flow causes more angiotensin II secretion which leads to vasoconstriction and Na, Cl, and water retention –> increased blood volume

36
Q

How do adrenal disorders affect BP?

A
  • Adrenal disorders that increase secretion fo epinephrine and norepinephrine –> vasoconstriction –> increased cardiac output
  • hyperinsulinemia is associated: mechanisms unclear
37
Q

What is the risk of HTN of a person that has no risk factors and SBP 140-159 and DBP 90-99?

A

low

38
Q

What is the risk of HTN of a person that has 1-2 risk factors and SBP 140-159 and DBP 90-99?

A

medium

39
Q

What is the risk of HTN of a person that has more than 3 risk factors and SBP 140-159 and DBP 90-99?

A

high

40
Q

What is the risk of HTN of a person that has no risk factors and SBP 160-179 and DBP 100-109?

A

medium

41
Q

What is the risk of HTN of a person that has 1-2 risk factors and SBP 160-179 and DBP 100-109?

A

medium

42
Q

What is the risk of HTN of a person that has more than 3 risk factors and SBP 160-179 and DBP 100-109?

A

high

43
Q

What is the risk of HTN of a person that has no risk factors and SBP >180 and DBP >110?

A

high

44
Q

What is the risk of HTN of a person that has 1-2 risk factors and SBP >180 and DBP >110?

A

very high

45
Q

What is the risk of HTN of a person that has more than 3 risk factors and SBP >180 and DBP >110?

A

very high

46
Q

What are the 2 blood pressure measurement methods? Which one is preferred?

A

oscillometric (electronic) –> preferred

auscultatory (mercury)

47
Q

How to treat HTN?

A
  • reduce risk of CD and renal disease
  • lower BP to clinically appropriate level
  • weight reduction
  • physical activity
  • nutrition therapy
  • pharmacological interventions
48
Q

What are the pharmacological interventions that can be used to treat HTN?

A
  • loop diuretics
  • thiazides
  • carbonic anhydrase inhibitors
  • potassium sparing diuretics
49
Q

What are the causes of HTN associated with obesity?

A
  • insulin resistance/hyperinsulinemia
  • overactivity of sympathetic nervous system
  • alterations in RAAS
  • Leptin mediates sympathetic activity, this function is preserved with leptin resistance
50
Q

How does weight loss affect HTN by numbers?

A

5-20mmHg reduction per 10kg weight loss

51
Q

What are the weight recommendations for HTN?

A
  • BMI <25kg/m2

- waist circumference <102cm men, <88cm women

52
Q

What are the weight loss approaches for HTN?

A
  • diet education and instruction
  • increase P.A.
  • behaviour modification

** weight loss be more difficult if patient using B-blockers

53
Q

What is the name of the study that has been done on sodium and HTN?

A

The INTERSALT Study (1982-85)

54
Q

What is the effect of sodium intake on HTN by numbers?

A

For every increase of 100mmol/Na/d –> increase in 3-6/0-3 mmHg SBP/DBP

55
Q

What is salt sensitivity?

A

Salt sensitivity is a measure of how your blood pressure responds to salt intake. People are either salt-sensitive or salt-resistant. Those who are sensitive to salt are more likely to have high blood pressure than those who are resistant to salt.

56
Q

What are the factors involved in heterogenous responses to Na reduction?

A
  • familial/genetic factors
  • age
  • severity of HTN
  • degree of restriction
  • RAAS (low renin) –> genetic defect
  • Sympathetic response (high NE response)
  • duration of trials
  • largely influenced by K –> increased K intake = decreased Na sensitivity
57
Q

What is the AI for Na

A

14-50 –> 1500 mg/d
51-70 –> 1300 mg/d
71 + –> 1200 mg/d

58
Q

What is the UL for salt

A

2300 mg/d

59
Q

What are the recommendations of the 2014 Canadian HTN Education Program (CHEP)?

A

To decrease BP, consider reducing Na intake towards 2,000mg (5g of salt, 87 mmol of Na)

60
Q

How much sodium does 1/2 tsp of salt have?

A

1,150 mg

61
Q

What is hidden sodium?

A

77% from processed foods –> manufacturing and restaurants

62
Q

What is conscious sodium?

A

11% added at the table and in cooking

63
Q

What should we look for on labels in terms of sodium content?

A
  • buy unsalted and lower sodium foods whenever possible –> “sodium-free”, “low-sodium”, “reduced sodium”, “no added salt”
  • check the serving size and note the amount of sodium -> chose the foods with less than 120mg sodium per serving or have a %DV of 5% or less.
64
Q

What are the 3 categories of sodium controlled diets? Explain each

A

3000mg Na

  • Eliminate high Na processed foods and beverages (fast foods, salad dressings, smoked meats, koshers meats, canned foods)
  • up to 0.25 tsp salt permitted during cooking or added at table

2000mg Na

  • eliminate processed and prepated foods and beverages high in Na. Limit milk and milk products to 2 cups/d
  • no salt in preparation of foods or added at the table

1000mg Na

  • same as above. Omit canned, frozen, deli foods, cheeses, margarines
  • limit regular bread to 2 servings/d
65
Q

What is the relationship between K and BP?

A
  • inverse relationship

- decreased prevalence of HTN with higher K intake

66
Q

What are the mechanisms that K decrease BP?

A
  • Natriuresis
  • suppressed renin
  • attenuates vascular contraction –> vasodilation
  • may reduce sympathetic activity and angiotensin
67
Q

What is the DRI for K?

A

4700 mg/d

68
Q

What is the effect of potassium intake on HTN by numbers?

A

+ 50mmol (2000mg) –> - 3.4/-1.9 mmHg BP

69
Q

What should the dietary intake of K be in order to decrease the risk of stroke mortality?

A

> 60mmol (2300mg)

70
Q

What are the recommendations of K supplementations for treatment of HTN?

A
  • for normotensive ppl obtaining 60 mmol of dietary K per day, K supplementation is not recommended as a means of preventing high BP
  • K supp. above DV of 60 mmol/d is not recommended as a treatment for HTN
  • K should come from the diet
  • K supplements may be useful with diuretics - induced hypokalemia treatment
71
Q

What is the relationship between sodium and potassium?

A
  • we always excrete the excess
  • the higher sodium intake in the diet the more K will be lost even in higher K concentrations in blood
  • high sodium diet will favour high potassium excretion
72
Q

What are the risk factors for hypokalemia?

A
  • Pt. using R-A-A inhibitors
  • Pt. receiving other drugs causing hyperkalemia
  • Chronic kidney disease
  • Baseline serum (K > 4.5 mmol/L)
  • DO NOT ADVISE INCREASED INTAKE OR SUPPLEMENTS.
73
Q

How is Calcium related to BP?

A

inversely related

74
Q

What are the potential mechanisms of increased calcium intake on BP?

A
  • increased Na excretion
  • increased sensitivity to NO –> vasodilation
  • decreased production of superoxide molecules and prostanoids (vasoconstrictors)
75
Q

What are the recommendations for calcium?

A
  • for normotensive ppl Ca supplementation above RDA is not recommended as a means of preventing high BP
  • Ca supplementation above RDA is not recommended as a treatment for HTN
  • Using CFG and consuming 2-3 servings of milk products daily is sufficient
76
Q

How is Magnesium related to BP?

A
  • inverse relationship between Mg and BP
  • potential mechanisms relate to the role of Mg in vascular structure and functionL regulates vascular reactivity and contractility
77
Q

What are the recommendations for magnesium?

A
  • increased dietary intake to reach DRI (men 420mg/d, women 320mg/d)
  • supplement above DRIs not recommended
78
Q

How is alcohol related to BP?

A
  • dose response relationship between alcohol intake over 2 drinks/d and increased BP
  • alcohol has an immediate vasovagal effect (decreases BP) but followed by elevated BP in the next 10-15h
79
Q

What are the potential mechanisms of alcohol intake on BP?

A
  • stimulation of sympathetic NS
  • stimulation of cortisol secretion
  • increased Ca uptake by cell membranes
  • moderate consumption does not raise BP and has a cardioprotective effect
80
Q

What are the recommendations for alcohol?

A
  • limit to 2 drinks/day
  • beer 360ml
  • wine 150ml
  • spirits 45ml

6-Clinical Nutrition 1 (21 decks)

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